4/7

John continued his streak on the pressure support setting of the ventilator today. He has been able to comfortably tolerate that setting for 9-12 hours a day for the last 4 days while maintaining his blood pressure and oxygen saturation. At night, he goes back on assist control where the vent does more of the work and John can get a little rest. Curiously, John's blood pressure has dropped the last two nights while he has been on AC. Speculation is that when the ventilator is doing the work, it increases the pressure in the chest cavity pushing on the veins and diminishing the amount of blood they return to the heart; and that reduces the blood pressure. John has needed small, sub-minimal doses of the pressor levofed for the last two nights to keep his blood pressure up where it belongs. He doesn't need any help during the day while he is on pressure support. Not sure if this is going to delay a transition to intermittent dialysis which requires the ability to constantly maintain blood pressure; we will talk to the kidney docs and see what they think. Respiratory today said that John was moving a lot of air in his lungs. That's good; when the pneumonia was at its worst, there weren't a lot of air sounds. John had a lot of secretions yesterday which were removed with frequent suction. Today, his nurse pronounced that he sounded a lot less "junky" which I am convinced is a medical term since I have heard several nurses and doctors make that assessment. John's weight is back to 170; that was his weight when he was admitted to the hospital. So, while it is painfully thin, it does mean the edema is finally gone. John is alert more frequently for brief periods. That is great to see but also means he is more aware of his pain. Even though it is carefully managed with position changes and meds, it is clear he is often in pain. PT is still working on range of motion; and this week surgical trauma may evaluate John for a peg tube and for surgical debridement of a large and deep bedsore. If it's a go, John will be able to get more nutrition with less irritation and that should help the healing. The air mattress also helps as does the frequent turning. It's just hard to avoid skin break down when you're confined to a bed for weeks at a time. The night staff shaved off all of John's beard which must be much more comfortable for him. He looks like his old self with his ruddy complexion and black hair coming back. Thank you for the continuing prayers, good wishes, cards, pictures, anecdotes, and emails. We look through them together each day as I deliver your encouragement to him.