The Revised Plan

Monday mornings the entire team of Lung Specialists gather together to dicuss all inpatients so that all the doctors know what is going on. From what I'm told there was a rather lengthy discussion as to what to do with Mr. James.

48 Hours after starting back on the Gentamicin James is still having fevers. Last night and this morning he spiked high ones (40.6C/105.1F) immediately after vomitting. Unfortunately there's still no answers. The Gentamicin isn't working so that could mean these fevers are not infection related. At the same time there's a possibility he's built some resistance to the Gentamicin because he was just on it. So we still have are no further on putting the puzzle together.

The new plan is to stop all antibiotics. James technically should have been done the other antibiotic (Tazocin) yesterday but they continued it given the fevers and restart of Gentamicin. Since we're still dealing with fevers they've decided to just stop all antibiotics. The next move is a WLL. They hope to gain some insight from doing this as well as assist James by once again cleaning his lungs. They feel their tests will be better if he is not on antibiotics which many cover up things that are going on in the lungs.

This time when they do the WLL they plan to do it differently, going back to their original plan when he first arrived in Emerge over a month ago. (Click here to read the difference betweent he two techniques). All the talk we have heard has always indicated that they were quite happy and excited about the technnique they used last time, although as time went on they did admit that they didn't get a full seal when they went in to do the right lung. I have no idea if this could be a factor in todays problems as we aren't always told everything (information tends to slowly leak out here and there). When they came up with the technique they used last time they told us it would be less risky then their original plan. Since we're now going back to the original plan that also means there are more risks to this procedure as this technique makes it harder to keep the lung stable while washing. The only good side to this procedure is that it has been done several times by a collegue in France so they have more literature to support their plan. We realize that often we are kept in the dark on the greater details of these procedures. Before there was any plans for such a procedure they quite openly told us how risky it was, but when the time came to actually do the procedure they tried as best as possible to downplay everything.

Since we are stopping the antibiotics the PICC Line has been put on hold for the time being. They would like to get the results from the lavage before they decide if it is necessary, although there is feeling that it will still be ... likely to give long term antibiotics. Someone still came by today to go over the details of the PICC so that we are ready to go if one is needed.

We are waiting for GI to show their face. Since our original visit with them we have not seen them back ... maybe this is just the way GI people work since we had the same issues at Mac. We have finally gotten the Respiratory Team to realize that we have greater issues in James stomach then just swallowing a bit of phlegm from his lungs. James continues to ask to have the bubbles (air/gas) out of his stomach and has been quite uncomfortable the last few days. I am unable to get air out because all that comes out of his stomach is phlegm ... usually more phlegm them formula. Where did the formula go if all I'm getting out is phlegm? Yesterday I showed them what I had withdrawn from his G-tube just before they arrived. I had about 20ml of phlegm with a few streaks of formula in it. They were quite in agreement that he couldn't be swallowing that much from his lungs and something else is going on, but they have absolutely no idea what. PAP is an issue of the macrophages not working in the lungs ... but marcrophages are in other parts of the body as well and we wonder how they are functioning in those parts. We have requested an endoscopy (when they look inside the stomach) done while James has the lavage. We're not sure if this will really give any answers, but feel we won't get anywhere until they have a look. The Team is in agreement but GI is the one who has to put in the orders and do it, so we're waiting!!

So for the time being we try to control the fevers and wait for OR time, hoping that both the lavage and endoscopy can be coordinated for the same time in order to avoid additional aneasthetics.