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.