Batcave

We are stuck in the bar cave another day.  His kidney function isn't fantastic yet despite the creatinine dropping to 1.3.  He hasn't seen a normal creatinine level in a long, long time.  They gave him some IV lasix as he has some noticeable swelling, and not just in the arm with the blood clot.  His weight has gone up despite the fact that he continues to have decreased appetite.  The lasix worked well and he started producing a lot more :-)  

The appetite is slowly increasing.  He's working hard to get the protein in, which helps with healing.  He walked four laps this morning and is ambulating to the restroom without assistance, unless you count someone pushing the IV pole and carrying the chest tube drainage collector thing. 

Blood sugars remain in great control.  He's getting a third dose of the thymoglobulin.  They want to continue to hold off on the prograf  until his kidneys perk up a little more.

They took out the arterial line so now he only has a PICC line and the chest tubes.  He's doing very well!

It Was a Good Day in Transplant Land

It was a good day.  Things are looking as they should.  When I walked in he was much more alert than yesterday.  I figured since he was a captive audience with no ability to grab the remote, I'd chatter away at him.  He responded with nods to questions and was just more engaged than your average unconscious patient :-)

He saw the PT and OT ladies.  They did some range of motion and he showed off.  They were asking if he had a cane or walker at home.  I looked at them like they were crazy.  I told them he had been going to the gym up until the day prior to The Call.  They were surprised.  I told them, we don't play around.  We've got a volleyball dynasty to grow!  We discussed any potential issues once he goes home...like stairs, etc.  Fortunately our bedroom is on the first floor so he won't have any issues there.

They did start the thymoglobulin but at a much slower rate.  He tolerated that fine.  The plan was too extubate if he passed RT's tests once the med was done.  It took a little longer to make it happen and in fact, I thought the ICU intensivist was going to not order it.  But when I got back into the room he was off the vent with just a little oxygen nasal cannula, smiling at me :-).  Oh happy days.  I can always handle just about anything as long as he can talk to me.  Him being heavily sedated and on a vent are just not things I tolerate well.  Anyway, I didn't have to lay the smack down so all is well...lol. 

So kidneys are improving with creatinine at 1.8  and good output.  Minimal drainage from the chest tubes.  They say those stay in an average of 3-5 days.  Still no need for the pacing wires and the dobutamine is being weaned down.  The epinephrine was shut off much earlier today and he has kept his blood pressure up.  He's been getting his anti-rejection and anti-infection meds by IV but tomorrow they will start transitioning to oral medication.  He will start to get up tomorrow and move around a bit as well.

Drama Mama

Carlos had a bit of drama.  They started him on a medication called thymoglobulin that he really didn't like.  I wrote this whole long post and this stupid program didn't save it.  So here's the short version.

He had some unpleasant side effects that are common so things were feeling a little intense.  Blood pressure dropped, there was projectile vomiting with something that looked like blood at first glance, etc.  It was exciting to say the least.  He was stable again when I left.  He was nauseous but communicating more, not liking the lying flat on his bed, and the tube in his throat.  They have him back on minimal vemt settings so hoping maybe he will be ready to be extubated this evening as originally planned.

Then I'm going home to sleep.  Its been a lot of hours since I last slept.  Its like working a busy weekend!