Baby steps

Phil here, typing for Lisa. Here's the update she wants to communicate to all of us that are pulling for Naomi. Her update came in this afternoon but I wasn't able to retrieve voicemail until tonight. Sorry for the delay.
Cardiac: Epinephrine was lowered from yesterday (4 to 2.67) and Naomi's tolerating the change well so far. Her blood pressure is steady, even a little high (which in her case is a good thing). She's on 2ug (micrograms) of Dobutamine, which is used to get stronger heart contractions, but we'd like to see the need for this drug be lowered (or better yet, eliminated). Stronger contractions are what she needs, but the drug can sometimes cause the heart to pump too fast (tachycardia) and when the heart's pumping too fast, the contractions aren't strong and forceful enough to get blood out to keep vitals organs perfused with oxygen (make a strong fist, then open your hand wide 5 times slowly and then try doing the same thing as fast as you can... see how your fingers flutter and the fist isn't strong? Same idea with the heart). In addition to weening Naomi off the meds, there will be an attempt made to ween her off of the heart pump. Right now the ratio is 1:2 (1 pump of the machine, 2 pumps of her heart). This helps give Naomi's heart a rest so it can heal, as the machine is doing 1/3 of the work right now. The next goal is 1:3 (machine doing 1/4 of the work), then to 1:4 and so on. In order for this to happen, the heart muscles have to become strong. The doctors, even with their skill & application of meds & mechanics, can't do this for Naomi. So pray fervently for healing & strength of the heart.
Respiratory: no change from yesterday.
Nephrology: Kidneys are still functioning as well as they were yesterday, so the dose of the diuretic (helps the kidneys produce more urine) was lowered. Wait and see, and pray for pee (that's from me, not Lisa).
They started feeding Naomi yesterday. I don't know whether this would be TPN (total parenteral nutrition via a needle) or if a feeding tube was inserted. A downside of TPN is that it has infection risks. But when there's multiorgan failure, TPN may be a better choice than trying to do surgery to insert a feeding tube. Either way, this should give Naomi the extra energy she so badly needs to keep up her fight.
As I think about today's concerns (Dobutamine and the risks, TPN versus feeding tube), I am reminded of the mind-blowing balancing act that is necessary to stay alive and healthy. Tweak one little thing to help this organ, it can throw off the function of that organ. Increase the oxygen percentage to get more oxygen into the blood, it can make the lungs brittle and blow a hole, causing loss of oxygen in the long run. The examples are endless. It seems at times that practicing medicine can be as much art as it is science. As I wrote for the last post, toss up prayer for an extra dose of wisdom & insight for the medical pros. Also, toss up prayer for those in Naomi's family that are also getting a crash-course in medicine so that they can keep on top of what's going on and make the best decisions for Naomi's care when called upon to do so.