Todd RN called & informed me that Perry did have several toss & turns as well as hot/cold spells throughout the night otherwise it was another uneventful night. Jason RN & Jenn RN (orientee) were assigned to Perry on day shift. I arrived at 740a & greeted with an "I love you!" He then slept intermittently. At 0958, Perry was able to rid a huge amount of thick whitish cream mucous with trach cuff deflation & weak cough. Bill RT then allowed him to say a few words on 2 different occasions. He repeated Nick’s name several times on the first try & said "I love you" on his 2nd try. I got his first try on video but not his 2nd due to having used all my phone storage. He was placed on trach collar breathing which was a lot of work back to back within a very short period of time. He became sweaty & was not able to tolerate trach collar breathing but about 30 minutes due to increased labored abdominal breathing, nasal flaring & oxygen saturation decrease to 86%. He was totally exhausted & slept for about 4 hrs straight. Dr. Valapour visited & plans to keep his Prograf dosage the same today as the Prograf lab values for several of the patients were all rather odd today so she will make adjustments based upon lab values tomorrow. She planned to also follow up with Neurology as his twitching this morning was significantly increased & continued to be more significant throughout all of today. The Nephrology Dr was pleased with his dialysis results from yesterday but anticipates that Perry will need to continue on intermittent dialysis for a bit longer timeframe. He plans to give Perry Lasix IV & see if he is able to wait & undergo dialysis on Monday. Dr. McCurry (Cardiothoracic surgeon) was in & pleased with his progression & trying to emphasize Perry that each day he's making progress. A swallow study was inquired about with Dr. McCurry by the RT & an order for such was written. Caution to avoid an aspiration & thus a potential lung pneumonia are serious risks. If he passes the basic swallow study, Dr. McCurry plans to allow for very small quantities of ice chips to be given. Dean came in for PT session @ 1015 but Perry was in a deep sleep so rescheduled @ 1130, & then again @ 1p as Perry continued to sleep soundly. He did well during his session which ended & 115p with an assisted pivot into the chair by Dean with Jenn RN & me helping as well. A nap was again immediate. Kimberly OT saw Perry for upper extremity range of motion exercises & reaching exercises with his L arm/hand & then @ 320p Lauren, the Speech Therapist, was in to see Perry to complete a preliminary swallow study. He was able to demonstrate mouth & tongue movements used in swallowing. Green food coloring ice chips & water via spoon & then by straw were given as well as green food colors vanilla pudding to assess if his oral intake is ending up down his airway (trachea) & into his lungs. Upon completion the trach cuff is deflated & trachea suctioned - because Perry has been getting rid of huge amounts of mucous with cuff deflation he had green stained mucous but once the cuff was reinflated & trach suctioned there was no green food colored secretions so it was determined that he passed the preliminary study. He will undergo a more thorough barium swallow study also known as a videofluoroscopic swallowing study, or VFSS at a later date. More rest followed & @ 420p, he was lifted back into bed. His abdomen remained very distended but he was having frequent releases of gas so the NG tube was not passed today. His formula mL/hr was increased to 65 mL/hr relative to the results of the Metabolic Cart. Unfortunately Perry had increased body twitching the entire day, so he was very frustrated & was experiencing bladder spasms, so he required lots of TLC today & this evening. He eventually settled down with warm heat packs with weight of a 500 mL IV bag, abdominal massage, & being allowed to vent his frustrations & hitting a lap pillow. He made it through it, exhausted & back to sleep by 10p. Tomorrow will be another day! And we are both looking forward to Ryan coming to see us! Wishing everyone a safe & fulfilling Labor Day weekend!