A minor setback

Today was one of those days that reminded us that Woody's time in the hospital is not just, well, fun. Let us begin with the reminder that Woody has a diagnosed nasty condition, namely bronchopulmonary displasia, or BPD. It is better known as chronic lung disease, and it is characterized by lots of scar tissue and nodules in the lungs, as they have been thrashed by weeks and weeks of artificial respiration and, well, regular respiration, because a kid just ain't supposed to be breathing at 23 weeks and so forth.

Woody got moved back from the high-flow cannula to the CPAP today, because in addition to his normal marginal-to-high CO₂ test result today, he also scored low in his blood electrolytes, which is suggestive of his kidneys being overtaxed by the effort of making his blood pH acceptable (that's simple, right? We all understand the interconnection of dissolved CO₂ and electrolytes and metabolytes of carbohydrates and stuff, right? Okay...).
To sum up, today seemed like all the old banned words were making a comeback.

"His lungs sound really wet."
"Well, you know that this time in the NICU can be a roller coaster ride."
"His lungs just still look like white out when we see the x-ray."
oh, and my favorite:
"It's times like today that we remember that caring for him is an art and not a science."

(My response to this is "well, that's true. If it was a science then we wouldn't be adjusting two variables at once. If his lungs sound wet and he has a chloride shift, why not change his lasix or his breathing apparatus, and not both? Now it will contaminate any lessons you'd learn from either of these changes, and not know whether to credit/blame either one of these inputs if he gets better/worsens.")

Maggie happens to be out of town today. She left on a plane to Phoenix, where her friend Honorary Auntie Mary (who called Woody in utero "Raoul") took her on a free travel agent jaunt, a junket if you will. Right before leaving, she went and got her blood pressure checked and then saw Woody right after he'd been put back on the CPAP. I assure you, the sight of Woody with more equipment back on his face did nothing for her blood pressure. But she is gone, now, and with any luck she's getting plenty of relaxation at her spa.

To tell the truth, Woody's setback isn't a big one. If he's in need of a little extra respiratory support, of course I want him to get it. And he does seem to be responding nicely to the CPAP: his O₂ needs have been steadily declining all day, and his heartbeat and breathing rate are similarly going down, which basically means that he's not working as hard to breathe. Of course, the elephant in the room with all this stuff is that if he doesn't figure out a way to keep getting his CO₂ out of his blood the hospital staff would have to re-intubate him, which is not what I want, because he will hate it.

I will continue to watch him and make sure he's improving. Tomorrow morning's blood gas test is going to be a pretty big one.