July 25, 2004

Dear All,


This has been a very trying week for all of us, but most especially Ivy.  With the onset of sepsis, Ivy's condition became very precarious.  On Monday, when Ivy's primary pulmonary doctor returned, he changed the ventilator from a pressure control mode to a bi-level mode that was not only more comfortable for Ivy, but was a lot safer from a standpoint of preventing more pneumo's.  Kathie and I were very appreciative of this and were much more comfortable with this means of support.


 Tuesday (the 29th) it was so bad that the doctors were very afraid that Ivy might not survive the day.  Her troubles began when the CRRT (dialysis) stopped working because the dialysis catheter clogged. Without the system to balance her Ph, it quickly dropped to very dangerous levels.  Ivy became so acidotic that the doctors were in fear they would lose her.  


Not the best news to get when you are almost 150 miles away from the hospital...Kathie had called and told me that I needed to get to the hospital.  I was telling everyone I was leaving when I got another call from Kathie, telling me that maybe I should stay at work.  The doctor actually got on the phone to tell me what was going on. 


When I told him that I was three hours from the hospital (because of traffic at that time of day) he told me that if it would take me three hours to get there, it wouldn't matter if it took me three hours or six.  Because of all that was on my mind at the time, it was several hours later before I realized what the doctor had actually told me.


Later, Kathie told me that the doctor had come into the room with tears in his eyes; it was obvious to her that he did not expect Ivy to survive the infection that was taking over her body.  Fortunately, the nurse was able to get the catheter to work again and restarted the CRRT. Within a few minutes, Ivy became a bit more stable. With some adjustments to the ventilator and some medication adjustments, she was getting closer to the right levels.


When I got to the hospital later that evening, Ivy was still very critical and "moment to moment" in he doctor's words, but she was a lot more stable than she was this morning.
Ivy still had a long way to go before she was over this horrendous infection... her temperature would drop to 94 degrees and the nurse would work to get it back up where it belongs. Two hours before Ivy's temperature was 101.5. It had been this way all day long.


Wednesday morning brought slight improvement in her stability, but Ivy was still very septic and the doctors were using just about every anti-biotic they can think of to try to reduce the white blood cell count and fight off the overwhelming infection.  The infectious diseases doctor has been very communicative with us.  He has shared with us all of his thoughts and decisions concerning Ivy's treatment.  This has been a very big help to Kathie and I in dealing with this situation.


Her pulmonary doctor continued to feel that the condition Ivy was facing was NOT a re-occurrence of ARDS.  The issues with her saturations were strictly a metabolic imbalance.  The chest x-rays were still showing her lungs were clear, which was reassuring to all of us.  He felt Ivy would have a quick recovery once the infection was in check.  He also told us that Ivy must be a cat, because she seems to have nine lives.  All I could say was "thank you"…I know that her doctor felt it was a miracle once again that she was still with us. 


After taking numerous cultures of Ivy's blood and the results were always negative, the doctors were finally convinced that the infection was not in her blood stream.  Because of all the anti-biotics Ivy was receiving, they had caused an imbalance in her normal bacterial levels that the body saw as a very bad infection and the sepsis set in.  Once they understood what they were dealing with, the doctors determined what they could do to treat it.


By Thursday, Ivy's condition was showing steady, but slow improvement.  The ventilator was being adjusted to lower oxygen levels and Ivy has maintaining her saturation levels.  Her oxygen level was adjusted down to 55% and her saturation levels are staying above 97%.  This is the level she was on before the sepsis set in.


 Ivy is resting somewhat more comfortably right now. The doctors have decided that she should be moved back to a "Clinitron" bed to prevent any further bedsores. This bed is 2/3rds sand that is pressurized and heated to provide a non-pressure surface that Ivy lies on. It is like a big air bed that circulates sand.  It's great for her wounds, but doesn't allow Ivy to sit up as the other one's a bit of a trade-off, but I'm sure it's the best solution for now.


Friday evening the doctors told us that he considers her over the sepsis and well on her way to recovery once again.  He made small adjustments to her ventilator settings on Friday evening, lowering her peeps and the pressure levels.  All steps in the right direction. 


Ivy's ABG's on Saturday morning were not quite as good as they were Friday evening and the Doctor declared it a "day of rest".  He decided not to make any vent changes, but to work on reducing the amount of sedation and blood pressure support that Ivy was on instead.  Ivy had a good, calm, quiet day resting.


This morning (Sunday) when we arrived at the hospital, Ivy was back on CPAP support from the ventilator.  This was what she was on before this whole incident set in!  An amazing show of strength on Ivy's part.  She can now have small bites of ice to chew on once an hour.  If all goes well, she maybe allowed to have drinks again as soon as tomorrow.  I know it will be at least a few more days before she will be trying to breathe on her own again, but I can't help but be very pleased with the speed of her recovery. 


As I type this, we are watching the fireworks out of Ivy's room window.  A little bit of the fourth celebration for us all after all...


My thanks once again to everyone for their kind words of support and your many prayers and well-wishes for Ivy.  I know in my heart that they have all been a very big part of her success in her recovery.  God bless you all.


With My Best Wishes Always,