Crossroads

      Tonight we are at the crossroads of two unknown paths.  Both look tough and rugged with not much view of the view or the path beyond. The choice of which path is not ours to make, it's primarily up to one thing... his kidney's. 
     If his kidney's don't start functioning better by tomorrow, we will journey down a particularly life changing path.   Today his kidney levels rose again, his kidney function is not improving.    They are on the fence about choosing to put him on dialysis.  Dialysis will not fix the kidney failure, it will only replace the function of the kidney's and give them time to find the root of the problem.  If this is the path it could start as soon as Friday.  Depending on if they can find the reason, our hope is that it would just be temporary for a few months.
      The other path, which is the slightly smoother path is that his levels improve.   This is the typical path of kidney disease they believe he has, and once it starts to improve, it generally continues to improve, they just haven't seen it do that yet.  Once they believe his kidney's are on the mend, we then will reach another branch in the woods as we determine what to do about the problem with the carotid artery in his brain that is causing his right eye to not move.  The imaging and treatment he needs at this point is too dangerous. 

      The other day after my brother came to visit me, I texted him to say thank.   He replied and let me know that "Prayers and Hope were always headed my way".   It struck me at that moment, and has stuck with me since that he would include the word "Hope" in his message.   With all we've been through, hope is something that is quickly dwindling.  Tonight with the sound of the ventilator humming, I take solace that he' may finally get a good night's rest.   Perhaps it's an omen that better days are on the way. 

Weather the Storm

     

      Today's morning update unfortunately was not good news.   His creatinine levels took an unexpected turn in the wrong direction and are headed up again.  We met again with nephrology and they are considering putting him on dialysis.   It won't do anything to fix the problem, but will give his kidney's a little bit of a break while they figure out what to do.   After they consulted with the ICU team, they decided not to do it today, so I guess we'll find out tomorrow.  We did bring up our concern to them that the major thing prior to finding about his kidney's, is that we've been worried about is his right eye not moving and the information from the neuro-opthamologist.  Kidney's are now up high on the priority list.  We told them that in order for them to proceed they need to be able to do imaging and treatment with dye and that we don't want to fix his kidney's only to beat them up again.  So requested that they consult with that doctor and their team to see what the overall big picture is.  

       

     Specialists are great for being experts in what they do, but the frustrating thing is that they tend to look at you through a spyglass while standing right next to you.   Focused on a very particular part of the body and not seeing the whole picture.  It seem's that Chris's problem keeps getting more and more complex and involving more specialties.  Hopefully we can get a team of them working together to possibly fix the whole problem.   

      Today was a hard blow.   I thought perhaps there was a possibility of going home today, but that seem's like a day in the distant future.  He's still in a lot of pain that very little seems to help.   It also for other reason's was a particularly tough day in the ICU.  We're trying to put our head down and weather this most recent storm.   My mom had a poem I remember memorizing as a kid that perfectly fits this situation.   

 Whether the weather be cold

or whether the weather be hot,

We'll weather the weather,

whatever the weather

Whether we like it or not!

Life is a Mixture

     As far as updates, a ton more testing today but not much news.   His kidney levels have plateaued but have yet to start improving.  Because of the high/low values of his potassium and sodium they are really worried about his heart, so that was quite a bit of the testing.   There were doctors, nurses and technicians in and out of our room from about 4:30 in the morning all the way until about 5:00. 

      One of the most memorable... we met with a very intense group of doctors, the nephrology team.  They spoke very quickly in a strong foreign accent and with new unfamiliar complicated medical terms.   It was a bit much for both of our tired brains.   The basic understanding from the visit was that they still aren't sure what caused the damage to his kidney's but really know what they are doing.  They understand things far beyond our capacity and are watching his case closely and trying to get things back in balance.   When they left Chris and I looked at each other and I immediately burst out in laughter.  Not a usual response to meeting with doctors but laughing felt good I think it's both what we needed in the moment. 

      Another intense experience was that they decided to add another IV line.   This time not just a regular one but a mid-line.  It's a step up in from your typical IV, they can draw blood from it so it will save veins from the endless sticking.    It's a sterile procedure where there was a lot of precautions taken to eliminate the chance of an infection.   I'm pretty sure he's had one before, but they were likely added in the OR. 

    Today we both received a lot of support in many forms from family and friends.   Last month my heart ached when my Grandma passed away and I couldn't be there to give my Dad a hug.   So for all of those who are far away and can't make it, know that we do feel your love and prayers.   Many from my family have also been able to come to the hospital to support me.   Thank-you for everyone for everything, you are our sunshine in the crazy storm we have been through these past four years. 

Everything in Balance

     Still here, in our room with a view, trying to get everything balanced back out.   The human body and all that it does is simply a miracle, what a crazy balancing act.   In addition to the creatinine to measure his kidney function, they have also been watching his potassium and sodium.   This morning's labs showed that they were both headed in the wrong direction.   To help his potassium they gave him insulin, and to counteract what that would do with his sugar they put him on a sugar IV.  It's a delicate balance involving lots of blood tests and even more medications.   Any kid would probably think that a sugar IV or shot sounds like a dream, but the sugar shot was pretty painful. 

    This morning we also had the blessing of having some service missionary couple come and provide the sacrament.
     Sitting in a hospital after a month full of intense pain really brings it into perspective the symbolism of the broken bread and the understanding that there is one who knows exactly what Chris has been going through.  While the water is meant to symbolize the blood that was shed, tears running down my cheek during that tender moment reminded me that many tears were likely also shed as well.
      So much has been done to focus on fixing Chris's broken body, that the intimate and personal sacrament provided just for us was a quiet small moment to step away from the stress and pain of a broken body and rejuvenate our souls.

"While of this broken bread Humbly we eat,

Our thoughts to thee are led In rev’rence sweet.

Bruised, broken, torn for us On Calvary’s hill—

Thy suff’ring borne for us Lives with us still."

Jesus of Nazareth, Savior and King Verse 2

     In addition to the trials, we have been blessed with many family and friends there to help balance things out and lighten our load.   Thank-you to everyone for your prayers and fasting on our behalf and for the many offers of assistance.

Blessings in Everything

     It goes without explanation that a hospital is not the most enjoyable places to spend your time.   But, being grateful sure does make a stressful situation much more bearable.  

     Today I'm grateful that real life isn't how it is on TV, where there's always visiting hours.   Thanks to my work understanding true priorities, I've been so lucky to be able to be with Chris in the hospital the entire time he's been here (both this time and all our previous stays).  This morning after spending some time on the ventilator he had a period of respiratory distress.  He went into"desat" meaning that his oxygen levels dropped into dangerous levels that set off lots of alarms.  Even with his two nurses (his main nurse has a training shadow today) and the respiratory therapist were in his room, despite changing the delivery method and level of his oxygen, he kept declining.  I sat there holding his hand, encouraging him to take deep breaths but nothing was helping.   Inspiration struck and I remembered that his trach cuff was still inflated from being on the ventilator.   The cuff makes it so air can't get around the trach, so everything that they were doing to try and increase his oxygen wasn't making it past the trach to where it needed to be.   I brought this to their attention, they released the saline in the cuff and things quickly improved.   Trach's aren't super common even here in the hospital, and his is a rare very custom one.  I'm sure they likely would have eventually figured out the problem, but being in the right place, at the right moment is something I am truly grateful for.  

       Taking time to walk around the hospital, I've learned that for me, it's best to look straight ahead.  While the clothing they have is surely a giveaway, the look of fear and trauma in the eyes of guests visiting family or friends is enough to make your heart break.  No matter what we are going through, there's many people in the hospital in much more challenging situations.  Just the signs on the door is enough to convince you that things to could be worse.  When doors are open in an ICU, without your eyes straight ahead you can see some pretty scary situations.   Today while looking straight ahead there was a cart with some snacks.   My first thought was that it was a thank-you to the hard working staff, but walking past I noticed a ticket saying it was a bereavement cart.   My heart breaks for the family who lost their loved one today.  

       We thought we might be going home today, but his kidneys are still declining.   His potassium levels are still high, but luckily stable.  If his potassium gets higher, it can cause problems with his heart.   They believe his kidney's will improve, but said they they will likely get worse until they get better.   So for now we are here waiting for them to improve.   The past month and a half has been a challenge with lots of unexplained medical issues, and trying to get to all of the appointments has been stressful for both of us.   Today I'm very grateful to be in a place where they can watch over everything and where the doctors come to you.  

One Step at a Time

      They originally thought we would come to the MICU for just a few hours, but here we are for  a second night.   It might possibly be our last night, at least for now.  Tomorrow they are expecting his home ventilator to arrive and we're hoping for some time here to get used to it before they send us

home but hopefully we'll feel comfortable with it and there won't be the need to spend another night.
      The kidney function they were worried about yesterday has been their primary concern today.  More blood tests and an ultrasound to try and figure out what the problem is, but still no answers.   With his kidney's in as much trouble as they are, the imaging that he needs is much too dangerous.  They mentioned "kidney failure" a few times today, not sure if he's in actually in kidney failure or approaching it, neither is good.  For right now it's priority number one in order to be able to move forward.  More ducks to try and get in a row, our only option is to take it one step at a time.
 

Back Again

     One of our doctor's called this morning and said that they felt it would be best for Chris to be admitted to the ICU today and that they were waiting for a room to open up and be cleaned.   I had the prompting to pack everything we might need on Sunday, so most everything was already loaded in the car.   Kinda hard to pack when you don't know how long you'll be there, but with the knowledge from last time, I'm prepared. 
       Once they called and gave us our room assignment we headed up and got here about 2:00.  Didn't have to even check in, just came straight up to the MICU (Medical ICU) in a wheelchair.   Not your typical entrance to the MICU and not a traditional patient.  Our room this time has got an amazing view of the valley.   The nurses again are our hero's, we've lucked out with both nurses so far. 
       Once he got settled in, ENT came and changed out his trach.  It wasn't a smooth process and they had to try several different ones.   The reason for the trach change is that he needs to be able to be on a ventilator in order to get a CT and/or MRI to confirm their diagnosis and to perform the procedure to fix it.  The new trach he got in August does not have a cuff.   A cuff is like an inflatable ring that surrounds the tube of the trach and makes it so that the air is forced into the trach and not around in the trachea. 
     After they changed out the trach, they immediately put him on the ventilator.  Having a machine breath for you when you are awake, alert and used to breathing on your own is probably pretty scary.  It took some time, and getting him into a chair where he could sit up for him to feel better, and things finally settled down.
     Some initial blood tests were concerning in regards to his kidney function, something they will monitor while they are here. 
      Not sure how long we will be here, but hopefully tonight he can get some rest.   The past few weeks trying to go to Doctor's appointments has been exhausting.
 

Pressure

   Shortly after his last surgery, Chris began to have horrible headaches and problems with his eye.  His right eye would not move to look to the right and was causing double vision.  (A problem with the 6th cranial nerve).   Thanks to a referral from an inspired co-worker, we've been seeing an opthamologist who did everything he could to try and help us.   Dr Wong has been one of the most amazing doctors in our journey thus far.   We've been anxiously awaiting an appointment with Dr Warner a neuro-opthamologist at the UofU that was scheduled at the end of the month.   

      Over the weekend, his right eye lost further function and would no longer look left or up and down.   Dr Wong pleaded our case and they were able move up our appointment to yesterday afternoon.   After lots of tests and questions, they are fairly certain in their diagnosis.  The carotid artery is leaking into the vein in the Cavernous Sinus area of his brain.   This area is where the 6th, 3rd and 4th cranial nerves are.  This blood is putting pressure on the nerves which is why his eye will not move.   His also has higher pressure in his eye from blood flowing into it.  There's a very small chance it could get better on it's own, but left untreated there's a very high chance that he'll lose vision in that eye. 

       There are additional tests they can do to confirm their diagnosis, such as a CT Angiogram or MRI, but the test that would give us the best confirmation is a Cerebral Angiogram.   It would be performed by a highly specialized team involving an interventional radiologist and interventional neurosurgeon.  Dr Warner is going to present his case and see if they will be willing to do the procedure.   It is one they don't want to rush into, and they want to make sure they have "all their ducks in a row".   The silver lining is that this invasive test would also be able to be combined with the treatment. 

      While they discuss with each other to determine if they could do this procedure safely, we are off to another appointment with our ENT.   There are signs that his airway is narrowing again which could further complicate the possibility of doing the procedure.

       Yesterday was a tough day, but it is a relief to finally have answers. 
   

Deflated

    The surgery at the end of August to treat the tracheal stenosis (narrowing of his airway) did not go like we expected and has been very difficult to recover from.   His airway has healed pretty well, but his lungs however have not.  He can't even do the simplest of tasks without his oxygen levels dropping into unsafe levels.  Before he was on oxygen only at night, now it's his constant companion. Having to work so hard just to be able to breath is tough on his body and he's exhausted.

      His ENT and Primary care doctor have said that they think the lower lobes of his lungs have probably collapsed.   It's a complication that apparently can happen from anesthesia.   The fact that his lungs battled pneumonia earlier this year probably made them weak and more susceptible to this complication.  We are waiting to get into yet another specialist to try and figure out a solution.

     Yet another specialist now treating Chris is an ophthalmologist.   A particularly tough cough to try and clear his lungs has lead to another complication.   It resulted in palsy (paralysis) of the 6th cranial nerve.   This makes it so that one of his eye's can't move like normal and gives him double vision as well as a debilitating unrelenting headache.   There are a few possibilities.   It could have caused a mini-stroke to the nerve, if that's the case there isn't much they can do but wait for it to heal, hopefully within 2-3 months.  He's requested a CT to try and rule out an aneurysm.  He also wants him to do another test to determine if the coughing might have caused a bleed in his pituitary gland.

      Thanks to our Primary Care Doctor and some strong antibiotics, the infection in both of his legs from being in the hospital is finally starting to heal.   Having low oxygen levels has made it extra challenging but it's nice to be least see progress somewhere.

     So like his lungs, and the poor ducky to the right we fill a bit deflated and like we are just dragging along.    With at least a dozen appointments, tests and procedures scheduled in the coming weeks, and likely more to come we'll just do our best to survive.  Having a rare brain tumor with accompanying complications from surgeries is no fun!

To Everything there is a Season

     For our season, it's a time to wait and learn patience.  Just over three months ago we were on the tail end of a very long hospital stay.   While here then, the season's changed from spring to summer (typical of unpredictable Utah weather a little bit of snow in between).   Now, here we are again at the University of Utah hospital for another surgery.   On the way here there were many signs of the change of seasons, it's still hot outside, but it's back to school time which means fall will be here shortly.  There was a traffic sign as we neared the "U" warning us... "Watch for incoming freshman".

       It's just after 1:00 in the afternoon and Chris was taken back about an hour ago.   Today's surgery is the same as the first one in May, a dilation to open up his airway. When we scheduled this one, the prime goal was to remove the trach.   Talking with the doctor today, I'm not so sure that this will happen.   If anything, they might change it for a different one.

  Compared to the past two surgeries, this time the waiting room is bustling with activity.  People constantly coming and going, phones ringing, people receiving updates, nurses walking around with stacks of binders (aka charts), even a lady with a service dog for people to pet if it will help calm their nerves.

     His first surgery in May was the complete opposite.   Late at night with no one manning the information desk, and not a soul in the waiting room but me.   A situation that in other situation would have terrified me, ended up being precisely what I needed.   Through previous trials I had been prepared me for it and given the strength and comfort to endure.   I was able to take solace in the quiet moment by writing in my journal.   When I was able to see him in recovery, and things went downhill I was able to focus completely on being with him in the moment.

     His second surgery that stay, when they added the trach, was similar.  It was on Mother's Day Sunday, and this time I surrounded by family, but we had the entire waiting room to ourselves.  Together we waited and some very tender moments followed when everyone was reunited in the SICU.

    Today I am alone, but I'm fine.   I know I could have asked someone to be with me, but today should be a simple procedure and I'm at peace.   When I was searching for the picture of the tree above, this one also came up in my search.  It fit my feelings also, we've both faced some scary things but is our faith that has given us courage.  In the event we end up in the ICU again, it's not the terrifying place it once was, the nurses and doctors there are amazing.


_______________________________________________________________________________

     Surgery today was longer than they predicted.   Got an update from Dr Smith about 3:00.   From the pictures he showed it looks like the stenosis has returned.  It didn't look as bad as in May, but it didn't look as open as the last office visit.   They had to use the balloon multiple times to stretch it.   Chris was having a tough time coming out of anesthesia and that he wanted him observed in recovery to determine if he should be taken to ICU.  

     He didn't feel it would be wise to remove his trach completely, so instead he changed it out for a different kind.   They replaced the custom one....with a tube so long that it reaches to the bottom of his trachea. with something different.   What he had before is somewhat similar to the one to the left but with a much longer tube.   The one they put in today is  like the one on the right.   It sticks into his throat and and is held in place on the inside with flanges.   While not the complete removal of the trach we were hoping for, we know it's a step in a better direction.

      About a half an hour after the update from Dr Smith, they let me go back to see him.  He had stabilized enough that they allowed me to sit with him.   He stayed stable the entire hour and a half I was there.  He was tired and in and out, but when he saw me he gave me a great big smile (he sure knows how to make a gals day).   Once they finally had a room free they moved us to a regular room on the Acute Neuro floor.  Took some time to get situated and bring in everything he needed, but he's all settled in.   He was able to eat dinner, and said his throat is super sore, but otherwise he is doing well.   Dr Smith said that cold things should help with that, I see lots of ice cream in his future.

      Overall a long day, but very grateful for all the prayers said on our behalf today.
 
     This year has by far been the most challenging "seasons" of my life, and I'm sure that Chris would agree it has also been his.   We've been tempered in the refiner's fire and it's changed both of us in many ways, but one of its purposes has been to make us stronger. Hopefully that strength won't be for more trials yet ahead, but our journey is not yet over.