Tues - sept 22nd update

The cause of his illness is from a very potent bacteria called Streptococcal pneumoniae. Likely started off as a pneumonia, and then spread to the blood stream - causing dad to be weaker than usual --> fall and suffer an aspiration event in which stomach acid "burned" his lungs.

The bacteria has been identified and is being treated with the correct antibiotics - but now Dad is dealing with the aftermath of inflammation that this bacteria caused on his body (like the destruction that a tornado leaves afterwards).

Today started off on the lowest dose of pressor medications (still two pressors being used) since he was admitted - which was cautiously encouraging - Dad's BP (blood pressure) and oxygen status have been where they need to be.

He needed two transfusions of platelets today for his very low platelet count. but his white count has gone up from 2K -->10K today which is a good sign - means his bone marrow is now responding.

Unfortunately - dad went into an atrial fibrillation rhythm today - not unusual when someone is in septic shock. but the atrial fibrillation can affect the heart's ability to keep the BP up - which dad experienced later today.

Dad is suffering from severe cyanosis (blue hands and feet) due to the high doses of pressors he is on - so it's even more imperative we get the pressor medication off as soon as possible to prevent possible long term damage to his hands and feet. But understand that the pressor medication's use is keeping the blood flow to his heart and brain as first priority.

As his doctors stated: He is in a better clinical status than he was yesterday morning -but clearly not out of the woods by any means. Dad is tolerating all the treatments but clearly still on maximum support. However, many people do not survive what Dad is going through.

We know that Dad is tough, as my mom calls him: IronMan for having tolerated his parkinson's disease for the last 2o years - slowly robbing him of his motor function, particularly his balance.

Dad is persistent and stubborn and had plans "to live a long life"...so we are hoping his body can pull through this with our encouragement and support.

We are lucky that Dad, besides his parkinson's, was generally very healthy before this - we know his heart and lungs were in excellent shape - so these are things in his favor.



Current diagnoses - for our family and friends versed in medical knowledge:

1. Septic shock from Streptococcal pneumoniae (penicillin sensitive) bacteria that started with pneumonia and spread to bloodstream (on Zosyn, vancomycin, tamiflu, Xigris. Also on levophed 20 mcg/min, phenyleprine 200 mcg/min, hydrocortisone 100 mg IV q8. vasopressin tapered off)

2. Acute kidney failure due to profound shock (max creatinine 2.7) on CVVH.
3. Acute respiratory failure due to profound shock on maximal ventilator settings
-- (FiO2 100%, PEEP 16).

4. Rhabdomyolysis (CPK peaked at 5400 U/L)
5. Severe lactic acidosis (peak 9 mmol/L).
6. Encephalopathy due to sepsis - (not on any sedation - morphine as needed for pain).
7. Bilateral cephalic vein thromboses (from sepsis?)
8. Cyanosis of extremities related to shock and pressors - on topically applied nitropaste.
9. Thrombocytopenia - 13,000 - s/p 2 platelet infusions.
10. New atrial fibrillation (9-22-09) - started on amiodarone infusion. (depressed EF 35% due to septic shock -based on yesterday's ECHO).


Dad's team of medical doctors:

Pulmonary/critical care: Dr. Duhamel, Dr. Kruger, Dr. Wyckoff
Infectious disease: Dr. Michelle Ritter (dr. holman's group)
Nephrology (kidney): Dr. Thomas Rakowski, Dr. Kevin Lowery
Cardiology: Dr. Tony Parente
Vascular Surgery: Dr. John Garrett/Joe Kirby PA-C
Internal medicine: Dr. Anthony Rimicci

His wonderful ICU nurses thus far:
Carol Marsh (2 nights)
Jenny Beutler (2 days)
Leah Marks