Up, Down, and All Around

That's a good description of the day. Basically, Mason's saturations were all over the map today from up in the 90's to down in the 50's while awake. Most of the time, if he was calm, he did great and saturated in the 80's. However, calm was hard to find for much of the day because of a number of reasons.

Sleep:
For the first time in I can't remember how long, Mason slept through the night last night. He fell asleep around 9:30 after a very exciting and fun day with his Staramama and Pom Pomp and didn't wake up until the ENT resident came in at about 7:30 this morning to check on him. I'm not sure why the resident felt the need to come in, but she did and she wasn't subtle. The good news is that she was happy with what she saw and just reminded us to change his trach. Anyway, back to the sleep thing. Unfortunately, Mason's not the most calm person when he wakes up before he wants to, and now is no exception. He played frenetically for quite a while after waking which caused him to take short quick breaths and so he didn't saturate well for that time. After we got him settled some, he did much better.

He took a nap after his bath today and slept for an hour or so before the wound care nurse came in to look at his G-tube site. Once again, he was quite frenetic after that for some time and so saturated poorly. Thankfully, after some cuddle time with Mama, he was able to settle down and saturate a bit better. He stayed awake just long enough to see his Staramama and play a little bit before settling in for another long nap (4 hours!)

Thankfully, after this nap, he awoke on his own and was happy and playful for much of the rest of the evening - with a few exceptions. Right now, he's lying in his bed, playing with Papa - well, really, watching TV with Papa and saturating fairly well.

G-Tube Site:
Unfortunately, Mason has been a little tortured by some work we are doing on his g-tube site. I just did a search to get more information about the treatment we are doing and I'll change that last statement. He has been a lot tortured by the work we are doing. I am so sad that we've had to do it, and really, really hope that we'll be done soon. Anyway, Mason's g-tube site has formed granulation tissue - a type of scar tissue that grows around wounds. Mason's body is trying to close the g-tube site, but since it can't the tissue creates problems. In Mason's case, it was interfering with the tube itself and causing some bleeding. So, we are treating it with Silver Nitrate - a medicine that kills the tissue. Unfortunately, this is very painful for Mason, but necessary. We are making progress and the granulation tissue is nearly gone, but in the meantime, Mason is upset a lot of the time which also causes some desaturation and decreased tolerance for pretty much anything. Can't this guy catch a break?

Decreased Methadone:
Sometime last week, we started weaning Mason's methadone. He has done fairly well since we found out the right amount and rate to decrease. Again, unfortunately, with this comes some trouble. Mason is having to go through some withdrawal again which makes him a little unhappy. I think if he didn't have to go through the granulation tissue stuff, he would be doing great with the withdrawal, but when added together, he's having somewhat of a difficult time. One of the good things that comes with the wean of the methadone is that Mason is more aware of what's going on. He is interacting appropriately, playing a lot, and his eyes are even starting to line up a little better. Maybe being so heavily drugged didn't agree with him! I am hopeful that Mason continues to get stronger so that he can re-learn to sit up on his own. He does get so frustrated that he can't move like he used to, but I think that determined spirit he has will help him regain his strength quickly.

Well, I think that covers it for Mason today. He's got a lot to deal with, but is doing amazingly well despite the deck being stacked against him. Oh yeah, one more positive thing. This morning in rounds, we were all ready to agree to another wean today and the attending intensivist said, let's wait one more day. Maybe we are in fact starting to see things don't need to rush along....

Rate: 28
Inspiratory Pressure: 22
Inspiratory Time: 0.65
PEEP: 11
FiO2: 67%