Don’t worry. Everything’s fine. It’s just that Paul’s still in the hospital. You know that 12 hours without complications that I mentioned in my post last night? Didn’t happen. Here’s what did…
Just before 11 last night, Paul called me. He was in a lot of pain from the tube feeding that he’d started shortly before I left the hospital at 7:30. His nurse had said she was paging a doctor over half an hour before, but nothing had happened, and Paul was scared. I rushed over to the hospital. Paul’s abdomen was extremely distended, and his pain was worse when he took deep breaths.
After talking with Paul’s doctors, the otolaryngologist on call came in to the hospital to see Paul. Dr. Izzard was someone whom we hadn’t seen before (he was out of town when Paul’s surgery was done, and consequently isn’t part of the team), but he was really great. A lanky, soft-spoken Australian, he had a marvelous, gentle bedside manner. Paul told him that he was afraid that the PEG wasn’t placed correctly, and that whatever was going in through the tube was going into his abdominal cavity rather than his stomach. Dr. Izzard carefully checked Paul out for any signs of peritonitis (and probably some other things as well), and said that, while he was concerned, he felt that what he observed didn’t warrant any emergency treatment. His orders: a little more morphine for the pain, a small amount of IV fluids, an x-ray in the morning to check that the PEG was in the right place. Neither one of us slept much… a combination of worry, Paul’s pain, and its being an unusually noisy night on the floor (someone screaming, several loudspeaker calls for “all available personnel to 4NE, stat”, etc.)
When the residents came by on rounds this morning, Paul’s stomach was less distended, and he was in less pain, but was still not back to normal. An x-ray verified that the PEG was correctly placed. So, the best guess is that Paul still had some air in his stomach from the PEG placement, and was getting really gassy from a full “meal” of the feeding formula. By around noon, his stomach was feeling OK.
Next step… start over. This afternoon, they started Paul on the tube feeding formula at 10ml (about 2 teaspoons) per hour. When I left for the evening, they had gotten him up to 40ml/hr, and he was feeling fine. The goal for this particular formula is 480ml (a little under 2 cups) 4 times a day, in order to give Paul the number of calories he needs. As Paul tends to be a “grazer”, I think he’ll feel better with more frequent, smaller “meals”. Also, a little web research turned up another “medical food” formula that is both more calorically dense and lower sodium than what Paul’s being fed now. I’m going to ask the nutritionist about it tomorrow.
Oh, in post-surgical news: Dr. Wood removed the staples from the dressing on Paul’s thigh (which will now peel off on its own as the graft donor site heals) and the incision in his arm (which extends a few inches beyond the skin graft). There’s still a lot of swelling on the right side of his face, though it seems to be succumbing to gravity, and is mostly below the line of his jaw. (It still looks like the worst wisdom tooth extraction swelling I’ve ever seen times 3 or 4… and of course they get at wisdom teeth through the mouth, rather than from the outside.) The incision appears to be healing really nicely. When I changed the dressing over the trach hole this afternoon, the hole was about half the size that it was yesterday morning – if it continues at this rate, it will be closed by Monday.
So, my guess is that Paul will be in the hospital until Monday, in order to work out the whole feeding thing before he comes home. While I wish he were home, at I’m glad that this problem showed up while he was in the hospital, rather than here.