From now on we will plan on posting just one update daily, usually at the end of the day. If we have any major developments we will let you know with additional posts. We were just finding that information is changing so fast, that often it is best to wait until the end of the day when we have all of the details to report.

The major development of today is that Dad has had what the doctors call a "setback".  During the night Dad's fever spiked to 40c (104f), which is unusually high for an adult.  They were able to cool his body temperature down with a body ice pack.  

The concern with the fever (and a change in his white blood cell count) is that they feel that it indicates an infection of some type.  Urine cultures, blood cultures, and cultures from the lungs were not positive for infection, which leads them to assume that the infection is in his Cerebral Spinal Fluid.  This type of infection is also known as meningitis (but it is not the super scary kind that you hear about in the news).  They have started him on an array of major antibiotics to try and take care of  the spinal fluid infection, or whatever type of infection it may be.  The tricky part is that we many never know for certain if it was a CSF infection or what type of infection it is. Any spinal fluid samples that they take may not show infection, as he is already on antibiotics. The antibiotics would suppress the culture from growing.   The doctors felt that it was important to start the antibiotics immediately rather than waiting for any spinal fluid cultures to be tested.

The spinal fluid infection is most likely caused from the tear he has in the membrane of his brain that is allowing spinal fluid to leak from his nose.  Bacteria can enter through that tear and cause infections.  It is very important that the spinal leak is repaired, or the risk of infection will remain.  So today they took steps to repair the leak.  Today Dad had a "spinal drain" procedure, to drain his spinal fluid down.  They placed a tube in his lower lumbar (similar to an epidural) to drain the fluid.  The purpose of this is to relieve pressure in the brain so that the CSF leak can seal.  This can happen fairly quickly, or it can take weeks.  If it is not successful, they will have to enter through the nose to try and patch the leak, or, as a last resort, go in through the skull to try to repair it.  The issue is that these leaks can be very tricky to locate, like finding a needle in a haystack.  We are obviously really hoping that the spinal drain will work and the leak will seal off on its own and that the additional measures will not be necessary.

Dad's infection is weakening him and may slow the healing process down in other areas as well.  
The goal is still to get Dad off of the ventilator, but he did not make any progress in that area today.  They are still waiting for him to cough.

We continue to hope that they can remove the ventilator soon so that Dad can be more comfortable.  We would also like for them to take his neck brace off.  We are hoping that the wrist surgeon will be able to replace his exterior wrist screw with a titanium one so that the MRI can be done tomorrow to rule out neck injuries.  This needs to be done before they take the brace off.  It is so hard seeing Dad so obviously uncomfortable.  When he is alert he often thrashes around trying to get all of the various paraphernalia off of his body.  He has been nicknamed the "master manipulator" by the nurses because he is so good and finding ways to wiggle out of the compressors on his legs and the ties and straps on his arms.  When we talk to him it feels like he is pleading for us to help him out and make him more comfortable, so it is very difficult to see.  This is especially hard on my mom.    We feel that once he can get the ventilator out, he will be much more calm, so we would really love to see that happen soon. 

When Dad gets agitated, his blood pressure shoots up (above 200 sometimes).  Dad has never had high blood pressure before, so this is a bit concerning.  He has now being given blood pressure medication to help control that.

On a positive note - Mike noted that this morning was the most alert that he has seen my dad.  My dad was properly responsive to the neuro team when they stopped by. 

Tomorrow will be a week since the accident occurred.  As a family we would have loved to see more progress made up to this point, but realize that this whole situation is going to require much patience and love on our part.  Dad is physically starting to look much better and less swollen and more like himself.