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Day 4 -- 07/23/04

I talked to Christy at 6:00 this morning, and she said that Joshua's blood pressure is back up and stable.  It started rising around midnight, and is now stable with means in the 30s (that's where we want them).  She said that he's been weaned down on the vent to 25 breaths per minute and is on 24-25% oxygen.  She said they had to give him some sodium bicarbonate because of a low blood gas, but that he's OK now.  All in all, he had a very good night.

10:00 AM:  Talked with Lou Ann (his day nurse), and his bilirubin count is down to 3 (from 6), and that they'll probably take him out from under the phototherapy lights...he may rebound, but that's not unexpected, and shouldn't cause worry.  His BP is holding just fine -- they gave him the second dose of Indomethacin this morning and he did well with it...he's due for the last dose later this afternoon.  They changed his IV (a routine procedure), so the IV has come out of his head.  They did the cranial sonogram, but haven't received the results of it yet.  Just as our own observation, his right-hand fingers are looking better...they look more individually developed.

5:00 PM:  Went to see Josh again.  He had a "bad" blood gas earlier, so they went up a little on his vent settings.  The next blood gas was much better.  When she suctioned him to turn him over, she said that everything looked good.  The results were back from the cranial ultrasound:  he has a mild level 2 bleed on his left side.  The potential side effects (according to the same doctor who talked with us about the echo, who I think errs on the side of worst-case-scenario) are motor skills difficulties (mainly on his right side), learning disabilities, and other behavioral issues.  The doctor who talked to me the first day while I was still in the hospital indicated that typically, a level 1 or 2 bleed is nothing to worry about, a level 3 needs some attention, and a level 4 is something to watch very carefully, so I'm trying not to stress too much about the level 2.  The doctors will do another scan in a week, then another several weeks later, then possibly one more before he leaves.  As long as the bleed doesn't get worse, there isn't anything else to worry about with the bleed (whatever blood is there will be absorbed by his body and will not create any lasting problems).  Joshua will get his 3rd dose (end of round 1) of the medicine for his PDA at 5:30...they've scheduled another echo for Monday to determine if it's closed up, or if they need to pursue a second round of the medicine.

11:00 PM:  Josh has gained an ounce...he's up to 2 pounds, 5 ounces.  They attempted to insert what's called a PIC line, which is a central IV that goes in through his arm and should serve to replace one or more of the lines in his belly button.  The first attempt didn't go all the way in, and the doctor was attempting to get it in place when we left.

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