I can’t believe how quickly the last few weeks have flown
by. We have had many changes and challenges in the last few weeks to keep us on
our toes and me away from my blogging duties. I will try to recap our last few
weeks of the ICU as Kyle made huge progress. Kyle was transferred to the 7800, a pulmonary specific floor
in the hospital. Unlike the ICU, it had many patients who were chronically ill awaiting
transplant, even those who had been hospitalized for over a year waiting for a match. The other
half were post transplant patients who were struggling with a few things (i.e
rejection, breathing issues, etc.). Despite the older, smaller facade the unit
felt home-ier. Our room was small enough that I could elbow Kyle’s bed from the
recliner (which served as my make shift bed for a few weeks). I believe they
said it was the smallest room that they had on the floor but I couldn’t have
cared less as I was happy they were going to get him some much needed sleep on
the ventilator. He was on a 5 day no sleep binge, as his body couldn’t support
him as he slept. It was the only unit that would allow a ventilator; otherwise
you would have to be transported back to the ICU.
We were happy to have a change of scenery, without it being
another ICU. This unique unit was overseen by pulmonologists, not surgeons so
we were seeing many of the doctors who Kyle saw pre-transplant and during his evaluations.
The first week we were surprised to see that Dr. Alice Gray, a doctor who had
been involved with Kyle early on and big advocate for him getting listed would
be on rounds for the entirety of our first week. It was safe to say Kyle was
already feeling better with sleep on the horizon, and a familiar face. Dr.
Gray’s goal was to get Kyle stronger, and to wean him off the ventilator and
place him on a home bipap unit. As
he progressed through the week, he felt much stronger with a full nights sleep (in terms of hospital sleep).
He was walking over 20 laps a day (1.25 miles) and started working with
weights at the hospital gym. During that time they continued to ween him
off oxygen use, as his saturation levels were stable enough to push his body more. He felt like a new man, and was
happy to be progressing.
They continued testing him daily and his first bronchoscopy since
the lobectomy came back negative for rejection. But the small lung tissue sample
showed he was still fighting an aggressive bacterium called abscesses. They
continued to administer heavy antibiotics via IV, breathing treatments and pill
therapy to keep the bacteria at bay. This aggressive bacteria requires 6 months
of antibiotic treatments, administered by a 24 hour IV. As unfortunate as the news was we were happy to have the smart infectious disease (ID) team
working to keep his lungs stable. During the bronch they also used a balloon to
dilate one of his airways, in hopes to help relieve one of his bronch airway of
restriction.
Despite a few hiccups he continued to make progress. Kyle
continued to ask for the swallow test so he could eat and drink. They eventually
decided was ready for the test and he passed with flying colors. So to his delight
they had him gradually work his way up from a liquid diet to a soft food diet,
with nocturnal tube feedings. I will never forget his first sip of water after
almost 2 months he was ecstatic. He was starting to feel human again. I had to capture it on video (as seen below).
As the week progressed they removed the last chest tube, and
downsized his trach from an 8 to a 6. He struggled a bit with the new trach
size as it was a huge difference but they said as he continued to downsize
things would get easier for him to acclimate to the home bipap and regular
breathing. On January 13th
they mentioned the words discharge. I was a bit thrown back as he had many obstacles
ahead of him, and Dr. Zaas’s plans for the week were going to be huge in preparation
for home; bipap at night, downsize trach to a Jackson (all metal trach, size 4
which is corked), room air when walking and sleeping. The thrach downsize would allow him to speak more normally without strain. Not only was he facing respiratory challenges
he was having a very hard time hearing.
Another Obstacle
When he was diagnosed with Wegener's over 12 years ago he
suffered hearing issues due to repercussions of the disease. He had a mastoidectomy
to remove a cholesteatoma growing around his eardrum. This was major surgery
that left him partially deaf in his left ear. He managed to hear with his right
ear, but continued to suffer ear infections in his right ear. Soon after his
lung and kidney transplant he complained of hearing issues and they found there
was fluid behind his eardrum so they prescribed eardrops to clear up the fluid.
After weeks of no progress we pushed to have the ENT’s examine his ear for further trauma. They performed a hearing test, and used a high-powered
microscope. They removed some build-up in his ear which exposed he had a hole
in his eardrum. By removing the build–up it removed any hearing he had which made
him nearly deaf without an amplifying device. They recommended hearing aids for
long term but this would take months to order and fit. They also requested he get a head CT
to verify he didn’t have another cholesteatoma growing in his ear. After
reviewing the results of the scan there was an indication of another cholesteatoma but we are still waiting to hear final results and recommendations from an ear surgeon. Until then Kyle struggles with his immense
hearing lose.
With our discharge day approaching we had visits by a discharge
nurse, insurance coordinators and home healthcare representatives. It was a lot
to handle as we were quickly approaching “D-day” and I had much to learn. I
would be taking care of his foot wounds, trach cleanings, breathing treatments,
tube feedings, 24hr IV administrations, clinic schedules, rehab visits, vital signs and pill
administrations. I felt our discharge was rushed because not everything was
arranged prior to Friday (January 17th) our “scheduled” leave day.
Despite Duke’s amazing team of people I felt a bit overwhelmed by the chaotic,
and disorganized discharge checklist. Due to some last minute procedures we
were discharged at 5:00pm that Friday. We were scheduled to have a home
healthcare nurse visit to give me an orientation on IV administration at 6:00 so we were
cutting it close. Not to mention all of his meds (which were in a large
shopping bag) needed to be organized and administered. After gathering 2 months
of belongings and wheeling Kyle to the parking garage we on our way home. I
hadn’t had time to enjoy the moment as I felt the pressure of the timeline. Our
friend Sara was kind enough to run some errands for us and grab groceries so we
didn’t come home to an empty fridge. She was such a lifesaver, we were so
grateful for her help. Despite the rough timeline we got home in time to be
greeted by Sara and our medication delivery. One small problem, the nurse
showed up 2 hours late, so we didn’t get to bed till the wee hours of the
morning. My brain was fried. After a long night we had to wake up early to get
him to an evaluation at the Pulmonary Rehab Center. Sadly, things didn’t calm down
the rest of the weekend.
Finding Our Groove
Just a few of Kyle's supplies taking over the pantry. |
Weekly Maintenance
He has clinic visits once a week for a chest x-ray, pulmonary
function test, lab draws and doctors visits. Since we have been home his labs and
x-rays have proven to be stable and some are showing small improvements. They are hoping
to remove his trach next week after his bronchoscopy. He will also have a
stomach emptying test and acid reflux test in the coming weeks to decide if he
can push forward to eating normal foods with little restrictions. We continue
to pray for these little victories and accomplishments, as this is getting him
that much closer to getting us home. We are so thankful for the family visits (Miss
Tina) and the sweet cards and gifts. I wish I had time to thank you all personally
for the gifts and sweet cards but just know Kyle and I are forever grateful for the love we have been shown. Your continued support is pushing us that much closer to the finish line.
Much Love,
Stephanie & Kyle