Cassie's Journey

Cassie continued to remain stable overnight. She was unable to get much rest as the ICU team performed a scan of her gallbladder. This test confirmed that she doesn’t have any infection in her gallbladder and is continuing her recovery. Cassie has remained off the use of the ventilation machine since 9 AM on April 27th. The Respiratory team will perform one more “stress test” of her lungs without the use of any ventilation later this afternoon. If she passes the final stress test, she could be ready for extubation. She has continued to decrease her usage of blood pressure medication which is allowing for the team to begin fluid takeout procedures.

The vascular team redressed some of the wounds from the fasciotomy performed on her left leg. They cleaned the wounds out, confirmed that there was no further infection, and reapplied wound vacs to help her open wounds avoid infection. The ICU team continues to remain concerned about the viability of her lower left leg at this time.

Cassie continued to remain stable overnight and was able to get some more rest. The ICU team is continuing to test her ability to breathe without the use of the ventilation machine. She has been able to go up to 4 hours of breathing on her own without any machinery support. She will need to continue to strengthen her independent breathing before she can be extubated. The ICU team has continued to decrease the blood pressure medication that she is using. As she weans off the use of blood pressure medication, the ICU team is looking to find a way to offload the extra fluid in her body. At this moment it is estimated she has an additional 50 lbs. of fluid weight in her body. She will need to remove this additional fluid before she can be extubated. Cassie continues to be awake and aware while communicating non-verbally with the family. She was able to listen to the St. Mark’s sermon given by Dan Metzger today. The family thanks all those that have continually prayed for her recovery and appreciates the outflow of support offered to them.

Cassie continued to remain stable and got around 6 hours of rest last night. She is continuing to get more rest as her pain management is currently under control. She still has a large amount of fluid in her body that needs to be removed before extubation can be considered. However the ICU team is unable to begin fluid removal medication until they are able to reduce her reliance on blood pressure medications. Her left leg continues to be a concern to the medical staff and they are continuing to consider the need of amputation or skin grafts.

A pathology report confirmed that Cassie’s previous heart suffered from medium vessel vasculitis, which they believe could be a contributing factor to her original heart failure and the cause of the left leg compartment syndrome. However, more pathology testing is required to confirm if this continues to affect the rest of her body. Vasculitis is an autoimmune disease that will be treated with the same medication that she must take post-transplant. Rheumatology will come and visit her today to determine if any further steps need to be taken to address the vasculitis.

The ICU team goals of the day are to reduce her blood pressure medication and temporarily turning off the ventilation to allow her to breathe on her own.

Cassie continued to remain stable overnight and was able to get 5 hours of rest. Cassie went into the OR at 1:30 PM today to address the wounds remaining from the fasciotomy on her left leg. Unfortunately her left leg has not continued the progression that gave the doctor’s optimism on 4/23. Her blood flow past the ankle of her left leg has greatly reduced. The vascular doctors were unable to close the remaining two wounds on her lower leg and had to reopen a wound on her thigh to confirm there is no infection. The vascular team confirmed that none of her wounds are infected and plan to perform a bedside dressing change on Monday. The spyware equipment used during today’s procedure continued to show functionality in her left leg muscles. However, the skin in her lower left leg was not showing functionality and may require a skin graft.

On top of this, Cassie has had preliminary tests identify that she most likely is suffering from Vasculitis. Vasculitis is a condition where blood vessels throughout the body become inflamed. At this time, Vasculitis does not pose a serious risk to her but must be addressed with medication over the coming days. A Rheumatologist will evaluate her on Monday to decide how to best address her Vasculitis.

While this has not been her most positive day in terms of recovery, the doctors have confirmed that her new heart continues to function well and is working independently of any machinery. Cassie will continue to fight through any adversity on her path to recovery. The family asks for continual thoughts and prayers as she looks to tackle the next challenge in this lengthy process.

Cassie continued to remain stable overnight as her heart and lungs are continuing to work without the use of any life saving machines. Last night she got her first non-sedative induced sleep (roughly 3 hours) since her first surgery on April 11th. Her left leg is continuing to recover using the support of wound vac’s. There are two remaining incisions on her left leg that remain opened. Cassie is scheduled to have her 10th visit to the OR tomorrow where the vascular team will wash out the remaining incisions and look to close up her wounds. As of now the only machine support that Cassie requires is Dialysis to help her kidneys work overtime to clean her blood and the ventilation to continue to supply her with oxygen while she remains intubated. The medical staff are still unable to confirm a timeline for when she will be able to be extubated. However, the ICU team is working to reduce the ventilation she is using throughout the day based upon her tolerance to the reduction.

The family would like to extend their deepest gratitudes to all those that have donated meals, gift cards, and shared their thoughts and prayers. Last night we were able to read all the comments to Cassie as her awareness continues to increase daily. She is able to move her head to communicate with the family, and she was deeply moved by all the wonderful words. Please continue to share your kind thoughts and prayers through the comment section and the family will continue to read these to her each and everyday. These words of encouragement will help strengthen her as she continues to fight each step of the way in her lengthy recovery ahead.

Cassie had yet another stable night and she was able to function without ECMO since 11 AM EST yesterday. She went into the OR today at 2 PM where the vascular and plastic surgery team re-evaluated her left leg. The Vascular team was pleased to report that her thigh muscles have remained completely intact. The inside and back of her calf muscles do have significant damage, however there was no further muscle degradation. Overall the vascular team was pleasantly surprised and pleased with her status. However, the team is still unable to comment on the long-term functionality of her left leg. The vascular team will take her back into the OR on Friday for one final visit to close up the remaining wounds on her left leg.

While Cassie was in the OR, her heart surgeon was able to completely remove the ECMO machine! This is a significant milestone in her recovery as her lungs and heart are working independently of any support. She will remain intubated for a few more days as she remains in critical condition. She will be returning to her room after yet another successful OR trip in a few hours and the family will get to see her. Please provide any words of encouragement that we can share with her before she rests for the evening.

Cassie had another good night where she remained stable the entire time. She continues to have a good pulse in all four extremities as she remained on VV ECMO. She will go into the OR tomorrow at 2 PM to clean out the remaining injuries in her left leg from the Fasciotomy and replace the wound vac that is helping her heal. Cassie was more aware this morning and the ICU team is continuing to closely check and monitor her pain levels. They paused the fluid offload in order to maintain her blood pressure but are planning to resume later today if appropriate. The ICU team also turned off the sweep unit to the lungs at 11 AM EST and Cassie has remained stable without its support. The ICU team will continue to test her stability without the assistance of ECMO, but she will remain intubated for the time being. We all continue to see good progress out of Cassie, but know this remains a lengthy process as she is still very critical. Cassie and the family continue to appreciate all the prayers and support that the community is giving her as she continues her journey to return home.

Cassie continued to remain stable throughout the night and was brought into the OR early this morning to reduce her dependence on ECMO. Cassie officially moved off VA ECMO (which supports the heart and the lungs) to VV ECMO (which will only be supporting her lungs as they continue to reduce the fluid built up inside of them). She has now also been reduced to the lowest setting in the VV ECMO and it is supporting her lungs. This is significant progress in her recovery and it will be a critical 24 hours for her as her new heart will now be working independently. The ICU team’s goal for the day is for her to remain stable and monitor her heart closely.

Happy Easter Sunday! Today is one day of many to appreciate sacrifice and believe that God’s message will become known with patience and perseverance. Thank you to Pastor Dan Metzger for the lovely message this morning at St. Mark’s Methodist Church and for the outpouring support and prayers we continue to receive for Cassie.

Cassie had another stable and productive evening. She was able to adequately offload fluid (with kidney assist) and maintain progress towards recovery. She continues to rely on ECMO support to offload stress on her new heart and recovering lungs, with the goal to decrease support while maintaining proper blood flow into all extremities. Support will be weaned slowly as they continue to struggle to maintain proper blood flow into her left leg without assistance.

All neurologic tests continue to be positive, and the team is having to increase pain management as she is starting to become more aware of her surroundings.

The care team goals are to string together a multitude of stable days to allow her body adequate recovery. We will continue to update regularly as she crosses milestones under the assumption that this process is lengthy.

Cassie continued to be stable for another night. She remains on the ECMO machine to support both her heart and lungs after the transplant. This morning at 8:30 AM she re-entered the OR to review the healing progress on her left leg that suffered compartment syndrome. The vascular doctors were pleased with the amount of reactive muscle that remained in her leg. The doctors are still worried about loss of function to specific areas in the lower leg (anterior compartment muscles and the medial head of gastrocnemius). They believe she has a high likelihood to develop drop foot with some plantar flexion weakness. Doctors remain unable to make a determination if she will avoid amputation but if the healing continues she could maintain her left leg with the use of orthotic assistance. Today’s goal of the ICU team is to maintain her stability and continue to give her body time to heal after the invasive surgeries she has undertaken.

The family greatly appreciates all those that attended the prayer vigil to support Cassie, her family, her medical staff, and the donors family. It was truly amazing to see the community that has come together to support Cassie through her healing journey.