Update #68

Today was a big day for Dave. Seems strange since he actually didn't do the trach collar at all, but the rest of his activity more than made up for it.

First, he sat up for almost six minutes! I don't know why, but simple things make him look so much more like Dave, and having him sit up on the edge of the bed is one of them (seeing him in his glasses, which he has been wearing much more recently, is another). He looked so incredible, and we were so proud of him for sitting for so long in spite of how dizzy it made him.

After that amazing but exhausting experience, Dave got his massage. Gayle, a wonderful massage therapist who works mostly with cancer patients in the hospital (and maintains other offices so she can offer her services at the hospital for free), came today and worked on Dave's legs and hands, then even rolled him on his side to massage his back. He looked so relaxed, and I think Gayle is his new BFF. Not only did she give him a massage today, she plans to come two times per week herself and send one of her associates one other time per week.

After the massage (which, in spite of how wonderful it was was still pretty stressful for him) and a quick break, Dave continued his ICU spa day by getting his hair washed with real shampoo and hot water for the first time in two months (thank you Jennifer M. for the suggestion). Between the massage and the shampooing, I don't think I've seen Dave this relaxed since before the accident.

None of this information may seem huge on the Internet, and I'm not sure that I am capable of communicating how great it is. But to be standing in the room to see how much progress he has made, how relaxed and happy he was, how much like a non-ICU patient he seemed - it was truly incredible.

A few of specific prayer requests:

First, please continue praying for Dave's eye to heal. He is still really struggling with not being able to see out of it and with the dizziness and confusion that it is causing.

Second, the level of drainage from his colon was back up again today. Nothing else can happen with his wounds until the hole closes, and he probably can't get out of the ICU until the wound is fixed.

Third, Dave still isn't sleeping well. The new meds didn't help much last night, so the doctors are increasing the dose. Be praying that Dave actually gets some sleep tonight.

Thank you all so much for the cards and comments that continue to pour in. We read every one to Dave, and I know they make it easier for him to keep pushing on toward recovery.

Update #67

Things continue to progress very well. For the most part, it is a case of "steady the course" - no big changes, which in and of itself is almost a nice change after the past seven and a half weeks.

Even with no major changes on the doctors' part, things are moving in the right direction. First, Den and Cherie told me as soon as I got here last night that Dave had sat up for the first time! I guess the physical therapist stopped by yesterday and helped him put his legs over the edge of the bed and sit straight up. He was dizzy for a minute or two then seemed to do okay. His parents didn't get to see it (nor did I), so we are hoping they will do the same thing tomorrow when they come back.

Dave's platelets are up to 188,000 and his white blood cell count remains in the normal range at 9.4. The drainage from his colon was up again yesterday, so they reduced his tube feeding to 20 and put him back on TPN, which seems to be helping. He has been working consistently on the trach collar, usually eight hours per day (in smaller intervals), including four hours straight yesterday!

Otherwise, holding steady. He seems to be in good spirits, and the nurses continue to spoil him (we're doing our fair share as well). He even gets to have a therapeutic massage tomorrow! I'm wondering if I can get one as well if I just "happen" to be around when the massage therapist comes. :-)

Sorry if this is a little disjointed, but I'm posting from Dave's room while he is napping, so I don't want to be on my laptop for too long. Thanks for the prayers - keep them up!

Update #66

Believe it or not, I've never been a fan of blogging. The idea of broadcasting the innermost parts of my life to the entire Internet never appealed to me and, as is true with any form of electronic communication, made me very wary of the fact that a lack of interaction with the person reading the message may make me more likely to communicate things online that are better said in person.

The reason for that extra special glimpse into my life is to preface the phrase "Dave and I are engaged" with a reminder that we really wish we could tell each of you the news in person (or at least over the phone).

In case you just missed that, Dave and I are engaged. :-) On Sunday, July 13th, with his parents on one side of his bed, his sister at the foot, and me on the other side, Dave "said" (mouthed) that he needed to talk to me. Somehow, everyone else in the room lipread his next sentence better than I did, and his family was smiling and/or crying before I even knew what was going on. I caught it the second time, though. "Will you marry me?" Never in my life did I think I would hear...lipread those words staring at the face of the guy that I love lying in bed in the ICU, but at that moment, no proposal could have been more perfect.

I said yes, in case you were wondering, while smiling and/or crying myself. I have to admit, though, that my next words were, "Are you going to remember this conversation tomorrow?" He promised me that he would, and his nurse assured me that the conversation had been recorded in his medical record, so I guess that made it official. And to reassure me further, the first thing Dave said the following morning when I arrived for visiting hours had to do with being engaged so I would know that he hadn't forgotten.

For a while, we considered keeping the news quiet, at least until Dave could call his friends to tell them himself (which is why it is coming to you two weeks late - that and the fact that it takes a while to track down my whole family, who I was fairly certain would not be okay with reading about the engagement online - go figure). But word travels fast in a hospital, and once we had been congratulated by the 50th nurse, we figured it might not be a bad idea - okay, we were both pretty excited - to broadcast our happiness to everyone who has been so supportive through this whole process.

Obviously, we have a long way to go before we get to husband and wife. But it's the "we" that is most important. Although Dave and I have started talking wedding plans (mostly to pass the time and to enjoy thinking about something outside of the hospital), our true focus is on celebrating the fact that we will be together, and our marriage will be stronger because of the past seven weeks.

If I keep typing, I will almost definitely become the babbling blogger that I used to avoid, so on to the rest of the update for yesterday and today...

Things continue to progress well. Dave's white blood cell count is still normal, and his platelet count is high enough that the doctors feel comfortable putting him back on blood thinners to try to dissolve the clot in his pelvis permanently. Hopefully, that will help his left leg feel completely better for more than a day at a time.

The drainage from his side has started to increase, most likely as a result of the increase in his tube feeding, so the doctors decreased the amount of food that he is getting to 30 (from 55) but increased the concentration to keep his calorie intake at a more normal level. From what I understand, the octreotide continues to work, but closing the hole in Dave's colon will take time.

Because he has not been sleeping well, Dave's doctors also changed his sleeping meds to something stronger last night. It worked - too well. Den said that Dave was pretty out of it all day today and didn't breathe with the trach collar at all because he was so tired. His nurse Prisila (one of his favorites) is hoping to convince the doctors to switch him back to Ambien tomorrow.

Overall, a short update, but positive just the same. I'm headed back tomorrow, and I promise to do my best not to get so wrapped up in being with Dave that I forget about all of the other people who wish they could be with him too. In other words, no more three-day intervals without posts. :-)

Love you all - and can't wait to celebrate with you (in person, not online)!

Update #65

So as it turns out, I do better keeping up on with the blog when I'm not in Knoxville. It's probably because when I'm in Cincinnati, I understand how difficult it is to be without updates for more than a few hours at a time - it's a little easier to forget that fact when I'm standing next to his bed holding his hand. The positive side to the lack of posts, though, is that Dave's nurses have been letting us stay in his room pretty much all day so he has company while he is on the trach collar. Everyone in the ICU is pretty attached to him, so they spoil us quite a bit to make him happy.

Spending so much time with Dave - reading to him, talking to him, anything to distract him from the fact that he is breathing on his own - has been wonderful. I realized the other day, though, that you know you've been a visitor in the ICU too long when the nurses start inviting you to staff lunches with them. On Thursday, there was a picnic for the groundbreaking of a new wing at UT Medical, and Dave's nurse asked if I wanted to go with some of the other nurses to grab lunch. I have to admit, it made me feel pretty special, but when you've gained "staff" status at the hospital, it's time to check out. :-)

I talked to Dave's parents earlier today, and he is continuing to improve. His white blood cell count is at eight, back in normal range for what I believe is the first time since his accident! He continues to tolerate his tube feedings well, and the food does not seem to be increasing the drainage coming from his colon (thank God for octreotide!), so the doctors increased his rate to 55 and turned off the TPN (the nutrition he was getting through his blood stream). Yeah!

Dave was on the trach collar for about two and a half hours again this morning, and if I understand correctly only came off because of some work that his nurse had to do on him that would be too strenuous to handle while breathing on his own. He was on pressure support on the ventilator all afternoon but will probably be back on the trach collar tonight or tomorrow. Just in case anyone was wondering, one of the respiratory therapists explained to me the other day that people who are breathing normal air are getting 21% oxygen - Dave gets 50% while he is on the trach collar. Also, he will have to be able to breathe for 48 hours straight on the trach collar in order to be off the ventilator completely - be praying for strength and for peace for him as he continues to progress toward that goal.

Although he has been getting his Ambien and Celexa again, Dave does not seem to be sleeping well. He was off both meds for a few weeks because of his infection, so please pray that he will start getting more sleep again as the meds work their way into his body again. His leg also continues to bother him (the pain seems to fluctuate depending on the day), so prayers that the clot will disappear completely would be great as well.

One other wonderful update - Dave will be off of all antibiotics for his sepsis/infections on August 1st (next Friday)! The doctors had said that he could be on them for a month, and Friday will be three weeks - once again, Dave continues to surpass every expectation that they lay before him. :-)

Obviously, I'm missing Dave and wanting to be down in Knoxville with him getting news in person, so I promise to be better about updating the blog every time I talk to his parents, at least until I go back on Tuesday. If you do have a chance to send a card, I know he loves getting them and hearing about all of the people who are supporting him. The address at the hospital is:

David Heckel
c/o UT Medical Center
SCC2, Bed #15
1924 Alcoa Highway
Knoxville, TN 37920

Thanks for the continued prayers, support and comments on the blog. It has been wonderful knowing that so many people are fighting for and with Dave, and us.

His Spirit, His will, His peace, His glory,
Kendahl

Update # 64

I just heard from Kendahl. We were reminiscing that at 10:30 pm tonight marks 7 weeks that Dave has been in the ICU unit in Knoxville. What a thrill it is to celebrate this milestone.

Kendahl wanted me to share as she has mentioned in the past - no news is good news! She hasn't been able to post anything lately since she and Dave's parents have been able to spend more time with Dave.

Here are the updates:

The medicine that Dave is taking to repair the hole in his colon is working! The drainage has been reduced by about 50%.

The plastic surgeon said that the "mesh" that they used to cover Dave's large wound has done its job in spite of coming apart. It is holding his internal organs in very nicely.

The doctors are seeing a lot of new tissue growth everywhere in Dave's body. This is really good news. It means that his organs are healing.

As Dave's condition improves the surgeon will place a thin skin graft over this wound. The body will ultimately heal itself. This will be all that they will have to do to this wound.

The doctors did say that Dave will have a bulge on his side as a result of moving skin. Please pray that this won't be the case. Dave is struggling with this thought. In fact, he mentioned that he doesn't want to look like a blob. Now he will be able to join the rest of us with our blobs.

They aren't completely sure if the blood clot is still in Dave's leg. However, the swelling in the leg is almost gone. If it is still present...it doesn't seem to be affecting him much.

Dave has been able to receive more "food" through his feeding tube. It was at 10 and now it's up to 40. He seems to be tolerating it well.

Dave is now able to have juice and other liquids. This really good since he loves juice.

They have now discovered the problem with Dave's eye. The problem isn't with the eye itself. It is functioning well. The doctors have said that it is due to his brain injury. Please pray that this will improve! As you might imagine Dave is really struggling with this. He can't see out of it, plus it causes him to be dizzy.

A huge praise: Dave was breathing on the trachea collar for 9 hours yesterday in 3 hour increments. This type of breathing is very difficult for him. It can be painful and exhausting. However, he is persevering like a champ. Apparently, when he is officially off of the vent...his overall condition should improve more quickly. Please pray for his perseverance. I am reminded this evening how much I truly take for granted...especially the ease of breathing.

Dave's parents have moved into a place called Fellowship Center. It is for cancer patients and for families who are from out of town. It is a one bedroom apartment. It is free and just 5 minutes away from Dave. The hotel they were staying in was about 15 minutes away. When Kendahl is there she can stay on the pull-out couch in the living room. This is a huge blessing for all!!

While Dave is working really hard at breathing through the trachea collar...Kendahl and his parents are reading to him. In fact, they continue to read the cards and letters that you all send to him. Please keep sending them. He really loves it!! You can do this via mail or through an ecard. By sending these notes you are helping Dave with his respiratory therapy!

I hope that I was able to pass on everything correctly. I told Kendahl to correct anything that I missed. Please keep praying for Dave. What an amazing update to report.

Update #63

I just got a really positive update from Dave's parents. Sorry for not posting yesterday - I talked to Den in the morning, but by the time I got to my computer to post last night, I was pretty confused about what he had said and figured it would be better to wait until I understood what I was typing before confusing the rest of you with me. :-)

First, the drainage from Dave's side (from the hole in his colon) has been drastically reduced - seems like the meds are working! The doctors are continuing to monitor the amount of drainage, but they have decided to keep him on the meds to see if they hole will close entirely. Dave's glucose was up yesterday, which may have been as a result of the TPN (the nutrition that is going into his blood), so they have altered the TPN slightly and have also decided to partner it with a very low dose of food administered through his feeding tube (they set the dose at 10 ccs - he has been at 70 ccs to get his full 2,000 calories). Using the feeding tube in these very small amounts will stimulate his digestive system and also allows the doctors to give him his sleeping meds again - yeah!

The tube in Dave's chest, which had been draining the fluid from behind his lungs, seems to have stopped flowing, so it may be removed in the near future. His leg seems to be feeling better today, a huge improvement from Sunday when Chris (his roommate) said that Dave's nurse actually gave him enough pain meds to make him sleep because the pain was so bad.

One other great update - Dave was on the trach collar again last night and went for almost two hours breathing on his own! According to his dad, Dave still is certainly not volunteering to use the collar, but he seems to be doing well with it when they put it on him.

And since I'm full of positive news today, Tony (Darlene's husband) is being moved to a room outside of the ICU today! I got a text from their youngest daughter last night, and she was overflowing with excitement. Can't wait to give them a hug when I get back to Knoxville tonight.

Keep up the prayers - lots to be thankful for today!

Update #62

I just got off the phone with Dave's parents, and he seems to be having an okay day today. Although they did not get updates on his platelets and white blood cells, the doctors VERY (are there any other ways to emphasize VERY?) cautiously told them that the drainage from the hole in his colon has decreased since yesterday. The extreme caution comes from the fact that the level of drainage can fluctuate from day to day, and the doctors reminded Den and Cherie that it will take three days to know if the meds are working.

For anyone who is interested, the medicine that they are using to treat the hole is called octreotide (also known as somatostatin), and it had been tried for cases similar to Dave's in the past with inconclusive results. One of Dave's doctors, Dr. Mack (who may be my new BFF - Best Friend Forever, for anyone who does not speak middle school), found a more recent study in which the medicine had been effective, so the doctors are trying it (not sure if he did the research on his own or if it was assigned to him, but I'm willing to give him the credit...). Assuming it won't cause Dave any additional harm (and I truly believe the doctors wouldn't use the med unless it was safe for him), in my opinion any activity is better than doing nothing. Tuesday is the day they will be able to tell if it is working - anybody else feeling a little impatient? Keep praying...

Beyond that, Dave was on the trach collar (where he is breathing pure oxygen on his own through his trach - i.e. no ventilator support) for over an hour today! According to his parents, he certainly didn't enjoy the experience and has no desire to try again this afternoon, but the doctors were impressed just the same.

Dave's left leg (the side where the blood clot is in his pelvis) is continuing to give him problems, but from what I understand from Den, the pain is coming more from the blisters caused during the swelling (which covered the entire surface of the top of his foot and are now popping) and less from the clot itself. We'll see if the pain improves in the next few days as the blisters heal.

In the midst of all of this, please be praying for Dave's spirits - I guess he seems to be a little bit down today. He is no longer able to be on antidepressants or sleeping meds because both of them have to be administered through his feeding tube, which the doctors aren't using, so be praying that his normally positive attitude and amazing personality will continue to shine through. With everything that he has endured, even just in the weeks that he has been awake, it is incredible to see him smiling, joking around and working so hard to recover, and I'm sure a lot of that comes from the power of your prayers and his awareness of God's presence, even when we can't be with him.

One more really phenomenal story - I was sitting at a friend's bridal shower yesterday afternoon and got a text from Darlene, the wife of the man who was hit by the drunk driver - "Tony alert. Following commands. We r on cloud 9." For the first time since his accident, her husband Tony is responsive, even sticking out his tongue on command. Such an answer to prayer! Thanks for thinking of them in the midst of everything that Dave is going through - they have truly become wonderful friends, and I know I was pretty teary when I got her text.

That's it for today. I hope you are all having a relaxing Sunday!

PS For anyone who cares, I think I found the study that Dr. Mack used to justify trying octreotide. I thought it was interesting... http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijs/vol6n1/fistula.xml

Update #61

I talked to Dave's parents yesterday, and Dave continues to improve. His white blood cell count is remaining stable, and his platelet count increased again in the last 24 hours. The most important update from Knoxville, though, was that Dave was put on some medicine to help close the hole in his colon. I'm not sure what the meds are, but I'm looking at them as a very specific answer to our prayers on Friday. The doctors said they will know in three days (by Tuesday) whether they are working or not - they are looking for a 50% reduction in the amount of drainage coming from his side. Please be praying that this reduction will happen - it is the next crucial step on Dave's road to recovery.

Sorry for the short post - I'll update more later.

Love from Cincinnati,
Kendahl

Update #60

Today, let's cut right to the chase - please pray that the hole in Dave's colon/intestines will close soon. From what I understand (and I may not understand, so my apologies to everyone in the medical field who may be reading this), the drainage from the hole may have partially caused the mesh that was used to cover his injury (under the skin graft) to disintegrate, which means that the doctors will not try to fix the injury site until the drainage is under control. In addition, the hole is preventing doctors from feeding Dave through the tube in his stomach, resorting instead to TPN, which is a nutritional mixture that he receives directly into his blood stream. Although the TPN is helpful in Dave's situation, slowing the drainage flow through the hole in his colon because his digestive system does not have to process the food, it also may cause Dave's digestive system to get lazy from lack of use.

Because Dave cannot have any food or drink in his stomach, Icees and fluids are out of the question - he is back to ice chips again. We did receive permission from his nurse to give him flavored ice chips, using flavored waters and even Gatorade to make the chips, but nothing compares to a nice cold glass of skim milk (Dave's most recent drink request).

All of that to say that the next major step in Dave's recovery is getting the hole to close. Doctors gave three options:

1. The hole closes on its own, which would allow doctors to begin feeding Dave through his stomach again and to move forward with fixing the wound in his side;

2. The hole doesn't close on its own, and doctors wait until he is strong enough to endure surgery again to fix it (much longer process);

3. The hole doesn't close on its own, the doctors don't know if Dave is strong enough to endure surgery, but the drainage is causing enough problems that they do surgery anyway out of necessity (the scariest option).

Please pray hard for option #1.

The positive side to this specific prayer request is that it is a good indication that the infection is coming under control. Dave's white blood cell count dropped from 24 to 18, and his platelets are up to 50. Blood pressure and heart rate are both normal, and Dave is tolerating the pressure support setting on the ventilator very well.

Also on the positive side, the swelling in Dave's left leg is almost completely gone, and a doppler scan (ultrasound) yesterday afternoon showed that he has no new clots. In the words of the vascular nurse doing the scanning, "He has the blood flow of a 19 year-old marathon runner." He seems to be in good spirits and has been tolerating much more movement of his arms and legs.

I'm headed back to Cincinnati this evening until Tuesday evening, so posting will be more sporadic, but I will do my best to keep you updated. Please keep praying - Dave smiles every time we tell him how much support he has all over the country.

His Spirit, His will, His peace, His glory,
Kendahl

PS It doesn't seem fair to me that my picture with Dave is the only one displayed on this site. If you have electronic versions of fun pictures of your favorite memories of/with Dave, please email them to me at klund7 at yahoo.com, and I'll create a slideshow of them for everyone to see. Or, like Jason did, post the link to online photos in the comments section, and I'll download them from there. Thanks!

Update #59

The power of prayer never ceases to amaze me. It shouldn't surprise me as much as it does, but I'm a slow learner, I guess.

First, Dave slept through the night last night - yeah! I got to his room just in time for the 11:00 p.m. visiting hours, and he was sound asleep. He rolled his head toward me, opened his eyes, smiled, then fell back to sleep. When I arrived at 5:30 a.m., he was still sleeping - his nurse didn't even have to disturb him to change his dressings. :-) Dave has been put on a very low dose of relaxers to help with his anxiety, so I'm sure that is helping him to sleep better - it was amazing to see him so peaceful.

If that wasn't enough, this morning on rounds, Dave's doctor said that his platelet count is back up to 42,000 all by itself (he had a transfusion right before surgery yesterday but nothing since then), which means that his body is producing platelets again and the bacteria from his infection isn't killing them. Also, his white blood cell count dropped again - from 36 to 30 between Tuesday and yesterday, and from 30 to 24 between yesterday and today. So incredible! Sepsis...staph infection...nothing can stop the power of a country full of prayers. :-)

Dave also had his surgery, yesterday instead of Tuesday, and I apologize for not giving any updates, but I was back in Cincinnati trying to focus on a meeting while waiting quite impatiently to hear how it had gone. The screen in his vein was inserted successfully, and his heart and brain are no longer in danger from the clot in his pelvis. Although the clot is still causing him pain, he did allow us to move his ankle and foot quite a bit this morning, which has been nearly impossible in the past few days.

When the infection was at its worst, the nurses were pumping Dave full of fluid again, which was causing a small part of the pain that he was feeling in his leg as the skin stretched and blistered. As the infection improves, the fluid is disappearing - coming out of every small scratch, hole and blister and leaving his sheets and bed soaked - which is reducing the pressure on his leg and foot, as well as on the rest of his body.

Although the infection may take weeks to heal fully, Dave's improvement is amazing - evident in the fact that the respiratory therapist has started him on lung PT again (the CPAP - pressure support only - setting on the ventilator) and the physical therapists worked out his arms and legs pretty intensely this morning.

Dave has been very awake and talkative, and he really does seem much more relaxed than he has in the past few days. He talks constantly about getting out of the hospital and can't wait until he can do things for himself again. Keep praying for the wound - they took the mesh out (what was left of it) and have left the skin graft attached on one side until they can figure out what they want to try next - and for his continued fight against infection.

Love you all,
Kendahl

Update # 58

I just got off the phone with Kendahl. She is on her way back from Knoxville.

As you have read from her last couple posts, Dave's condition has stabilized since Friday. This is a praise report! Thank you for your praying!

Kendahl said that Dave's blood pressure is good and that his kidneys are functioning well and won't need to go on dialysis. His heart rate is good too. Dave's body is fighting the infections.

Here are some very specific prayer requests:

1. Dave's platelet count is still low. As previously mentioned, a normal count is 200,000 and Dave's are now at 19,000. It was as at 12,000 and as high as 58,000 in the last several days. It is important that this count continues to climb.

2. Dave will undergo a surgery this afternoon or this evening. The doctor's will place a screen in Dave's vein to block the blood clot in his pelvis. The hope is that when the clot begins to move that it will be "blocked" by the screen and not be a danger to his vital organs. Let's pray for a successful surgery and that the clot will be gone soon.

3. Perhaps the biggest prayer request right now is for healing to Dave's wound. There aren't too many options left...expect for Dave's body to heal it on it's own. This is a frustration and concern by everyone.

4. Please pray for Dave's infections to be completely gone from his body. And pray that he will be protected from new ones. As mentioned, he is fighting the infections, but they are serious and they take a lot to be eradicated.

5. Lastly, Dave has been experiencing a lot of anxiety. He is having trouble sleeping because of the changes in his medication. This and just the environment of the ICU is taking a toll on Dave's emotions and overall sense of well being. Let's pray that Dave will experience more sleep and peace.

Thank you all for your continued prayers and taking this journey with Dave. Let's continue to intercede on his behalf.

Update #57

Sorry for the lack of posts for the rest of the day yesterday. Dave is doing really well. The doctors identified two of the bacteria that are causing the infection yesterday and a third this morning, and they have changed his meds to be the most effective to treat them (using a total of five meds, one of which is antifungal). The strain of bacteria that they identified in his blood this morning (the last culture they were waiting for) was MRSA, a resistent form of the staph bacteria. According to the doctors, because Dave has been in the ICU for as long as he has, a staph infeciton was almost inevitable. They are monitoring his temperature and blood pressure, and so far, the meds seem to be helping quite a bit. Because the bateria is a resistent strain, he will most likely be on at least some of the antibiotics for up to a month.

The good news on his blood pressure is that he is completely off of his blood pressure meds, and everything is holding steady. Considering the fact that he was on full strength as of Friday night, the progress is incredible. His white blood cell count is also going down. No decision yet on dialysis, but they are continuing to monitor his kidney function.

Dave's platelette count has been down a lot (healthy people have approximately 200,000 platelettes - Dave's got as low as 12,000 yesterday). He has been getting blood transfusions and had one round of platelettes administered yesterday, but the doctors are very hesitant to give him too many platelettes because eventually his body will start forming antibodies and destroying the new platelettes before they can do any good.

Dave had another ultrasound on his foot this morning, which is still very swollen and tender. It will take a few hours to get the results, but be praying against abscesses in his foot and leg and that there are no additional blood clots anywhere else.

Another prayer request - we did finally hear the report from the retinal specialist, and it sounds as if Dave's retina is not detached. That being said, the damage seems to be coming from the pinched optical nerve, which Dr. Nagy, one of the residents, told us this morning may make the blindness in his right eye permanent. Another "wait and see" situation - please be praying that Dave will begin to see out of his right eye again sometime soon.

In spite of the infection and all of the unknowns, Dave is doing really well. He is very talkative (and we're getting REALLY good at reading lips) and seems to be feeling much better. He is awake, coherent and in good spirits, and the doctors and nurses are very impressed at the progress he has made since Friday night. Keep praying that the infection will go away quickly - I know it would make Dave very happy to be able to enjoy another Icee again soon. :-)

Love you all,
Kendahl

Update #56

Got to see Dave early this morning - never thought I could enjoy 5:30 a.m. so much. :-) He seems to be doing better and was quite talkative. Of course, one of the first questions he asked was why things have changed so much and why he can't have juice anymore. How I wish I could get him something to drink...

As of last night, Dave's blood pressure meds were at 100% strength to help keep his pressure up - this morning, his nurse had them down to 75%, and he seems to be doing great. His heart rate still fluctuates quite a bit, occasionally shooting up to 140 or 150, but it was very stable almost the entire time I was in there this morning and seemed very relaxed, even though he had just endured another dressing change on his side.

Although his leg is still very swollen, the pain is less severe, to the point that Dave let Dr. Alexander, one of the residents, touch it and move his foot a bit this morning, a huge improvement over the past few days. The doctors did a scan on his leg last night to make sure that his leg is not infected, and the scans only showed fluid build-up and cellulitis, most likely as a result of the clot in his pelvis (which, by the way, seems to be the only clot he has). Because of the clot, he is receiving injections of blood thinner in his leg, which is causing him to bleed from the wounds in his side. The bleeding is not serious, but he has received three units of blood since last night to help compensate for what he was losing.

According to Jessica, his nurse last night, Dave's blood tests came back positive for infection (two different samples), which we were fairly certain they would, and it seems to be a bacterial infection. As of right now, they are leaving him on the strong antibiotics that they started yesterday, which will help control the infection until the specific culture comes back in a day or two.

Overall, Dave is looking and doing much better than he was on Friday night or even yesterday. He is still very sick and will have to continue to fight, but it was good to see him awake, aware, and even smiling from time to time in spite of everything that he is going through. Keep up the prayers - I'll keep you posted.

Love from Knoxville,
Kendahl

Update #55

Just a few corrections since I wasn't thinking very clearly (or probably speaking very clearly) when I passed on the update to Mike to post:

Still no word on the infection - it could take up to 72 hours to get the exact culture, although they should know by tonight whether it is fungal or bacterial.

There is a possibility that there are more blood clots, although the extra fluid in his leg and the discoloration may just be from the original clot in his pelvis.

The skin graft seems to be okay, but the mesh underneath it is not taking. It has been constantly inundated with the drainage from his abdomen over the past few weeks, so we knew it was possible that the doctors would have to replace it, but on top of everything else this weekend...

He still may need dialysis, although so far his kidneys seem to be fine. The doctors are watching the acidity level of his blood very carefully. If he does need dialysis, it will be the special kind (CRRT) that he was on after his cardiac episode on day two, the constant transfuson versus the three or four hour kind.

In spite of everything, his nurse Angela (who was with him through part of the first terrible week) says he seems to be having a good day. His vitals are stable, and his parents said that he seemed to be resting at 3:00 p.m. when they saw him.

More to come later...

His Spirit, His will, His peace, His glory,
Kendahl

Update #54 - Urgent Prayer Request

I spoke with Kendahl about an hour ago. She is unexpectedly on her way back to Knoxville from Cincinnati. As Kendahl previously mentioned, Dave is very sick and his condition hasn't improved.

Here are the details:

• Dave definitely has an infection. It may take 24 to 36 hours to figure out exactly the type of infection he has. Once they know, they will be able to be more intentional with treatment.

• There are some additional blood clots.

• The skin graft is beginning to "die". The doctors said that this could be a possibility.

• Today, Dave may go back on kidney dialysis.

• He hasn't been very coherent today.

To all who read this blog: Please continue to pray for Dave. Share this news with your friends and family. Dave has come so far and he is such a fighter. We have faith that he will pull through this major challenge.

Please stay tuned to this blog for the latest information and not call or text Kendahl. Also, continue to pray for Kendahl, Dave's parents and sister. Your comments continue to be a blessing.

Update #53

Just talked to Dave's parents. The tubes were inserted fine, and his chest tube is draining well. But according to the doctor, "Dave is very sick." He does have a new infection (in addition to the abscess, as a result of it, related to it - I'm not sure), so they are running tests to see what the bacteria is. He has already been started on a new antibiotic, and they are trying to treat the infection very aggressively like they have in the past. I don't have a whole lot of info right now, but please be praying tons. More details as I get them...

His Spirit, His will, His peace, His glory,
Kendahl

Update #52

Just got a call from Kendahl who is currently on her way back up to Cincinnati for the weekend. She gave me a lot of information, so let's see if I can relay it all:

*They found the source of the pain in Dave's leg. It is being caused by a blood clot up near his pelvis. There has been a lot of fluid build up in his ankle that they think is being caused by this clot. They have started him on blood thinners.

*Because his heart rate has continued to be up and his blood pressure down, they did a CT scan that showed he also has fluid build up behind his right lung. They are adding a chest tube to drain this fluid.

*They have also found an abscess in his abdomen. (a localized infection) They will also be inserting a drain tube in his abdomen and putting him on antibiotics to treat this.

*The feeding tube they had inserted directly into his stomach previously has been slowly slipping out, so they will be inserting a new one to correct it.

So, the procedure today will consist of inserting/replacing 3 different tubes.

And for an update on his eye, the retinal specialist will be stopping by this afternoon sometime to check his eye and make sure that his retina has not be been detached.

Please continue to pray for the procedure today and for continued strength and healing for Dave. Kendahl did say he was having a pretty good morning, and that he seemed relieved to know they had found the cause for the pain in his leg.

Check back later today for another update.

Update #51

Dave slept really well last night - six full hours - rest that he desperately needed to prepare for what has already been a very long day.

When I arrived for the 5:30 a.m. visiting hours, Dave seemed very relaxed and didn't seem to be feeling nearly as much pain in his foot. Within an hour and a half, however, his heart rate was up, his blood pressure low, and the look on his face made it clear that the pain was back. While I was in his room, the doctors did an ultrasound and found no sign of blood clots in the veins in his legs (they checked both legs to be safe). A second ultrasound sometime today will tell us if there are clots in his arteries. If that test also comes back negative, the two most plausible explanations for the pain are a sprain/strain from some type of movement over the past two or three days or an infection. So far, although his white blood cell count is elevated, he does not have a fever, so it appears that infection may not be the issue. The doctors ordered another dose of ibuprofen to help with the swelling, and we have been icing Dave's ankle as often as he can endure the extra pain that pressure on the area causes.

In addition, although Dave's elevated heart rate may be due to the pain from his foot, the combination of his high heart rate and low blood pressure caused some concern for his doctors (and for us every time the alarm sounded on his monitor to indicate that his rate was over 150). After talking through a few options, the doctors decided to give him a liter of fluid as well as two units of blood, hoping the combination would help to stabilize him. When we left after the 11:00 a.m. visiting hours, his heart rate was fairly steady between 110 and 120 (still high, but better), and his blood pressure had risen to a healthier level as well.

Because Dave has had such a rough day so far, he has not been able to breathe without the ventilator to work out his lungs or do any PT. Hopefully, by this afternoon, he will be more comfortable and ready to work out a little bit to keep his recovery moving forward.

This week has been difficult so far, but fortunately, Dave has had a full four-person support team by his side every step of the way. His mom seems to be doing much better - less coughing and no mask when she visits now - and his sister Jen has been back in town since Sunday. I'm sure we are an overwhelming clan for Dave from time to time (and for his nurses - somehow the "two visitors per patient" rule has never really applied to us), but the boy can never doubt how much he is loved... :-)

One other update: I mentioned a while back a man named Tony who is also in the ICU. Last time I updated you, his family had just found out that his was in a vegetative state. The past two weeks have been full of highs and lows for his wife Darlene and their kids. Tony does not appear to be in a vegetative state, but he is struggling quite a bit. The biggest struggle, unfortunately, has been convincing the doctors not to give up on him. Please be praying for the McPeek family, especially today and tomorrow as they prepare for a meeting with one of Tony's doctors and the Ethics Board at UT to determine if and how they should continue treatment.

It's been a gray and rainy Thursday in Knoxville, but I keep looking for a rainbow, knowing that God is still working and tomorrow is another (hopefully sunny) day. More soon...

Update #50

Just FYI, the time of each of these posts now appears at the bottom of the post so you can keep track. Someone had asked for the timestamp a few weeks ago, so I thought it might help.

Dave had a pretty exhausting afternoon (he's sleeping pretty soundly right now - at least he was when I left his room around 8:00 p.m. - so that's good). The main reason for this post:

Sometime late this morning, Dave began complaining about some pretty severe pain in his left foot and ankle (the leg that was NOT broken in the accident). Early in his recovery, that foot had been colder and more swollen than the other, and from time to time, the nurses would have some difficulty finding a pulse. After a while, the problem seemed to resolve itself, but today, it was back in full force. The pain started sometime within the past day or so and really hit when we tried to do PT with him during the 11:00 a.m. visiting hours. Honestly, in the two weeks that Dave has been truly awake and coherent, this is by far the most pain I have seen him in (and that includes every single painful dressing change he has experienced). Every time anyone goes anywhere near his foot, he flinches, and touching any part of that leg from the knee all the way down to the toes causes him to cringe. During his dressing change this evening, the pain shot all the way up his leg, and he was noticeably panicked every time we tried to move him.

The doctors performed an X-ray this afternoon, and there is no sign of a fracture or break. Beyond an issue with the bone, the problem could be just about anything - a sprain or strain from too much PT, an abscess or even an infection concentrated in his foot. His doctors gave him some ibuprofen, and we put some ice on it, but so far, not much change.

As I mentioned, right now he is sleeping soundly, probably as a result of his pain meds and the exertion of his dressing change, but be praying that he is able to sleep just as soundly through the night and that the doctors will be able to determine the source of the pain tomorrow so he can begin to feel better.

Thanks for the continued prayers - you guys are amazing!

His Spirit, His will, His peace, His glory,
Kendahl

Update #49

I have really been slacking with the posting. My apologies to everyone who refreshes the blog every five minutes - just over 1,000 refreshes later, I'm finally giving your index finger a break. Please do remember that no news is always good news...

Dave had a pretty mellow holiday weekend. The doctors and nurses did not work him nearly as hard as they have been, giving him some time to relax away from PT and ventilator work. In spite of the break (or maybe partially because of it), Dave has been pretty tired this week as he gets back into his normally strenuous recovery routine.

The opthamologist came by on Monday afternoon to check Dave's right eye, and it seems that Dave's optic nerve was pinched (but not severed) during the accident. Based on the amount of injury that the doctor saw on the MRI and CT scan, and in person, the damage should not be enough to cause complete blindness in that eye, so he asked for a consult from a retinal specialist to see if his retina is separated from his eye. Although the opthamologist did not say that the injury would heal, he also did not say that it would not heal, so we are taking the optimistic perspective and seeing the uncertainty as a good thing.

On Tuesday, Dave passed his swallowing test (yeah!), which means he is officially cleared to drink all of the fluids that we had already been giving him (the nurses did say it was okay before), a full bar that now includes Passion Fruit Iced Tea from Starbucks, orange juice, vanilla milkshake, and most recently Icees. He seems to be enjoying the various flavors, but he did protest the tomato soup that the nurse tried to serve him for lunch yesterday.

Although the nurses are still changing Dave's dressings three and four times per day, they have stopped using all tape (which was tearing his sensitive skin) and have also changed the type of drainage tube they are using in order to avoid using the plastic vacuum packs with which they had been covering his major wounds. The drainage has slowed considerably (yeah!), to the point that most of Dave's wounds are simply packed with four-by-fours and gauze, with no suction or tubes and no binding or tape to hold them in place. Drainage continues coming from the tubes in his side (I think there are only two of them now), but it seems to be more under control, and his dressing changes are not nearly as painful as they used to be.

As for breathing, although Dave's break over the weekend made ventilator work more strenuous for him, he managed to breathe on his own with only pressure support from the ventilator (called CPAP) all night last night and still managed to sleep well. Just to help clarify, there are three basic levels of "breathing" that Dave is doing right now:

1. Ventilator On -Dave initiates breaths on his own, but in the event that he does not take a breath, the vent will take it for him (this is his highest level of support);

2. CPAP - Dave breathes on his own, with the ventilator only serving to provide pressure support to help keep his lungs open between breaths and to assist him in getting the full volume of each breath;

3. Trach Collar - Dave is completely off the vent, breathing pure oxygen on his own through the tube in his neck (normal breathing, but pure oxygen instead of the air in the room).

So far, Dave alternates mostly between the ventilator and CPAP, but he did go for a full hour on the trach collar on his first try on Thursday, which, considering the injuries to his diaphragm, was very impressive.

Although Dave still has a long way to go in his recovery, this week's attending doctor said this morning that he is "doing great" and "making lots of improvements." Just a few specific prayer requests:

*For his right eye as doctors continue to try to determine why he cannot see out of it;

*For the drainage in his side - that the "controlled fistula" will become more and more controlled and dressing changes fewer and farther between;

*For his blood pressure - it was low enough on Monday night that the nurses could not give him his sleeping meds, which probably contributed to his level of exhaustion all day yesterday. His blood pressure was high enough last night to give the meds again, but the doctors are watching it carefully.

Thanks for sticking with us through the lull in posts. More updates as we get them.

Love from Knoxville,
Kendahl

Update #48

Kendahl is on her way home to Cincinnati for a couple of days and here is her report for the day. Please pray that she gets home safely and is able to rest while she is home.

Dave continues to do well. For those of you who know him personally, you will be happy to know that he is acting more and more like himself. He is making jokes and laughing. Today, a nurse went to take a break and when she left, he told Kendahl that they should make a break for it and get out of the hospital quick while she was gone. He also is enjoying a variety of beverages at his request and has said his room is like a bar. He has requested, in addition to the soda, cherry slushy and passion fruit ice tea from Starbucks. He is now able to drink them from a spoon. He is able to use the TV remote and push the call button for the nurse. Today, he used a pencil for the first time since the accident. Kendahl said that it is getting easier to communicate with him as she is getting better and better at reading his lips. They had a great 20 minute conversation today. It is funny how you take those things for granted. There are so many things we should say that we don't and so many things we do say that we shouldn't. (my thoughts, not Kendahl's)

Today at 3:00, Kendahl was putting eye drops in Dave's eye and he mentioned that he couldn't see out of his right eye. He asked if his eye was open and mentioned he couldn't see anything. They are having an eye doctor come in on Monday to check it out. The doctors have said that they aren't quite sure what is going on. Kendahl said that the eye does respond to light and that he can move it to track when they ask him to, but he sees nothing. Please pray that his eye would be healed and that he would have his vision restored in his right eye. Pray that the doctors would be able to find the cause and that it is nothing permanent.

Dave's parents are doing well. His mom is still not feeling well. They think it is allergies but it sounds like it has settled in her chest to something else. Please pray that she would be healed and feeling better soon. Not feeling well doesn't allow her to see Dave as much and puts unnecessary stress on her. His dad is helping out with a lot of Dave's physical therapy. From the sound of it, this is a special time for the two of them. It allows Dave's dad to really contribute something to Dave's recovery. I am sure this is such a blessing after four weeks of feeling helpless.

Continue to pray against infection as that is always a threat to Dave's recovery. To be reporting such good news four weeks after such a tragic accident is absolutely incredible. Our God is a great big God (to quote the children's song). How blessed are we to witness His power, His grace and His love.

Update #47

Dave is off the ventilator for the first time! It's just a trial, and it may be temporary, but while we were in his room during the 11:00 a.m. visiting hours, the respiratory therapists turned off the ventilator completely (up until this point, he has been connected to the vent for pressure support to keep his lungs open when he is breathing on his own) and hooked him up to a trach collar, which is a tube that gives him pure oxygen through his trach every time he takes a breath (pretty much like breathing through an oxygen mask on an airplane, but through his neck). We watched him for about 45 minutes, and he didn't seem to be struggling at all - definitely more focused on his breathing and probably a little more tired from the effort, but his heart rate stayed low and his blood pressure was normal. So incredible!

The cardiologist also came by this morning and said that Dave's EKG was normal for the rest of the day yesterday and his heart seems to be doing fine. Very early in Dave's recovery, the doctors put him on some meds to help slow his heart rate (remember the day when it was at 175 for almost an hour?), and he has been on them ever since. Those meds combined with everything else his body has gone through was probably what caused his heart to stop yesterday. The cardiologist stopped the heart slowing meds and, as I mentioned yesterday, put him on different meds to actually stimulate his heart, and things look great today.

I may have written about this already, but the tube that was draining fluid from around Dave's lungs has stopped draining, and his chest X-ray looks good, so the doctors should be in sometime today to remove that tube from his side.

Overall a positive day so far. Oh, and Dave finally got his soda...pop...carbonated beverage last night. His night nurse Pam decided it would be okay for him to have a little bit on a sponge, so we enjoyed some Sprite together while watching Italian Job on my laptop. Nobody pictures their perfect "night out" in a Knoxville ICU, but I have to say, it was one of the best dates ever. :-)

Update #46

3:00 p.m. visiting hours were really good. Dave was much more awake and definitely more upbeat. While we were gone for lunch, the cardiologist ordered an EKG to check Dave's heart and started him on some meds to help regulate/stimulate his heart beat. His blood pressure has been lower since this morning, so he will be getting two units of blood at some point today as well.

Quick story that anyone who knows Dave (and has seen how convincing he can be when he wants something) will really appreciate: While we were in his room just now, Dave was motioning for us to work out his broken leg a little bit, which he "says" (nods when we ask him) has been hurting more in the past couple of days. After we had worked him out for a bit, his mom offered him some water, which we have been able to give him in very small amounts for the past few days through a sponge on a stick that he can suck on. After having a few spongefuls, Dave looked at me, tilted his head and mouthed the word "soda." Once I had confirmed that soda was what he wanted and told him that he couldn't have any because it might affect his stomach, heart, or any number of other things, he continued mouthing "soda?" with a questioning look in his eyes and a mischievous smile on his face, probably hoping to wear me down. After we laughed with him and refused a few more times - which was, by the way, incredibly difficult with him smirking at us like that - he gave up and switched to "pop?" still smiling, probably hoping to win over his parents who prefer that other word for referencing carbonated beverages. You'll be glad to know that we did manage to resist his charms until the end of visiting hours but promised to bring him some cold water with ice chips (to replace the tepid tap water in his room) when we visit at 5:00 p.m. Good thing we didn't have anyone from Texas with us, or he might have tried his luck with "Coke?" next. :-)

Needless to say, it was good to see Dave acting much more like himself, especially after this morning. Keep praying - for his heart, for his colon, and for his spirits - and know that God is using you and your prayers to make Dave stronger and more like himself every day.

Update #45

Sorry for the change of location. Up until this point, we have been using the website for the student ministries at WellSpring Community Church where I work, but Dave really deserves his own page, and we are trying to avoid having you sort through announcements about upcoming youth ministry events in order to see how Dave is doing. The first 44 updates about Dave will remain at http://studentsatthewell.blogspot.com/, but all future posts will appear here, at http://daveheckel.blogspot.com/. Sorry for the confusion, and for the lack of creativity on page design. Just wanted to get it up as soon as possible.

With that out of the way...

In the past three and a half weeks, Dave's doctors and nurses have reminded us repeatedly that there would be ups and there would be downs. We got a small reminder of that roller coaster ride this morning. Before I continue, let me assure you that Dave is fine and seems to be very relaxed. That being said, he did have a "down" this morning when his heart stopped for a few moments. Although we have yet to hear from the cardiologist, the nurses say that it is one of the ways that his body is coping with everything that it has endured thus far. The moment was scary, even for the nurses and doctors who rushed into his room, but everyone recovered quickly when his heart restarted with no drugs, no crash cart, and only a few taps on his chest. Dave's nurse, Prisila, has been a little more doting since this morning and has stayed closer to his room, but otherwise, nobody seems overly concerned. Please do be praying for Dave's heart and for whatever caused the issue with it this morning. There have been some talks about drugs to regulate his heart rate, but we will know more once we have a chance to speak to the cardiologist.

In addition to whatever is going on with his heart, Dave also has a small hole where the doctors reattached his colon to his small intestine. We have known about the hole, a "controlled fistula," for a little while (I'm not sure if I mentioned it in an earlier post or not), and the doctors decided as soon as they discovered it to allow it to heal on its own as opposed to doing another surgery, which would risk undoing everything that they had already done in previous surgeries. While it heals, however, it is leaking large amounts of drainage, which is being fed through one of many tubes coming out of his body. The doctors are watching the drainage carefully, but they do seem concerned about how it would affect Dave's health if it ever gets to the point where it is not "controlled" and begins leaking into other parts of his abdomen. Please be praying that the hole would heal quickly without undermining his overall recovery.

With the downs out of the way, Dave was smiling more yesterday evening and slept five uninterrupted hours last night. He is gaining more strength and mobility in his arms, hands and feet and is getting more comfortable signaling his needs with his hands whenever he is unable to talk because of the ventilator. He seems tired but fairly relaxed, and he continues to improve in his lung PT, including breathing on his own with his lowest pressure support yet for over six hours yesterday.

Visiting hours are coming up soon, so hopefully I'll have more positive news then. While you are praying today, please lift up Dave's mom who has a bad cold and decided not to come to the hospital this morning in order to avoid passing it on to Dave. Pray that she will heal quickly so she can be back by his side very soon.