July 31, 2007 - 10:00 p.m. Aunt Joni called Karin today to announce that Karin's cousin Kristin and her husband Bob now have a baby girl, Isabella who arrived weighing 8 lb.-3 oz.   That makes two newborn babies in under 24 hours for Great Grandparents Freund.  Karin was waiting for pulmonary therapists to arrive when Brandon and I talked.  She was having some difficulty again today with hard coughing so she was hoping they could help relieve that before she calls it a night tonight.  Brandon says they both plan to get to bed early since neither slept real well last night.  Karin managed to get in a walk before 10 a.m. with Brandon and then later with PT.  She has been off the heparin she had been on for several months since some small clots were discovered in her shoulder area at that time.  They did a Doppler of that area today to see if that area is clear now.  Brandon says he's noticed a slight rise in her blood pressure (121/53) since she is off the heparin but he isn't sure if that is directly related.  Actually he says it seems like a more normal BP to him but, of course, he is not a doctor nor does he play one on TV!"  The MRA order is still on the charts so to speak.  Brandon says he thinks it is a matter of squeezing her into the schedule and that didn't happen today...perhaps tomorrow.  If this test is one that is going to inform the doctors and enable them to be more effective in their treatment of Karin we ask that you pray with us that it will be performed safely and with clear results.  But if it is not going to provide significant information and is not needed please pray she will not need to undergo this one or any other unnecessary or unduly risky procedures as she continues to fight to regain her strength so she can go home soon.

July 30, 2007 - 10:45 p.m. The highlight of Karin's day was to receive the news that she became an aunt again. Her sister-in-law Kelly and brother Brian became the proud parents of an 8 lb-7 oz baby boy, Gage Marks. During her dialysis treatment today Karin also received two units of blood. They took an X-ray of her stomach to check the position of the feeding tube and found it had not moved and was placed exactly as desired, so that was good. An is still being planned. She enjoyed a strawberry milkshake. All in all, it was a pretty restful day for Karin, and she will be sleeping using the bi-pap machine again tonight.

July 29, 2007 - 10:40 p.m. Karin had another good day, Last night she slept using the bi-pap machine so she got a very good night's rest. The bi-pap helps blow the air sacks open in her lungs, according Brandon. Karin took three walks today. She had no nausea. but not much appetite either. She did manage to consume a strawberry milkshake, some lemonade, and a protein supplement. They did not perform the bronchoscopy and biopsy on Friday, so it will be sometime during this next week. Karin did not have any visitors today, just Brandon and her mother Linda. Brandon bought Karin some zip-up nightgowns with pretty feminine frills just to make her feel special. She spent the entire day today lounging in a pretty blue one. And here is some cause for praise and thanksgiving - Brandon finally got a COT in the room to sleep in tonight!

July 28, 2007 - 10:40 p.m. Karin had another good day, with nothing much new to report. Her mother Linda came in for the weekend, and that always brightens Karin's up. Karin got in two long walks and enjoyed a lemonade milkshake which one of the nurses made especially for her. So Karin had a pretty uneventful day and went to sleep a bit earlier tonight. We hope Linda gets a good night's sleep in the chair - still no cot in Karin's room.

July 27, 2007 - 10:25 p.m. As of today, Karin has had her new heart and lungs and has been in the hospital for 5ive months now. She had another good day. She was up and about a number of times and made frequent trips to the bathroom. P.T. showed up rather late in the day, after 4 p.m., but they took her on a walk down the hall to the nurse's station - her second long trek of the day. Dialysis was able to draw off 1-1/2 liters. Karin had been cut back on eating because of the nausea, which she did not have today, so she is still on a feeding tube. In terms of taking liquids by mouth, however, Karin has been enjoying ice tea, flavored water, and ginger ale. She drank about 15 ounces total today. She is supposed to get a protein supplement at noon, too.This evening Karin ate half a jar (2 oz) of peach cobbler. Please make it a matter of prayer that Karin will stop passing out from coughing - that started back up again today. Aunt Marilyn and Uncle Bob and little Bobby came by and visited. And she spoke to Aunt Rosemarie and Uncle Ralph by phone. They told her they think it is about time to start planning a "welcome home" party for her, and she said, "Yeah, that sounds good!."

July 26, 2007 - 10:10 p.m. Karin had another good day again today. She took two walks and went almost all the way to the nurse's station and back. One was with PT and one with Brandon, Karin has been drinking a lot of ginger ale with something added called "Thick and Easy" that turns it into a gelatin, but she says it does not affect the taste. Consequently Karin's kidneys have her visiting the bathroom often and this a very good thing. She is still battling nausea but the treatment for diarrhea seems to be working. Another good indication of progress toward discharge is that Karin will not have used the bi-pap machine for three consecutive nights now. Tomorrow (Friday) will mark 5ive months since Karin received her transplant - she will receive a bronchoscopy and they will do a biopsy of her lung to determine the amount of rejection since increasing the dosage of Prograf, the anti-rejection medicine. In addition to praying for Karin's nausea and digestive problems, please remember to pray for a cot for Brandon to sleep on - he is still sleeping in a chair in Karin's room. But the nurse's were kind enough to included him when they "ordered out" for dinner tonight.

July 25, 2007 - 10:50 p.m. - Karin had been sipping water throughout the night and day and Brandon said she had about 20 oz. total today.  Karin had another dialysis scheduled for today.  After drinking and keeping that much water down her kidneys seemed to want to take care of some of the fluid naturally.  So the therapist did not try to take off more than 1-1/2 liters by dialysis.  Karin has had some relief from her gastric problems most of the day but did throw up twice.  An abdominal X-ray has been ordered because there was a little blood in what she spit up.  So right now she is being restricted from eating anything by mouth again and her feeing tube has been shut off temporarily.  Brandon said it seems like  her symptoms are being experienced by many others on the hall right now.  P.T. came  in and worked with Karin some today.  But the farthest she walked today was back and forth from the bathroom.  She is still a bit drowsy but does seem to have a little more energy.

July 24, 2007 - 10:30 p.m. - Brandon was preparing to spend the night sleeping in a chair in Karin's room tonight when he called about 10:15 pm.  He said Karin has been drowsy all day probably the result of a medication they have given her to help with nausea.  She even fell asleep while trying to do her breathing exercises.  Chaplain Carol peeked in on Karin again today and Chaplain Dale Anderson also commented to Brandon about her webmaster's good work.   Karin probably wasn't much company for Gram & Pap who spent about 2 hours with her and Brandon this afternoon, but they didn't mind.  She was a little more alert when Joanie, Bob, and daughter Chelsea came by this evening.  Cousin Kristen and her husband Bob also came by.  Even though Karin was not the life of the party today, no one was complaining.  It was good to see her getting some rest.  The gastric distress had been really getting her down but this new medication and a complete day of fasting seemed to be helping to turn that around.  At about 9 p.m. they did resume her nutrient feed on a very light dose which amounts to about 3/4 oz. of the "milkshake" an hour.   X-rays of her abdomen today did not show anything out of the ordinary and a culture sample was negative for intestinal nasties, so those were both encouraging reports. Brandon said they still need all the prayer support they can get and they so appreciate knowing that so many of you do pray for their specific needs every day.

July 23, 2007 - 11:30 p.m. update - Karin has been moved out of the CTICU and back to her old room upstairs - D-922! Praise God ... but they cannot find a cot for Brandon, so it is back to square one for him. Karin needs him there, so please pray a cot will show up for him today.

The 4:00 p.m. report: Tim reported this afternoon that he & Linda are on their way back home after an extended weekend with Karin.  They feel quite comfortable today as they leave because they had a very informative and encouraging time at the hospital with some members of Karin's team.  One of the respiratory supervisors conferenced with them and with Brandon & Karin answering questions and addressing concerns.  He gave Karin a list of things reviewing what her daily regimen should include including things she is to do independently as well as with them.  Some of these are things which he encouraged her to push herself to do even when she'd rather not.  He reminded her of the obligation she has to do so, not just for herself, but out of respect for taking care of the donor's gifts entrusted to her care.  Knowing Karin's strong feelings of gratitude for organ donors and their families, his exhortation was sure to inspire her to give it her all even when she is not feeling personally at her best.  Dr. Murray came by and said he is really pleased with her response to the treatment of the labored breathing problem.   Whether the labored breathing had been caused by the rejection or by the pneumonia is as yet still unclear but he feels the medications are doing their job well.  Another biopsy in about a week will tell more about whether the meds have rejection under control.  Before he left her room in CTICU he asked her if she wanted to move back upstairs today.  Of course she said, "Yes!"   Being invited to go back upstairs sends a strong message that things are under control and so it was good to hear she is ready for a move.  Tim said it took him, Linda and Brandon by surprise.  They had assumed a stay in CTICU would be a little more prolonged thinking she would have to be off some of the extra IVs etc. before a move could occur.  Room availability will be a factor so it might still take several days to be accomplished.  Karin isn't packing her bags just yet.  Nevertheless having such a positive report was very refreshing and encouraging to all.  Karin's gastrointestinal tract is still in distress and Dr. Murray said it is another tricky balancing act to control nausea without aggravating the diarrhea and vice versa.  He wants to rule out a possible flare up of her pancreas before considering any pharmaceutical treatment and meanwhile wants her to let her system rest without taking anything by mouth for a while until things quiet down.  This will be hard because she has been craving things to drink.  Before Tim and Linda left they did also manage to take a stroll with Karin down the hall inside CTICU.  Dr. Murray and the unit nurses all seemed to enjoy seeing her on her feet and walking.  They usually see patients in this unit in bed at their sickest and don't always get an opportunity to see them in the more advanced recovery stages. Their obvious appreciation of her progress also encouraged Karin.  This afternoon is scheduled for dialysis so Tim and Linda turned Karin over into Brandon and the staff's good hands encouraged by a good report as they headed home to go back to work. Please continue to pray particularly for Karin's gastrointestinal tract to calm down and for the anti-rejection medications to be effective.

July 22, 2007 at 8:40 p.m.  Karin had some very welcome new visitors today.  From North Carolina, Uncle Paul was back in Pittsburgh for the Marks Family reunion.  He came by with cousin Dave to cheer Karin and to encourage Tim & Linda.  Cousin Chris, his wife Jan and son Hunter also stopped in today.  Tim says Karin had a pretty decent day but is still struggling with some nausea and gastric distress that has been bothering her for the last two days.  It is difficult right now for her to keep down anything eaten by mouth and that is making her feel miserable.  It isn't clear whether this is just a sensitive stomach or a medicine reaction or a change in nutritional supplement formula or a combination of the above.  Karin has been up and about a little today but it would be good for her to be able to move about a little more.  Please pray that her gastric symptoms can be brought under control so she can feel better soon.

July 21, 2007 at 8:30 p.m.  Karin remains in the CTICU over the weekend. She had a restful day. Nothing major occurred, thank heaven. Dialysis was supposed to stop by and do some "filtering," but they have not shown up yet. Karin spent much of the day sitting up in bed. She ate mashed potatoes and some "Tutti-Frutti" baby food that Aunt Marilyn brought for her yesterday. Today she got the last dose of her steroid medicine, at least for now, and she is breathing really well today. She looks nice and clear tonight and is taking all this in stride.

July 20, 2007 at 9:00 p.m.  Good news, Karin is breathing easier today. Her dialysis treatment lasted about 4-1/2 hours and they removed 4 liters of fluid which may be one reason she is breathing easier.  Also they identified the bacteria that is causing the pneumonia so they are able to make sure she gets the correct antibiotic.  They had started her on multiple ones earlier actually so were able to take her off of one other.  She is still in CTICU and was resting comfortably when Linda left her room for quiet hours.  Aunt Marilyn came by to visit and help pass the time.  Karin enjoyed a yogurt smoothie drink today and Linda says the doctor has given them permission to resume some walking tomorrow even though she in CTICU space is limited.  Tim said he hopes to get to drop in on the Marks Family Reunion this weekend but he also needs to shop for new tires before driving his vehicle back home one more time.  Pray for Tim, Linda and Brandon's safety as they all continue to drive extra miles to be able to spend time with Karin.  Pray also that Karin will be strong enough to resume walking tomorrow.

July 19, 2007 at 7:15 p.m.  Linda reports that Karin is doing OK so far today.  She is still in the CTICU.  She was breathing really well yesterday, but today her breathing has been a little more labored.  Tonight that improved somewhat after they added a little more oxygen through a nasal cannula.  Test results from a tissue culture show that she has pneumonia, which could explain the labored breathing.   Also, the latest biopsy does show signs of "moderate rejection,"  They will continue with antibiotics for the pneumonia and they will increase the anti-rejection drug "Prograf" and will also beef up her steroid, Celcept.   Balancing her medications is a real challenge, but her doctor is very confident that "this too shall pass" and they will get her through this.  He says 80% of all patients have some rejection in first 6 months.  Karin has not been on a steroid regimen for a few months because it was causing problems with the healing of her esophagus back in April.  Because they had so greatly decreased steroids he said he wasn't surprised by the moderate rejection.   Increasing the steroids can impede healing of the pneumonia so it is a real delicate balancing act they are perfecting.  Karin did enjoy some sherbet and applesauce today but will probably get a protein supplement through a feeding tube later today to give her a boost.  She will probably be in the CTICU for another day.  As discouraging as it is to hear the doctors reporting signs of rejection and pneumonia, remember that these are both treatable and reversible conditions.  Now is the time to pray for wisdom for Karin's team that they will be able to efficiently and effectively balance out the medications and get her back on the healing track fast.  Karin needs our loving support and encouragement and prayers to help her over this hump in the road.

July 18, 2007 at 7:15 p.m.  Karin remains in intensive care today, mostly as a precaution.  They are able to monitor for any indications of fever and for the possible increased need for use of bi-pap machine for breathing.  However when Linda arrived this morning around 10 a.m. Karin was already off the bi-pap and was part way through dialysis.  She has not run a fever and she has not used the bi-pap all day.  She actually seems very comfortable.  She is resting in bed and watching TV but also talking quite a bit.  She had an upset stomach so they are not offering food right now but she is getting IV fluids and doesn't seem to miss having food. Many of the nurses who cared for her before she went upstairs have been stopping by.  When they ask what she is doing here she responds that she is "just sliding through."  Obviously she is not planning to be there long and Linda says she thinks they will move her back upstairs as soon as a bed up there becomes available in the next few days.  Her room on the 9th floor was reassigned to another patient almost immediately so she will probably get a new room number when that happens.  Right now she has the same bed number in CTICU as she did immediately following her transplant surgery.  Bed 9, CTICU.   Doctors still want to figure out what causes her to feel like she is going to pass put and to become so light-headed when she coughs.  They will be checking on blood flow and they have ordered an MRA which is an MRI with dye.  A CAT scan with dye is sometimes more precise but the dye used is very toxic and only if her test could be immediately followed by dialysis would they consider doing that.  Visiting in CTICU is somewhat more restricted with a quiet time between 6:30 p.m. and 8:30 p.m. so visitors may want to check on times before planning to visit in the next few days. 

July 17, 2007 at 10:00 a.m.  Karin walked a little bit yesterday and had a fairly decent night, She is scheduled for a routine bronchoscopy and biopsy this morning and is resting and on the bi-pap machine while waiting for them to come and take her for the procedure. We will report how things went later today. We are hopeful that the "bronch" procedure will tell them why Karin has been having difficulty breathing lately. If this does not clear up and if using the bi-pap during the day persists, she may have to be moved back to the CTICU. Your prayers for her, her doctors and nurses are essential for her to get completely well.
Follow-up at 9:15 p.m. Karin had her bronchoscopy and biopsy today.  It was about 3 p.m. before they took her in for the procedure and at about 4:40 she was being taken into the recovery room.  The doctors said things went well and they were able to do everything that they needed to do with a balloon to enlarge the opening where it is narrowed leading into one lung.  It is at the site of the transplant surgical connection on that side.  The balloon procedure is one which can be repeated several times before resorting to a stint.   The opening which normally would be between the size of a nickel and a quarter leading into her right lung was pencil sized before today's surgery.  Now it has been enlarged to about the size of a nickel so that is a big difference.  The doctors weren't really sure ahead of time how much Karin's new smaller sized trach tube would allow them do with it in place.  We were praying they would not have to take it out and our prayers were answered.  The doctor had cautioned earlier that it is more difficult for them to use the smaller tube as a channel for the scopes, etc. to do a biopsy or to insert a stent.  They would have had to abort the procedure if going through it would compromise her breathing.  So we are very grateful that they were able to do everything they needed to do.   It was after 9 p.m. before Karin was moved into CTICU for tonight and possibly a little longer as a precautionary measure following this procedure.  Faithful visitor and encourager, Aunt Marilyn, was at the hospital this evening and got to see Karin for just a few minutes while she was being transported from the recovery room to CTICU.  Karin was pretty alert but will probably be feeling the effects of the sedation for awhile yet.  Pray that she gets a good night's rest. 

July 15, 2007 at 11:00 p.m.  Brandon writes: "Karin did not sleep very well last night. She was on bi-pap overnight and the head gear that holds the mask tight over her nose & mouth gets uncomfortable. She received breathing treatments this morning but felt she did not need any till she got back into bed for the night. She spent a good portion of the day sitting in the chair. Karin was not interested in eating much today, but had a yogurt off the snack cart. She seemed that today was a lot better day than the previous days. Karin had visitors today: previous co-workers and good friends Laura Hoke and Jody Burkholder, along with Jody's husband Mark, a good friend of mine, who drove them. Karin enjoyed seeing them and shared a few smiles. Later in the evening she talked to Gram and my sister Kelli over the phone, and also talked with her Mom & Dad. Her cousin Rachael got married on Saturday and they sent an email to us today with some pictures of everyone wishing us well. That really cheered both of us up, especially the one where everyone was giving a "thumbs up" sign, and we wish all the best to Rachael & Ryan, too."

  

July 14, 2007 at 10:00 p.m.  Brandon writes: "Karin woke up early today from a fairly decent sleep. She received breathing treatments every two hours. She did not use the bi-pap machine today. She continues wheezing as she breathes but not nearly as badly as on Friday. Her constriction is at the site of the anastomosis (where the lung connections were made during the transplant). I was told that it was not as bad as expected. We are still waiting to see if her cultures grow anything so they can give her a specific antibiotic. Karin sat in the chair today during a movie, for lunch, and while we had visitors. Aunt Marilyn & Uncle Bob visited this evening for about three hours. Karin does not have much of an appetite - I think it may be the hospital "food." I thought baby food might appeal more. She seemed to agree, so I am going to get some in the morning for her to try. After the show "America's Got Talent," she is going to call it a night and head for bed."

July 13, 2007 at 11:30 p.m.  Karin awoke early this morning and was experiencing shortness of breath and wheezing. Respiratory Therapy was called in and they administered a breathing treatment and suctioned up some sputum, which is being cultured. Checking the results from yesterday's bronchoscopy they discovered some stenosis (thickening or narrowing) in a passage in her right lung, so they put Karin back on the bi-pap machine to open up the air sacks in her lungs, She slept all day and continued using the bi-pap through dialysis this afternoon. She did not consume much food, except for drinking a few strawberry smoothies that Brandon made for her. Karin has been put on steroids and antibiotics and there was some mention about her possibly having to go back to the CTICU. Tonight she is resting well and appears to be feeling better thanks to the bi-pap and breathing treatments. Please keep Karin and Brandon in earnest prayer - she has been doing so well and we hope this is only a minor and temporary setback.

July 12, 2007 at 10:00 p.m.  Karin had another sleepless night last night, but today was very busy for her. This morning she had a bronchoscopy to make sure her stent was in the right spot in her airway and not causing the fainting spells. When she arrived back she had some lunch. Mashed potatoes, pureed green beans, and pureed turkey with gravy. She skipped lunch and went for dessert, which was raspberry sherbet. After lunch we had Gram and Pap for visitors for about an hour and had them to cheer Karin on for a walk. Around 3 p.m. we, along with Respiratory Therapy, ventured to Children's Hospital for a milk shake and then proceeded to the patients' pavilion to enjoy some fresh air. When we arrived back Karin rested for an hour then went for a MRI of her brain. When Karin returned, I had made her a banana smoothie that I had picked up ingredients while she was having the MRI. With all the activity today, Karin called it a early night at 9 p.m.

July 11, 2007 at 11:30 p.m.  Karin had a good day today. She managed to get in two 100-ft walks between numerous visits from medical staff. Ellen, an clergy associate of Carol Henley, stopped by to encourage and pray with Karin. Karin got to eat applesauce, strawberry yogurt, a milk shake, and chocolate pudding. They gave her something called a "thickened dairy product" which she said was pretty "yukkie!" Brandon said, "For someone who has not had anything to eat in 4-1/2 months, she sure got picky in a hurry." It must have been pretty bad. About Karin's "fainting" episodes, they have ruled out seizures. She had an ultrasound of her neck and carotid artery today and they plan on doing an MRI. Tomorrow (Thursday) she will get a routine bronchoscopy just to check on how her lungs look inside since she has been breathing on her own from her mouth and nose. Dialysis tonight went rather well and produced two liters.

July 10, 2007 at 9:30 p.m.  For a while today Karin looked like a Smurf when she smiled. That's because the Speech Therapist used a blue dye to do the swallowing test which Karin passed with flying colors! She is now permitted to eat soft foods like yogurt, applesauce, smoothies, pudding, and ice cream. Basically any food prepared in a blender, but she turned down the idea of putting a pizza through the blender just so she could eat it. She had about 10 bites of vanilla pudding and about 8 bits of ice cream for starters. She must go slowly until her stomach gets accustomed to real food again - it has been quite a while. She had another sleepless night, so Brandon took her for a short walk at 2 a.m. Later today Karin stood up by herself and walked to the tray table and stood there and brushed her teeth (to try to get rid of the blue dye). Carol Henley, hospital clergy staff person, paid Karin another visit. Karin took time to read Post-a-Notes, but her dexterity is not strong enough yet to pound out responses on the laptop's keyboard. However she did OK holding a cup and eating with a spoon today, Brandon was preparing to give Karin a shampoo tonight using "Mr. Timmy's" special formula for itchy scalp. Don't ask. Please continue to pray they find out why Karin sometimes "passes out" when she coughs. All her vital signs are perfectly normal even during these episodes, so it may take the Lord and Dr. House, M.D. to figure this one out.

July 9, 2007 at 10:40 p.m.  Karin's day followed the old saying, "Two steps forward and one step back." Yesterday was the two steps forward, but today held little forward progress for her. Physical Therapy showed up at 8:30 a.m. and as they tried to get her up and walking, she fainted. They caught her so she was unharmed, but that ended her PT. It seems very recently Karin has been "passing out" from coughing and because all her vital signs remain perfectly normal they are perplexed as to what is causing it. It may be a side effect of one of the medicines she is taking, but to try to determine if it has anything to do with her physiology, they ran an EEG to measure her brain wave activity after the fainting episode this morning. They may also do an MRI on her head tomorrow. Later on today they let her take one short walk until they can figure out what's going on. Speech Therapy did not stop in today so there was no swallowing test today. Dialysis showed up around dinner time and will be dialyzing Karin until 11 p.,m. tonight. Please pray they can identify the cause of the fainting and get it under control soon.

July 8, 2007 at 9:50 p.m.  Karin answered the phone herself this evening because Brandon was out of the room, so this report is directly out of her mouth! How terrific. Karin said she is doing fine, but just a little tired and ready for bed. She said she took two of the L-O-N-G-E-S-T walks to date. She covered almost a quarter mile in the two travels today! No wonder she is a "little tired." She told me her Mom and Dad visited today, and she is really looking forward to having her swallowing test tomorrow. Please pray that she will do well and can resume consuming liquids and soft foods by mouth. The hospital has now enabled WiFi for patients, so she has been catching up on reading the Post-a-Notes you have written to her and "cleaning out my email." Karin said she is very grateful for each of you for giving so much encouragement and support to her and Brandon and their families. Karin concluded by letting me know SHE is ready to go home as soon as they will discharge her. And that's straight from "Wonder Woman's" lips!

July 7, 2007 at 9:30 p.m.  Karin spent last night in the CTICU after receiving her new custom trach and returned to her room around noon today. She is doing fabulously! The new trach is not even being used - it is capped off and she is breathing completely out of her nose and mouth, only receiving oxygen through a nasal cannula. It is as though the trach is there just in case her lungs needs to get suctioned out. But they have been encouraging Karin to cough in lieu of suctioning and she has been able to produce phlegm on her own. This is a good thing. Since Karin has not used the bi-pap for two days/nights, they have taken the device out of her room completely! Just to show how much progress she is making, Karin walked two VERY LONG walks today - much longer than any on the past, and even was game to stretch them further when challenged. Since I said the new trach was capped, you may be wondering about the speaking valve - since Karin is now breathing out of her mouth and nose she does not need the speaking valve to speak. We had a very delightful conversation over the phone which literally brought tears to my eyes. What made me melt was hearing her say in her own voice how much better she was feeling in general and how her spirits were buoyed up again. Karin had visitors today, too: Uncle Jack & Aunt Kathy and Aunt Marilyn & Uncle Bobby. Let us give thanks to the Lord for all the answers to all the prayers of so many supporters over so many days, weeks, and months.

Back on June 27th, fellow transplant partner, Karen Arrowood walked in with her husband, Donnie. You may remember Karen received her new heart-double lungs on January 4th and was sent home to Georgia on May 7th. She was back to UPMC for her first 2-month follow-up check-up and visited with Karin. Here is a picture of Karen (the blond) and Linda Marks (our Karin's mother). Karen A. and Donnie were very encouraging to Karin and very motivational. Karen A. identified with our Karin's challenges, saying how she remembered the discomfort of using the speaking valve, or the challenge of extended walks, or the bi-pap hook-up's, etc., At one point Karin coughed and Karen A. said, "Oh! I remember how that felt!" Karen A. today is no longer using oxygen, able to lay down to sleep, going to the mall and walking all the floors, and even flying to Pittsburgh for the first time without medical papers and oxygen. As you can see, she looks MARVELOUS! She has been a blessed inspiration and motivation for our Karin. The two "Special K's" were able to converse with each other audibly for the first time ever, thanks to the speaking valve.

Please check Karen Arrowood's blog periodically and send her a note of thanks and encouragement, too.

July 6, 2007 at 10:40 p.m.  Karin received her new custom trach at 2 p.m. this afternoon. The procedure lasted until about 3:30 p.m. because the surgeon also installed a stent in her airway to reinforce it - he found some scar tissue in there and took this preventive maintenance precaution against more scar tissue forming. Karin is in the CTICU overnight for close monitoring and observation and is expected to be moved back to her room sometime Saturday afternoon. Brandon reported everything is fine and Karin was receiving dialysis when he left to go home for the night. He also reported Karin said the new trach made it easier to speak, but she is not sure if swallowing is easier or not yet. She is now able to cough up phlegm into her mouth when she coughs. The new custom trach is about the size of a soda straw and Brandon believes this is the smallest and final step down to the 4-mm size. All in all, Karin's spirits are good and she cannot wait until the Respiratory Therapist comes on Monday. One of the accomplishments Karin must make in order for them to remove the trach completely is to go off the bi-pap - she went all last night without it and will attempt going all night tonight without it. This is another positive step toward discharge. Brandon was able to meet with another family today that is facing a heart transplant and to counsel them about fund raising. While in the CTICU this evening Brandon was able to visit again with a patient named Sherry who needs a double lung transplant but cannot receive it because of a virus she seems unable to shake. Brandon asks we remember to please pray for her, too.

July 5, 2007 at 9:30 p.m.  Don't be surprised if you call Karin's room and Brandon answers, "Legacy Shampoo and Hair Salon." I thought I had dialed the wrong number at first, but when I realized it was him, I made an appointment for a wash and style job. Karin had a good day today, She got in two long walks, her blood pressure was stable and her heart rate came down and was also stable. Both grandparents visited this afternoon, and she had a visit from a female clergy person who was making her rounds. She must be in good standing with the Almighty because someone from downstairs came by later to have Brandon sign the consent form for Karin to have her new custom trach installed tomorrow! This person explained that it is very flexible, she compared its flexibility to that of an IV line, and Karin will not require - NOT REQUIRE - any new incisions. Hallelujah!. The surgeon had a cancellation for tomorrow and Brandon thinks Karin might be his first patient in the morning, but he is not sure of the exact time Friday. Brandon said they should not have to put Karin out completely, typically. He said it will be a long weekend waiting until Respiratory Therapy gets there on Monday to administer a swallowing test and recheck the speaking valve. We have all been praying devotedly for this new custom trach for Karin and it looks like our prayers will be answered on Friday. God is good!

July 4, 2007 at 9:10 p.m.  Brandon reports that Karin had another day of R & R today, following the excitement of Monday night and yesterday, and given that today was a holiday and staffing was limited. Dialysis did show up but it did not go well for Karin. Her blood pressure dropped markedly and they had to quit dialysis before finishing. One of the heart-lung doctors checked Karin over and did not find anything out of order medically, Brandon thinks that perhaps Karin has been over-dialyzed recently because they took additional fluids off last Friday and then again on Monday.  Karin was not on bi-pap today and had no problems at all breathing. Brandon said he can tell her breathing is getting stronger because he could actually hear her voice without the speaking valve installed while she was on bi-pap during dialysis on Monday. Tomorrow they plan on getting back to her walking and exercise regimen again.

July 3, 2007 at 9:00 p.m.  Brandon and Karin had a very stressful morning. It all began last night when Karin simply could not get to sleep. She was up all night and was uncomfortable. She had the nurses there on the run all night but every time they checked her everything seemed alright to them. In fairness to the nurses, they can't give Karin medications unless they have orders from the doctor. Any pain medication stronger than Tylenol will stay in her system until it is removed through dialysis and if it makes her too relaxed, then she needs assistance from the bi-pap to breath and they don't want her to become dependent on that. This morning Brandon bathed her and got her seated in her chair but her breathing was labored, and she seemed troubled and anxious and when her oxygen saturation level dropped he put her back into bed and summoned the nurse(s) yet again. The respiratory tech was called in immediately. She listened to Karin's breathing and then "bagged" her - not once but several times. Then it was time to call in the big guns - Dr. McCurry (heart transplant surgeon) himself was summoned and showed up immediately. Dr. Ferson, the respiratory physician who did Karin's trach work, was paged but never showed up. Brandon said Karin's room was filled with medical staff - ALL the nurses on the floor were there. They did a bronchoscopy immediately there in her room to determine if her trach had moved, but found everything was fine. They did some minor cleaning at the base of the trach and said everything looked fine, then all scratched their heads. Brandon offered to them the possibility that Karin may have been so out of sorts and uncomfortable last night because of finishing dialysis at 10 p.m. (they never started until 6 p.m.), then attempting to sleep all night without the bi-pap. Perhaps all this threw Karin off schedule, so to speak. Clearly her heart rate was rather elevated. The medical staff agreed that may have been the issue.
      So the rest of today was a day of R & R for Karin. She was put on the bi-pap, then off for three hours, then back on again and is sleeping at this writing. One good thing did come out of all this - Dr. McCurry was not pleased about the delay in Karin getting her new custom trach and he "requested" things be expedited. The new trach is indeed at the hospital now and all Karin has to do is wait until the respiratory surgeon can schedule the procedure to install it. Probably next week. Please ask the Lord to bless Dr. McCurry abundantly - that man is awesome!   Have a Happy Fourth of July!

July 2, 2007 at 8:00 p.m.  Karin was up this morning and walking first thing.  X-ray usually comes to her room between 4 & 7 a.m. but they were late today.  ;Because they were off schedule they had a hard time finding Karin available.  The first time she was walking with PT.  The second time they came, Brandon had taken Karin down to the 3rd floor for an outing in the private patient pavilion. X-ray began questioning the need for them to come to her room since it must have seemed to them that she was out gallivanting.  Actually Karin had not been outside in some time so she was really overdue for some fresh air.  She seems to be feeling a little cabin fever and a change of scenery of the right kind was definitely warranted to try to raise her spirits.  An outing takes some extra preparation and a nurse needs to accompany her.  It is a matter of scheduling and staffing, too, so it can't be done that often.  Dialysis was scheduled between 1 & 2 p.m. but was unable to start until 6 p.m., which means Karin will be in dialysis for most of the evening until about 10 p.m.  Karin requested that she be allowed to go off the Bi-pap longer at night and Brandon said he thinks they are just going to let her try sleeping without it at all tonight.  She is still waiting for her new custom trach and it is somewhat discouraging to see how long that is taking.  It is important for several reasons: in addition to being able to use the speaking valve with more regularity it will also facilitate the introduction of liquids and soft foods to her resting stomach and kidneys.  When Karin starts taking liquids by mouth, it will take another adjustment for those her stomach and kidneys to get back to doing their jobs again.  The 4th of July is this week and Karin needs something to celebrate so please pray for her to have some sparklers of encouragement this week.

July 1, 2007 at 9:00 p.m.  Brandon says Karin was feeling a little tired today but still was up for a surprise visit with Uncle Dan, her brother Scott, and nephew Hunter.  Hunter was a little uncertain about things at first but soon warmed up to Aunt Karin. According to Uncle Dan, "Karin looked really good, walked goo, and her breathing was good."   She used her little machine that she uses to practice breathing deeply while he was there and also took a walk of about 200-250 feet.   In fact he said he was impressed with how easily she seems to be breathing even after walking that distance.  He said Karin needs to be reminded to use her voice once in a while since she grew so used to communicating by nodding or shaking her head & in other ways for four months.  But of course Dan said it was great to hear her talking during this visit.   Mondays are typically busy days so she and Brandon plan to wind down this evening by watching a little TV tonight.  Pray that they both get a good night's rest and that the custom trach arrives soon.