And The Verdict Is.......Nothing! Huh?

Today was another one of those long days. This morning I called to find out how Aaron did through the night and found out his weight went up another 130 grams and his girth went up as well. I talked to the nurse about what the options were to correct this. We talked about surgical drains, intermittent taps, and transfers to Primary's. It quickly became clear that I would need to go up for rounds and most likely would need to stay for quite sometime. I called in reinforcements from friends and neighbors and quickly made arrangements for the kids to be taken care of before and after school. (thanks everyone!)

When I got to the hospital I found out Aaron's urine picked up dramatically early this morning and the nurse practitioner was turning down the vent settings. Rounds started soon after. In rounds we discussed what to do about his increasing fluid accumulation again. The doctor decided Aaron needed a surgical drain and had the fellow call over to surgery for a consult. We all agreed that we needed to get on top of the fluid retention so that we didn't end up back where we were last week. In the meantime Aaron continued to have huge diapers and great blood gases. His feeds were also moved up to 20 mls (4 less than where he was when he went NPO) and vitamin D was added back in. The plan for his feeds is to add fortifier tomorrow to add calories, and then on Sunday start back with all his supplements. He has a ton of fractures to heal! The fellow asked the Attending why he thought Aaron was accumulating fluid again and the response was, "I have no idea, we can't figure it out!"

The surgical resident came over, examined Aaron, and said that he was not a candidate for a surgical drain at this time because he wasn't bad enough, but if he got worse they would reconsider it. I told him I was concerned that today being Friday would pose problems if that "get worse" scenario happened over the weekend as it typically does. He said he would take that into consideration and speak with the Attending and get back to us. Our Attending, fellow, and n.p. came back to discuss what options we had in front of us. They decided to to an intermittent tap just to relieve some pressure and allow his belly to drain again. After getting the tray ready for the procedure the Attending came back in and said that they should wait until we got the final word from surgery. During that time they decided to turn the vent settings down again and do his "cares". We changed another large diaper and weighed him and noticed he hadn't gained any new weight from last night and his girth was down a centemeter. About an hour later they came back and said they talked to surgery and decided they were not only not going to put a drain in, they were no longer going to do a tap. They decided Aaron was doing so much better on his own and they wanted to see if this trend would continue. They then changed his vent settings a third time to allow Aaron to basically breath on his own with minimal support from the vent. Hopefully we'll be off the vent soon and back on high-flow!

So we started the day thinking Aaron would have major stuff happening today and it turned out not too much happened other than he seems to improve when we threaten big procedures. Before leaving I insisted we set in place an "if things get worse" protocol for the weekend and wanted to know what doctors would be there. The fellow we've been working with all week will stay on through the weekend and the weekend doctor would be fully prepped on Aaron's status before our Attending left for the day. I like this doctor, he takes my concerns for continuity of care very seriously which allows me to sleep much better at night!