PICU - Day 4

Today is pretty much a wait and watch day for Garrett. The EEG detected two subclinical seizures early yesterday evening, but it sounds like they are not necessarily concerned about that. Given the timing, I'm guessing they think the anti-seizure medication hadn't taken full effect yet. The nurse said he'd still be on the anti-seizure medication for "some time," which sounds as though it wouldn't be a life-long thing. I'll have to ask the neuro folks the next time I see them.

They were hoping to extubate him this morning, but he was much less active after the MRI than before it and they were concerned about that. He hadn't been given any sedation medication since the MRI, so they didn't expect him to be so "floppy." As they examined him more, they noted that his pupils were still pretty small and the kidneys (or liver -- I don't remember which) were still slow in flushing stuff out of his system, so they suspected maybe the sedation medication was still in his system and that was behind his lack of activity. Better that than some neurological problem. But they want to watch and make sure that's the reason before taking the breathing tube out. (He's essentially breathing on his own now with just a little boost of pressure from the ventilator when he inhales. Other than that, it's set to breathe at a given rate if Garrett doesn't take his own breaths, but he's been breathing way over the tube rate, so that's looking good.)

Since then, his nurse, Jeannie, and I have actually seen him moving around quite a bit. When they took the EEG leads out, he started squirming like crazy and opened his eyes as if to say, "What do you think you're doing?!" We don't like him to be uncomfortable, but it's good to see him respond. He got a nice scalp massage afterward as we tried to get most of the glue out of his hair, and he seemed to enjoy that.

When Dr. Cramer came by this morning, he said Garrett's creatinine levels show his kidneys are still improving. They're not quite where they should be, but the levels are moving in the right direction and he seems comfortable with the progress. He even said we probably won't see him anymore. Garrett's highest creatinine levels were 2.0, whereas 0.2 to 0.5 is considered normal for infants. This morning, they were at 1.0, so we're getting there.

His liver has apparently enlarged some since yesterday, as it's trying to work out some extra fluid remaining in his body. They've given him some diuretics to help him get rid of the fluid, but due to that uncertainty, the ventilation tube will have to stay in for sure until tomorrow. Essentially, if the diuretics removing the excess fluid doesn't help the liver shrink, that's an indication that the heart is still working too hard and he would probably need another angiogram to embolize additional feeders. I'm really hoping things look good enough to extubate -- obviously because we want Garrett to get bigger before another embolizm, but also because I'm getting very antsy to hold the little guy again. I've given him little massages and whatnot, but I haven't held the pumpkin since Sunday afternoon.