Not much to report. Ryan has been off of one of the heavier medications for a good long while at this point. His pressure has not responded as well as hoped but it is being managed. His swelling (not brain, but general) is going down as he puts more distance between himself and the surgery.

I apologize for the relatively boring update, but it will be this way for awhile as we wait for Ryan to heal, which will happen as his body allows. That said, there are a number of ways that all of those who care about Ryan can help as we wait, so please keep checking back to learn about those opportunities. We all need to pull together to help out Ryan, his family, and each other!

If anyone has a great picture of Ryan please email it to jim@pnola.org and I'll put it up. I can't promise I'll get to everyone's or be able to respond if you have questions, but feel free to send anything you think is cool.

Tonight's Report

Ryan is still recovering from surgery and there are no substantial updates at the moment. As mentioned previously, updates from now on will (hopefully) be slow, steady, and improving. Continue to keep Ryan in your thoughts, as his post op healing is our greatest concern at the moment.

Surgery Report

Jim provided a more thorough report below.

A More Aggressive Approach to Healing

Ryan's surgery lasted nearly 4 hours and was a success. He is now back in his room in the ICU recovering while doctors and nurses continue to monitor his condition. While the fact that they had to perform surgery on Ryan's head sounds frightening, it is not out of the ordinary that with a brain trauma and sustained high ICP they would do such a procedure. It is important to understand that this is not a sign that Ryan's condition has become more severe over the past couple of days, rather the underlying problem never changed and all we discovered was that the initial less aggressive (but safer) approach of medicating did not work (in much the same way that the sedatives were not strong enough to lower his ICP which prompted his doctors to induce a coma, his surgery was the next step if the coma medications did not work).

All of our initial reactions were to see this as a major setback and as a sign that any progress he had made over the last week was lost when really that is not accurate. The other way to look at the surgery is that it is better to do it to confidently relieve the pressure in his head rather than wait and hope it will go down while on the meds. The doctors have characterized this as really just a more proactive strategy to fix the same problem Ryan has had all along rather than a sign that his brain is getting worse. While the doctors and all of us were encouraged and hopeful at the news over the weekend that his pressure had responded well to the medically induced coma and disappointed to learn that the pressure had returned after several hours, we must continue to remember that Ryan has a long road ahead of him and will need all of us to stay positive and supportive no matter what news comes with each day.

Physically, Ryan looks no different than before the surgery. If anything, his skin looks and feels healthier and is finally normal/natural looking. He got a shave and they removed the remaining half of his hair, so it's more even. The pressure is coming back down as a result of his surgery, and right now his vitals are normal. He will remain heavily sedated for a while, although they're taking him off the some of the stronger medications over the next couple of days. Once again, updates will probably be infrequent and relatively similar. His condition continues to be very serious, obviously, but he has the good fortune to be in the care of well trained medical staff with the proper tools, medications, and procedures at their disposal along with a worldwide network of people who care about him all pulling for small but steady successes over the next weeks and months.

Please think about you favorite Ryan memory tonight/tomorrow, I promise he will get the message. In that spirit, we will continue to post our favorite pictures of Ryan.

Ryan needs us

Ryan continues to need our positive thoughts and prayers, perhaps now more than ever. Ryan's ICP pressure has been fluctuating over the past couple of days, and the doctors feel the best solution to relieve the pressure is to remove a portion of Ryan's skull (craniectomy) this afternoon. As you can imagine, this procedure can last several hours and although it sounds drastic, the doctors say that it is a common procedure for injuries like Ryan's. When we have an update on Ryan's status, we will update the blog. Keep Ryan in your thoughts.

Ryan and Friends

Ryan is continuing to heal very slowly but he is showing encouraging signs. Either tonight or tomorrow, the doctors will perform a tracheotomy so he can breathe easier and they will insert a feeding tube directly into his stomach so when he wakes up he won't be uncomfortable. His temperature is down with the aid of Tylenol and he remains on the antibiotic. However, he remains very sensitive to light and touch.

Ryan's parents stressed to me how much the Porcelli family appreciates the support they have received and the unbelievable response this blog has gotten. Thank you all!

Still Slow and Steady

Ryan did well today. He is still being weened off of the coma-inducing medications, just at a slower pace than originally planned. This is to keep the swelling in his brain at a stabilized level. His breathing continues to improve, with a reduction in ventilator assistance. Doctors have also observed Ryan moving his arms and legs. The movements are infrequent and subtle, but an encouraging sign.

The doctors and nurses keep encouraging us to talk to him, as he should be able to hear us. We've told him all about the Red Sox victory over the Yankees and share fun stories with him on every visit.

As of now, we need to remain patient and continue to send positive vibes his way. His family is comfortably settled into an apartment, and Ryan's support system in New Orleans is stronger than ever. Thanks to everyone who has come together over the past week to be there for Ryan and his family.

Ryan with Manny, one of the many homeowners he helped get back home after Hurricane Katrina