As crazy as it sounds, we are glad to be back in PICU. We are familiar with the staff and they are familiar with Brinkley. Our day shift nurse was one that that has had Brinkley several times before. Dr Gwyn has reviewed Brinkley's case before and was very aware of his history. I was very pleased with the time that he spent with me talking through our current situation and his opinion and plan for where to go from here.
Dr Gwyn says that it is necessary to treat the respiratory distress first and then tackle the gastric issues. For now Brinkley is on high flow oxygen. He is on 30% oxygen (21% is room air), so he is not on a high dosage. However, he is middle of the road on the level of pressure. He needs the 02 to be coming in at a high rate of pressure to keep his levels stable. We are working on coming down on that. Bryan and I both agreed that he is much more comfortable and his breathing looks better at this level.
Taking into consideration the fact that we just dealt with this a month ago thinking it was a virus, Dr Gwyn doesn't want to waste any time assuming that we are dealing with a virus. He feels certain that it is reflux related (as did the pediatrician and cardiologist) and wants to approach it from that angle. As soon as we can come off the high flow oxygen we will begin tweeking the formula and reflux meds. We are going to redo his swallow study and GI scans to determine the severity of the reflux. After this we will see if any procedures are necessary. We may be looking at making his G tube into a J tube meaning that instead of running into his stomach (as it does now) it would go into the intestines. Another option is to do a nissen which is a band that helps to control the sphincter and hold the gastric content back. We hope to be off the 02 machine and working on the reflux by Friday.
Tonight the resident introduced herself to me and informed me that Brinkley is quite the celebrity around there. He seems to make quite the impression on nurses. Meredith, our nurse tonight, is one that we have had before and she told me that the nurse fight over who gets to take Brinkley. They told us the same thing in PCICU at MUSC. He is quite the man! I can't say I blame them. I think he is pretty awesome too!