Friday, September 11, 2009

Ups and Downs

Friday AM:

Over the past few days James has made relatively steady progress in a lot of areas, but two things of concern have been that his belly is very firm and that he has need consistently needed additional platelets over the last few days. His platelet count has been well below 100,000, so twice a day he has been getting extra platelets. Normally this is somewhat expected as the platelets are used to help him fight off the infection. The concern now is that since he is now several days past the point when everything started, he should be getting to a point where he would not be needing them, or at least not as frequently. They have ordered another ultrasound of his belly for the surgeons to look at to try to determine if there has been a rupture in that area, or if it is simply inflamed. What they see on the ultrasound will determine the next steps which will be one of 3 things:

1. Continue what they have been doing
2.Take some sample from areas in his belly to see if it is firm from a rupture or simply from inflammation
3. Surgery to try to repair a rupture that shows up on the ultrasound

Among the many concerns with surgery is that the damage would be too severe to repair, or that he is not at a point where his body is strong enough to handle the surgery.

Please continue to pray for James, that he has not had a rupture, and that his bowels will continue to heal. One praise from yesterday is that the doctors decided since the blood culture they took last week has not grown any bacteria (indicating an infection in the blood), they did not do a spinal tap. We're so glad James was spared that!

Friday PM Update:
Tonight's ultrasound was reviewed by James' doctor and the surgeons and they determined that there aren't clear enough signs *right now* to indicate that he needs immediate surgery. However, they covered their bases by also saying that doesn't mean something might change in the next 6 or 12 or 24 hours which would push things over the line to then needing surgery. James' abdomen is still swollen and red and tender, which indicates that things are not working smoothly on the inside, but there's not a clear picture as to why. Most of his labs and vital signs look good, but the need for continuous platelets continues to be of concern. He is still one very sick little boy.

Of course, the gravest concern is what would be found if surgery is necessary...the possibilities of areas of the bowel being weakened from infection or constricted so tightly that nothing can get through, or areas of the bowel that may have died already and need to be cut out. If the tissue surrounding the cut out portion of intestine is healthy enough, they'd sew those two parts together and call it good. If the tissue is not healthy enough, they'd do something called an ostemy, where they make an incision on the outside of the abdomen and bring the two parts of the bowel up to the surface of the skin to heal more, then go back in later to re-attach them. You would think that with all the amazing advances in medical science and technology, including artificial limbs and hearts, that surely someone would have come up with a solution for damaged intestines by now! But apparently attempts at intestinal transplants with either human or man-made tissue have not been successful and it's really not an option.

Please pray for dramatic healing for James in these areas, especially over the next 24 hours as surgeons will be closely monitoring him and may be quickly deciding about possible surgery:
1. Softening of James' abdomen and reduction of fluid/swelling/infection in the abdomen.
2. Increased level of platelets that James is able to produce on his own and effective use of those platelets against infection, so that recurring doses of additional platelets are not as necessary.
3. Miraculous healing of the intestines and specifically the bowel wall, removal of any narrow spots or blockages in the intestines.
4. Physical signs of improvement in all areas, especially during the surgeon's exams, so that surgery is not necessary.
5. Strength and comfort for James, as I'm sure this whole ordeal is taking a huge toll on his fragile little body and spirit, and for Keith and me and our families during this draining, emotional roller-coaster.
6. That if surgery is necessary, angels would be watching over James' body and the surgeon's hands for a life-saving outcome with no long-term damaging effects.

We love you all! :-)

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