CHAPTER TWELVE   Michael (Kathie, Chris and Ivy too) UPDATE:  MARCH 22 Dear All, I am at Ivy’s side as I type this tonight.  It has been a very tiring week since Ivy’s terrible ordeal last Tuesday.  Kathie and I are both so very nervous that every event seems to bring us close to panic.  Ivy’s weekend was relatively calm, but this morning, just as I got to work, I got a call from Kathie telling me that Ivy’s sats had once again dropped.  The nurse was relatively certain that she was once again plugged and the pulmonary doctor was going to have to perform another bronchoscopy to clear Ivy’s lungs. I was ready to drive down to the hospital, but Kathie told me that I should stay at work and that she would let me know how things were progressing.  If I needed to travel down to the hospital, she would call me.  It was about 30 minutes later when one of the lead nurses called me to let me know that Ivy was tolerating the procedure well.  The doctor was still performing the procedure and that he was going very slowly so that Ivy might tolerate it better.  Once they were finished, Kathie called to let me know that Ivy had maintained her sats and was now resting.  Once again, things are somewhat calm….for the moment. Since Ivy’s ordeal last Tuesday, the pulmonary team decided to adopt the ventilator profiles for breathing that Children’s Hospital uses.  It is still a bi-level, but the high peep is set at 40 and the low peep is set at 20, with a respiration rate of 40 breaths a minute.  With the vent set this way, the thought is that Ivy’s lungs will remain more inflated.  The thought is that with less movement, her lungs will better accommodate healing.  The faster breathing rate is to support oxygen and carbon dioxide exchange. This seems to be effective as Ivy was down to 55% delivered oxygen and maintained saturation of 100% all weekend long.  This is the lowest delivered oxygen percentage she has been on since December 12th…a very long time ago.  Because this breathing pattern is very shallow and rapid breaths, Ivy has been kept a bit more sedated to deal with the anxiety.  She can be turned now with little or no impact on her sats, which is a good sign.  I can’t help but feel there is some improvement with Ivy although I also feel this has been by far one of the hardest weeks we have had. Right now, Ivy's oxygen has been turned back down to 60% and she is still satting 100%.  We are hopeful that she will soon be able to tolorate the return to 55% and lower, but as of 8:30 this morning (Tuesday), her ABG's are still very low (PO2 in the 70's).  We are hopeful that this will improve as she continues to rest. Once again, I need to thank you all for your prayers, cards and e-mails of support for Ivy.  They all mean the world to us all.  I know that they have all helped her so much.  God Bless you all for your continued kindness and thoughtfulness.  We are all blessed to know there are such wonderful people in this world.  God Bless you all. With My Best Wishes Always, Michael, Kathie, Chris and most especially, Ivy