Status Update

Judi has improved significantly since my last post. Her right lung is completely clear and her left lung is almost clear as well. The pace at which her lungs recovered eliminate infection as the problem (VERY good news). The data was reviewed by a lot of pulmonary folks today and no one is sure exactly what occurred. They have seen this before with brain injuries. The settings on the ventilator are down to normal and it is operating in support mode only. This tells us that her lungs are functioning well and that there is no reason to believe she will have any damage or difficulty breathing on her own.

The neuro team believes the underlying cause of the breathing issues is her neurological status. Her inability to swallow and handle the secretions that we all have were likely the source of the problem. The surgeons want to do the graft as soon as she is physically able to handle it. Believe it or not, Judi's blood pressure is once again the limiting issue. Her blood pressure is running low and we are having to give her medication to keep it up. Some of you may recall we had the same issue when she was originally injured. We can't take her to surgery until her blood pressure is stable in the normal range without medication. She could suffer severe brain injury if she had a low blood pressure transient during surgery.

The last thing we have to decide is what to do with the ventilator. (I have been getting an on-the-job training program on how they work and what the settings tell you from the respiratory technicians the last couple of days.) There is a balloon that surrounds the tubes that go down your throat. When the balloon is inflated, it provides a seal that isolates the mouth/nose from the lungs and allows all of her air to go through the tubes. It also prevents any secretions or fluids that come from her mouth or nose from getting to the lungs (this is what is protecting her lungs now). We need to do her head surgery and ensure she is managing these secretions before we remove the isolation. This leaves us with the following options: 1) keep her on the ventilator until she is done with surgery and then ween her off while monitoring the swallowing/breathing process or 2) ween her off the ventilator and put her on a trach. The trach has the same balloon setup, but exits in her throat and does not have tubes running through her mouth or vocal chords. I am leaning to the trach option. The trach provides the protection she needs and can theoretically stay in forever. The trach can be capped off (balloon is deflated when capped) to allow her to breathe normally, but can be quickly uncapped and the balloon inflated if she needs an airway. The decision may be driven by timing. They generally like to get the tubes out of the throat in two weeks, but three is the maximum. This prevents damage to her lips, mouth, chords, etc. So, if it takes a while to get her blood pressure stable, we may already be to the point of inserting a trach before her surgery.

I think that is the big stuff. Please keep her in your prayers. They are obviously working. I am not sure most of you realize it, but we came close to losing Judi last Friday. Many people do not recover from where she was Friday night. I know in my heart that God is watching over her for a reason. I will never forget looking into her terrified eyes while holding her thrashing body with one hand and an oxygen mask in the other trying desperately to get her to take a breath. I can only imagine what was going on in her mind. She gave me a smile today when I wished her Happy Anniversary and told her how much I loved her. I sure needed to see that smile.

Steve