Irv Update - January 2011 #11

Dear F&F;

When I went in to see Irv this morning he informed me that he got to come home today. He had eaten eggs, pancakes and juice for breakfast without any trouble so he was cleared to leave the hospital. Hooray!

He is allowed to eat anything he wants, just small amounts at a time and chew thoroughly! Several small meals a day and no huge amounts of anything. Plus lots of fluids.

The dogs were overjoyed to see him in his recliner again. I like the look of him there as well.

Irv will see the surgeon Dr. Kowalski next Friday, one of his Physician Assistants on Monday for the removal of the staples in his incision and then the gastroenterologist the following week. Irv is back on the prednisone (30 mg/day) and the generic Prilosec. He was given some pain pills, but really isn't needing them very often. Just if he has a big coughing bout, which seem to come on every so often for no apparent reason.

Just being home and being allowed to rest/sleep whenever he wants is a joy. He had nurses and other caregivers in and out of his room all hours of the day and night. Checking vitals, checking his glucose, measuring his oxygen level, weighing him. Since the TPN (which was 15% glucose) was removed, his glucose levels have all been normal. That is a big relief and just what we hoped would happen. Irv is to keep checking his glucose 2x day and see his family practice doctor if it is greater than 125 fasting, or 160-200 just before the evening meal. Before the surgery it was always much lower than those numbers, but he wasn't eating anything either. At least nothing that stayed in him that is.

Now we just wait for him to heal completely. The projected recovery time is 8 weeks from now. He just wants to be able to get in the hot tub again. That is taboo until his stomach is completely healed and the doctor says he can get in the tub. I've lowered the temp to 80º so he won't be tempted. (He doesn't know how to raise the temp, even tho it is really easy to do. Hah!)

Thanks again to you all for so much support! Let's hope this is the last of all our health problems for a really long time. Both of us are so over being sick.

Penny and Irv

Irv Update - January 2011 #10

Dear F&F;

Today I took Stella and Izzy to see Irv in the hospital! St. Charles allows approved pets to go into the rooms of patients. Stella and Izzy passed inspection so they got to see Irv today. It was very cute as Irv hadn't seen them for over a week. The dogs kept sniffing all the new stuff attached to their "daddy" until they finally just laid down on the floor. Several people passing by had to come in and pet the dogs and exclaim about how well behaved they were.

Irv had eaten a custard and a banana milkshake was delivered while I was there. Over the course of the day other "fluid" items he ordered came every few hours and he managed to eat them all - slowly- and not feel nauseated or over-full. His TPN nutrition will be gradually decreased in volume throughout the day and night until by tomorrow morning they will stop it completely. As long as he keeps eating, that is. Also, his pain medicine and antibiotic will change to pill form tomorrow. When I see him next he may be IV free! They will keep in the PICC line until discharge, just to make blood draws easier, as well as an easy access port if needed before then.

Irv even had a real shower today. It was a little challenging as the IV pole with its 3 pumps were still attached to him, but it had to stay outside of the shower curtain. No matter. It allowed him to really feel clean for the first time in over a week.

The dogs get to see Irv with me tomorrow and hopefully I'll be bringing him home on Saturday! I'm finally relaxed enough to really enjoy this progress. At least I'm no longer worried my husband is going to die on me. At least not in the foreseeable future.

Thanks again for all the loving support. It has really been necessary to keep me going, believe me. Thanks!

Penny

Irv Update - January 2011 #9

The NG tube is outta there! Hooray! Irv still has a very sore throat and he still sounds kind of funny when he talks, but that tube is gone.

He also was moved up to the 5th floor, room 522.

Not only do we have farts, but poo-poo as well! We were all so proud! The nurses even have to view it and try to figure out volume, etc. Isn't that a nice part of a job description?

His heart is still being monitored, but by some device that sends a signal back down to the 2nd floor only if there is an arrhythmia. Or something like that. But, he hasn't had anything like that for over 24 hours so no one is worried.

He was allowed jello and a Popsicle today. He said they were delicious! The cold popsicle especially for his sore throat.

After so much of nothing it is dizzying to have so much progress in such a short time. He does have to manage some Ensure or such type of food tomorrow. If that goes well he could be home by the weekend! He is still getting the TPN via the PICC line because he is still nutritionally deficient.

I'll keep you all informed. It is so nice to see my Irv looking more like himself instead of a barely walking shadow of his former self.

Penny

Irv Update - January 2011 #8

Dear F&F;

My internet has been up and down for a couple of days, mostly down. Repair people coming this morning.

Anyway, at 10:17 pm on Monday night Irv produced a fart! Hoorrayyy!

Yesterday they plugged his NG tube and even put some 50 cc's of fluid thru it into his stomach in the afternoon and he was fine. If the same continued during the night they will pull that damn NG today.

Plus, they stopped the Cardizem, too. As long as Irv doesn't have any a-fib events by this morning he can go off the full-time heart monitoring and they will move him to the regular surgical floor.

LOTS of progress!

I await the Internet repair people and then will go to Bend to see Irv and find out the latest news.

Yesterday, Dr. Koteen, the gastroenterologist taking care of Irv the last several months, came to see him. Dr. Koteen has already started the ball rolling to get Irv to Virginia Mason as soon as he can travel up there. This Dr. K. also contacted OHSU in Portland and even the Mayo Clinic docs, who pioneered the autoimmune pancreatitis treatments. After he pulls all the information together he will be advising us as to what we should do to find a real diagnosis for Irv and hopefully find a way to treat it effectively and get Irv healthy again. I hope it doesn't require us going to the Mayo Clinic, but we will if we have to to get this fixed!

I'll send this now as the Internet is still up. More later.

Penny

Irv Update - January 2011 #7

Dear F&F;

Not the progress we are waiting for, as in farts, passing gas etc. BUT at least Irv is looking more like himself. Finally, today, he had a really good "bath" and was able to shave himself. He in so encumbered with paraphernalia that he can't go anywhere except to a chair from the bed, but he did it today. Yaaah! Since walking would help his digestive system "wake up" the nurse was going to help the nurse assistant follow Irv around his room a little, dragging/pushing all the stuff, to see if his tummy would start functioning again. (He has 2 IV poles running 4-5 different things and a heart telemetry monitor thing. Plus the suction apparatus for the NG tube in his nose and a blood pressure cuff on all the time, plus those squeeze things on both legs. Those last three could be left off for a while.)

Irv was much more "himself" by joking and taunting all of us as well. Roger and Marilyn, Irv's brother and sister-in-law, arrived yesterday afternoon for a surprise visit from Newberg, OR. I had already gone home for the day, but they visited with Irv, stayed in a motel for the night, and then came back this morning. It was so wonderful to have someone give me big hugs! Irv seemed to appreciate the visit almost as much as I did. Irv's biggest complaint is that the TV in the room is only a 19" one, and up on the wall! How was he to see the football games on that? (See, he really must be getting well.)

I was finally able to catch all the doctors who checked up on Irv today. Before, no matter how early I got to his room they had already been in! So today I managed to get there by 6:45 am, and of course, it being Sunday, they didn't start showing up until almost 10:00. No one is concerned that the bowel hasn't started functioning again, today would have been the earliest anyway. The complete pathology wasn't available yet, but again, no one expect there to be any cancer. I am hoping that a more definitive diagnosis can be made from the pancreatic biopsies. Autoimmune pancreatitis has a specific look and Irv had sort of that look last May when the last biopsy was done, but not definite.

I'll be in his room again very early tomorrow in order to catch the doctors, I hope.

For those of you who asked, we live 42 miles from the Bend hospital, St. Charles Medical Center. No flowers are allowed in the IMCU. There isn't a phone in his room so no one can call him. The nurses have been WONDERFUL. I have heard this about the staff for years, and it is true.

I'll keep you updated as thing progress. Gross as it may be, we are praying for farts, or whatever name your family has for them. You do the same!!

Penny

Irv Update - January 2011 #6

Today when I got to the hospital, about 8:00 am, Irv was sleeping! He said he had actually had a pretty good night. A new IV assembly was present - it was the pain medicine that he can give himself, up to a predetermined amount, of course. There were some vinyl apparatus' on his legs that squeeze on and off to keep the blood moving. He had nasal cannula delivering 2L. of oxygen, too. Every hour some machine takes his blood pressure and he is supposed to exercise his lungs with some respirator device when that happens. An antibiotic was flowing in with the regular IV.

Because he can't take any medicine by mouth and he will stay on the Cardizem (thanks for the spelling Pat and Kerrin, you dogs) by IV to help keep his heart in a normal rhythm. That also means he will stay in the IMCU until he can take the medicine by mouth because his heart has to be continuously monitored while on this IV drug and the regular floor doesn't do that. He is also getting a form of anti-clotting medicine via a shot in his abdomen to help keep any stray clots from forming in his body since he isn't moving around much.

The nurses tried to get him up into a chair, but he was too dizzy and weak so he has just been sitting on the side of the bed and dangling his legs.

IV Therapy inserted the PICC line and about 3:30 he got his first TPN feeding into his blood system. With this PICC he also can have all the blood draws plus most of the IV's done thru it. The Cardizem needs to be given in normal saline, so it still has its own IV, but at least instead of three Irv still has just two IV's.

One quandary is that Irv's glucose levels are now too high, running around 160-180, with the D5W IV. He was given a couple units of insulin and will be put back on Lactated Ringers solution with the next IV change.

About 2 liters or more of bile and other fluid is still being removed with the NG tube from his stomach each day. So far, no promising bowel sounds. That isn't unexpected.

At least I felt good after seeing him today. He is obviously ill, but seemed to be more hopeful and positive than he has been in a long time. His voice wasn't so dead and lifeless in tone. Does that make sense?

Let all hope and pray this is the start of a miraculous recovery!

Thanks to you all for your notes and encouragement. It does help. I'm also thinking there is a future again. Whew!

Penny

Irv Update - January 2011 #5

Dear F&F;

Sometime last night Irv's heart reverted to a normal sinus rhythm. He couldn't tell it was in a-fib, and he couldn't tell when it came out. I guess a lot of people can tell when their heart is screwing up, but not Irv! He is still on the Cardazyme (sp?) thru an IV line. I don't know how long they will keep him on that. I was wrong about him getting glucose in his IV. He was just getting the boluses. Still his glucose levels were too low, around 60-70 so he is now on glucose IV's.

After an endocardiogram Irv's heart was okay and no clots had formed from the a-fib, so he finally had the surgery about 4:00 pm today. NO cancer was found anywhere!! Yahoo.

His pancreas had a hard/woody feel to a large portion of it. Probably due to the autoimmune process, but not cancer. Dr. K. was so sure there would be some cancer somewhere, so now he, along with everyone else, have no idea why Irv is having so much trouble. It must be autoimmune, but right now no one can say why. I hope and assume that we will finally be referred to OHSU in Portland for some sort of work-up by specialists that aren't available here in Bend, but that is a guess on my part. He will certainly have to be healed from this surgery before that will happen.

From the exterior of the bowel, there was no indication there was a obstruction! Dr. Kowalski could feel and manipulate it, but otherwise it would have been hard to detect if the endoscopy on Jan. 7 hadn't confirmed it was there.

The by-pass was completed successfully. Irv is now seriously nutrition depleted so tomorrow a PICC line will be placed for IV nutrition called TPN. Trans parenteral nutrition, I think is what that means. A dietitian came in today and explained the process. There are about 4-5 steps Irv has to complete before he will be allowed "real" food again. TPN is #1, then when they are sure the stomach and bowels are working clear liquids is #2, then #3 is liquids like Ensure, #4 is bland mushy food, etc.

He will not be allowed to eat anything by mouth for 2-3 days (at least) so it was felt he needed this other type of nutrition now to not only help him get better but to help him heal faster.

It is expected that he will stay in the hospital for 5-7 days. He will remain in the Intermediate Cardiac Unit for at least another day, then probably be moved to a regular room without the continuous heart monitoring. He has to be at least to #3 above, if not #4, and passing stool, before he can come home.

I'm so exhausted that I may sleep for 12 hours tonight! I hope Irv will be able to rest as well. He still has the damn NG tube in his nose and into the stomach, plus a urine catheter as well. Neither of those is making him happy. Too Bad - I say. Deal with it! At least now we have hope he will start getting well! I imagine tomorrow the PICC line will be another annoyance.

Any interesting news and I will pass it along.

Penny

Irv Update - January 2011 #4

Yesterday when Irv and I went to the hospital to check in for the surgery it was found that not only was his glucose level quite low at 65, but his heart was in atrial fibrillation and his blood pressure was low and irregular. He was taken to the Intermediate Cardiac Unit and started on IV's with glucose boluses, and he was placed on a continuous heart monitoring system. Some medicine to hopefully get his heart to start beating regularly was added with another IV (so now he had two going) as well as an initial bolus. (My sister Kerrin was called immediately and she assured me it was the correct medicine, but I don't remember the name right now.)

Obviously, surgery was canceled and today Irv will have at least an echocardiogram to check out his valves, etc. A series of heart enzyme and heart functioning tests were done and by the time I left about 8:30 pm they were all negative. I'm pretty sure that means his heart is just beating irregularly and not that he has had some sort of heart damage due to that.

A nasogastric (NG) tube was placed thru his nose into his stomach to get rid of all the build-up of fluids. No only to make him feel better (except for the NG tube, which is a pain) but to see if that was one thing contributing to the heart problem.

Meanwhile, the nurses kept checking his glucose levels, which refused to stay up. One IV was giving him glucose, but they couldn't run it very fast in case it overloaded his hearts pumping ability. So, he kept getting boluses of a high glucose solution.

Irv was dehydrated - another reason perhaps for the heart a-fib?

He has lost about 40 lbs in less than 6 weeks.

I'm on my way to the hospital now. Lots of conferencing will be done by all the medical team to decide when to get the surgery done. It HAS to be done so everyone just has to agree on when it would be safe.

Trav and Casey are leaving today.

I'll keep you updated when I get any news and can get to a computer to send the info.

Penny

Irv Update - January 2011 #3

Dear Family and Friends (F&F);

Dr. Kowalski called today. He has talked to Dr. Koteen and they have agreed there is little or nothing medically that can be done for Irv. But, Dr. Kowalski is going to consult with other gastroenterologists in the Bend Memorial Clinic where he has his office. Just in case there is an option no one has thought of yet.

If nothing comes up, Irv will have surgery on Wed. Jan 19. Somehow they will bypass the obstruction with another section of bowel. I'm not exactly sure what happens to the existing area except that it isn't involved in the digestive system anymore. Nor do I know what happens to those ducts that empty into the bowel in this area. I have a lot of trust in Dr. Kowalski and know that he DOES know! I wish we didn't have to wait until then. If there is a good reason I don't know what it is.

Meanwhile, Irv is on Ensure, Carnation Instant Breakfast, chicken broth, PowerAde, Jello, and Jello puddings, but NO chocolate flavors. Obviously he can drink milk.

So far he isn't throwing up much at all, but still feels quite full of fluid all the time, but something must be working its way thru the obstruction. His blood work showed an elevated white count and so far his nutrition status is low, but acceptable. A few parameters were elevated on his liver function tests, but nothing to worry about right now. That is a relief.

Travis and Casey will be here next week until Thursday Jan. 20 and I am so relieved. Having my sons here when Irv has surgery will help my stress level quite a bit.

That's all for now.

Penny

Irv Update - January 2011 #2

Finally, we have a diagnosis. After much foolishness by the medical profession (or rat bastards, I would rather say), the endoscopic exam today showed a small bowel obstruction. Not "blockage" but "significant obstruction." Dr. Koteen had the gall to say it wasn't seen on the CT scan of Dec. 27, done when Irv was in the ER. Hah! I say. Irv's symptoms have not changed since before that time,only worsened, so it was there, some idiot radiologist (rat bastard) just didn't see it. I want it known that I did suggest that Irv had a small bowel obstruction to the ER doctor - who totally ignored me, of course, because he is a rat bastard.

It is right after the pyloric opening of the stomach at the beginning of the small intestine. It is 3-4 cm in length.

It will require surgical correction, but we are awaiting the numerous biopsies taken by the doctor (rb). If they show cancer, then that will determine how extensive of a surgery Irv will have. If it isn't cancerous, a less invasive option will be done.

I would have preferred that it be done this afternoon! Meanwhile, Irv is on a liquid only diet. Dr. Koteen (rb) did try to expand the obstruction opening (he was able to get the endoscope thru the obstruction - barely) by using a balloon, but it did revert to almost the same small opening size as before. About a quart or more of fluid was extracted from Irv's stomach. (Just yesterday, Dr. Koteen (rb) said Irv didn't have a build-up of fluid - HAH!)

There was a lot of "sludge" left that was too thick to aspirate and it is hoped that it will make its way thru the slightly larger opening in the obstruction.

Irv felt so much better having that very large amount of fluid removed from his tummy!!!

Since it is Friday, I can only hope that some how, some way, the pathologist(s) (rb's all of them who only work M-F) will read the biopsies soon. Dr. Koteen was hopeful that he would have information by tomorrow - Saturday. I have my doubts and can only hope that Irv will be able to feel okay until we know something. It amazes me that so much of medicine is DO IT NOW! or I want it yesterday, yet this can wait until Monday. WTF!!

I will keep you informed as I hope to have a resolution to the questions very soon!!

Penny

Irv Update - January 2011 #1

Well, we spent yesterday at St. Charles on the 5th floor in the infusion room. Irv had 2 liters of fluid IV'd into him again. Another change of medications. But, he didn't ever see the doctor or even talk to him. Everything was done through his nurse/receptionist. Another bunch of blood testing was done. One new thing is they are testing for H. Pylori, a bacteria that causes a lot of the symptoms Irv is having.

Now the thinking is that maybe he has something called "diabetic gastric paresis" which means the outlet of his stomach to the intestines isn't working correctly. It would be another rare diagnosis as he hasn't really been a diabetic and usually it takes a long time of high blood sugars to impair the function of the vagus nerve to the point it causes this problem. But, Irv got some medicine called Reglan for that condition. A newer, very expensive (>$500 for a prescription) drug called Dexilant was also prescribed. Luckily, we got 75 days worth of doctor samples to see if it actually helps the excess acid production from his stomach and allow the stomach to heal.

On Friday, Irv may have another endoscopy of the stomach and a little farther along the GI tract. A biopsy would be taken for that Helicobacter Pylori, which is the "gold standard" for diagnosis. Plus, the doctor could see what everything looks like since the CT scan done on Dec. 27 in the ER didn't show anything unusual. We are hoping someone will call and tell us for sure! Dr. Koteen, the bastard, is in surgery all day today (as well as yesterday) and so we are unsure just how much on his feeble mind Irv is present!

Initially, the doctor's office was telling Irv that MAYBE he could be seen on Wed. or Thursday of this week. At that point I became an enraged person and called back and told the nurse/receptionist that was TOTALLY UNACCEPTABLE. WTF! If we don't hear anything by noon look for nuclear bomb signs in Central Oregon. That will be me.

Love to you all, and I'll keep you informed.

Penny