Day 36 - ...Results

Today is a busy day for our patient.

All systems normal for him during morning rounds though one of his skin cultures came back as being resistant to the antibiotic he was still receiving so they've switched it and will knock it out to protect his grafts. No cause for alarm, just doing what's called for. They're going to give him some blood before his surgery tomorrow that will boost his red blood cell count and generally "top him off" as there will be some bleeding tomorrow with surgery. This too is routine for him and how he responds to these surgeries.

First up this morning was the swallow test down in the basement x-ray imaging lab. Dan climbed into a wheel chair and we escorted him to the testing lab. His legs were shaking a lot - more of that blood rushing to his already plump legs causing intense pins and needles we think. On the way we quickly passed the morgue - are they always in the basement in hospitals?

Once we were in the test room we moved Daniel to the testing chair and slid him into position between a backboard (probably made of solid Pb) on his right side and the "camera" on the left side positioned right next to his head making him feel sandwiched. He was looking a little scared of what was gonna happen next. Most of us had to hide in the observation chamber while Dawn donned (like that?) a lead vest and helped with feeding him some of the goodies they had queued up.

• Fluid-like water (laced with barium) went down ok.
• Thicker apple juice nectar - went down better.
• Graham crackers (he was definitely looking forward to that) got a little stuck so there was some concern.

Here's a bitchin' picture, but the live action was even cooler!  

(You can see the feeding tube running from his nostril to the 

back of his throat and down - That's the way he's been 

"eating" since he arrived. 

The black button on his chest is a lead for monitoring vitals.)

Watching the swallowing movement live was really cool.  The conclusion by the therapist was that Daniel can drink thick fluids to start with. Something like nectar (in addition to ice chips) to retrain him how to swallow - it's been 5 weeks since solid food so all that inactivity weakens the throat/swallowing muscles; not just the walking, arms and all else! A little practice and he will be ready for solids soon - hooray!

His second test of the day was a metabolic cart test to measure his metabolic rate or resting energy expenditure (REE). This test was done in his bed with a bubble tent placed over his head and the equipment measures oxygen in versus CO2 out. The ratio of the two can identify the type of fuel he's burning (protein, carbs, fat, etc) and what his food energy requirements are. Many burn patients are hypermetabolic - meaning their metabolism skyrockets to heal the burn body. When this goes out of control your body will rob from muscle tissue, fat and organs to grab what it needs to heal. (There's a limit to how much food you can metabolize so they've got drugs to slow down your metabolism to a safe level: use the food, not vital tissue in your body. Dan's been getting that for awhile now to keep things under control.)

The test: First off Daniel seems to be the Zen Master of calm. Normally they want the patient resting for 2 hours with no interruptions before the test. Then when they administer the test with the bubble tent on his head they need anywhere from 15 to 30 minutes to calm even breathing. According to the tech who has been doing the test for over 10 years she never gets a patient who can be calm which is why the test usually runs for 30 minutes or so. But in Dan's case she was done by 15 minutes! She had never before seen someone so calm and even.

The results show that the metabolic needs for Daniel with a burn injury are somewhere around 1.5x more than what he would need in an uninjured state. And that's at complete rest. As he starts therapy, moving around, and eating that number will be even higher. Luckily his dietician had calculated that number very closely to the results of the test so he's been getting just about the right amount of caloric intake to keep him moving along the road to recovery.

After that test it was time to replace his central line in his leg with a midline in his arm. Now that his arms have healed some it's better to have the line there (less chance for infection compared to one located down by your thigh and naughty bits). I had to step out for that procedure as they want to limit any chance of infection so out I went and typing today's blog post I did!
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The rest of the day will be set aside for the always enjoyable wound care. I suspect they will walk him over to wound care if the timing is right. Then he can rest the remainder of the day and be all good for surgery #8 tomorrow.
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And now for some Zen like music.