Day 13: Endoscopy

This blog post is copy-and-pasted from our CaringBridge account (https://www.caringbridge.org/visit/thomaslauer) and published in retrospect.

November 30, 2020, written by Mama

Endoscopy Planned

Thomas's overnight was peaceful with no more emergency bleeding (just steady NG output). Thomas had a very sweet morning with me, with his brightest open awake eyes yet. He was awake for three whole hours and I talked to him, read him stories, and we watched Fireman Sam. He was trying to talk to me in many sentences, but he can make no sound: however, it still warms my heart that he is trying so hard! This was also the first time he was alert enough to look down at his own body and discover what his belly looks like covered in a huge incision, bandages all over, and dried blood: I talked through that with him in extremely simple, babyish, comforting terms.

PRAYER INTENTION: Within the window of 11:00 a.m. and 1:00 p.m., Thomas will be undergoing an endoscopy to try to locate the source of upper GI bleeding and, we hope, to stop it.

There are risks and set-backs to doing an endoscopy, so the team had wanted to avoid it, but he has continued bleeding significantly through four days of medication treatment, so the risk-benefit ratio has shifted.

The doctors say that all of Thomas's other post-operative healing is being hindered by the continued bleeding. For example (and perhaps most importantly), his kidneys cannot begin to heal properly (from kidney failure to "waking up") until they are happily in a state of steady blood volume and steady, healthy blood pressure. As it is, Thomas has had blood volume fluctuating significantly with all these blood products he is receiving and his blood pressure is all over the place (for the last 24 hours, extremely hypertensive., e.g. 190/100).

This mama cried in front of the big team of doctors knowing that Thomas will have to be put back under general and re-intubated. We've worked so hard to get him extubated and several days into his journey of withdrawal. However, we are told that if the endoscopy goes beautifully as intended, he may even already be extubated by the time I come back to the room.

There is a chance that the GI team will do a repair on a localized bleed and will desire to plan a second endoscopy the following day to make sure the repair is working and, in that case, they would leave Thomas intubated and sedated.

Please pray during the 11:00 to 1:00 window.

Endoscopy Results

 

So many of you have been praying, for which I thank you heartily! A number of you reached out to inquire about results, so I want to write this update ASAP.

The procedure went smoothly and it is greatly helpful to the team to have obtained this information.

Thomas has "severe" gastritis, which means his entire stomach lining is severely inflamed and bleeding and looks "very sick." Even with an NG tube placed for drainage (which I knew was insufficient!), the stomach was still full of blood that had to be suctioned for the GI doctor to see anything with his endoscope. Thomas had developed two ulcers and the GI doctor sprayed those with a special spray (whose name I forget) that provides a protective layer and helps stop bleeding. 

Even though just about 12 hours ago, Thomas vomited up huge clots that the nurse said would have filled an emesis basin, he has a significant clot filling up half of his entire stomach. The doctor said it is about the size of a cell phone. They chose to leave the clot alone rather than risk dislodging it and starting crisis bleeding again. It is conceivable that there is another source of localized bleeding beneath the clot. If the body does its job properly, the clot will slowly resorb, melt away, and be digested down the intestinal track.

Thomas will remain on Protonix and Octreotide drips at the higher doses. They will also give even more transfusions to try to "provide great support" to his coagulating and platelet factors.

What caused this Physiological Stress-Induced Gastritis and Ulcers anyway? I will try to explain what has been explained to me: This is a condition seen more in the ICU than in regular populations because the physical (not mental) stress of critically ill people can spark a cascade of problems. Thomas experienced the SIRS response from his surgery, so his internal organs became severely inflamed, stomach included. Then he had low coagulants and platelets because of surgery, so, while they were giving reactionary transfusions and lots of vitamin K (and probably things I am forgetting) as a result of CBC results, the bleeding that began in his stomach got worse and worse. Then blood itself is very irritating to the stomach lining--God did not intend for us to ingest raw blood--so the problem compounds.

Thomas needs bodily support and he needs TIME.

The GI, ICU, and Anesthesia teams all agreed that they wanted to leave Thomas intubated. GI may chose to do a second endoscopy tomorrow. They even may leave him intubated for "several days" so his whole body can rest. Since extubation, his oxygen needs had been increasing and increasing anyway. Also, his hypertension has simply got to be brought under control and they need time to do that.

This is where my Mama's heart flags and I try to exercise fortitude. I had missed Thomas so much for more than a week while he was intubated and sedated, and now he is "deep inside" again where he cannot interact with me. He had just started smiling at me yesterday. I know it was so important to obtain this clinical information, so I will try to offer up my Mama's emotional suffering, which pales in comparison to Thomas's physical suffering.