What's Been Happening...

Well, it's been so long since our last entry, many of you who aren't signed up as followers have probably quit checking for updates. However, I am going to try and get the word out that we have updated it. Our lives have gotten so busy since Brett came home - although it was busy before, it's different now. We're so glad to have him home!! Every time we feel as though we are too stressed and it's too hard, we just think about how much we love our sons and are so thankful first of all that he has survived the first six months, and second, that we are not in the hospital. First I'll go through an update on Brett's health, then (in another entry) I'll try to describe our daily regimen and answer a few specific questions some people have asked me that you all might be interested in reading. If you have a question, please post and I will try to answer it. So here is the timeline:

August 28, 2009 - Brett is discharged from the hospital after a 153 day stay. Whew! We were so excited and relieved to bring him home. Of course, he will always have CF, but his health was under control enough for us to take him home. He had finally started to gain weight on a consistent basis. Although he was coming home, he was/is still very medically fragile, so the central IV catheter (broviac) was left in just as a precaution. The doctors felt that there was a good chance he would be sick soon enough again that he would need to be put back into the hospital and/or need fluids for dehydration. If he was dehydrated it would be extremely difficult to get good IV placement on his little body that would be effective. This isn't the best option, of course, because anytime you have direct access to a vein/artery, there is the chance of infection. However, it turned out to be beneficial for his 2nd hospital stay.

September 10, 2009- First CF Clinic visit at UNC since discharge. Gained an average of 23 grams a day. The goal is 20-30 grams, or around an ounce a day. The weight gain was good, but his throat cultures had grown klebsiella and enterobacter, and so we started oral antibiotics.

September 17, 2009 - Doctor called because September 17 throat cultures grew klebsiella and enterobacter, and the antiobiotics we were using was not doing much for those particular bugs. Started a new oral antibiotic that night.

September 24, 2009 - Went for his 2nd clinic visit, and he had only gained 15 grams a day, so the weight gain was still happening, but certainly had tapered off. The doctors felt that after a week of the antibiotics his breathing and cough should've gotten better than it was. So they suggested re-admitting him to the hospital that weekend to start him on IV antibiotics. They really don't want Brett in the hospital any more than we do - mainly because of the viruses so prevalent in the hospital. However, the medicines must be started in the hospital. Also, they felt that we should admit him now at the beginning of the season and try to get his system "revved up" for the winter so he may not have to come back and stay during the worst part of the winter/flu season. We hope that will be the case.

September 26, 2009- A bed opened and we got Brett settled in his room around 9 PM. Started the antibiotics right away, and stayed 5 nights receiving IV antibiotics and checking the doses to make sure they were giving the correct amount for his body and to see that he was definitely improving. All this time Brett seems the same temperament-wise. If he felt worse than normal, he didn't really show it. So it was not very stressful or emotional as hospital stays go, just stressful/lonely in the fact that being in the hospital drains your energy and the family is separated.

More than anything, I was glad Brett had been moved out of the NICU during his last three weeks the first time he was in the hospital and up to 5th floor children's, which is where he will go whenever he is admitted under the pulmonary service. Because of that experience, I had sort of "learned the ropes" for 3 weeks, and I was confident and more effective as a parent/advocate this time, knowing how things worked on the floor, and also having had Brett home with me for almost a month, I knew him better as well. I knew all the office staff and many of the nurses, and I wasn't afraid to ask for things or tell them how I wanted things to go. In fact, they took my spreadsheet of times for medications I use every day and made a copy of it, so they would be able to follow it and bring him his meds the same time I do so that he would stay on the same schedule. I thought that was really cool.

One of the things we really wanted was to be discharged if possible before October 1 , because that was the date that they closed the hospital to ANY sibling visits under 13 years old. During the last stay and during this stay, Gantt was allowed to stay with me night and day. They are being proactive in infection control because the anticipation of a bad flu season, which I do agree with for the health of my patient; however, it sure will make it hard on our family whenever he's in the hospital. So we're praying he won't have to go back all winter long.

October 1, 2009 - Discharged again and met the home health care nurse that afternoon to get us started on the IV antibiotics at home. If Brett did not still have his central line, we would have to stay in the hospital 3-4 weeks, just to receive the treatment!! Needless to say, we are VERY thankful the doctors had the wisdom to do that for Brett.

October 2, 2009 - Twins turned 6 MONTHS OLD!!

October 6, 2009 - Gantt had his 6-month checkup, with regular immunizations and his first flu shot. Gantt weighed in right about 17 pounds, which is 45th percentile on the regular six month growth chart (not a preemie chart). His height is the 50th percentile, so he may be the tallest one when everyone is grown up!

October 9, 2009 - Brett had his 6-month checkup, with regular immunizations and his first flu shot. Brett weighed 11 pounds and 9 ounces, which is 9 ounces more than when he was discharged October 1. Remember, the goal is about an ounce a day, so we are very encouraged by that. Brett's weight is 23rd percentile on a preemie 6 month scale, so that is pretty good for a child with CF. His height is 50th percentile on a preemie 6 month scale. Our doctor estimated his physical development is about the same as a 2-month old right now. Mental development seems normal for a six month old. Now our whole family has had the flu shot, and the twins will go back next month for a booster. Still waiting on H1N1 vaccinations to come out.

What the next few weeks look like:

The nurse comes twice this week (October 12th) and twice the next week (October 19th) to weigh Brett and get his labs and stuff. On October 22, the early intervention people are coming to assess Brett and set up services, which he'll probably qualify for almost all of them. On October 24, we go to the special infant clinic at UNC, which is exactly what the name is. They monitor developmental progress for premature or ill infants who are behind. Just more closely monitoring than our regular pediatrician does. Also on October 24, we go back to CF clinic for a follow-up and determine whether Brett can stop the antibiotics.

So for the last week we've been trying to settle back into being home, and make sure we are getting all the administrations done. It is very tough to get any sleep. Really. Between caring for the basic needs of both twins, then all Brett's extra care, and of course, Mark - there isn't much time to get a whole lot of uninterrupted sleep. That is perhaps the hardest thing right now because without sleep/energy, it's hard to get everything done, and of course the kids have to be fed & clean, clothes have to be washed, homework has to be completed, backpack/lunch packed for the next day, etc. etc. Fortunately, Mark is old enough to take care of himself in a lot of ways, such as taking a shower on his own and many other things. Unfortunately, some other things we just have to put off until they just absolutely can't be put off any longer. Oh well, such is our life right now. We are so happy, happy to have all our boys home, and we are enjoying our family time.

BRETT IS HOME!!!!

Brett came home yesterday and we are trying to get settled in to a routine.  So many meds and so many things to do.  It is difficult enough by itself without having another baby in the house.

Pics will come later. 

One Week on 5th Floor

Well, we've made it a week now on the 5th Floor of the UNC Children's Hospital. After a few days of trial and error, and making various changes to Brett's nutritional calories, volume, and rate of administration, he finally gained 20 grams at his weight check yesterday! At his weight check this morning he had gained another 40 grams, which puts him at 4.12 kilos, equivalent to 9 pounds and 1 ounce! We are so encouraged to finally see a little bit of progress after a week. The events of the day haven't changed much - he still gets his various breathing treatments several times a day, various medications, his enzymes, and chest pats 4 times a day. We are able to feed him a bottle every 6 hours on top of his continuous feeds. He eats around 10 milliliters in each bottle. Gantt and I (Jennifer) pretty much hang out all day - it's almost like it would be at home, except we are in a hospital. They eat, they play, they nap. We just get a little cabin fever being stuck in this tiny room, just like you get cabin fever when you're stuck at home with one or two babies. But it isn't home, so we don't have the comforts of home, and we don't have the whole family together. Can't wait until that day!

Since Brett started coughing on Sunday, they did a throat swab to see if there is any bacteria growing in his lungs. The doctors wanted to hold off on giving antibiotics first because sometimes antibiotics can complicate what is going on in the bowel. Second, they want to see exactly which bacteria is growing so they can use the appropriate antibiotic - not start something without information, then get the information and have to change the medication. But each day Brett has been coughing a little more, so today they pretty much decided that they do want him to go on an antibiotic, but they still are going to wait to see what antibiotic they are going to give him.

Thank you all who have come to visit and made my days a little better. Thank you all who have volunteered to come sit with Brett and give us a break as well. We appreciate everyone's support! New updates soon!!

This one I call the "fist bump"

Notice the size difference between the twins! It is striking how much smaller Brett is!

Day 3 on the Pediatric Floor

When I posted last, it was in the afternoon on August 5, last Wednesday, and I explained how we were expecting to be transferred to the pediatric floor possibly by this weekend. Well, I got home at 5:00 that day and we all went out to eat, and at dinner, I got a call from the hospital telling me they were moving him right then! So we still had to go home, get Mark in bed, and pack a bag before I could make it back to the hospital. I arrived around 11:30 and stayed the night.

Although it is a very good thing Brett does not need intensive care anymore, it is a lot more difficult on us because someone needs to be here with Brett all the time. It is not required by the hospital of course, but with a private room and sharing a nurse with several other children, we are determined that he not be left alone for more than 30 minutes or so. Thankfully, they are making a special case for Gantt to be able to stay overnight. Siblings are not usually allowed. Also, Brett's room is right at the nurses' station, so if we leave to go to the cafeteria or whatever, we just tell them to please listen out for him since we will be gone.  We have many more "liberties" on the floor than in the NICU, as I also explained earlier. It is so nice for Gantt to have his pack and play to sleep in. 

Overall, we are getting settled in fairly well, although still "learning the ropes" as things are very different here. Brett is sleeping better in a quiet, darkened space, and he is able to do a lot more interacting. As hard as it is to sleep here every night, it is nice to not have to leave him, either. The CF doctors and nutritionists are working with his feeding protocol to help him gain weight. I talked with a friend today and was able to explain a lot about what it is that Brett's disease does to his body. If you would like to read a little more information about CF, go to this website for the most accurate and most recent information.

cff.org

 

Hi Everyone,

We are sorry we have been slack in updating the blog. Things were going really well with Brett, and he was actually scheduled to come home today, August 5. But then over the weekend after they took him off his IV fluids in preparation to come home, he did not continue to gain weight. Unfortunately, this is enough of an issue to delay his homecoming again indefinitely. One good thing is that he didn't come home only for this to happen and have to be readmitted to the hospital. This is the scenario the doctors are trying to avoid.

The other thing we are so happy about is that although he must still stay longer, it is not because he is sicker or critical in any way. He is about to be moved out of the newborn intensive care unit to the regular pediatric floor. The main reason for this is that he will be under the care of the pulmonologists and gastroenterologists that work with kids with CF all the time. There will be a lot more consistency in his care and hopefully a specific strategy to get him to absorb his nutrients and be able to leave the hospital. Whenever he gets sick in the future and has to stay in the hospital for a little while, these are the doctors who will take care of him then. It will be good for them to get to know him now while he is "well" respiratory-wise and before he leaves the hospital the first time, so that when he returns in the future, they will be familiar with him already. Also, we as a family will learn how things go on the pediatric floor so we will know better what to expect for our family when he goes to the hospital for inevitable respiratory issues/illness/infections.

On another note, I (Jennifer) had surgery last week to have my gallbladder removed. I had gallstones caused by my pregnancy and they were causing gallbladder attacks and a lot of pain. That surgery was successful and after 3 days of recuperation, I was pretty much back to normal. My mom came and helped while I was not able to take care of myself or the kids. She and Rob tag-teamed and got everything done during my convalescence.


Whenever a bed opens up on the 5th floor, Brett will be moved there. It may be as early as this weekend. This will be quite a change for our family. This is going to be better for us in many ways. Brett will have a private room with our own bathroom and place for Gantt to spread out (sleep in his pack and play, have other toys) and we can be a lot more comfortable. Mark will be able to come visit (he has not been able to see Brett since Mother's Day - close to 3 months ago now), and we can have visitors. we can eat in the room, watch TV or play games, lay down and take a nap, whatever. These may sound like small things, but these are things we have not been able to do all these months that Brett has been in intensive care!! We have to leave him just to go get something to eat.

We will be doing a lot more to care for Brett ourselves, so there will be more consistency in his daily schedule. We will get lots of practice caring for his special physical needs (feeding bottles, giving enzymes (right now every 3 hours), giving breathing treatments (3-4 times daily), giving chest physical therapy (3-4 times daily), administering medications through the g-tube and learning general maintenance of the g-tube working the pump), and practice caring for both babies before we actually have them home. We are going to be really comfortable caring for Brett before he comes home, so we will know better what our daily regimen will be like.

The only drawback to this change is that someone will now need to be with Brett pretty much all the time. That is going to be especially difficult for our family as a whole. In the nursery he is in a room with 10 other babies and under constant nursing care. On the pediatric floor he will be in a room all by himself, and the nurse will be responsible for 3 or 4 other children as well. We are not willing for him to be alone in this situation. This means I am basically going to be living at the hospital now - pretty much "moving in" with Brett. Although there are certainly great things about this situation, it will also certainly put a greater strain on our family. Additionally, although it looked as if he would be coming home this week, we are now looking at one more week at a minimum and a couple more months at the maximum maybe. There is just no way to know how long this process will take.

You may be asking yourself - what can I do to help? Well, if you or anyone else in your family is not sick, you can visit us sometime. In the NICU I am around the nurses and other people all the time. In a private room, I will be pretty isolated. Although I'll be hooked up technologically, it would still be nice to see a friendly face here and there.

Also, I am concerned that he will be in the hospital for a good while longer. If it was just a few days or a week, I am confident that Rob and I could handle it and take care of our family just fine by ourselves. But if it is several weeks to a few more months, we are going to need help. I am thinking that if this takes longer than a week or so, it would be really nice to have people who might help us sit with Brett - to give us a break, maybe even stay a whole evening so we can enjoy a "normal" evening here and there with Mark and Gantt at home. Or go out for dinner & ice cream with Mark and Gantt or whatever. Please let us know if you are willing to do this at some point. You would not be "responsible" for any of Brett's care. Obviously, the nurses and doctors are responsible for his care. It would just be staying in the room so a four month old baby is not ever alone. If he cries, you would be there to comfort him and hold him for awhile, play with him - as he is getting to be a lot more interactive and social now that he's older. Also, I will never be able to leave for awhile with peace of mind unless someone I know is with him. Even if you are a church member or a friend of a friend that I haven't even met, don't let that keep you from contacting me if you are willing to do this.

Thank you all for your prayers, encouragment, meals, etc. The support has been wonderful - from local friends bringing meals to far-away family and friends just sending encouraging words our way. We ask you to continue to keep our family in your thoughts and prayers, and keep checking for updates - we will try to get better at keeping you up to speed through this blog.

--Jennifer & Rob

103 Days Old!

Brett above and Gantt in his stroller

Brett is doing great.  Right now he only needs to do a few things to come home.  

1.  Get to full feeds.  He is on track to be on full feeds (based on body weight) by the end of July.

2.  Tolerate full feeds.  He has to absorb the feeds properly and have appropriate output.

3.  Once he is doing this, he must go 1 week without any episodes.  After that week he comes home!!!

Brett completely weaned of the continuous morphine drip.  They have to give some to him a few times a day to help with withdrawals, but it is a big step to not be on the drip.

Happy 3 month birthday

Well it has been 3 months.  Jennifer got a couple photos, but Brett was not very happy about it!  They should start feeding Brett tomorrow.  Hopefully he does not have any strictures and the feeding will progress normally.

We also got the tests back for Mark, and he is a carrier of CF.

Cute Pictures

Brett got a new chair to sit in.  He loves the vibrations and is enamored with the hanging toys.  It is great that the hospital wants us to bring stuff like this in so he can develop like a normal child at home.  They even have volunteers that come in and hold the babies when the parents can't make it in.  

Mark loves his brothers.  Here is a picture of what he likes to do everyday when it is playtime for Gantt.

6/29 Update

Brett did well during his surgery.  Came back extubated and wide awake.  They asked us to bring in his car seat so he can sit up and not have to just lay there all day.  We are also going to bring in some toys so his brain can get stimulated as well.  Currently we are waiting to finish the antibiotics.  Once he is done, he will get a lower GI to check for any strictures.  If he is clear, then they will begin feeding again.  If not, another surgery.  All of us are hoping and praying he is free and clear.

6/26 - update

They could not get the PICC line in Brett this morning.  He is currently in the operating room getting a broviac.  This is medically necessary so they can give him everything he needs through an IV.  He will go under general anesthesia, but the procedure should not take long.  Hopefully he will come back and not be intubated.

6/23 - update

So Brett had his second lumbar puncture today.  Yesterday they could not get any fluid after two tries.  Today it worked and the results were negative for meningitis.  He has had a problem with his broviac clogging and they removed it this evening.  They will wait 24 hours for any bacteria to get killed by the antibiotics and then put in a PICC line.  All of this will be done bedside, however, it will be completed by the surgical team.

His abdominal x-ray still does not look as good as it should.  There is not an issue with NEC anymore, but they are still a little concerned about the air in the wall of his intestines.  They are still taking x-rays every 24 hours and looking for improvement.  Once the x-rays are normal, they wait 10 days and then begin his feeds through the G-Tube.

We need to get him on feeding by mouth again because enzymes are so important for kids with CF.  Enzymes work best if taken orally.  The enzymes help him break down his food (even breast milk) so the nutrients will go in his body.  

He seems to be doing better, but the roller coaster ride of the newborn critical care center is very hilly.  Some days it is up and others it is down.  Please continue to pray for his health.

Happy father's day!

So it seems Brett is "out of the woods" regarding the NEC and blood infection.  The antibiotics have been working.  It seems that we will not be totally comfortable until Brett gets to come home.  It looks like it will take at least a month before he gets back to full feeds.  There is also a possibility (25%) that when his intestines heal, it will create some scar tissue which would require surgery.

Not so good Thursday morning.

Today we got a call from the hospital.  Brett took an unexpected turn for the worse last night.  Everything seemed to be going so well.  However, he developed necrotizing enterocolitis.  It is very serious and they are treating him.  We will know more by Saturday evening.  Hopefully the antibiotics and other treatments will work.  If not, it could be fatal.  Please continue to pray for him and his doctors.

Everything is going so well.

Gantt above and Brett below

Everything is really going well.   Brett came off all breathing aids much faster than anticipated.  He is still weaning off morphine (will take several more weeks) and he is not showing many signs of withdrawal.  

His G tube fell out on Saturday, so they installed a mic-key button.  The best way to describe it would be like the plastic plug on a beach ball that seals the air in.  You can remove the tube and then put that little plastic plug in place so the stomach is sealed off.  This is great because he would then be able to put a shirt on and nobody would know the difference.  We will need this long term because we anticipate having to feed him through this tube for many years to come.  (mainly supplement feedings during the night -- CF kids have a hard time getting enough calories)

The next step is for him to be able to suck on a bottle.  He is currently getting continuous feeds through the g tube.  Once he can swallow, they will begin giving him enzymes.  The enzymes will allow him to break down his food and keep as much nutrition as possible.  Many CF babies begin taking enzymes as early as 10 days old!  The occupational therapist is working with him so he can breath, suck, and swallow without his heart rate and oxygen saturation dropping.

It still may be 6 more weeks, but it is nice to see him sleep and actually begin to look comfortable.

Gantt is fat and happy!  He is so wonderful to have at home and Mark is taking to him very well.  The other morning I (Rob) was having a hard time comforting Gantt.  Mark asked if he could try so I let him.  Within seconds, Gantt was quiet and Mark had the biggest grin on his face.

Mark began a new hockey class.  It is 1.5 hours long beginning at 8AM on Saturday mornings.  I am so shocked he stays on the ice the whole time without a break.  He is really enjoying himself out there.  

Making Progress

Brett is making some progress.  It looks like they will take him off the ventilator either today or tomorrow.  We hope he does well and does not labor to much to breath.  He can go 15-30 minutes okay, but he labors a lot right now.  The though is that he could not keep it up 4 hours later because of how hard he has to work.  

Jennifer got to hold him yesterday and he is beginning to look a lot better.  He still has a couple more months to go, but getting off the ventilator is the first big step.

Mark began mini-mite hockey yesterday.  It begins at 8:00 AM and ends at 9:30 AM.  I was happy he stayed on the ice pretty much the whole time.  His previous hockey classes were only 30 minutes.  

Gantt is still doing very well.  He weighs almost 9lbs!!  There is no real update with him, except he is so easy going and that helps greatly with all that we have going on.

60 Days Old!!

Today the twins are 60 days old! Gantt continues to do well and he has his 2-month check up this week. Brett is doing a little better every day. Today his oxygen was at 36%, and the doctors are talking about beginning to "challenge" him a little more with his breathing. That means turning down the settings some on the ventilator and seeing how he will tolerate it. Tonight he did not do so well, so they turned it back up, but not quite as high as it was before, so he is still making some progress. The goal for this is to get him back on a conventional ventilator - two reasons, one is that they are more familiar with the conventional kind, and the other is that he does not have to be quite as sedated on the conventional kind. Of course as little sedation as possible is best, and that way he could also move around more, and that's good for his body as well. He continues to release the fluids the way that we want, and today he was back down to about 8 1/2 pounds. At one point he had gotten over 9 1/2 pounds because of retaining all the extra fluid. 

Also, now that it's 10 days post-op, his surgeon gave the OK to start feeds again! He is on continuous feeds of maternal breast milk at 1 mL per hour. They started this afternoon and he has tolerated it well so far the couple of hours he's been on it. Tomorrow we have the meeting with the doctors.

Today was Mark's last day of kindergarten.  I made it through the "celebration" with minimal crying! I must brag on him a little. On his standardized tests he scored very well.  What I am most proud of, though, is his score on Bible assessment. A score of 565 or above is considered advanced on Biblical knowledge, and Mark scored a 633! This means "exceptional mastery of biblical facts and principles with a strong understanding of how to apply them." We pray that Mark continues to grow in his knowledge of the Bible and in his relationship with the Lord. We are so proud of what he has accomplished this year at school. 

Nine days post-op now. Brett has done a little better each day on the high-frequency ventilator. We've seen the oxygen percentage decrease while his oxygen saturation increases, and that is what needs to happen for him to be able to be free of the machine. Just last Monday, Memorial Day, he was on 100% oxygen. As of yesterday he was down to 37%, and he is doing a lot of the breathing on his own. We and the doctors are very encouraged by his progress. He has responded well to the diuretic medication they have given him to help him release all the extra fluids his body was retaining from the surgery, so he is looking a little more like himself now. Yesterday I (Jennifer) saw him open his eyes and look around for the first time since May 21.It also was the first time since his surgery I have been able to see his chest rising and falling from breath.  He is still on a continuous morphine drip, but instead of giving him additional morphine doses, they have changed to a different pain medication that is keeping him comfortable but doesn't leave him completely sedated. He is now stirring around more. He still does experience a lot of pain, but that is to be expected with all he is going through, and they try to keep it under control. 

He still gets chest physical therapy and has his lungs suctioned out several times a day. Right now he is in a more stable place than last week. There are no more surgeries or procedures that must happen before he comes home. However, that still may take a long time. We are talking with the doctors on Tuesday to discuss what things Brett needs to accomplish before he can come home. Probably he will be at UNC a few more months, but we will see.

Gantt continues to do well. He is such an agreeable baby and he is such a joy to have. With all the additional stress of having Brett sick in the hospital, it is a blessing to have Gantt be a low-maintenance and good tempered baby. He is just happy. 

Rob and I have been able to get a lot more sleep for the past few days because G.G. (my mom) came to visit. She got up with Gantt for 4 nights! It is amazing how much better a little rest can make you feel. 

We had Mark's 6th birthday party yesterday with kids from his class at school. Tomorrow is Mark's last day of Kindergarten and he is out for the summer. We are keeping him busy with fun day camps through the summer while looking forward to first grade. No vacations this year...we're counting on everyone being well enough to go next year though!

Recovery....

Recovery for Brett has been difficult.  His chest is full of mucus because of the CF and he cannot breathe on his own.  Today they switched him to a high frequency ventilator.  They keep him on a morphine drip and have him sedated because just a little bit of stimulation aggravates him greatly.

After putting him on the new ventilator, they were able to lower his oxygen output to 90% which is a step in the right direction.

His body was pretty beat up during the surgery and he is retaining a lot of fluid.  They also added a G Tube that should help with his feeding when he is ready.  

He has had a lot going on and he has required a lot of attention.  Please continue to pray for his recovery.  The doctors anticipate a full recovery from the surgery, but they said it will be a slow process.

On the eve of surgery

Mother's Day Picture

Tomorrow morning Brett will undergo several procedures during one operation.  He will get his intestines reattached tomorrow which is the main reason for the surgery.  However, while he is in, they want to take advantage of him being under and perform a few other things.

He has had issue with reflux.  Last week he developed pneumonia again combined with vomiting.  Unfortunately he got very sick and was vomiting bile.  They took him off of his feedings and began to monitor him closely.  It has been decided that they will do a procedure that will help his reflux .

The third procedure will help treat his CF.  They will do a bronchoscopy and while they are looking at his lungs, they will inject some saline.  They will then withdraw the saline and process it in a lab.  This will determine specifically what type of bacteria is in Brett's lungs.  Once they know the exact "bug" they will be able to treat him more effectively.  A direct result of this procedure is that Brett will have a fever and will be sick.  Please continue to pray for his health.