June 17, 2006

Hello all.

Kelsey asked me this morning to send out an update on Dirk's condition. This week in Honolulu has been filled with several "hurdles" that Dirk has needed to face. Dirk had been able to progress to the point of coming off of life support/ventilator and moving all four of his limbs (some more than others). He had been advanced onto a softer diet by a speech pathologist who felt that his swallowing was still intact (though the diet was still not a "regular" one as there was felt to still be a small risk of aspirating - i.e. swallowing food into the airways). He seemed, with every day, to be more like "the old Dirk" as Kels said - wanting to go over plans of their backyard shed, giving her the items needed for her to concoct his salad dressing, etc. He appeared to have less of a "filter" - meaning that he would voice things that normally he would not have; in addition, he had periods of being less alert and more confused.

The decision was made mid-week by the doctors to move forward with the VP shunt, as it was felt that the drain could not be removed without having some replacement to drain the fluid in his ventricles. Attempts to remove the drain left Dirk increasingly somnolent and were signs that Dirk's body still needed "help" to drain the fluid in his ventricles. After the surgery was performed, Dirk was much less alert - he spoke barely and was not moving his left side at all.

Last night (day #2 after surgery) they decided to replace the feeding tube for Dirk - while they were attempting to do so, Dirk's breathing became very labored/unstable and his heart rate increased significantly. Given his deemed instability he was put back on the ventilator/life support.

He proceeded to have another cat scan last night of his brain that did show a new area of bleeding - localized to lateral ventricle and around the VP shunt catheter. The prior site of bleeding (his midbrain/brain stem) looked improved. It was felt that this new bleeding could have accounted for his less awake state after the surgery. The question of why his left side is moving less still remains unanswered. They are looking into this by doing an MRI of his brain today. They may also be looking at other causes, such as seizure activity or vesels spasming depending on the MRI results. In addition, they are looking at more blood tests to make sure he is not at a higher risk of bleeding unnaturally.

To complicate matters, Dirk was also diagnosed yesterday with a blood clot in his leg vein (a DVT=deep venous thrombosis). This happens commonly with bedrest (he has been in the hospital for 14 days now). DVTs are treated with blood thinners, which in his case is absolutely contra-indicated as he could bleed more in his head. He therefore had an IVC filter placed yesterday (inferior vena cava - the big vein that collects all the return blood flow from your legs/body and brings it back to your heart). The reason for this filter is that the blood clot could travel through his leg veins, to the IVC, to the right side of his heart and into his lungs causing a blood clot in his lungs = a pulmonar embolus. Thankfully, a special cat scan done last night in the setting of his breathing failing did NOT reveal any evidence of a blood clot in his lungs. The type of filter that dirk has is a removeable one, so that it does not need to be permanent for life.

In addition, Dirk has also acquired an infection of his urine - for which he is receiving antibiotics. They are also going to do a cat scan of his abdomen (the VP shunt courses through his brain/chest into the abdomen) to make sure that everything looks good there.

Dirk appears to be a bit more awake today - his eyes open and he was able to squeeze Kelsey's hand when she asked him if he was hearing her. Per Kelsey he seems to be saddened deeply and be getting some of what is being done to him - she is doing everything she can to keep his spirits up to give him something to hold on to. The doctors there appear to be very committed to helping Dirk through this, saying to Kelsey that they are going to do everything they can. I can only ask all of you to keep praying harder and hoping and providing Dirk with the love and strength to guide him through a recovery. We cannot nor will we ever lose hope! It is so crucial to pray and hope and never lose sight of a time when he will be at home with all of us again. If you can continue to send emails (to the queens hospital site) providing him with words of love and hope, I know that this would mean a lot to him and kelsey who has been reading them to him during periods when he is more alert.

I will keep you updated as Kelsey feels appropriate to do....lots of love,

Kiki

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