Friday, July 28, 2006

Readying the sharp sticks

So here's the deal. Woody's CO2 readings are bad still. His 'bicarb' readings are bad too, as a result of (among other *waves hands* reasons) because of the diuretics they give him (like lasix) in order to keep fluid from accumulating in his lungs. The bicarb is, like sodium bicarbonate-- baking soda-- a basic compound, so his kidneys try to keep his blood pH steady by retaining extra CO2 for its acidotic value (counteracting the alkylotic properties of the bicarb). The more his CO2 remains in his blood, the more he has other problems, including:

  • making his right side of his heart work harder in order to keep the blood exchange happening in his lungs;

  • possible negative changes in the blood vessels in his lung bed;

  • possible delays in growth;

  • messed up electrolyte levels in his blood, as his kidneys keep messing with the nutrients they keep;

  • ...which can lead to heart arrhythmias.

which is all bad. The really frustrating part is that measuring Woody's success or failure on the extubation can happen on a lot of levels. On one level, he's doing well in keeping himself oxygenated. But on a deeper, systemic level, he seems to be having some fundamental problems in keeping his CO2 adequately purged. (We continue to be straight on the connections of everything, right? Bad lungs-> need for lasix-> bad effects on the kidneys -> messed up electrolytes/bicarb -> retained CO2 ->bad stuff. of course, you also have Bad lungs-> retained CO2, etc., so the links are never as easy as 1-2-3.)

There are, of course, some other possibilities for many of the symptoms that are bothering him. First, his bad electrolyte reading could be an anomalous outlier, caused by a double dose of lasix given to him the night before that test (any diuretic can alter your electrolytes). Second, his hemoglobin levels have been low for two weeks now, but because the doctors wanted him to be making his own red blood cells, he wasn't given a transfusion even though prior to then those test readings would have triggered one. Extra hemoglobin means that he would be able to move oxygen around his body easier, thus making him work less hard overall, which could be very helpful to some of his body functions measured by the disappointing tests. Also, his occasional arrhythmias could themselves be caused by his anemia. Finally, he could also be a little sick himself, considering that both Maggie and I have been sick in the last month (although the doctors have officially pooh-poohed this suggestion).

I really, really really don't want to see him re-intubated. I have joked around to nurse J that I will be barricading myself in his room with sharp sticks to poke anyone who threatens this course of action. She pointed out it would get me arrested, but I reasoned that at least I could delay the action.

I won't let them do anything drastic, but it's pretty discouraging to go from the nasal cannula to talk of re-intubation in two days. I hope the transfusion turns everything around and that all looks great by this evening. Thanks for the support.


At 5:03 PM, Anonymous Anonymous said...

Just wanted to let you know we are still praying for Woody every day. I know this 'set back' must be so very difficult for you, (I think the term set back should be put on the banned list) but don't forget how far Woody has come. He is a strong one for sure. We are in agreement that everything is going to turn around and he will be heading back in the right direction on all of his levels, etc. so that no intubation will need to take place. Don't start poking with those sharp sticks just yet!!
Christine: aka Woody Admirer (junkie) from Oklahoma :0)

At 5:06 PM, Anonymous Aunt Susan said...

Thinking of sorry about the set-back. We are all out here thinking about... and praying for Woody...and for his fabulous parents.

At 5:48 PM, Anonymous jared said...

Keep fightin' the good fight 'drow, we're still pulling for ya out West - you remain in my positive thought.

Much love,

At 7:48 PM, Anonymous Auntie Val said...

We got ya covered in prayers out here in the southeast Woody!

At 11:00 PM, Blogger Bill Hooker said...

I still believe in Woody. This is a bump in the road; he's going to get past it.


At 11:10 PM, Anonymous Aunt Susan said...

Nathan, I just told your mom (grammie) that you are SO maternal.... you are practically a breast. God love ya. Wish I was there to give you a big hug.

At 9:33 AM, Anonymous Grammie said...

Yes, Nathan is always abreast of the situation. But is he a breast??? Hmm. All I know is that I'm very proud of him and think he's doing a great job being Woody's comfort and liaison. You go, Natie! Hang on, Woody!

At 10:23 AM, Anonymous Anonymous said...

I agree the post above. Just a bump in the road. Woody has already shown he is a fighter.

On the other hand I can make a pretty sharp stick. Call me up when the siege starts.



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