Wednesday, January 20, 2010

Day 3 of Intubation...

I'm having a particularly down day myself (no 1 particular reason, I just miss talking to my boyfriend and seeing him smile and hearing his voice)'m going to get lost in just reporting back to you all (technically) exactly what's gone down in the last couple of days.

Every morning, right before I start work, I call the hospital for an update on how he did through out the night. Yesterday A.M., I called to get the report. His nurse Kathy said that he had a pretty quiet evening, and that his iTunes were still playing, (when I left on Monday night, I made sure his iPod was on shuffle and told his night nurse to keep it going all night no matter what. Music mellows him out and with his erratic heart rate, both Lori and I thought it would be a great idea to keep the tunes on).

It's a good thing for Mark to have a "quiet" and uneventful night so I was happy. I got even more excited when Kathy told me that early yesterday morning when she called his name he tried to open his eyes and did, though only a little bit. (They have him under very heavy sedation, and on an "amnesia" drug that makes you totally lose track of time). Then she told me that she held his hand and told him to squeeze her hand if he could hear and understand her, and he did. She then asked him to wiggle his toes, and he did that too. I cannot tell you how much this information changed my day immediately. I was so happy to hear this. I mean, I know he's just placed under sedation, and that he's fine, it's just scary and any amount of communication or lucidity for some reason makes me happy.

Then Kathy let me know that they held off on giving him his third dose of Campath because they were worried about his kidneys and they wanted to see if the kidney problem was brought on because of one of the side effects of the Campath.

(NOTE: One of the things that happens in patients with Leukemia, that are undergoing Campath treatments is that as soon as the Campath starts to work, the cancer cells in the body start to break down. When cancer cells break down, they release various toxins into the bloodstream that could cause a myriad of other issues and complications. So, when giving Mark each Campath treatment, he is closely monitored to make sure that they can head any of the nasty toxins off at the pass. What they'll do is administer other drugs to counteract the effects of certain toxins. This IS something we definitely want them to do; but it also makes him very sick and very weak. The fact that he's under sedation doesn't help a lot either; but as we all know, that's to keep him oxygenated enough to keep working. (If it isn't 1 thing, it's another)...)

SO, they are worried about renal failure, (i.e kidney failure). I asked what exactly caused that; or what their suspicions were that could have caused that and they actually DON'T suspect that it was the Campath that did that. What they think is that it was his brief code that shocked his kidneys. (ANOTHER NOTE: When other more important organs in the body are in distress, the kidneys are the first to sacrifice themselves, so it would totally make sense that the code (i.e. heart and lung failure) is what shocked them. Basically what they immediately do is stop accepting blood from the body in order to keep running smoothly thus forcing that vital blood to be used up by whatever organs are in distress, (heat and lungs). Make sense?)...

Now, what they've told me is that they're not worried about long term damage at all. They in fact believe that the kidneys will eventually and totally heal themselves over time, but that in the course of Mark's treatment, they may have to give him some dialysis in order to help him sufficiently clean out his body, (thus also helping to remove and rid his body of all of the toxins that are being released from the constantly breaking down cancer cells because of the Camptah).

That's that explanation.

They also inserted a chest tube yesterday in the lung that had the pleural effusion. (A pleural effusion: excess fluid that gathers in the pleural cavity, which is the fluid filled space that surrounds the lungs). Now, originally I thought that they placed the chest tube in the side of his lungs that had this excess fluid, in order to drain it...not the case. I spoke directly to his oncologist last night and she explained to me that they actually put the chest tube into the side of his chest that experienced the pneumothorax (which can actually be a more dire medical emergency where air or gas is present in the pleural cavity, and this happened during his bronchoscopy when they accidentally punctured one of the tiny air filled sacs in his lung). A pneumothorax can cause a shitload of pain, (more-so I understand than excess fluid, though both are painful), so this was of a higher priority. The chest tube was inserted and the air (and a small amount of fluid) were helped to be released. Almost immediately, his pulse ox went to the mid 90's (freaking outstanding!!), and his heart rate stayed at a very solid 99, (also freaking outstanding). So moral of the story: we like the chest tube decision.

After speaking with Dr. Odenike at length again, she informed me that because Mark missed his third day in a row of the Campath that he did in fact receive one last night (TUESDAY JAN. 19TH). I asked her if he was back on track and that he'd get his three days in a row again of it; she explained that since Mark is an inpatient that his new schedule of Campath administration would now be on Mondays, Wednesdays and on Fridays...which is better actually as it makes it easier on his body and also so that his team can closely monitor any possible complication that could arise from treatment.

Below is one of the last chest films that they took of him BEFORE they inserted the chest tube, (I'll get a snap of one later tonight of what it's looking like now, about a day after the chest tube was inserted, and will post that in the coming days). (chest xray: any of the dark space you see is actually, free and clear breathing space, any of the white space you see are imperfections and fluid, which are the culprits of his not being able to breathe at all).

(Oxygen update as of Jan. 19, 2010: they've totally taken him off of his Nitric Oxide gas (very good news), and he is now at only 50% oxygen (awesome), and he's been maintaining a healthy mid 90's pulse ox, and around a 100 heart rate).

WHITE: 81.5
RED: 3.06

WHITE: 84.3
RED: 3.20

WHITE: 86.5
RED: 3.17

WHITE: 98.1
RED: 3.12

Mark's night nurse today was Jean (730pm-730am)

Chest Xray: