Day 48, early morning update

Greetings from a crisp sunny morning in New Hampshire.

Sage had a good day yesterday, sleeping in until 9:30 and waking up to a breakfast of  bacon and eggs, then had some physical therapy. The occupational therapist as well came by to check on things, noting that Sage was doing so well and so much on her own in the realm of self care that she did not need to be seen by occupational therapy anymore.

Sage spent the whole day on a 'trach collar' with the high flow system, which is effectively a plastic bubble or cup that sits over the trach site and delivers warm air through plastic tubing for Sage to breathe in of her own accord. No pressure support and no PEEP. It's like a warm mist or humidifier delivering air around the trach site - kind of like sitting in front of a fan that is blowing warm air directly at your neck - and Sage being the one to generate both the inhalation and exhalation of air. She did this all day yesterday, for 12 hours, and spent the day exercising, watching more Veronica Mars with Mary (who is now hooked!), skyping and laughing with the Donpineo family in Germany, her friend Johanna (who also lives in Germany), and her cousin Luke in Rome, getting up, stretching, and then going for an early evening walk - only connected to an oxygen tank.

walking outside the ICU with nurse Seamus and Vicki the RT

walking around the atrium

looking north and out

This again is a huge step in the right direction of moving out of the ICU, to a room on the floor, or just out of DHMC. Apart from the ventilator, Sage is very close, so close, to graduating from intensive care. The only thing keeping Room 12 occupied by the Donpineo/Don/Pineo/Team Sage/Miracle Channeling Team clan and posse is the ventilator. The next few days will probably bring a 24 hour trial run off the ventilator and Sage having only the trach collar.
This may sound like not much of a big deal, but it is. Sage is effectively retraining her lungs and muscles to do work that the majority of us take for granted when we go about our day and just breathe. Being off the ventilator and then being off any support or air being delivered, even with the high flow, is sort of like that breath each newborn takes - using the lungs for the task they were designed - and just trusting, knowing, that the breath in, and then as importantly out, will come easily and comfortably.
Today, Wednesday, Sage will try a 'fenestrated trach'. What this means is that the plastic tube (the 'shiley') inside her trachea will be replaced with one that has holes in it - sort of like swiss cheese, as explained to us - so that air can pass around the cuff and the tube. What this means is that air will pass above Sage's trachea, and what this means is ...... that Sage will start to be able to speak!! as the reason she has not been able to use and exercise those vocal chords is because air has not been able to go up and past the trach site. At first, her voice will probably be hoarse, but as we all know, Sage has forces beyond measure.
Alleluia and stay posted. Blessings on your Wednesday, and for those in the market, turkey season (the wild ones it is hoped) begins October 1st....