Woody gets a gold star

"I've never seen perfect nutrition labs before," said nurse practitioner C, as we walked in. "But that's what Woody is giving us today." And not just then nutrition-- Woody's numbers were across the board great today, from his prealbumin to his urine tests to his hemoglobin (up from the last one, which is a first) to his CO₂, which was down to an amazing 56, an absolutely unheard of number for him. In absolute terms, the 56 is still a bit high, but in Woody terms, it's the best his CO₂ has read in at least six weeks, and is a great sign that his body is getting better at purging itself of excess carbon.

The best part about the improved CO₂ number is that it's giving us the coveted trend we wanted to see. He had the 62 last Sunday, which I made a pretty big deal about, only to see it go up to 70 on Wednesday, which I thought was bad, but in retrospect it seems explainable by whatever made him seem sluggish earlier this week. Woody is, as I've mentioned, a pretty fluid sensitive kid, and I think he was retaining some liquids earlier this week, because after he got a bonus dose of lasix on Wednesday, he lost about three ounces of water weight and ever since has been feisty, more awake, and improving again in his oxygen needs. Thursday night his CO₂ was down below 70 again, and now today's reading shows that when he's feeling better, he can improve his lung performance pretty quickly. This is setting us up for an interesting week, because if he doesn't wind up needing eye surgery, he's going to get another extubation attempt next weekend.

The eye thing winds up being the wild card yet again, and not just because of the timing issue; around every extubation attempt the protocol is generally to give them a burst of steroids to minimize swelling and to give them the best chance to succeed right off the bat. As I've mentioned, there are substantial risks in systemic steroid use. The two big ones are compromising brain development and disrupting the adrenal system (the stuff in the body that makes your own natural steroids). To minimize the danger, doctors don't (generally) give steroids longer than three days consecutively, and they don't like to give a burst any sooner than four weeks after the last one. That's not a problem, as his last burst went with his last extubation attempt, but if they do eye surgery they would also want to give him a steroid burst, which would mean that the extubation afterwards would happen without the benefit of the 'roids. So again, the eye surgery could change all the calculations. But I have some hope that he can duck the eye surgery based on the comments of the eye doctor, and if so, he'll get his shot at extubation next weekend.

Woody has also been cleared to listen to music now, which we love. Maggie has brought in her mandolin and plays him songs, and he actually seems to like it. I imagine that he might associate it with his time in utero, as she played a good amount with the instrument pressed up to her belly. And it makes the hospital visits generally more pleasant. We're also excited to play him some music on the CD player in his room now too.