Picture not drawn to scale

When we're at the hospital, I carry around a small pad to take notes about everything that is going on with Lewis. In one of our updates today, the surgeon borrowed the pad and drew a picture to help explain what they believe is causing most of the complications. He apologized for his poor drawing and he didn't give me permission to distribute it, but it helped me understand what they think is going on. It looked a lot like this...

Lewis' stomach

The circle at the top represents the Nissen Fundoplication. On the right side, there is a small circle - that's where the g-tube goes in. The circle at the bottom is the pylorus, at the bottom of the stomach, above the intestine. Right now, the end of the g-tube is right around the pylorus, or maybe just a little past it. If you look closely, you can see that he's drawn where the g-tube should empty into the stomach, right in the middle. The end of the tube is in the wrong place because of the shaded area at the lower right. That shaded area is the hematoma (bad bruise) in the stomach wall that was caused by the first g-tube insertion, which didn't go right and had to be done again. They think the swelling from the hematoma may be compressing the stomach, pushing the g-tube too far down and causing a partial blockage. The fundoplication keeps that air from going up. The blockage is keeping air from going down. The g-tube has been pushed out of place, so the air can't vent out that way, either.

Based on this hypothesis, they put in a naso-gastric (nose to tummy) tube to vent out the air this afternoon. Here's how this is impacting everything else:

Respiratory - still on the ventilator. They believe the swelling in Lewis' belly is putting pressure on his lungs - making it hard for them to expand. When they get the swelling resolved, he should be able to get off the ventilator. As of this afternoon, the doctors hoped to have Lewis breathing on his own within 24 hours.

Feeding - right now, nutrition is coming through the IV. The g-tube placement won't keep them from feeding Lewis through it. There's no problem with the food going into the belly a little lower, as long as the naso-gastric tube stays in to vent air. However, the g-tube position will need to be corrected before Lewis is able to come home. We're told that shouldn't require surgery, but it has to wait until the wound is fully healed. Best guess - a week or so, at least.

Blood Pressure - still up. They aren't sure why, exactly. They just finished a sonogram of the kidneys to see if they can figure it out. It is likely to be a circulatory issue within the kidneys. The doctors seemed confident this could be resolved with medicine, when they figure out what is causing it.

Fever/Infection - fever seems to have gone away, but they still aren't sure that Lewis doesn't have an infection. If there is one, it may be an inflamation in the abdomen from stuff that leaked out during surgery (peritonitis).

They're looking over the ultrasound and considering adding a second antibiotic now. Hopefully this stuff will start kicking in overnight.