Pop is about the same today and his nurse said he had a good night. We are busily loading the van and the final "push" is on to "Get Outta Dodge" and head to the cottage on the South Channel. The next blog post will not be until this evening, live from Seven Mile Narrows. Hang in there Pop, you are the consummate tough ol' bird!

Johanna and I went to visit Pop late tonight and his condition was unchanged. Although he is stable, he is still critical and appears to be completely exhausted. He has not been as responsive to our presence as he was a couple of days ago, but this is the way it goes for patients as sick as Pop is. We know the roller coaster car is still firmly on the tracks, but the ride is far from over. I want him to get better as quickly as possible, but came to the realization tonight that Pop will likely be in the ICU for quite some time as he regains his strength. I brought my iPod with me on tonight’s visit and asked his nurse Joanie if it would be ok to play him a tune or two. She said that would be a wonderful thing and beneficial for him. I hooked him up with the iPod ear buds and played “Bridge Over Troubled Water” by Simon and Garfunkel and “Year of the Cat” by Al Stewart for him. His eyes opened a little and I think he enjoyed the tunes.

Suzanne, Kiera, Kiera’s friend Erica, Ian, Elijah, and I will be heading to Parry Sound tomorrow morning. Saturday is Dominion Day, also known as Canada Day or Canadian Independence Day, and I plan to conduct the second round of water testing on Monday after the flurry of long weekend recreational activity abates. This is the optimal time to take water samples and will highlight the impact humans have on the fragile ecosystem of Georgian Bay Thirty Thousand Islands area. Pop would certainly approve. Given his stability, we are comfortable with heading north and will be just five hours away should anything happen. It seems to be a good time to take a break from things and I’m looking forward to getting back to our beloved South Channel. Mom will be staying at our home while we’re away and will keep us updated with Pop’s condition. This will give both her and Johanna some much needed quiet time to recharge their batteries.

Brenda Lind will be undergoing surgery tomorrow to repair her broken kneecap. As we sit by the fire at the cottage this weekend, I won’t be able to keep from occasionally thinking about Brenda’s now famous line “Watch it burn!”, which she uttered as one of Pop’s primo pieces of hardwood was thrown onto the campfire at the cottage. Pop has become a connoisseur of fine firewood and thinks that junky pine is the only wood suitable for an outside campfire which you roast marshmallows on. Although he is generally a good sport about all of us descending on his cottage and disturbing the tranquility of his island paradise, that time he really expressed his displeasure with us burning up his “good wood” for such folly. Later on, we all had a good laugh about that night (including Pop) and the tale has become that of family legend. Good luck Brenda with your surgery tomorrow.

Pop's condition is mostly the same this afternoon. His ventilator settings are unchanged, with the PEEP still set at 16 and the FiO2 level at 40%. Pop's heart rate is in the low 70s and his blood pressure is normal. His rash is coming back and he now has a new spot on his foot. The doctors suspect it may be a reaction to one of the other antibiotics they have given him and are considering stopping it altogether, since he may not seriously need it right now anyway. Pop underwent dialysis again this afternoon, but they were only able to remove 3.8 liters of excess fluid before the machine was whisked away because it was urgently needed for a crisis situation with another patient. Channel Man is still sailing in a thick fog bank and has not been awake much at all today. The dialysis treatment doesn't help things because it makes him so tired. Rest up Pop!

And the roller coaster runs on...

Pop had a more difficult time breathing and staying saturated last night, so the doctors put him on an IV of Propofol, a short-acting intravenous anesthetic, to help calm things down. It seems to have done the trick, as they have discontinued the Propofol drip and he is resting comfortably and doing well this morning. The rash on his arm is starting to clear up and things are on track for another round of dialysis today. Yesterday, the nursing staff made a point of telling us that Pop is finally relatively stable after a couple of bumpy weeks. This is good news. Fight, Channel Man, fight!

Pop continues to do well today. However, he is exhausted from all the treatments and changes, especially the dialysis session yesterday. The nurses tell us that undergoing dialysis really zaps the energy out of you. During yesterday's session they removed a whopping 4.9 liters of excess fluid, which weighs about 11 lbs. Pop's weight last night after dialysis was 394 lbs and today he weighs in at a hefty 390 lbs. He started to display a rash on his arm today, but the doctors think it may be a reaction to erythromycin. Go Pop Go! You are one tough old bird, that's for sure!

Pop continues his journey down the road to recovery and is doing well today. The PEEP setting on the ventilator is down to 16 and his O2 saturation is still stable. His nurse will be stopping his IV of the sedative Ativan this morning and delivering the small dose he is still on via a feeding tube. His eyes are open and he is awake, but he's still in a very deep fog.

Pop continues to get a bit better tonight. His heart rate is 65 and his blood pressure is strong. His respiratory function is improving, so they lowered the PEEP setting on the ventilator to 18 and his blood oxygen saturation is maintaining at a robust 99%. He looks comfortable, but exhausted, and is not as responsive as earlier today and obviously wants to sleep. We are all very encouraged by his progress today. Fight, Channel Man, fight!

Another medical tragedy has befallen friends and family today. Brenda Lind, one of Johanna’s dearest friends and a close friend of the Topping family, fell and seriously broke her patella today and is now one of the walking (or not walking) wounded. Brenda has been a constant supporter of Channel Man Stan and our family during this difficult time and has been a regular at the hospital. Her presence there will be missed (until she shows up there on crutches sometime, that is). Our prayers go out to Brenda for a speedy recovery.

I wanted to say one other thing in relation to Kiera’s high school graduation. Before Pop got sick, he strongly expressed to Mom that he wanted to buy Kiera something for her graduation that she would have forever and that would be a keepsake remembrance given from them in celebration of her accomplishment. Mom had other ideas, but Pop won out and bought her a pair of beautiful aquamarine and diamond earrings, which Mom presented to her at her luncheon on graduation day. This is so typical of Pop. Channel Man has good taste in jewelry, and Kiera was delighted with her gift and cherishes them.

Goodnight Pop. Goodnight World. Goodnight Moon.

Pop is steadily improving and the roller coaster ride is a bit smoother today. However, we remain cautiously optimistic because the nature of roller coasters is to lull you into a false sense of security, and then scare the bejesus out of you.

I just got back from the hospital where Pop is undergoing dialysis and things are going well. He is awake. Yes, awake! He is still in quite a foggy state, but his eyes are open and he can move them, and he is responsive to people around him and can respond somewhat to questions by blinking his eyes. His blood pressure and respiratory function are good, and his intestinal tract is unstoppable at this point (at least I’m sure that’s what his nurse thinks!). The doctors will be aiming at removing 4.5 liters of fluid during his treatment and will clean his blood again as well, as there is a full schedule of ICU dialysis patients lined up for tomorrow. The current plan is to skip treatment for Pop tomorrow to give someone else a turn. He currently weighs in at a hefty 404 lbs, but will probably be about 10 lbs lighter than that about three hours from now if the dialysis treatment goes as planned.

Channel Man Stan is still slowly trekking down the path to recovery this morning. I spoke with Wendy, his nurse today, and she said he had an uneventful night and that they had slightly lowered the settings on his ventilator because he was doing so well. His intestinal function is moving along (pun intended), and he will be getting an abdominal x-ray later this morning to take a closer look. Wendy also said she discontinued infusing him with Fentanyl, the narcotic pain reliever he was receiving, and that he should become even more alert by mid afternoon. This is the first time since he was at the Hospital in Hornell that he has not been receiving it, and that is a very encouraging sign. We’ll know more about the treatment plan for today later this morning after the doctors have consulted and completed their rounds. The ride goes on.

Sounder is doing better this morning and continues to improve as well. He isn’t quite as zippy as usual, but seems to still be on the mend like his owner.

Pop’s condition is still improving tonight. Pam, his nurse on the overnight shift, spoke with me at length about his condition and said the doctors and staff feel upbeat about his recent improvements. His vital signs are all good and his heart rate is in the mid to high 50s tonight. The dialysis treatment today was successful at removing four liters of excess fluid and he tolerated it well without the help of norepinephrine. He now weighs about 410 lbs, but his weight is on its way back down again as the fluid comes off his body. Pop opened his eyes for me several times this evening, but wasn’t as responsive as he had been this afternoon. I asked him to blink twice in response to a question and he seemed to make an effort, but he may have been too tired to be able (or want) to make it happen. Pam said he frequently opens his eyes when the nursing staff is moving him around and sometimes he grimaces like he is getting annoyed at what they are doing. That’s Pop! Rest up, Channel Man. See you tomorrow!

Pop continues to improve today. His heart rate and blood pressure are pretty good and his blood oxygen saturation is doing so well that the doctors will start lower the pressure settings on his ventilator again. The dialysis machine was in the doorway of his room this afternoon and they were getting ready for another treatment to clean his blood and remove some excess fluids. Mom reported that Sounder was also improving today. Remember, like owner, like pet.

I got some excitement in the ICU today when I first got in to see Pop. Mom was there and Pop had a sheet pulled over him and tucked in on all sides with a warm air blower blowing air under it. I felt his foot and it was very warm, and I know his body tends to “run hot” at the cottage as he frequently goes around with shorts and no shirt on. When I got next to his side I started talking to him like I usually do, and then his eyes popped open. Not the kind of open like you’re squinting or staring out in space, but he had his eyes pretty wide open and he was focusing on me and trying to follow me when I moved with his eyes. Mom was surprised and watched as I told Pop where he was, what had happened to him, about the graduation and anniversary weekend, and doing water testing in Parry Sound. During this time he kept his eyes open, moving them and blinking occasionally, and he seemed to understand and respond to what I was saying.

The real excitement came when I explained the “tent” over him and asked him if he was too warm. I told him to blink his eyes once if he was too warm and wanted me to have the nurse turn down the heater. I was in complete disbelief when he immediately blinked both eyes closed once and then back open again. Mom saw all this and got excited too. To make sure it wasn’t a fluke, I told him I wanted to confirm that he understood me and again I repeated the question, asking him to blink once and only once if he was too hot. He then deliberately blinked his eyes once again. Mom and I were about ready to dance around the room at that point, as this was the first time in a month that we have had two-way communications with him. I am confident that this wasn’t a fluke and will ask him to blink twice for something when I see him again later today. Go Pop Go!

The roller coaster ride goes on… but there is more good news this morning and the ride seems not quite as unpleasant at the moment. Sounder and Channel Man continue to make strides in their recoveries. Sounder has begun to drink more water and eat larger quantities of his special food, and even more importantly he is keeping them down. At the hospital, Pop had a good night and his vital signs are good. His lung function continues to improve and he is critically stable. His intestinal tract is rumbling back to life and doctors can hear things moving along inside him again, which is a very good thing. He had the day off from dialysis yesterday, so they will likely be resuming the sessions today and will undoubtedly be continuing to work on the “de-Michelinization” effort.

The news is good this evening. Both Sounder and Channel Man Stan are doing better tonight. Sounder got through his initial dose of medicine and has started to be able to drink a little water and eat small amounts of a lean specially prepared beef and rice mixture. Go Sounder! Meanwhile at Highland Hospital, Channel Man Stan continues to hold his own. His blood pressure and heart rate have improved and he still doesn’t have a fever. The ventilator FiO2 level is set to 40% and his blood oxygenation is very good. His abdomen is still quite distended, but hopefully the drugs and frequent position changes will help relieve things. The doctors took him for his first ride during his stay at Highland and wheeled him down for a CAT scan of his abdomen. Hopefully tomorrow we will hear more about what the doctors see on the scan. Pop is getting two doses a day of 200 mg each of itraconazole, once in the morning and once in the evening. In addition, his pain and sedation medications have been lowered significantly. Tonight he moved his eyes and tried to open them in response to me talking to him. It is very apparent that Channel Man Stan is in there somewhere! Fight, Channel Man, fight! Happy Anniversary, you tough old bird.

My Mom enjoyed a delicious relaxing meal with us tonight in celebration of Mom and Pop’s anniversary. She was in good spirits and headed to Johanna’s afterwards with Sounder. Thanks Mom, for making the delicious strawberry rhubarb pie! I think everyone will sleep well this night.

During the three and a half hour saga with Sounder at the animal hospital today, they finally ended up giving him a bolus of fluids to fight his dehydration. This was injected under the skin of his back and sides, and could easily be felt with your hand when touching him. It was cold and sort of like a water balloon. Then it hit me! Did you ever see pictures of people and their dogs that highlighted the fact that many pet owners choose pets that bear some resemblance to them? Pop’s dog Sounder suddenly seemed to have a lot in common with Pop. Today, Sounder was Michelin Dog!

Today is Mom and Dad’s 46th wedding anniversary. Mom started the day early and visited Pop this morning at around 7:00 AM to wish him a happy anniversary. We will be having dinner together tonight in honor of this very special occasion. Happy anniversary Mom and Pop! We love you both to pieces.

I didn’t get a chance to do my normal morning blog post today because a new crisis was breaking that needed my immediate attention. Mom called me from Johanna’s house around 8:30 AM after she got back from the hospital and asked for my help with their almost 10 year old Golden Retriever named Sounder. Sounder had been vomiting violently and my mom needed to get him medical attention fast. Sounder has been diagnosed with and is undergoing treatment for Addison’s disease, which is the common name for hypoadrenocorticism, or adrenal insufficiency. I called the 24 hour emergency animal hospital to let them know we were on our way and raced over to Johanna’s house to pick up Mom and Sounder, and off we went to the dog hospital. Sounder was quickly triaged when we arrived, but vomited violently several more times there in the office, with a deep elephant roar sound (as accurately described by Mom).

The veterinarian on staff ran blood and urine diagnostic lab work, did an abdominal x-ray, and met with us to discuss the situation. She explained that she believed Sounder was reacting to his disease and was under additional stress due to being in unfamiliar surroundings and on a strange schedule, and also probably was missing Pop. She offered hospitalization as an option, but we decided that Sounder would be less stressed if he was at home if that was at all possible. The veterinary hospital staff gave Sounder injections of the steroid he is on to treat Addison’s, another injection to stop the vomiting, and they gave him a bolus (I sure didn’t think I would run into that word in a different context from Pop’s illness so soon) of fluids to help fight his dehydration. Sounder is resting at our house right now and my mom is busy here baking fresh strawberry rhubarb pies. I can’t wait to get a bite. Mom makes a killer pie crust!

Pop’s condition has improved slightly today compared to last night, which is not very hard to do given his situation, but at least things are heading in the right direction again. His blood pressure and heart rate are up slightly and his blood oxygen saturation is excellent. The doctors have discontinued the infusion of norepinephrine for the time being, as his blood pressure is ok for now, but that may change if they perform dialysis today. His abdomen is still distended and they are giving him drugs to help the situation, but the excess pressure in his intestinal tract is the biggest concern for the time being. Hang in there Pop!

Pop’s condition is back to being very tenuous tonight. The colonoscopy procedure to relieve some of the excess pressure in his intestines was unsuccessful this afternoon, and his abdomen is still very distended. Mom, Johanna, and I spoke with the gastroenterologist right after the procedure. He said they will start trying to treat this with drugs, turning him on alternate sides on a regular basis, and doing other small things to help relieve the pressure. However, his concern is that Pop could end up with a perforation in his intestine, which would be deadly.

One of the things the doctors are doing to treat Pop’s current condition is to decrease the sedation and pain medication he is under. This evening, that had the uplifting effect having him move and open his eyes in direct response to our being there. Johanna and Mom both saw him open his eyes briefly as they were talking to him, and I saw some eye movement when I was interacting with him in the room. We are confident that he is somewhat aware of what is going on and that his eye movements are a result of the combination of lower sedation and external stimuli, like our visits and being regularly moved from side to side and back again. Pop’s heart rate is dangerously low and his blood pressure is being kept elevated with the help of norepinephrine, but he is still hanging in there. Fight, Channel Man, fight!

Once again, congratulations Kiera! Your Grandpa would be proud.

Kiera’s high school graduation ceremony was wonderful! She graduated with an Advanced Regents Diploma with Honors, was recognized for being a member of the National Honor Society, and was ranked 5th in her class out of around 440 students. We are very proud of her and in celebration took her and her friend Erika and Mom to enjoy a lovely Asian luncheon at the Golden Port in downtown Rochester. Yum, yum, it was simply delicious!

Johanna just got off work and called from the hospital a little while ago with an update on Pop. A gastroenterologist was consulted on Pop’s bloated abdomen and determined that with problem lies with gas build-up in his intestinal tract. The two options for treatment are a drug based treatment, or a colonoscopy. The doctors would prefer to use drugs, but because of his general instability and low blood pressure have decided that a colonoscopy is the route they will take. The procedure is scheduled to be performed around 4:30 PM today and carries about the same amount of risk as the tracheotomy they performed under less than ideal conditions. The main risks of the colonoscopy are the possibility that the procedure could cause a perforation in his intestine, and that fact that they have to roll him on his side to perform it and this typically causes him to destabilize as far as his heat rate, blood pressure, and blood oxygen saturation levels go. We are all heading over to the hospital to be there for the procedure and are keeping our fingers (and toes) crossed.

Pop's condition is about the same this morning. The doctor's are growing increasingly concerned about fluid build-up in his abdomen and will be using the dialysis machine later today to remove excess fluid.

Kiera is all dressed in her cap and gown and we are off to her graduation. Congratulations Kiera! We are all extremely proud of you.

Our pop is still hanging in there. Jennifer is his nurse tonight and said things have been quiet in the ICU this evening. Pop is on a drip of norepinephrine to maintain his blood pressure, which now looks good, and his heart rate is normal now too. He received his 200 mg dose of itraconazole around 10:00 PM and is physically looking better tonight. The doctors say it takes a typical patient about two days to mostly recover from the trauma of undergoing a tracheotomy. He is still not outputting a lot of fluid volume, but will be undergoing dialysis again tomorrow to help alleviate the problem. The doctors have now installed a new Quinton catheter, the port used for the dialysis, in the other side of his groin. Pop has swelled up pretty good again in these last few days and is in dire need of "de-Michelinization". He would make a good sumo wrestler right now, but the ventilator might get in the way. Sleep tight Channel Man.

Pop's condition is mostly unchanged today. His blood pressure is good and his blood oxygen saturation level is ok. His heart rate is a bit low at around 45, but this also has the positive effect of giving his heart a rest. They have discontinued infusing him with atricurium, the paralytic agent they gave him to do the tracheotomy, and they will be starting to decrease the sedative Ativan to allow him to become more conscious.

I spoke with Rose Ann This morning, Pop’s nurse for this shift today, and she said Pop had an uneventful night last night. His blood pressure is good, he doesn’t have a temperature, and he is stable. His heart rate is running a bit low, but this seems to be somewhat normal for him. Rose said the doctors had not changed the settings on the ventilator, but that his blood oxygen saturation was currently at 100%. Perhaps this is a sign that the tracheostomy is already having a beneficial effect. The doctors have not yet started to do their rounds, and Rose said it looks like they will be running late again.

My daughter Kiera (Channel Man Stan’s granddaughter) will be graduating from high school tomorrow morning, and this weekend the focus will be on her. Kiera has just finished up a very successful senior high school year and has been accepted at the University of Rochester. She is enrolled there for the fall semester and is very excited about the college experience. Kiera also applied for and was accepted into the REMS program at the U of R. REMS is an acronym for Rochester Early Medical Scholars, which is a fairly elite program for pre-med students at the U of R. She was one of 10 students selected out of a very competitive field of over 1,000 applicants, and realizes that being chosen as a REMS student is a very big honor. Kiera plans on attending medical school at the U of R and the REMS program guarantees her acceptance into the U of R School of Medicine, as long as she successfully makes it through her undergraduate years of study and maintains a reasonable grade point average. No medical school applications. No MCAT exams. No stress about getting into a medical school. It looks like Kiera is on the path to being a doctor.

We are extremely proud of Kiera and her accomplishments and wish her the best as she begins her college education and future career in medicine. Congratulations Kiera!!!

Dr. Hirokawa just came out into the ICU waiting room and told my Mom and sister that the tracheotomy has been completed and Pop is fine. The respiratory therapists and nurses are finishing up the post-surgical procedures and Dr. Hirokawa said he will provide more details in a little while. We are all relieved and breathing a little easier now, especially Pop.

Johanna and Mom are presently in the ICU waiting room as Dr. Horikawa, a top surgeon at Highland Hospital, prepares to perform a tracheotomy on Pop in his room in the ICU. Pop's condition has been less stable the past two days, but Dr. Horikawa consulted with Mom a little while ago and said he felt that the procedure could be performed safely. Members of the ICU staff have repeated ad nauseam how skilled Dr. Horikawa is and that the surgery will be fairly quick. Johanna has worked with him before and confirmed that to be the case.

We are now rounding a sharp turn on the roller coaster...

This morning I spoke with Dr. Morgan in the ICU. Dr. Morgan is a pulmonologist fellow, which is a doctor accepted into an advanced specialty training program that deals with diseases of the lungs and the respiratory tract. Fellows evaluate and care for pulmonary patients under the direct supervision of an attending pulmonologist. Dr. Morgan said that Pop is about the same as he was last night, but that he had taken “a few steps back” yesterday as a result of a secondary infection. The lab results came back overnight identifying the secondary infection and the doctors have broadened the spectrum of antibiotics to treat it. They believe this infection was responsible for his fever last night and had caused his breathing to be labored.

Dr. Morgan also said Pop’s renal output had slowed and that the diuretic Lasix did not seem to be effective at increasing it. However, she said that this is a normal side effect of a secondary infection and that they will remove excess fluid through dialysis today. The current plan is to move forward with the tracheotomy this afternoon, provided he doesn’t suffer any additional setbacks. Dr. Hirokawa, the surgeon who will be performing the tracheotomy, will be consulting with the medical staff in the ICU this afternoon and then making the decision as to whether the “trach” can be safely done given Pop’s condition at that time. The doctors firmly believe that a tracheotomy will help improve his respiratory function significantly.

I just returned from the hospital, and Pop is still holding his own. Mariah, his nurse tonight, said his vital signs weren’t as strong as they had been recently, but that they were all within acceptable ranges. He was sweating profusely when I got there, but he had taken a fever earlier and Mariah had given him a dose of Tylenol that had just caused the fever to break. His temperature was at 37.6°C (99.7°F) when I was there around midnight. The doctors think he may still have a secondary infection and ordered his main arterial line and other lines changed as a precaution, which the nurses and technicians completed this afternoon.

Pop was back on the paralytic Atricurium tonight, but the Attending Physician told my mother today this was a strategy to help lower the pressure settings on the ventilator so they could perform a tracheotomy soon, hopefully tomorrow. The doctors would like everything to be optimal when they do the “trach”, but they feel with increasing urgency that the benefits of getting a tracheotomy outweigh the risks of doing one, even if the conditions aren’t perfect. I suspect they will move to complete the procedure tomorrow unless they really feel his body can’t take it. We are hopeful that this will help him get onto the fast track the track to recovery.

Hang in there, Pop. We are all here for you.

Dad had another “episode” this morning. His heart rate rose very high (~180) and his blood pressure dropped, and he started running a fever again. The doctors administered digitalis to slow his heart down and he was given Tylenol to control his temperature, which has now returned to normal. They also gave him two more units of whole blood to increase his blood volume and help him oxygenate better. We don’t know if this will impact the plans to perform a “trach” on him today, but will getting an update from the doctors this afternoon. Additionally, everyone is concerned about another secondary infection, which is a constant risk for someone in the ICU.

Mom called and said she had just talked with the ICU desk. The report was that things were really crazy in the ICU this morning, but that Pop's night was uneventful and he was still stable. The doctors may be late again doing their rounds, but we expect to be getting an update late in the morning on whether they intend to perform a tracheotomy today.

I just got back from the hospital and Pop is stable and resting comfortably. His vital signs are good and his blood oxygen saturation level is at 99%. The ventilator settings are still higher than they have been the past few days, but tonight they were lower than they were earlier in the evening. The doctors will attempt to continue to decrease the "vent" settings throughout the night to get them back to where they were previously. Pop continues to prove that he IS one tough old bird.

Mom and my nephew Elijah came over for a nice dinner tonight and filled us in on the latest update from the hospital. Pop is still stable, but suffered a temporary setback last night. The Attending Physician in the ICU today said that Pop’s respiratory system had taken another hit last night after the ventilator pressure settings had been reduced to wean him off the machine and prepare for a tracheotomy. He said that Pop’s body had successfully coped with the change for quite a while, but his weakened lungs just couldn’t handle the lower settings yet. He also said that this is not unusual, and that they would start the process of lowering the pressure settings again and was confident that they would eventually get things to be “where they need to be”.

I finished compiling the South Channel water quality testing data from the June 17, 2006 sampling and have posted the numbers on the South Channel website. The results can be viewed by clicking on the ‘2006 Water Quality Data’ link which can be found at Water Quality Sampling.

I made it back home from the cottage and feel accomplished for how much stuff I got done while I was there. I was on schedule to leave the cottage as planned for Parry Sound, but my plans went awry when a cloudburst hit just as I was loading the boat and it started to rain very hard. I waited it out for 45 minutes and then decided to make a mad dash for town when there was a slight break in the downpour, but I ended up getting soaked anyway. Other than that, my trip home was uneventful and I ended up getting to Rochester in the “wee hours”.

Channel Man Stan hit a small bump on the roller coaster last night. Yesterday, they suctioned mucus plugs from his lungs to help clear his airways and improve his blood oxygen saturation and overall lung function. During the night his saturation level dropped, so they had to increase the settings on his ventilator and temporarily put him back on the paralytic to suction his lungs some more. However, he’s off the paralytic again this morning and they are starting the lower the “vent” settings again and will be decreasing them throughout the day. Because of this minor setback, the doctors have decided to wait until later this week (possibly tomorrow) to perform the tracheotomy.

The sun has been shining here at Seven Mile Narrows and the mosquitoes have taken a break, at least for now. Matt from Craganmor Point called this morning and said his wife Natalie was in town and that she could give me a ride back to the island. I was able to zip into down and drop off my Dad’s boat, and Natalie was kind enough to give me a lift back. Thank you Natalie and Matt!

Pop continues to improve and his kidneys have been kicked into high gear, so his fluid is output is good on its own today, without the assistance of the dialysis machine. Lasix and albumin seem to be the magic cocktail. Go, Pop, Go, literally! Dr. Hirokawa, a top surgeon at Highland Hospital, consulted with the ICU staff this afternoon about the details of the tracheotomy and it was decided that hey will do it tomorrow in his room in the ICU. Overall, things look stable and seem to be on the correct trajectory.

The final “push” is underway and I hope to leave the cottage around 7:15 PM. I’ll try and post again after I get home with the latest update.

It’s an overcast morning on the South Channel, with a hint that more showers may be in store for us today. The rain last night slowed to a steady pace, but sufficient in volume and duration to allow it to soak into the peat laden soil. It’s currently 19°C (66°F) and comfortable, and the mosquitoes are noticeably more numerous after being resurrected by the rain.

I’m busy packing up things and preparing for the big “push” later today for the trip home. The just power came back on at 9:10 AM this morning. This is reassuring, as I didn’t feel comfortable leaving without knowing for sure all the lights and electrical devices here at the cottage were in a “turned off” state. Having the power go off is a regular part of having a cottage in Georgian Bay. In our situation, it’s not really so bad since we use propane for our cooking and most of our hot water, and our water system is gravity fed. I pumped our water tank full as soon as thunderstorms threatened yesterday just in case we lost power. I guess I chose wisely.

The report from the hospital was pretty much the same as last night. Pop is still slowly improving and stable. The pressure settings on his ventilator were lowered slightly (IP 65, PEEP 16) and the FiO2 level is still at 40%. The doctors are expected to be late making their rounds today. Since this is a Monday, it will take extra time for the weekend crew to turn things over to the weekday shift. The ICU staff is preparing to perform a tracheotomy on Pop sometime this week. Although this sounds extreme, it’s really a normal step in the slow process of weaning a long term ventilation patient off the ventilator entirely. Having an intubation tube inserted down your throat is very uncomfortable and requires much more effort when breathing. Doing a tracheotomy will lessen the stress from these things and allow the doctors to decrease the sedation Pop is under, so thay can slowly start to wake him up. Click on this link for more information about a Tracheotomy.

The cottage is dark tonight. A series of rainstorms passed over this evening and provided the area with some much needed rain and extended the break from the hot muggy air. The power flickered several times a little before 9:00, and then finally succumbed to the urge to stay off. It came on briefly a little while ago, but experienced cottagers know it usually goes off again until the Hydro boys get it fixed for good. My dad calls it a “little teaser on”, as it will typically stay on just long enough for you to feel comfortable that it’s really back, and then will dash your hopes by going off again just about the time you’ve blown out your candles. I do love rainstorms on the bay, but a little power is a beautiful thing. However, with candles, a laptop computer with battery backup, and a working phone line, the blog goes on.

Channel Man Stan had a good day today and is having a good night. Laura is his nurse tonight, and she said he is doing well and continues to slowly improve. His vital signs are still holding solid and a new combination of diuretics is working like a charm helping him output fluid. Happy Father’s Day Channel Man, you ol’ pisser. Sleep tight, and get well soon!

Pop continues to slowly improve this afternoon. His vital signs are good and he doesn’t have a fever. He got a break from his dialysis treatment today, but will be resuming tomorrow and they will attempt to remove some more fluid during the session. The FiO2 level on his ventilator is at 40% and his tidal volume is running around 400, and the doctors have finally been able to start lowering the pressure settings (PEEP 17). Despite these changes, his blood oxygen saturation remains good. His nurse also confirmed that he will be receiving his daily dose of the antifungal itraconazole. Go, Pop, go!

Weather-wise, it has been a changeable day here on the channel. It started hot and sunny with a bit of a haze, much like parts of yesterday. Early this afternoon a thunder-boomer came quickly through and we had heavy rain for a bit less than half an hour. The rain was needed and welcome, and helped cool things off a little. It is currently a comfortable 23.5°C (74°F) with overcast skies above. With much success, I finished up the water testing today and am in the process of compiling the results. Kineras Bay wins this time for having the cleanest water, with almost no detectable coliforms and no E. Coli. I will post the complete results on the South Channel website sometime tomorrow or Tuesday.

Even though it’s Father’s Day, I wanted to pay a small tribute to my mother. People keep asking me how she is holding up, and my response has been nothing but positive. Throughout this whole ordeal with my father, my mom has just been fantastic. She has been strong, determined, upbeat, and has shown grace under fire. She has also displayed her usual sense of organization and “take charge”, which anyone who knows would instantly recognize. She has been by Dad’s side as much as possible, but has still found time to be a good mother and grandmother. I applaud her, as she’s quite a lady. We love you Mom. We’re here for you, so keep hanging in there.

The last words Pop said to me as he was lying in the ICU at St. James Hospital in Hornell was, “Don’t worry. Channel Man will be back before you know it.” I believed him, and I’m going to hold him to his word.

The report from the hospital was much the same this morning, which in Pop’s situation is good news indeed. Mom called early with the update that Pop’s vital signs are still solid and he continues to be critical, but stable. He has finished his course of penicillin, which was aimed at treating the possibility he has contracted leptospirosis. However, the lab results to date are still inconclusive as to what may have been the source of his illness. My sister Johanna and I still feel deep down inside that knowing well the area that our cottage is located in, and Pop’s exposure background and symptoms timeline, there is a startlingly perfect match for a case of blastomycosis or histoplasmosis. The doctors have mentioned discontinuing his daily treatments of itraconazole, which treats both “blasto” and “histo”, but our family is adamant at this point that they should continue with the antifungal treatments until they can positively rule out these two or any other mycological based illnesses.

Today is Father’s Day. Happy Father’s Day Pop! We love you. You have cared for us throughout the years and imparted to us your wisdom, hardheadedness, and sometimes opinions, but you have been a good father and we honor you on this day, and on every day.

My sister shared some writing Dad did for a meditation for Trinity Episcopal Church, in Canaseraga, NY, on March 25, 2001, for the service of Lent IV. Trinity is the church back home where my parents attend and are heavily involved in. His writing was based on a passage in the Bible from the book of Isaiah.

Isaiah 59:1-15a. “Behold, the Lord’s hand is not shortened, that it cannot save, or his dull ear, that it cannot hear.

It is your own iniquities that raise a barrier Between you and your God.

Dad’s writings on this topic follow below and seem to have been perfectly made for Father’s Day and the way he taught us to approach life. One of Dad’s strongest messages is that we all have free will and that it is incumbent on us to choose wisely. Dad’s writings on his thoughts on this topic, in verbatim, are as follows:

I love the story about the person who cries ceaselessly, “Why me, O Lord, why me? O why me?” On and on. Finally an answer comes booming out of the clouds, “BECAUSE YOU IRRITATE ME!”

This story illustrates for me, how easy it is to assume that the deficiencies in particular situations belong to the Almighty rather than to us. How can we really think the lord was unable to change the situation?

Maybe he wants us to change it. And maybe he wants us to live our way through it, trusting that he is at our side at every moment. At every single moment. How can any one of us think that the ruler of the universe had a momentary bout of deafness as we were saying our prayer? Or is it possible that god is now waiting for us to listen for His response? The response that He has been giving us all along.

And what about this: Is it possible that we really do irritate God? Well, we most likely do, I suspect. I know that my children irritated me from time to time, even as my grandchildren do now. (And vice versa, of course). This is not to imply that my children don’t still manage to irritate me from time to time. But my irritation with them has always been minor compared to my love for them. So, I have always been there for them, at least in the long run of things. And they have always known that, in the long run of things. And according to them I have been a very good parent. In the long run of things.

And now, we have to believe that god is even better at parenting than I am.

I've been meaning to mention a little bit about the state of things when I got here at the cottage. All in all, things were in pretty good shape, although it was evident that the maid, the gardener, and the garbage man were all on strike. Pop usually runs the weedwacker on a regular basis. In his absence, the grass in front of the sleeping cottage was almost waist high! I will attend to that tomorrow. Thanks are due to Neil from Holiday Cove for checking up on Mom and Pop’s boats and making sure they didn’t sink, and to Matt and Natalie from Craganmor Point for monitoring the cottages while we were away. Thanks are also due for Neil and Matt and others who helped get Pop into town when he was so very sick. We are all very appreciative.

This evening there is a chorus of frogs and peepers serenading the night, while a loon sings his eerie “loon-song” from across the bay. The honking of geese can also be heard occasionally from the beach area. The sounds of the channel are soothing and I will sleep well tonight.

Mom called with a final evening update and said that Channel Man is still stable and hanging in there. His vital signs are good and he is resting comfortably. Sleep well Pop, and you too Mom.

This morning I gathered the samples for the water testing without any problems, prepared the ColiPlates with test cultures, and they are currently cooking in the incubator. The results will be ready tomorrow afternoon and I'll post them on the South Channel website as soon as I can. Today turned sunny with a mild breeze and was a humid 29°C (84°F), and it was gorgeous on the bay. I always like to say, “Hot and sweaty, rhymes with machete.”

I just got off the phone with my mom with the report from the hospital. Dad had a pretty good day. He is stable with no fever and his vital signs are good. The dialysis treatment went well and lifted another 3 liters of fluid from the Michelin Man. The doctors treated him with a different antibiotic to fight his secondary infection, and they believe they have it on the run. He opened his unfocused eyes twice while my mom was there, in what was probably somewhat of a reflex response. The first time was when Mom told him I was at the cottage doing his water testing. The second time was when the nurse washed his hair and she and my mom were trying to comb it out so it would “look nice”. He has always said he hates being “messed with” like that. The doctors say sometimes patients remember snippets of things that happen when they are largely unconscious. Only time will tell.

My father and the Topping family would like to thank everyone for their outpouring of kindness, caring, blog comments, offers of assistance, and most of all prayers. This is a very difficult time for our family. However, with all of our friends and family at our side, we will get through this. Thank you all for your love and support.

The forest on the channel is teeming with the sounds of life this morning. Birds and other critters are all out and about. A pileated woodpecker can be heard hammering away in the distance, searching for its breakfast. Rat-tat-tat-tat-tat-tat. The temperature is still 24 C (75 F), and again, there is a light wind from the southwest. The sky is overcast, but the sun is bright and shines through the thin clouds.

I spoke with Roseanne at the ICU, Pop's nurse this morning, and she reported that his condition is much the same as last night. He is stable and has no fever. The doctors are busy doing their rounds and are congregating outside his room to discuss his prognosis and treatment plan for the day. He will be getting dialysis sometime later, but whether they will attempt to remove more fluid from his body is unknown at present.

I have assembled all the equipment for my water testing excursion, and feel I have all my ducks in a row. I will be leaving momentarily to begin my sampling rounds.

Darkness has descended on the South Channel. The occasional drone of nighttime boat traffic continues, as Friday night cottage stragglers make their way to their Georgian Bay refuges, far away from the busy world. Navigating at night on the channel is not for the fainthearted. With the aid of powerful lights, electronic wizardry such as GPSs, and especially the skills of an experienced skipper, plying the waters of the bay in the dark for a night trek to the cottage is doable for most, but only comfortable for a few.

There is opaque cloud cover tonight, with rumbles of thunder and faint flashes of lightning in the distance. However, this is the way of weather in the Thirty Thousand Island area, and by no means portends a dreary day for tomorrow. The temperature is 24 C (75 F) and there is a light wind from the southwest, which helps keep the mosquitoes and other insect pests at bay. A light to moderate rain tonight would make for ideal water testing conditions tomorrow morning.

Mom reported that Dad is doing about the same tonight. His vital signs are stable, but the doctors believe he has contracted a secondary infection from being on the ventilator so long. They are treating him with additional antibiotics and he seems to be responding. His dialysis session went well today and they removed another 3 liters of excess fluid from his system. Hang in there Channel Man.

Live, from McLaren Island, it's the South Channel Blog!

Channel Man Stan continues to slowly improve today. His nurse reports that his vital signs are solid and this has been a good day for him. We are all encouraged with his progress and are hopeful that the trend continues. However, we also remain mindful that we are riding the ICU roller coaster.

My trip north to the cottage went without a hitch. I am especially pleased that I seem to have beaten the mad rush of cottagers heading up from Toronto. The bay is alive tonight, with regular boat traffic every few minutes as people head out to their South Channel retreats in anticipation of a banner weather forecast for a beautiful weekend. The natural beauty of this place is beyond description. Channel Man will kick himself for missing out on this one.

I am assembling equipment and notes in preparation of starting water testing tomorrow morning for the 2006 season. On my way into town, I stopped by the Township of The Archipelago offices and picked up ColiPlates and documentation for the new testing protocol to be used this season. Unfortunately, Greg Mason was unexpectedly called out to do a last minute inspection this afternoon, so I didn't get a chance to meet with him in person. However, I left the cottage phone number at his office and he called me here to discuss the new procedures. I feel confident that I will be able to temporarily step into Channel Man's size 13 shoes and get the job done to his satisfaction. It's good to be "home".

Roseanne, Dad's nurse this morning, reports that Channel Man Stan had a good night and is doing well today. His vital signs are solid and his appearance is good. The dialysis has slimmed him down to a mere 362 lbs and he's due for another round today, but without the fluid removal.

I'm am leaving for Parry Sound in a few minutes and will be meeting with Greg Mason this afternoon to prepare for water testing. I will be unable to update the blog until this evening, but check in then for a posting live from Seven Mile Narrows on the South Channel itself!

I went to see Dad late tonight to say goodbye until I return from Parry Sound. He looked good, but was freshly agitated from being turned. His vital signs are holding and his condition is stable for the time being. His nurse said he is starting to open his eyes on a regular basis, and although he is still unconscious and unable to focus, it is a very good sign. While I'm out of town, blog updates may be a bit more sporadic then they have been in the past, but I will try and keep things current as best I can.

Goodnight Pop. Hang in there, you tough old bird.

Pop is currently undergoing his dialysis treatment and they are hoping to remove another 4 liters of fluid from his body. The process is going smoothly and his vital signs still look good.

I thought it wasn't fair that only the night shift got good munchies, so I dropped off submarine sandwiches for the ICU staff at lunch time to show our appreciation for their support and efforts taking care of Dad.

I have made arrangements to go to the cottage in Parry Sound tomorrow and through the weekend to check on things and take care of unfinished business, like disposing of garbage that has been there for 3 weeks and getting my parents boat to town. I will also be meeting with Greg Mason, the Planner for the Volunteer Water Monitoring Program for the Township of The Archipelago. Greg will be giving me an update on the new testing protocol that is being used in this year's program and providing me with documentation. I plan on doing water testing on Saturday and should have the results on Sunday, the perfect Father's Day gift I could ever get for Channel Man Stan. If he could speak, I'm absolutely certain this is what he would want.

Pop had a good night. Yea! Roseanne, his nurse this morning, reported that his vital signs look good and his blood pressure is normal. He doesn't have a fever and his blood oxygen saturation is at 98%. The doctors are starting to do their rounds and the plan is that Pop will be undergoing dialysis later this morning to remove excess fluids.

Pop is doing better this evening. His vital signs are good and he doesn't have a fever. They have lowered some of the ventilator pressure settings and he is tolerating it well. He seems at peace tonight.

This evening at about 11:00 PM, I went to McDonald's and bought the ICU staff some food from the Mickey-D's Dollar Menu; 10 double-cheeseburgers, 5 chicken sandwiches, 5 chicken fajitas, and a bunch of salads and fixings. The ICU staff were very appreciative and expressed their gratitude. I wanted to recognize their professionalism and attentiveness, and express my appreciation for their support of my father. Thank you to the Highland Hospital ICU Staff.

After speaking with Dr. Shelley earlier today, I left a detailed voice message for Dr. Susan Richardson in Toronto, asking for her help in a consultative capacity. Our hope is that she will assist Dr. Shelley with recommendations on performing molecular identification tests for possible mycological pathogens, especially those responsible for causing blastomycosis, histoplasmosis, and similar fungal infections.

Channel Man's condition is still stable this afternoon. He underwent dialysis today and they removed one liter of excess fluid with no complications. He has lost over 30 lbs of water weight in the last several days and now weighs in at a hefty 370 lbs! (his normal weight is around 250 lbs) As extreme as it sounds, this is a normal part of the ICU patient experience. The motto in the ICU is, "You've gotta swell, to get well!" And swell, he did!

Channel Man Stan continues to slowly improve today. His vital signs look good and his physical appearance is greatly improved from yesterday. The doctors are carefully testing lowering the pressure settings on the ventilator and the results look encouraging. I just spoke with Dr. Shelley, the head of Infectious Diseases at Highland Hospital. Dr. Shelley relayed that the lab tests are all still negative for the cause of Dad's illness, but that there are still many test results that will be coming back in the near future. He also reminded me again that in almost half of the cases similar to Dad's, the doctors never make a final determination as to what the initial cause of the illness was. I am very comfortable with Dr. Shelley's thought process in formulating a diagnosis and treatment strategy for Dad and appreciate his feedback.

Pop had a good night and is doing better this morning. Ann, his nurse today, reported that he was no longer running a fever, his blood pressure was good, and his blood oxygen saturation was in the high 90s (> 95%). He is scheduled to resume dialysis today, and seems to be physically ready to do so. The process of deflating the Michelin Man and weaning him off the ventilator will resume.

Johanna and I checked in on Dad shortly before midnight and he was stable and resting. He was receiving his daily dose of itraconazole and will likely be resuming dialysis treatments tomorrow. His blood pressure and vital signs were good and things seemed to have quieted down for the time being. Goodnight Pop.

Pop is doing a little better this evening. He still has a low grade fever, but his blood pressure has improved significantly without medication. We spoke with the new Attending Physician and he felt that they removed bit too much excess fluid (a whopping 4.7 liters!) during yesterday's dialysis session, which caused his blood pressure to drop. This combined with the fever caused Pop's condition to start to deteriorate. We are all hoping for a quiet, boring night.

Channel Man Stan is having a tough time this afternoon. He is running a high temperature again and his blood pressure is borderline.

The latest update from the hospital is that Dad's fever spiked fairly high earlier today, but then abruptly subsided. The doctors are looking into the possibility that he has a secondary infection, but they don't know anything for sure at this point. They also believe his blood pressure dropped as a result of the dialysis treatments and they have given him additional fluids intravenously to help raise it again. He is creating more sputum, which they have sent off to culture, but there are still no definitive results from the laboratory tests.

Welcome to the roller coaster ride. Dad had another rough night last night. He is running a fever again and had problems with low blood pressure, so they had to infuse him with a liter of saline solution and they won't be removing excess fluids from his body via dialysis today. He also had problems with poor blood oxygen saturation again, so they turned the FiO2 on his ventilator up to 100%. Hopefully this will be very temporary. This morning I will be attempting to contact Dr. Shelley, the Head of Highland's infectious diseases unit, to get an update on the status of diagnostics and lab tests to determine what is wrong with Dad.

Dad's condition remains stable and unchanged this evening. His dialysis treatment this afternoon went off without a hitch and they were able to extract several more liters of excess fluids from his body. Hurry up and get better, Pop!

The 2005 water quality results and program review reports are now available and have been posted in PDF format on the South Channel website. They can be viewed by following this link 2005 Water Quality & Environmental Report and Program Review.

This morning I spoke with Greg Mason, Planner for the Volunteer Water Quality Monitoring program for the Township of The Archipelago in Parry Sound. Greg said they had a good workshop on Saturday, with a turnout of 18 people. Dr. Karl Schiefer was there to answer questions, and discuss the program and water quality in general. I let Greg know that my mom and I would be assuming Pop's water testing duties for the time being, and he offered to meet with me when I get to Parry Sound to review the new bacterial monitoring protocol that will be implemented for this year's tests. Greg also just sent me the electronic version of the Volunteer Water Quality Monitoring Program Data Report for 2005, which will be posted on the South Channel website later today.

Rhonda, Pop's nurse this morning, said that he had a good night and although he is still critical, he continues to slowly improve. She saw him open his eyes several times again and he is starting to occasionally move one hand a bit. His vital signs are stable and the ventilator settings were holding, with the FiO2 still set at 40%. Rhonda said they may try and start decreasing the pressure settings (IP and PEEP) later today to continue the process of weaning him off the ventilator.

The inspiration pressure (IP) is the pressure used to inflate the lungs on each breath. The positive end-expiratory pressure (PEEP), is a special setting on the ventilator that keeps the lungs expanded to help get oxygen from the lungs into the bloodstream. Click on this link for more information on Mechanical Ventilation. Pop is currently being ventilated using positive pressure controlled ventilation (PCV), but this mode will probably be changed as he starts to breathe more on his own.

Things are still stable for Dad tonight in the ICU, reports Rosie, Dad's nurse for the evening shift. His ventilator settings are unchanged, and he seems to still be tolerating the 40% FiO2. The "de-Michelin-ization" process is scheduled to resume tomorrow with another dialysis treatment to remove excess fluids. Dad was also supposed to get his first haircut during his stay at Highland Hospital. He needs to look as dapper as possible, given that he has a new girl looking after him each day, literally waiting on him hand and foot. I just know he'll love hearing about that part. Sleep tight, Pop Dog.

Channel Man Stan is having a good day. His vital signs are stable and the doctors have been lowering the FiO2 on his ventilator over the past 24 hours. It is now at 40% and he seems to be tolerating it. However, they have had to use higher pressure settings on the ventilator (IP 50, PEEP 22), which may be working better for his specific lung physiology. The staff has also been trying to decrease the medication he is on, particularly the sedative Ativan, and this has resulted in him starting to show small signs of being on the verge of a conscious state. His nurse Rhonda reported seeing him open his eyes on several occasions, although there was no focus or recognition, and Johanna said she saw his fingers twitch more than once. The Attending Physician told my mother he was critically stable, but improving. Fight, Channel Man, fight.

Pop was doing ok and resting comfortably when Johanna and I visited him just before midnight last night. The ICU is always a busy place in the morning. The doctors are currently absorbed in their rounds, likely deciding if another round of dialysis is in the plan for today, or if today is a day of "rest". Pop's nurse is busy giving him a bath (I think his nurse is male today, so Pop would be rolling his eyes right now) and performing an overall assessment, but things seem to be under control and about the same this morning.

Johanna called from the hospital and reported that Dad was still stable and resting comfortably, his vital signs pretty much the same as earlier this evening. Rest up Pop.

Channel Man Stan's dialysis session went well again. They removed 3.0 liters of fluid and finished up the process around 6:00 PM, and his vital signs held solid throughout the treatment.

Around 7:00 AM this morning the pressure settings on Dad's ventilator were decreased. Unfortunately, he didn't tolerate the change very well and the ICU staff spent the next 2 or 3 hours trying to stabilize him again. They ended up having to give him a bolus of a diuretic, which he responded well to and he is now stabilizing again. The doctors are currently busy doing their rounds and visitors are not allowed in the ICU at present. We should have more information and a specific course of treatment for the day in the early afternoon after rounds are have been completed. Hang in there Pop!

I spoke with Greg Mason at the Township of the Archipelago in Parry Sound this morning. Greg is the Planner for the Volunteer Water Quality Program for the Township and is conducting a 2006 season volunteer kick-off meeting this afternoon at 1:00 PM that Pop was planning on attending. Dr Karl Schiefer, a regional expert on water quality, is expected to be on hand to discuss water quality reports and answer questions.

Just before Pop was moved to the ICU in the hospital in Hornell, he asked if I would be returning to Parry Sound the weekend of June 10th and whether I could attend the water quality workshop on his behalf. I fully expected to do be able to do that for him, but given Pop's current condition I cannot. I asked Greg if I could conference call in this afternoon to the meeting, but he couldn't work out the logistics to make that happen and offered to meet with me individually the next time I'm in Parry Sound. I am making preparations to assume Pop's water testing responsibilities until he is able to do so, and am committed to serving in this capacity and supporting our love of the South Channel and related environmental causes on his behalf.

We called the ICU nursing station at about 8:15 AM this morning, but were unable to speak with Dad's nurse because she was very busy and she requested that we call back at 10:00 AM. I finally spoke with Dad's nurse Rhonda, a bit after 10:00 and the conversation was very brief as Dad was having some issues with fluid build-up and ventilation settings and she was busy attending to him. I also spoke with Dr. Pirillo, the Attending Physician and Head of the ICU unit at Highland, and we discussed Dad's situation in general and how to best communicate with the doctors caring for him. We are now heading over to the hospital for another ride on the roller coaster.

We all went out to dinner to celebrate Johanna's birthday tonight. It was a welcome distraction from the hospital, and Johanna got her birthday wish that things would chill out for a moment.

Upon our return I spoke with Pam, Pop's nurse for tonight's ICU shift. Pam reported that Pop's condition was about the same this evening and that he was receiving his nightly dose of itraconazole when I called. He appears stable, his blood pressure is good, and his SpO2 (blood O2 Sat) is hovering around 96%, so they lowered the FiO2 on the ventilator to 70%. Getting rid of excess fluid seems to agree with him and help him oxygenate better, and he has shed a little over 10 pounds of water during the last two days of dialysis treatments. This is good, but what a way to lose weight! Dr. Dhukal, Pop's nephrologist (kidney specialist), will decide in the morning whether he gets to lose some more fluid tomorrow courtesy of "la machine".

As Dr. Greenberg would say, "He's a tough old bird." As I would say, "He's my Pop." Rest well, you tough ol' bird Pop.

Pop continues to slowly improve today. The dialysis treatment was able to remove another 2.8 liters of water and about 0.3 liters of liquid toxins from his system, and he tolerated it well without the need for norepinephrine to raise his blood pressure. His ventilator was set at 75% FiO2 when I was there at 2:45 PM this afternoon and his blood pressure and blood oxygen saturation looked good.

He is continuing to receive daily doses of 200 mg of the antifungal itraconazole, but the lab results are still not back with a positive diagnosis for anything. When we met with Dr. Shelley on Wednesday, he said he was sending urine and/or blood samples to MiraVista Diagnostic Laboratories in Indianapolis for testing for antigens indicative of fungal infections. MiraVista specializes in rapid identification of fungal pathogens that are responsible for diseases like blastomycosis and histoplasmosis.

So far, we have gotten our wish. Kristin, Dad's nurse on this shift in the ICU, reported that Dad had an uneventful night and was still stable. The FiO2 level on the ventilator is still set to 85% and his blood pressure and blood oxygen saturation look good (her words). The doctors have another round of dialysis planned for today and I'm certain they will be trying to remove more excess fluids from his body, much as they did yesterday. Deflating the Michelin Man is no mean feat.

Today is my sister Johanna's Birthday. The best gift our Dad can give her right now is to make progress toward his recovery. Please wish Jay a Happy 25th! (wink, wink)

Things got a bit dicey earlier today, but Pop's dialysis treatment seems to have been effective, at least for the short term. The doctors were able to remove 2 liters of excess fluid from his body and this has helped stabilize his overall condition. His blood oxygenation is very slowly improving again and they have been able to reduce the FiO2 level on the ventilator to 85%. He was given some norepinephrine at the end of his dialysis session to keep his blood pressure at a reasonable level, but that has again been discontinued and his blood pressure levels remained normal at 10:30 PM tonight. Pop was starting to try and take small breaths on his own this evening, but the ventilator is still doing all the work for him. The ICU staff will continue to try to decrease the FiO2 level and reduce the ventilator pressure settings, and resume attempts to wean him from the machine.

The roller coaster is in full motion now. We are hoping for a quiet night and uneventful day tomorrow

Channel Man Stan is undergoing dialysis at this very moment. The doctors wanted to wait for a few days before trying to remove excess fluids from his system using the dialysis machine, but decided that he couldn't wait until then because of his declining blood oxygenation situation. The downside to this is that dialysis tends to drop the patients blood pressure, and Stan can't afford that right now. The doctors will be ready to quickly administer norepinephrine during the dialysis treatment to elevate his blood pressure if necessary. The dialysis session is expected to be finished at 5:00 PM.

Pop had another relatively tough night last night. He started having trouble oxygenating at around 10:00 PM last night, so the FiO2 on his ventilator had to be increased to 100%. Now his SpO2, or blood oxygen saturation, is in the high 90s percent-wise and his blood gas numbers have improved, but patients can't tolerate staying on 100% FiO2 for very long. The doctors feel some of his oxygenation problems are related his position on the bed. He is on a bed that automatically turns him on a regular basis and he does better in some positions than others. The doctors haven't started rounds yet, but should have a new action plan for the day later this morning. Hang in there Pop.

Late this afternoon my mom, my sister Johanna, and I met with Dr. Gary Dudek, the current Attending Physician of Highland’s ICU. Dr. Dudek discussed Dad’s illness and condition with us, answered many questions, and laid out the plan for Dad’s treatment. Dad was put on dialysis this afternoon to clean his blood and prepare for using the dialysis machine to remove excess fluid building up in his body. The doctor’s strategy is to start giving him daily dialysis treatments and slowly begin to regulate and remove excess fluids from his body after a couple of days of treatment. It is hoped that this will help increase his blood oxygenation and improve his blood pressure situation over the long haul. We feel encouraged that communication with the medical staff at Highland Hospital improved significantly today and are in agreement with Dad's current diagnosis and course of treatment.

I have some very sad news to report today. Tom’s wife Carol passed away this afternoon at around 1:15 PM. Carol’s sister Karen had spoken with us in the ICU waiting room this morning and said that Carol was in the final stages of death, and that they expected her to die sometime today. When we went to visit Dad this afternoon, we were filled with sadness about the loss of Carol. The finality of her passing really set in after seeing the hospital housekeeping staff cleaning and disinfecting ICU 6, the room Carol and Tom had spent the last 8 weeks of Carol's life in. The reality of the ICU can be so harsh.

God bless Carol, Tom, and their family.

Dad had a pretty rough night last night and was still struggling this morning with problems with poor blood oxygenation and low blood pressure. The doctors had to increase the FiO2 on his ventilator to 80% and put him on an IV of norepinephrine to increase his blood pressure.

Dad's renal specialist, Dr. Dhukal, was in the room when my mother and I went in to see Dad this morning. Dr. Dhukal said he was recommending that they insert a "port" into Dad's groin and put him dialysis. My mother signed the consent forms and this will be done this afternoon.

At about 11:00 AM, my mother and I met with Dr. Shelley, the Head of Infectious Diseases at Highland, to discuss Dad's diagnosis, condition, and treatment. The meeting with Dr. Shelley was nothing short of spectacular. We covered all aspects of Dad's case including the details of his condition, what was being done diagnostically to confirm what kind of "bug" is infecting him, and the detailed thought process behind the diagnostic process and treatment he is receiving. Dr. Shelley said he had tried to contact Dr. Richardson in Toronto twice and had left messages, but had not yet spoken with her. We are now reassured that things are moving as fast as they can and in the right direction and we are very happy with the quality of care Dad is receiving.

Pop's condition is "stable", but extremely tenuous. I have spoken to his doctor in Hornell and others that care for him and plan on meeting with the Chief Administrator at Highland Hospital tomorrow morning. I expect some sparks fly in the 'morrow.

I just stopped by the hospital and things are quiet in the ICU for a change. Pop is resting comfortably and his numbers look good. His blood oxygen saturation continues to improve, so they lowered the FiO2 level on the ventilator to 45%, the lowest level it has been set at since he was admitted to Highland Hospital 10 days ago.

Johanna just checked in on Pop and reported he was doing better today. He is not running a temperature and his vital signs look pretty good. His blood oxygen saturation had improved enough that they lowered the FiO2 setting on the ventilator back to 50% and his SpO2 is still staying put at 96%.

Mom talked to Pop's nurse in the ICU this morning and she said that Pop is still hanging in there and is "stablely sick". I know it's not a word, but we'll take it.

I can't sleep and I need to post one last thing for the night. Dad's illness has been a crazy roller-coaster ride that nobody ever wants to go through. We are all as one, family and loved ones pulling together to get through a tough time. Tonight at about 11:15 PM as my sister, my mother, and I were reassembling at the hospital, we passed Tom's wife Carol's sister, Karen, in the Highland Hospital parking garage. Karen, who is always upbeat and full of enthusiasm, was clearly on a huge down. She was nearing the verge of tears as she said that Carol was never going to recover and was on the brink of death, and that they were going home and had some huge decisions to make. I hugged Karen and she told me that our Dad and our family are in her prayers every day. I told her she and her family were in our prayers every day as well.

When we got back to the ICU waiting room, Tom was alone in the room sound asleep, snoring, simply exhausted from his 8 week vigil. He had approached us early in our stay at the ICU and had comforted us, kind of "showing us the ropes" about how a family goes through an extended ICU stay. Tom has been faithfully by the side of his wife Carol for the duration of her illness, and has always been her advocate, her strength, and her love. He is living proof that the ICU holds not just pain, but an incredible amount of hope. Please pray for Carol, Tom, and their families.

We just got back from the hospital, where they got Dad stabilized again. They administered Tylenol, which lowered his temperature to 37.6 C (99.8 F). They also infused him with a drug to improve blood pressure and gave him a bolace (a quick way to inject fluid intravenously) of saline to increase his blood volume. They will also be infusing him with another unit of blood to improve his body's overall ability to oxygenate.

Please keep him in your prayers.

I just received a call from my sister Johanna at the hospital. Channel Man is having a rough night tonight. His SpO2 level is dropping, so they have increased the FiO2 on the ventilator to 70%. He is running a fever again for the first time in over a week, and his temperature is registering at 38.6 C (101.5 F). He also having issues with low arterial blood pressure, so they are administering medications to try and improve things.

It's been another crazy day. Dad's overall condition improved slightly earlier today. His blood oxygen saturation level increased and stayed between 95%-99%, without any changes being made to the ventilator settings. The doctors removed the Swan-Ganz catheter, and his blood gas and overall lab numbers came back better than at any time during his stay in the ICU. However, he remains unconscious and in extremely critical condition and his situation is still very tenuous. We are anxiously awaiting additional results from the lab, but as of yet have heard nothing. We still suspect that this may be a case of blastomycosis or histoplasmosis.

Yesterday afternoon I contacted Annie Crossby again to ask her help in finding a contact familiar with blastomycosis and infection by mycological pathogens. She put me in touch with Ursula Bunn, Head Technologist of Mycology at the Ontario Ministry of Health & Long-Term Care, Central Public Health Laboratory in Etobicoke (Toronto), Ontario. I explained Dad's situation to Ms. Bunn and asked if she could help direct me to an expert in the field of identifying and treating blastomycosis and related diseases. She agreed to assist and said she would send an email to Dr. Susan Richardson, an expert in the field of mycological infections, to ask for her help. Dr. Richardson is the Head of the Division for Microbiology at The Hospital for Sick Children in Toronto and President of the AMMI Canada, Association of Medical Microbiology and Infectious Disease Canada.

Dr. Richardson called me today at around 1:30 PM to discuss Dad's situation and the possibility he is afflicted with blastomycosis. She listened carefully to my long story of Dad's illness and possible exposure to Blastomyces dermatitidis, the organism responsible for blastomycosis, and agreed that this sounded a lot like an acute case of blastomycosis. I also discussed treatment strategies with Dr. Richardson and she agreed to act in a consultative capacity for doctors at Highland Hospital if needed.

Mom and I pressed for a consultation with the Attending Physician in the ICU, but he was unavailable until tomorrow or later. This was simply unacceptable, so we pressed for a consultation with Dr. Mark Shelley, the Director of Infectious Diseases at Highland. Dr. Shelley discussed our concerns regarding diagnosis and treatment for Dad's condition and said he would press the lab for enough lab results to hopefully make a presumptive diagnosis of blastomycosis so he could feel more comfortable starting a more aggressive treatment plan. He also agreed to contact Dr. Richardson to consult on the case and discuss diagnostic and treatment options.

For more information on blastomycosis, follow this link to an article co-authored by Dr. Richardson entitled Blastomycosis in Ontario, 1994-2003. Ursula Bunn was also cited for assistance in the lab work associated with this article.

I'd like to extend a special thank you from our family to Annie Crossby, Ursula Bunn, and Dr. Richardson for all the assistance you have given us.

The nursing station in the ICU reports that Dad had another good night. His vital signs are stable and "look good", and there have been no changes to the ventilator settings. He will be receiving his fourth dose of itraconazole intravenously later this morning.

The doctors will be determining Dad's treatment strategy for the day after they complete their rounds. They will likely be removing the Swan-Ganz catheter monitoring his heart sometime later today. Coincidentally, Dad's next door neighbor in Hornell is Dr. Stephan Greenberg, and Dr. Greenberg recalls going to school with Dr. Jeremy Swan. Dr. Swan, who passed away in February of 2005, was a world-renowned cardiologist and the co-inventor in 1968 of the Swan-Ganz heart catheter. His invention, made with a student of his named Willie Ganz, revolutionized heart surgery. The catheter, which is still used today, enabled bedside monitoring in critically ill patients by measuring heart output and capillary pressure in the lungs. This improved the care of patients with heart attacks, serious burns, acute respiratory failure, and many other conditions. Click on the this link for more information including images of a Swan-Ganz Catheter .

Dad seems to be resting comfortably and his vital signs are stable and unchanged. At 10:00 PM he got his third antifungal treatment and was again infused with a brew of IV fluids and 200 mg more of itraconazole. The FiO2 levels on the ventilator are set to 55% and his blood oxygen saturation is at 94%. Today was one of the quietest days during Dad's stay at Highland Hospital. We are all tired and a period of peace, no matter how brief, is most welcome.

Good night blog. Good night Pop. Good night moon.

Holy bat poop, Batman! Could it be histoplasmosis? The syptoms and timelines don't match as closely as in Channel Man Stan's case, but the bat connection is something that makes one ponder. Check out these links for more info on Histoplasmosis and Blastomycosis.

Tammy, Stan's RN for the current shift in the ICU, reports that he had a good night and his condition is about the same as it was late last night. His blood pressure is a bit low, but that is an expected side effect of the propofol he was given to sedate him and is being closely monitored. The doctors are getting a late start to their rounds today and likely won't have a final action plan for Stan's treatment strategy today until late this morning or early afternoon. Stan is scheduled to receive a second dose of antifungal medication and will be infused with solution containing another 200 mg of itraconazole later this morning.

Channel Man Stan was started on a course of antifungal treatments and was infused with a solution containing 200 mg of itraconazole at 10:30 PM tonight. No additional lab results have yet been received and the Medical Fellow in the ICU said the antigen and blood test results can sometimes take several days. Stan's vital signs are holding and he is still off the paralytic agent, so he was given propofol, a short acting general anesthetic agent and ventilation sedative to help him rest. He is also being given Ativan, which is an anxiolytic agent, sedative, and anticonvulsant and fentanyl which is a narcotic analgesic. He is currently resting peacefully and in La-La Land.

A thought came into my mind this evening regarding Dad's possible exposure to bat droppings and fungi when chipping leaves near the active bat house at the cottage. Because of the unusually warm spring, the bats were present in their house early this year and several dozen could be seen roosting when we opened the cottage in April. I mentioned this to the staff and doctor assigned to the ICU tonight and will follow up again tomorrow.

Sleep well Pop. Sweet dreams!

This has been a very interesting day. Channel Man Stan's condition is slowly improving. His ventilator was set to 50% FiO2 and the doctors discontinued the infusion of atricurium (the paralytic agent) and Stan's respiratory system is being allowed to start to try and "kick-in" on its own. Although still unconscious, he is starting to cough and his lungs are generating secretions which have to be suctioned on a regular basis. His body reacts during the suction process and you can see him attempting to breathe on his own. It's been almost a week since we've seen self-initiated body movement from him and it's quite a refreshing sight.

Even more exciting was the conversation we had with the Attending Physician in the ICU. He said the bronchial wash cultures came back positive for yeast. This is consistent with a diagnosis of blastomycosis, histoplasmosis, and other diseases caused by dimorphic fungi, which exist as a mold in the environment and then as a pathogenic yeast form in the body. The drug of choice in treating these infections (especially blastomycosis) is itraconazole, which is an anti-fungal agent. The pharmacy at Highland Hospital does not have it in stock, so they are checking with Strong Memorial Hospital to try and locate some and once they receive it they will infuse it immediately. According to Annie Crossby, who is from Grimsby, Ontario and is very knowledgeable on "blasto", itraconazole is fairly fast acting and we should expect to see a significant response to its administration, if in fact blastomycosis is the cause of Stan's condition.

We will be waiting for the results from the tests for antigens associated with blastomycosis and further lab cultures of bronchial wash fluid and blood samples before having a definitive diagnosis, but the Attending Physician in the ICU said that for now they are assuming it to be blastomycosis and will begin treating it accordingly.

Carol called from the hospital and said not to come until about 2:00 because the doctors were late doing rounds and the staff were busy performing some tests and tasks that required visitors to be out of the room. She said Dad's vital signs were good and that they had lowered the FiO2 setting on the ventilator to 50%.

I also wanted to share some pictures of Channel Man Stan on the blog.






Channel Man Stan and his daughter Johanna, at left.









and at right,
Channel Man Stan Today.









Pop will undoubtedly get a kick out of this post on the blog as he is known to sometimes have a very irreverent sense of humor.

Dad had a another good night. Tammy, his nurse for this shift, reported that his vital signs were about the same as last night. However, his blood oxygen saturations (SpO2) had increased to 100%, so they had lowered the amount of oxygen he was getting (FiO2) to 60% and then again to 55%, which was where things were yesterday evening. The doctors will be completing rounds later this morning and formulating a care strategy for the day, and everyone is eagerly anticipating results from the lab.

Channel Man Stan sure is one tough old bird. Overall he is doing roughly the same as yesterday, but I am encouraged after a long conversation with the Physician's Assistant Greg.

Today the doctors inserted a Swan-Ganz catheter into his heart, which involves the passage of a catheter into the right side of the heart to obtain diagnostic information about the heart and to provide continuous monitoring of heart function in critically ill patients. The results show that the high levels of fluid on his body are stressing his heart, but his kidney function is improving and they will be getting more aggressive with a diuretic tomorrow to help get rid of some of the fluid. Stan is like a big water balloon right now. He has gained approximately 120 lbs, or about 14 gallons of water! This will easily be shed when his condition improves. His liver function is good and he is not running a temperature. They increased the FiO2 level on his ventilator to 65% to improve the blood gas O2 levels. They also slightly increased the respiration rate and his SpO2 is holding at 94%.

The "buzz" of the day was related to learning more about blastomycosis, which has a profile that seems to closely match the pattern of Stan's illness. Stan's respiratory function should be improving by now, but it is largely unchanged and doctors are working feverishly (pun intended) to find out why. I spoke with Annie Crossby who lives in Grimsby, Ontario and is somewhat of an authority on blastomycosis. When she learned all the facts said she felt a tingle and that deep down she believes it might very well be the cause of his condition.

I also spoke with Dr. Mark Shelley, the Head of Infectious Diseases at Highland, and although he wasn't convinced blastomycosis was responsible, he agreed to run tests to try and confirm this. They gathered urine and a bronchial wash sample and sent them to Strong Hospital for analysis and culturing. They also will be running tests for histoplasmosis and leptospirosis, two other possible culprits. The antigen test results (urine) should be back tomorrow and the cultures (bronchial wash) should be ready in 24-72 hours. A positive result for any of these diseases would be more than a welcome bit of information.

Dad had another relatively good night. The doctors continue to work to wean him off the ventilator. They reduced his FiO2 level this morning to 55% and so far he is tolerating it

Neil Villeneuve from Holiday Cove Marina in Parry Sound called this morning to check on Dad's status and said the weather on the bay was beautiful. He mentioned a somewhat obscure illness that several people on the South Channel have contracted called blastomycosis, which is caused by a soil-bound fungi and typically infects dogs and occasionally their owners. The description of blastomycosis fits the profile of Dad's illness to a "T", so we will mention it to the doctors today as a possible root cause of his sickness. Check the following links for more info on blastomycosis Blastomycosis and Blastomycosis in Dogs in Canada .

It's been another very long day. Pop's condition is unchanged, but several other families with loved ones at the Highland ICU are really feeling the pain. A 40ish year old husband named Tom who has been extremely supportive of the Toppings is preparing for the imminent death of his 40 year wife Carol after her chemo-therapy treatments turned to infection, general decline, and finally septic shock which has ravaged her body and her family. Tom is a regular in the ICU waiting room and has been incredibly supportive of us from the first day we were there. Carol's general system failure and expected death has been extremely hard on his family. God bless Tom and his loved ones.

I am getting home very, very late after waiting to give a wife and daughter of a very poor family from Russia a ride to the far side of the city. They are in the United States alone and have no means for transportation or support, and Tom and other regulars in the ICU waiting room have been attending to their transportation needs. Now it's my turn to give. I feel numb after being exposed to the impending loss experienced by these people and the fear from the possible loss from within our own family. I'm hopeful for Dad's recovery, but accepting of what may lie ahead after seeing the pain and desperation shared by these families and the grace they exhibited when dealing with the loss of their loved ones. I hope that god will spare us from this pain.

Stop the presses! Stan's brother Harold just called from the hospital 5 minutes ago and reported that a nurse had just come out and informed them that there had been some type of transcription error and that Stan does not have the measles. This is very different story from the Physician's Assistant in charge who initially told us he had measles. When I asked her, "Are you sure?", she said they were positive. Stay tuned for more! This sure is turning out to be quite a bizarre day.

Stan's condition continues to slowly improve, but he is still critical. We spoke directly with the kidney specialist today and he said that Stan's kidneys have been heavily impacted, but are functioning as expected for someone in his situation. He also said that his kidneys can fully recover from this type of damage (assuming nothing else happens to stress them further) and that dialysis is not needed at present and he was hopeful that would not change.

The doctors decreased the pressure settings on his ventilator at 1:00 PM (IP 34, PEEP 20 - which is still pretty high) which made his tidal volume decrease to 450 mL. This is a step in the right direction to continue the process of weaning him off the ventilation machine.

Things took an even more bizarre twist when the doctor's announced they had positively diagnosed what was wrong with Stan in the first place. Stan has been diagnosed with measles. Yes, measles! We are unsure at this point what impact this may have on his treatment, but everyone is relieved to know what brought this whole situation on. They have sealed Stan's room and he is currently in isolation, and visitors and staff have to wear masks and gloves when in the room. The medical staff and infectious disease specialists don't seem particularly concerned about communicability because almost all of the general population has been immunized. However, they expect to move him to a negative pressure isolation room in the ICU later today as a standard procedure in these circumstances. Stay tuned for more later!

Channel Man had a good night. His SpO2 levels are hovering between 92% and 95% which indicates his body is tolerating the reduced FiO2 level of 60%. His overall blood gas levels are slowly improving and there are no new complications at this point in time.