7.13.2006

July 13, 2006 - 4:00 pm

So, we met with Dr. Lee, the neuro-intensivist. He met with Lonia, me, and Dr. Diana – Mike’s great seeeester who is up from Florida.

Dr. Lee said that when I’m here, the news is good, but when I’m gone “bad things happen.” Ok then. Break out the sleeping bag.

I’ve put together some dense information here from our meeting with Dr. Lee with the help of Dr. Diana. It’s g.r.e.a.t. to have her here. She's a great interpreter.

So, what bad things have happened? throughout last night and into today, Mike has been experiencing multi-system organ failure: Kidney, liver, heart etc. He’s in full blown DIC – which they think is from infection. Possibly from a gastro-intestinal bug –a bug that one can often get when on antibiotics. He’s on flagil to fix that.

Last night, his hemoglobin, hematocrit, platelets all went down. So, he got a lot of blood throughout the night and ffp (plasma) for the DIC.

So, why all these complications? He did completely flatline yesterday morning. The result of that is that the heart is not beating properly right now. Plus - he’s got a large volume of fluid in his body from all the many drugs, blood, flushes of water, he has been receiving through IV. Currently, he is 11 liters positive in fluid. You should be even at 0. Basically, all this fluid goes into his vasculature so his heart needs to process all of it. His heart is already having trouble, so this extra stuff to process only worsens the problem.

Cardiac output should be between 4-5. Last night it was 2…which is less than half of normal output. This is different from beating too fast… instead the heart just can’t take care of the volume it needs to – and his heart has too much volume to deal with on top of all this.

Why multi-system organ failure? Everything hinges on what the heart does. Blood preferentially goes to the brain and the vital organs – but because the heart is pumping less volume than it should, everything is getting perfused. The normal flow of blood through all the network of organs is diminished. This process then causes multi organ system failure.

Last night liver enzymes were in the 1000s. Normal is in the 2 digits.

Dr. Lee’s goal today was to get Mike’s CO (cardiac output) up again. He has done this. He increased Mike’s CO by giving him dopamine (as a vasopressor). Was on Neo and Levaphed, too, but now just on dopamine. Dopamine helps keep BP up and helps his heart to pump. That helped increased the CO, which helped get blood to all the major organs. Hence, liver and kidneys experienced improvement as a result. Now we’re actually seeing him output urine which is a big deal in the face of this.

So, I asked Dr. Lee, “If we can just get him to survive these acute crises and not die, can’t we have pretty much normal Mike back?”

His response, “Well, he’s not going to jump out of bed. He’s wrestling with multi-system organ failure which has a 50-70% mortality rate. That means that 5-7 out of every 10 people die of what’s going on with Mike right now.”

I placed my hand on Dr. Lee’s arm. “I understand that 50-70% is 5-7 out of 10.” He laughed and apologized…

After we relayed all this info to Susan this afternoon, Susan said, “Is there anything about Mike’s condition that Dr. Lee said is getting better?”

“Yeah,” Diana said ,”He’s gone from dead to… not dead.” We all had a very dark and hearty laugh over that one. Indeed, “not dead” is better than “dead.”

No comments: