CHAPTER THREE January 20, 2004 Dear All, I wanted to take a few minutes to share the latest news.  Ivy has had some difficult days and nights since the last update.  She went through significant stress as her dialysis machine clogged it's filter five times in two days.  This not only caused an interruption in the dialysis treatment, but it also caused Ivy to lose almost two units of blood, requiring even more transfusions to restore her levels to normal. This was especially troubling because it was discovered to be caused by the wrong concentration of citrate used in the machine.  The nurse caring for Ivy on the day shift found the problem, but not until she had suffered the stress and blood loss from so many changes in such a short period of time.  This, in turn, caused difficulties with her respiratory care, causing her to crash once again.  She developed yet another pneumothorax and her tenth (seven remain in place today) chest tube was inserted... Since this time the pulmonary doctors is very careful to keep her volumes (the volume of air pushed into her lungs) at lower settings and to watch her saturation levels very carefully.  She is being given a reduced oxygen level as she tolerates it...as we left the hospital tonight this was 75%.  The plan is to get her to fully saturate on 60% delivered oxygen before changes are made to the breathing pattern that the respirator delivers to Ivy's lungs. Sometime during the week Ivy also developed a shading on her x-rays on the right lung consistent with internal bleeding (this could be because of the new chest tube) or (hopefully not) pneumonia.  She is being treated with antibiotics and the x-rays this morning  looked slightly improved, so we will keep our fingers crossed and say a few extra prayers for now. There have been some positives as well and I'm happy to share that Ivy has regained the use of her kidneys and her liver is functioning at normal levels.  The doctor is so pleased with this progress that he anticipates taking Ivy off of dialysis as soon as Tuesday!  She will also have one of the remaining chest tubes removed tomorrow if the morning's x-ray shows the same or improved status.  This would leave her with six tubes (three in each side). With all the other improvements she has made, this leaves her with lungs to be healed and a LOT of physical therapy after some additional recoup time.  I know in my heart that this will happen, but I just can't begin to know when Ivy will finally be coming home. Something else that happened today that I wanted to share...We met the two gentlemen that cared for Ivy on the accident scene and in the Mercy Air helicopter.  They had brought in a patient (actually, I saw the two helicopters that fly to Palomar Hospital come in the the trauma center at least three times each today) and decided to come into the CCU to check on Ivy.  They were especially concerned for her because she was so critical when they brought her in.  I almost burst into tears when I met them and couldn't thank them enough for all that they did for her.  They have promised to keep in touch (and I with them)...offering to take Ivy for a ride when she's better...I am once again astonished by the kindness of  people... Once again I must thank you all for your kindness and thoughtfulness.  Your e-mails, cards on gifts to Ivy have most assuredly added to the strength she continues to show each and every day.  I know that she hears your kind words and thoughts as we read them to her...I thank you all for your prayers on Ivy's behalf.  With the Good Man upstairs help, she will be well once again.  God Bless you all! With My Best Wishes Always, Michael (Ivy's Dad)