4/1

No April Fool's Day jokes here. John still has the pseudomonas infection and is still being treated with ceftab and amikacin for that; the vanco is being discontinued. For the time being, respiratory is giving him a bit of rest on the ventilator until that infection begins to clear. Respiratory is trying pressure support again around noon today to see if he can tolerate it. Lately, his respiration rate and CO2 levels increase when he is challenged so if he doesn't do well on the support setting, we will go back to the assist setting where the vent does more of the work. The speech and swallowing team will be back in action once John can be off the vent more. John is much more alert during frequent, short periods now that the CO2 levels aren't as high. The communication board is still a bit of a challenge but we might begin to get to the point where that will be useful which would be a true gift. Right now John mouths words in an attempt to communicate but I am not very good at lip reading. His nurse today did figure out that he was asking "how much" when she told him one of his current meds was tacrolimus. Great sign of John's cognition to recognize the name of the drug and to remember that the amount was frequently titrated to produce the correct amount of immune suppression; great work by Julie to figure out what he was asking! John's belly is better; his tube feedings have been increased to 70 ml/hour and he is absorbing them fine at that rate (which is very near the previous goal rate of 75 ml/hour). He is also being supplemented with minerals and electrolytes to help the healing process. It would be just great if the bed sore could start to heal a little more; that is a source of quite a bit of John's pain. All other systems working as well as they have in the recent past. Hope to be able to deliver good news about the psedomonas infection (which seems to be one of the primary concerns at this time) soon.