The plan when the day began was to be home this afternoon. By 3pm that quickly began a potentially home and by 5 pm it was how does another night here sound. While not ideal it was unavoidable. It just seemed to be one of those days or chess where the doctors would try to do something and Elias would counter or do something that had a trickle effect. That is the way Elias is, he doesn’t make things easy, but there is always a good reason in the end. That is what history tells about him. The doctors here are quickly learning this. The biggest thing keeping us from being able to go home is not having a way to feed Elias. His “D-tube” his not acceptable anymore to continue feedings, so they must place the G/J Tube to feed. That was unable to happen today because the darn thing popped out several times last night and today. It was being stinted open with a 10 French Foley catheter. The G/J tube is a 16 French or in layman terms fatter or thicker. The stoma was too small to pass without dilating it. That takes time, and without sedation pushing and pulling gradually graduated sizes to achieve the size you need can become a little painful. They did not want to subject Elias to that without just cause or sedation. They are reworking the plan again for that. We will hear about it in the morning. They still really want to do the CT Angio study. This requires an IV so contrast can be injected into the veins to give a live view of the position of them and how things are flowing. The reason this is so important is they believe that one of the things they saw during his bronchoscope was the aberrant right subclavian artery that Elias has placing pressure on Elias trachea and may have been what the doctors in Maryland confused for granulation tissue that was blocking 80% of Elias airway at the time the trach was placed. It may also be impacting the esophagus. They need this study to confirm the findings. We knew the artery issue existed, but never knew it could potentially impact him the way it seems to be. Elias is having difficulty, as usual with IV access and they were unable to get him in to have the procedure today. He has had three separate IVs today on that was placed in Interventional Radiology with ultrasound, that was neat to watch by the way. The other by the IV team. They are guarding the existing one with their lives. Not only is the IV important for the procedure, but without the feeding tube Elias needs a way to get fluids. So it is multi-functioning at the moment. Elias also had some very intense retching and odd secretions after we returned from the failed G/J placement. They placed a standard G-tube back in again to stint the stoma. It took us several hours to figure out why Elias was behaving this way and his stomach was becoming distended. He was working very hard to breathe and the respiratory therapist was standing over Elias for nearly 25 minutes almost constantly suctioning him. When the episode passed while we were waiting for the resident to come in, Katharine noticed how deep the G-tube was placed inside. There are numbers on the tube as guides. Elias takes 2 at the opening, but it was placed in at 4. Couple this with the gross misplacement and we were having blockage issues so bad that the contrast they used had no where to go but up and around the Nissen and into the trach. Elias was immediately more comfortable as Katharine and I pulled the water out of the balloon and retracted the G-tube some. Thank god we have experience with that. Tonight he is resting comfortable, very much exhausted from the intense day. He is breathing a little harder, which we are attributing to the new size trach because that is when it began, This is the opposite of what they expect to see, but this is Elias they are simply still learning him. Not sure if that is what it is but his heart rate while sleeping usually is in the low 80’s to mid 75. It was ranging between 120-140. It is beginning to level out to about 120 without the spikes so they are keeping a watchful eye on this as well. Since he is stable and there are only a few things outside his normal baseline they are not overly concerned, but are being cautious. I suspect Elias will have improved by morning after a good nights rest. We will keep you posted on how things go tomorrow. Thank you all again for the thoughts and prayers.