3 PM – Lorraine and I were just noticing that Mikie is not even attempting to use his hands or lift his arms or legs at all.  He seems to be waking up a little more, but still only opening one eye completely and the other only slightly.  His breathing is like he is slightly gasping at times, and completely normal at others.  I wonder if he has had a stroke.

5 PM – Mikie’s heart rate just got down to 50!  I think he is slowing down just a bit too much now.  I’ll have to ask if they are giving him lopressor.  Even though it got that low, his oxygen levels only dropped to about 95.  I just touched him and rubbed his shoulder a bit and it picked right back up.

A few minutes later it dropped down to 48 and he still had an oxygen level of 97.

Dr. Emmer came in about 5:30 and we spoke for a while. A term we have heard a lot lately in a question asked of us is ‘baseline’, as in “What is Mikie’s baseline?”  What they are asking is what does he do normally? Though Mikie is much better, he has not come back to his baseline.  I pretty much discussed with Dr. Emmer what I had listed before, and he said they would try to keep us informed and involved but that it was not always possible.  (It has to be, it’s one of our rights, within reason.)

As an example, I told him about Mikie getting fospenytoin (Dilantin) yesterday via IV, and that Mike was on Dilantin years ago and had problems with it.  (Look it up, there are just too many side effects, some of which he experienced, especially the gum problems.)  His response was that his Dilantin levels were low, that’s why they gave it to him.  Duh, you’re levels would be low if you weren’t getting ANY!  He said they gave him some downstairs (ER or ICU?).  That was the first we heard about that, but now we ask when ever we see them giving him anything.  They are still hitting him with antibiotics like crazy.  If we were to get hit with Anthrax right now Mikie would be safe.

As for the feeding tube, he said it wasn’t his area and he couldn’t order the change, but would ask for another consult on it and have someone speak with me.  He said there was no way to know if that was the problem, to which I disagreed and told him that there is, let’s just pull the tube.  He wouldn’t agree to that but said he would get another GI doc to come and talk to me about it. I have been trying to figure out why Dr. Reddy used a MIC-KEY G-tube for Mikie’s jejunostomy and I have been able to find nothing on the internet, nada, zip, nutin’!  Dr. Galan says he would never do it, it just isn’t done.  Dr. Reddy’s files are in archive so they are not readily available, but by golly, I think I just figured it out!  You wouldn’t use a G-tube in a jejunostomy stoma because if you wanted to do that, you would have done a gastrostomy, not a jejunostomy. Well, Dr. Reddy planned to place a G-tube, but he couldn’t since Mikie’s stomach is too high, actually up under his rib cage.  The main reason you would do a jejunostomy is because the patient has stomach problems like reflux or gastroparesis.  Mikie does not have those problems, so why NOT use a G-tube.  It is rare because Mikie’s anatomy is rare, but that doesn’t mean it shouldn’t be done.  The only way for us to find out if the J-tube is the cause of the hyperreflexia is to pull it.

Dr. Emmer said he would write orders for another CT scan of the bowels using a contrasting solution injected, I assume through the J-tube.  Since they are going to miss more than 20 inches of the intestine, this would be a great time to use the MIC-KEY G-tube.  This is where I need to be here for the consult with the gastroenterologist.  The way they do things around here they will likely do the CT in the middle of the night before the GI docs get here.

Today they ordered an echo-electrocardiagram or something like that.  Dr. Emmer said they are looking at the heart as being a likely source of the infection.  It’s a possibility that the VA shunt might have something to do with Mikie’s current predicament, though the neuro-docs have pretty well checked everything and stepped out of the picture.

Another possible source of infection that we talked about was in the gut itself.  There was some suggestion earlier that the reason for Mikie’s VP shunt failure of several months ago was an encapsulated cyst.  They did not probe around and look for one when they pulled the old VP shunt hardware out of Mikie’s belly.

I don’t think the source of the cause of Mikie’s problems is an infection but I can’t rule it out completely.  Dr. Emmer wanted to run a couple more blood cultures and I agreed.  (Maybe if I humor him he will humor me and pull the feeding tube.)  When the tech came in and stuck Mikie tonight he barely reacted when she stuck him in the right hand but did react when she tried to do it again with the left.  Earlier they stuck Mikie’s right first finger to check his sugar and Mikie pulled his hand right when he stuck him, causing a slight slice and he bled more than usual.  I was glad to see that Mikie still has some pretty good reactions.

Becky (Mikie’s nurse from yesterday) came by and told me that she called Dr. Mauldin and he does have privileges here and will be up tomorrow to see Mikie.  There was some confusion about that but Becky helped to straighten it all out and inform Dr. Emmer.  

6 PM – The 50 bpm that I wrote about was bogus, according to the nurse.  He thinks the sensor was loose from his ear.  He secured it and Mikie seems to be resting as soundly as he was before and the rate hasn’t dropped below 76.  I do know it has dropped into the 60’s, so it might have been possible.

It’s 9:30 PM and I need to get some rest.  I put Mikie back up on his side and he is once again soundly asleep with a heart rate of 78.  I would call that his baseline. He looks good.  He has not vomited at all and has been on a continuous tube feeding of 30 ml per hour for better than 72 hours.  That’s about 3 cans a day, plus they are pumping IV fluids in at 150 ml per hour.

Mikie has a new nurse, so let me go give her an update so I can go home.  We have been coming back up at 6 AM and Lorraine stays all day.  I have no idea when they will send us home but I expect not until they find out why he is so unresponsive.