Another Trip to PICU

Well, we managed 2 days in ICS before ending up in PICU again.  But this time we were sent as a precautionary measure and not as an emergency.

Last night and this morning it looked like we would be able to stay in ICS.  Brendan was given his chemo treatment and they were monitoring his sodium levels carefully.  

Here is Brendan's reality after chemo.  A chart to remind Brendan when he needs to go to the bathroom.  Usually they have him so pumped full of fluids he doesn't need a chart to remember to go.

 With all the hustle and bustle going on Friday night, Brendan and I didn't sleep much.  So we were grateful for a quiet night and a little extra time to sleep in this morning.  (Doctors don't come in quite so early on Sundays.)

 With all the fans going here in the hospital, the air is dry and we feel the effects.  Brendan's mouth has been especially dry and pasty lately and he has to wipe it out in the mornings.

 Brendan's sodium levels dropped steadily (and slowly) overnight.  Blood was drawn every four hours in order to monitor it.  This morning he was tired and lethargic and a bit teary.  (All symptoms of low sodium for him).  His chemo arrived just before 11 a.m. and his 2nd dose of cisplatin was started.  (Brendan's attending doctor made sure it was understood that Brendan's chemo treatment had to go on as scheduled.  It was the most important thing.  Side effects would have to be managed.)

The oncology doctor on call brought PICU doctors up to discuss the falling sodium issues.  With chemo underway, they knew that sodium levels would continue to drop despite sodium solution being added to his fluids, and extra sodium being given to Brendan through his feeding tube.

Brendan's sodium levels fell to 129 so it was time to head to PICU.  (Sodium was 142 at admission, then steadily dropped after chemo from 137 down to 129. (Brendan's sodium level was 126 was when he had a seizure last time.)  

For some reason, the chemo is interfering with Brendan's hormone that regulates sodium levels and so his body is getting rid of sodium when it should be holding on to it.  Usually, in these cases, they just limit the number of fluids given -- but Brendan has to have enough fluids in order to flush the chemo out of his body, and especially his kidneys and bladder.  If he doesn't go every two hours, then the chemo can actually damage them.  So, since they can't limit his fluids, then they have to pump saline into him in an effort to keep the saline in his blood and the saline in his urine about the same.  What has happened is that he has lots of saline in his urine and very little in his blood -- and that causes problems.  So off to PICU we went. 

Brendan is not happy to be here.  The nurses and doctors are trying to not take it personally.  They say they understand, but they have been extra helpful and extra nice trying to help Brendan enjoy it a little bit more.  Or at least not hate it so much.

 We watched a movie to pass the time.

 I gave Brendan a good, long foot massage.

 We've enjoyed having a room to ourselves -- one with real walls and a little extra space.

 But no bathroom.  And it looks like my bed tonight will be a reclining chair.

 Brendan became more teary as the afternoon went on.  When he was asked if he was in pain he just shrugged.  When asked if he needed anything he just shrugged again.  He just doesn't feel well, but can't say just why.  The nurse explained that sodium affects every cell in the body.  It's not hard to understand that he wouldn't feel well with his levels out of whack.

 We will definitely be here through tomorrow's chemo treatment (since they expect sodium levels to fall again with the chemo).  But right now (Sunday night) his sodium has held steady at 130 for the last 8 hours.  More than low levels, they are concerned with rapid drops in levels.  And it appears that right now that is under control.  Brendan slept 3 hours this afternoon and is back to sleep again now.  With the anti-nausea medication "on board" I expect that he should sleep all night.  (Except for being awaken every 2 hours to use the bathroom.)  The question is, will I be able to sleep?