On Tuesday September 4 th Lee had a routine and follow up appointment with the liver team in Murray. His kidney function was elevated so they admitted him to IMC in Murray to help hydrate him and see if his kidney function would improve. Lee's mom, Jesse, Dee  and Jeri made it out to visit him on Wednesday.  

That day they also placed a small bowel feeding tube to help with nutrition and hydration. With his achalasia he was to the point that he was able to hold down food and sometimes not fluid. Achalasia: In layman's terms, the esophagus does not propel food towards the stomach, and the muscle of the lower esophagus does not relax to allow the food to advance from the esophagus to the stomach. The result is accumulation of food and saliva in the esophagus that needs to go somewhere. When upright, it can eventually trickle into the stomach by gravity. When lying down, it  can go back into the throat and even possibly get aspirated into the lungs. Thursday they took Lee to endoscopy to have a Botox treatment this it to help relax the pyloric sphincter and reverse the effects of the achalasia.

During that treatment Lee had some debris that consisted of undigested food and fluid in his esophagus he threw up and aspirated he was coughing and needed oxygen when he returned to his room. One positive note I can see life-flight helicopter pad from the window.

During the night he continued to cough and throw up. Yesterday morning they took him down to interventional radiology to have another small bowel feeding tube place they were not able to get it down. He once again threw up during the procedure and has a significant aspiration. Upon arriving back to the unit he was coughing and his o2 saturation's were 60%. A rapid response was called. A rapid response team, also known as a medical emergency team and high acuity response team, is a team of health care providers that responds to hospitalized patients with early signs of deterioration on non-intensive care units to prevent respiratory or cardiac arrest.  They acted quickly and stabilized his airway. They moved him to the Shock/trauma ICU and intubated him. He is currently on a ventilator with sedation. 

The doctor showed me his chest X-ray and you can see the areas where fluid has collected. Currently he is resting well and he seems to be stabilized. He will be ventilated for at least over night and the plan is to place the feeding tube before they extubate him. 
Today the doctors have decided to keep him intubated through the night and do a spontaneous breathing trial (SBT)in the morning to see how well he will tolerate being off of the vent.  

SBT involves the following steps:

• It be conducted while the patient is still connected to the ventilator circuit, or the patient can be removed from the circuit to an independent source of oxygen (T-piece)
• When using the ventilator a PS of 5 – 7 cmH2O and 1-5 cmH20 PEEP (so called ‘minimal ventilator settings’) will overcome increased work of breathing through the circuit (i.e. ETT)
• If still on the ventilator the patient should have ‘minimal ventilator settings”
• Initial trial should last 30 – 120 minutes
• If it is not clear that the patient has passed at 120 minutes the SBT should be considered a failure
• In general, the shorter the intubation time the shorter the SBT required

80% of patients who tolerate this time can be permanently removed from the ventilator

The hope is to place the feeding tube before the extubation.  SO the plan is to stay the course, increase the lactulose to help get the ammonia down and let the lungs heal a little better.

I hope to keep this updated so that all his family friends and followers can stay informed and keep him in your prayers. Thanks for following his story. 

Warning A couple of graphic photos from Lee's fall

On August 27th I got a panicked phone call from Lee while I was at work.  He has called me in the past to tell me he had fallen but this time was different I felt it in my gut when I answered the phone that there was something wrong.  Lee told me he has fallen down the stairs, he didn't dare get up and he could feel blood running down his face.  This was at 10:35 p.m.  I quickly told my charge nurse who sent me home right away.  Lee called me again as I was driving home and told me he was getting light headed and just wanted me to talk to him.  When I arrived home I found Lee sitting I found Lee sitting at the bottom of the stairs covered in blood.    I quickly grabbed a towel and pressed it against the wound that was bleeding the most.  I then called for an ambulance I did not feel like I should move him or if I could even get him into our FJ by myself.  While I waited I wiped some more of the blood off and looked down at his shirt although it was a black shirt it did have a superman symbol on the front that you could no longer see because of the amount of blood that was covering his shirt, needless to say EMS cut it off and tossed it. I want to give a shout out to the EMS crew and the operator that I was on the phone with.  Although I am a nurse I needed the reassurance that EMS was on their way and that everything will be okay.  EMS arrived got Lee loaded into the ambulance after a quick assessment and they were on their way.  I followed soon after I just grabbed Lee a quick change of clothes and checked on our Sadie girl.  Sadie was so scared she would not move from the top landing and just stood there not making a sound she was as still as a statue.  After I called for an ambulance I went up the stairs to put her in our room before the ambulance crew arrived she ran right into her kennel and laid down poor baby was quivering I did give her a quick love and shut the door.  I arrived to the Utah Valley Emergency Room shortly after the ambulance arrived. 

Lee looks pretty beat up and there was dried blood everywhere, the doctor and nurse decided the best way to get him all cleaned up was to head to the shower room and wash him up good and make sure there was no more glass left in the cuts. 
       
Just remember this is after I wiped him up at the house and the ambulance crew cleaned him up some to find the worse of the bleeding cuts.  The shower made a world of difference, I went in with him to help get him all cleaned and so I would better know where all the cuts were located.  I was still in my scrubs after all and I kept getting weird looks from the ER staff several asked if I was new, no I just left work and came straight here.  The ER crew were great this time.  I want to send a shout out the Lee's nurse Jake he was very nice and gentle while cleaning all of Lees wounds and then Bree took over,  not only was she very sweet and ind to Lee she let me use the computer in the room to catch up on all the charting I had not done before running out of the building to get home to Lee.  After x-rays and a CT scan there were no broken bones and no internal bleeding thank goodness.  Lee ended up with 6 staples in the head and multiple wounds that needed to be bandaged.  Here is a shot from the nest day after all was cleaned.  There are multiple lacerations on his head and his left arm is bruised and has multiple abrasions.

Here is the glass shelf that Lee fell into that did sit at the bottom of the stairs needless to say it will no longer be there and will be re-purposed into the table I will be making sometime this winter it will make the perfect frame.


There will now be nothing at the bottom of the stairs unless Lee decides he wants something there to sit on.  This was the bottom landing,  three stairs then the landing six more stairs than a landing and three more stairs before the top floor.  I had always worried about Lee on the stairs but he was so sure this is the house we were suppose to live in.  So he picked it out. 

September 1st:  Lee woke up having some severe pain in his left chest, pain medications, aspercream with lidocaine rub and heat did not seem to make a difference.  We headed back to the ER.   This experience was not all that good Lee was treated like he was only there for drugs.  The reason we returned was the uncontrolled pain, I know there had to be something else that was going on and I am on the cautious side with Lee it seems when there is something wrong it is a big something wrong. They repeated the chest Xray and for some reason did not see that he has 2 fractured ribs when we were in the ER the first time.  I just wanted to be sure there was nothing bleeding or no blood clots in his lungs.  I know from being a nurse that these things may not be seen at first but develop over time.  This doctor did not want to give Lee any addition pain medications told him to go home, continue with his daily activities and make sure he is taking deep breaths.  He did not see very sympathetic, just wanted to get him out of the ER.  I am a nurse and I do not like to utilize the ER so we do not go unless I feel there is nothing else I can do from home, I also felt that the insta-care would just send us to the ER for this issue.   Needless to say I do not like being treated like an idiot by the ER doctors and having an ER nurse that only came into the room once, and the xray tech just pushed him back into the room in his wheelchair and left him I got him back on the gurney.  I am a little disappointed with this ER 1 out of 3 times we have been there had been positive.  I am sorry that I have a very sick husband and we will be in the ER several more times.  Sorry that things happen when it is not 9-5 and I can take him to his regular doctor.  I just needed to rant a little and get that out of my system.  I am hoping to find a regular internal med doctor in the area that I can take him to and that will be flexible to work with him.  I hope things will get better soon I am trying to stay positive and keep my head up.