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John had good days yesterday and today; he was able to comfortably be on pressure support for about 9 hours each day. This is a first small step towards weaning from the vent if he can remain comfortable on pressure support and eventually move to the trach collar. A first today was permission to have an ice chip several times an hour; John really liked that. It was the first thing he had to swallow for more than a month. Speech and swallow will be back when John is alert for longer periods of time. His pain med has been changed to morphine which makes him a little tired. Next steps may include insertion of a peg tube into the stomach or small bowel for feedings. Then the nasogastric tube can be removed which should make John much more comfortable. It will also permit bolus feedings so John can get some extra nutrition which is important for healing. When the trauma surgeons assess John for a peg tube, they will also assess John for surgical debridement of the bedsore which is deep and pretty extensive. For the medical people out there, it is at least a stage 3 decubitus meaning it penetrates the epidermis, dermis and into the subcutaneous fat layer. Surgical debridement with a wound vacuum would help it heal a lot faster than debriding with the santel cream. Surgical debridement will be painful but John will be appropriately supported with pain medication. The sores on John's legs are slowly healing. These steps could happen as early as this coming week. John is making and maintaining normal counts of white blood cells without growth factors. This is an indication that the bone marrow transplant is working. He still needs frequent transfusions of rbc and platelets but that is not uncommon for the kind of infections and complications he has. The edema continues to improve as fluids continue to be withdrawn with the continuous dialysis. Some great comfort measures are a consult with podiatry to take a look at John's nails and a beard trim under John's neck. He looks much more comfortable thanks to the nurses and staff. In spite of John's progress, there was sobering news today. John's overall prognosis is still poor. The statistical approximate chances of surviving the kinds of complications John has in multiple systems is about 10%. If John can recover, there is a substantial possibility of needing dialysis indefinitely. And, even the quickest recovery would take at least a couple of additional months. So, we need your prayers and good wishes more than ever. If you have any pictures or notes you want to send, I will be sure to share them with John. He does enjoy hearing from all of you.