Three Steps Back?

Well, if I count the number of tubes/lines that were REINSERTED into Rudy today, I’d say we took 3 steps backwards!  I drove back to UCLA this morning from a great weekend with the kids in SB to find a room full of folks in Rudy’s room (never a good sign).  Dr. Mary (pronounced “Marie”) caught me at the door to tell me that Rudy was struggling with low blood pressure and low saturation numbers as well as needing more vent support because of a high heart rate.  All the indicators were pointing toward infection again.   (There are two nasty bacteria that keep recurring from around his ventilator (ET) tube)   After the morning rounds, a chest x-ray AND chest ultrasound, the docs determined it was time to put the chest tube back in.  As Dr. Rick described, the amount of fluid detected in the x-ray and ultrasound wouldn’t necessarily warrant the chest tube but because Rudy’s system is weakened by the infection, they need to get rid of the pressure…he just can’t breathe past it.  In addition to the chest tube, they put in an arterial line (ART) to more accurately monitor his blood pressure.  Then, late this afternoon, the nurse put his urine catheter back in his tollywaffer since he wasn’t urinating and they need to monitor that more closely again as well!  Ugh!!!  As a result, he has been sedated most of today and just now opened his eyes long enough to look at me, give me a quick “hello”, and then sacked out again.   Right now he is stable…his numbers are back where they should be but it took all day to tweak everything (from vent settings to meds to blood transfusions, etc)  just right…it can really be a maddening balancing act sometimes.   

This chylothorax fluid continues to be a real beast!!!  Last week I left with the impression that it was still just a matter of time…I talked to a couple of doctors who said they’ve seen prolonged battles with chylothorax fluid before that eventually cleared up and that was somehow comforting to me.  Drs Brian and Dan, however, feel we have run out of time to wait much longer…As Dr. Dan described, the longterm cases of chylothorax fluid they’ve seen did not prevent the patient from being extubated…in Rudy’s case it is and we just can’t wait to extubate him.  It’s a vicious circle…we can’t extubate until the fluid is gone and as long as Rudy is intubated he’ll battle this recurring infection weakening his system in general!!! 

As I understand it, the lymphatic system collects the fluid from the venous system and takes it back to the heart through the thoracic duct.  For whatever reason, the fluid in Rudy’s lymphatic system is leaking which is why they went in and ligated the duct (which normally causes it to stop leaking).  For an unknown reason it didn’t stop the fluid from leaking in Rudy which means there may be another thoracic duct (HIGHLY unlikely) or an extra lymphatic vessel somewhere that  is leaking.  To determine where the fluid is coming from, the team is considering a LYMPHANGIOGRAM.  Apparently it is pretty rare and only one doctor at UCLA does it…they are waiting to hear back from this doctor so I will know more details later.  It would basically map out the lymphatic system and potentially show where the fluid is coming from exactly allowing Dr. Brian to go in and hopefully fix it.  The lymphangiogram would be to the lymphatic system what Dr. Dan’s heart catheterization was to Rudy’s heart last week – a test that would hopefully give us some definitive information.  The results would help Dr. Brian determine what to do next…possibly a procedure called PLEURODESIS which closes off this space between the lungs and chest cavity preventing the fluid from accumulating.

I don’t know…it’s all a bunch of crazy information that, for now, doesn’t really mean a whole lot to me…I just REALLY want a breakthrough (as does EVERYONE else around here!).  I still would welcome a divine breakthrough for Rudy’s sake while at the same time bypassing the need for me to try to understand all the above information!!!!!!  Well, my little man is waking up finally!  I better go tell him how much I love him!!!  Thank you for praying…