Afternoon Update

Praise the Lord for much needed rest. I slept last night for almost eleven hours. Sorry for the delay in posting. I just went in to see Phil and while I was in there Dr. Ruiz came by and I was able to talk with him. So this is where we are at right now. I will break it down by organ.

LIVER: As they tell us that his current liver is slightly improving, my question was what about this liver is concerning to them and makes them want to pursue another one. They said that his liver enzymes are trending down, but that the two markers of acutely how the liver is doing are what is concerning. These are his bilirubin and INR. Both of them are not increasing so that is good but we need the liver to kick in and for these to start coming down. The liver makes clotting factors that help the blood clot and the INR measures how well the liver is clotting. We want this number to be below 1. His has been around 1.8 but this is with the clotting factors they are giving him. If they weren't giving him the clotting factors, it would go higher. His bilirubin is 3.1 today. It was 3.5 yesterday so we are headed in the right direction. If it starts to climb this tells them that the liver is becoming hard and not able to move the bilirubin.

My other questions was is the 15 percent of the liver that was dying an issue if the remaining 85 percent is able to function? He said no. It will just shrivel up and die. We figure that 85 percent of a huge liver is good.

He also told me that another good sign about his current liver is that he is requiring a little bit of insulin to lower his blood sugar which is a little high. The liver stores sugar and if it is not working you will have low blood sugar. Another good thing is his ammonia is coming down.

I asked him how long we can stay where we are at on the status one liver list. He said around a week. He said they go through times where they get 5 liver offer a day and then weeks when they get none. He said right now has been a slow time for livers. They have received 2 out of state offers that they weren't happy with. He said that they would have to receive the "perfect" liver and even if they did receive it, he would meet with Dr. Levy and they would call a couple of their colleagues to discuss whether it is worth going back to surgery. He said going back to surgery is risky not due to the technical aspects of the surgery, but because of the stress to Phil's body. He said they could probably have another liver in him in 2-3 hours, but that they would have to give him a lot of fluid and blood products again and more sedation. His lungs issues also aren't ideal for another surgery either.

He said another indicator of how this liver is doing would be to access his mental status. When they get his percent oxygen down to less than 50 percent, he said he would like to ease off of the sedation to wake him up and see how his mental status is. I asked if they wake people up even with a tube in their throat. He says obviously it is a little uncomfortable to their throat but that they do it all the time. This kind of excited us and we would like that Kristin would be able to see this before she goes back to Nashville on Sunday night.

We feel that we need to pray for his current liver to continue to be healed. It is kind of just teetering deciding which way it wants to go. Pray that the 85 percent of what is left will be restored and start to function. Pray that it would produce the clotting factors it needs to make, clear the bilirubin, and store sugar like it needs to. Pray that Phil doesn't need another liver. Pray for discernment for the surgeons and wisdom as to what needs to be done. Beth told Dr. Levy that we were praying for their wisdom and discernment and he kind of gave her a blank stare. Continue to pray that we can continue to minister to them. We praise God for answering our prayers of healing for this liver. It is improving slightly and the doctors continue to look puzzled. This is God at work!!

KIDNEYS: Praise God for healing his kidneys. Before they had even started the dialysis he started making urine. His urine output continues to be great and we are so thankful for that. Yesterday Justin was in there and Dr. Ruiz said it was amazing what was happening with his kidneys. Yea!!! Phil is going to laugh that we were all monitoring his urine output :) They are continuing the dialysis not because of his kidneys but in order to get all of the fluid off of him. There is now a total of 7 Liters off of him. His face is better and less puffy. They are now pulling off 4oo ml an hour. We still have about 16 Liters of fluid to go. They are getting him a special bed today that will change positions to help get the fluid off. It never came yesterday.

LUNGS: This is the big issue right now. He is not oxygenating well meaning that as he is receiving a lot of oxygen it is not getting in his blood. They feel that this is due to all of the extra fluid so that is why they are getting it off as fast as possible. They consulted a lung doctor and they are switching him to a different breathing machine that can more fine tune things. Bare with me here but I am going to try and explain something. There is something called FiO2 which stands for fraction of inspired oxygen is a gas mixture. The FiO2 of normal air is 21%. Phil was at 100% this morning which is the most you can give. The usually don't like to give above 50%. As I was originally starting to write this he was at 90% and they didn't think they were going to be able to go down anymore anytime soon. While Chris Jones, Cody Schwartz, and me were in there they were able to go down to 70 %. That is definitely from God!!!! The doctors are so confused right now and don't know what to think. We had a great time praying with Phil and talking to him. His color continues to improve. Will give you more as we get it.