Updates - Day 220

It was Thanksgiving and now it is nearly Christmas. It has been a busy month for us as it has for many of you.

Today, Dec. 21, Jim and I both had appointments. I know some of you have said you prefer to know what is going on with Jim than with me, but we are a couple, so our life is about us, not just him and not just me. You can always skip those parts that dwell on me.
          I had an epidural in my back this morning at St. Luke's Pain Clinic. Some of the muscle and joint pain of recent months that I thought was related to my left hip and leg was actually in my low back.
          Jim had a one-week follow-up with his primary care physician, Dr. Todd Butler. Last week on Dec. 15, his visit with Dr. Butler revealed his blood pressure to be 70/42 and weight 132 pounds. He increased Jim's dosage of midodrine from 5 mg three times a day to 7 1/2 mg three times a day and suggested a MRA (angiogram) of chest muscles might be in order. Today, after the increase in medicine, Jim's blood pressure was 80/50 and weight 130 pounds. His waist, which had dropped from 33 inches to 31, now measures 29 inches.  The doctor was concerned about the lower BP readings, but decided not to do anything about the MRA at this time. He would wait to see what Jim's cardiologist, Dr. Stephen Bailin, has to say. We see him on Jan. 15. Jim has not had any signs of dizziness or lightheadedness; his lungs are clear, heart and kidneys fine. Lab work was scheduled this past week, and results were normal. Jim is to return to Dr. Butler in 8 weeks.
          We also received a phone call from the office of Jim's rheumatologist, Dr. Michael Brooks. We had to return to MedLabs mid-afternoon so Jim could have an INI of calcium. Jim is scheduled to have a Reclast, an annual IV injection for osteoporosis, on Wednesday morning, Dec. 23, but that procedure may be delayed a week  if calcium results are not received by early Wednesday. He was low on calcium, and earlier this week, was told he also was low on Vitamin D. Both of these supplements were stopped from May to July, when he was having various procedures at UIHC.

Jim still is tired, probably because of the ischemic stroke and arthritis, but the Lord enables him to accomplish many things.
          On Nov. 29, he decorated the lamp post in front of our house and set up the vintage sleigh, reindeer and Santa my parents made many long years ago. He also set up lights so passersby could see it and the nativity in the evening hours. Most of the decorating indoors was done by Dec. 1, and on Dec. 5, Jim started baking for our open house. I  helped with decorating sugar cookies, writing and printing the Christmas newsletter, setting up the food display, etc. We had 35 people come to our Open House Dec. 12, including four members from Wilton Baptist.
          We have over 50 nativities (as well as multiple Christmas trees, angels and Santas) and 10 of them were obtained just this month. Among them: a silver nativity from Ron and Carla Dunnahoo at Wilton, a glass nativity with Merry Christmas across the top from church members at Wilton and one from a hospice client Jim visits in Central City.
          Various Christmas programs we attended were Cedar Rapids Washington Madrigal Singers during evening services Dec. 13 at Immanuel, Austin's preschool musical Dec. 15 at Taylor School, and Immanuel's youth choir during evening services Dec. 20, also at Immanuel.
     
We continue to serve at Wilton Baptist Church and love our time there. We are in no hurry to have it end, but that is all in God's timing, so we will enjoy whatever He gives us. Jim and I drive to Wilton every Sunday and sometimes Jim or both of us (if it works out) go there mid-week to visit members or lead a service. He also visits members who have had procedures in the hospital.  A Christmas Eve candlelight service will be Thursday, Dec. 24, from 6:30 to 7:30 p.m.

Thankfulness - Day 196

Today is Thanksgiving Day.

Today is the Day
the Lord has made
Let us rejoice
and be glad in it

Today was yesterday
Today is tomorrow
Everyday is the Day
the Lord has made
Let us give thanks
Let us be grateful
Let us look forward
toward the Lord
Keep us always aware
of Him who will guide us
along the path
He has for us.
(c) Cathy Orrick Luders
11.26.2015

Among requests in this morning's prayer time was that Jim would stop getting smaller. He doesn't think he is losing weight, however, his waist size is decreasing and he doesn't want to "waste away to nothing." Before his surgery, he wore 33 x 36 pants and large sweaters; now he wears 32 x 36 or 32 x 34, and depending on the cut, sometimes 31 x 34, and medium sweaters.

Jim still has occasional episodes of dizziness and shortness of breath, but nothing like it was.

Last night, Wednesday, we had Thanksgiving Eve services at Wilton Baptist. It was a good drive down even though the traffic was quite heavy on I-380 and I-80. There was and is much to be thankful for.

Jim has been working on his Christmas sermons. This coming Lord's Day, he will begin advent messages. The first message, on Nov. 29, has to do with prophecies. We enjoy our ministry with Wilton Baptist and hope the Lord will allow us to continue there, at the very minimum, through Christmas.

In a short while, we will travel to Waterloo and have Thanksgiving dinner with Jim's sister, Dianne, who lives in Ankeny, and their aunt, Effie, who lives at Friendship Village. We are looking forward to the visit and hope to play a game of Scrabble before returning home.

Since last writing, we've had our first run-in with snow. Jim got gas for the snow blower and it actually started after a few tries. The heavy wet snow began Friday night, Nov. 20, and stopped late morning on Saturday. He used the snowblower and the shovel on Saturday and was overly tired afterward.

Saturday night we had our family over - Rocky, Christina, Austin and James, for a Thanksgiving gathering - turkey, dressing, mashed potatoes, sweet potatoes, green bean casserole, scalloped corn, pumpkin pie, homemade potato rolls. All good. All filling.

Sunday morning, Nov. 22, the roads here were good. The roads and sidewalks in Wilton were not cleared, so ice was in many places. I had the day off from work, so we had lunch with Eric and Kathy in Wilton. It was good food -  Jim ate everything he ordered and even a piece of cherry pie - and a good visit.
 

Other things - Day 187

There really isn't anything healthwise to report re: Jim - he is better, the heart monitor will be returned by week's end, the only time he is short of breath is when he has over-exerted himself.
But there are other things, so I thought I'd share them.

We determined we were going to have our annual Christmas Open House this year no matter what. It is set now ... we have most invitations sent out and are working on decorating in and out. It is coming along much better in than out, because the weather is not very cooperative. We do have our outdoor nativity up, however.

We enjoy ministering to the people of Wilton Baptist. The 60.1-mile trip to and from seems to take less time the longer we serve there. We don't know how long we will remain there. Earlier this year after Jim had had his surgery, we talked about being willing to go wherever the Lord sent us. He sent us to United Federated in Lisbon for three weeks in August and then returned us to Wilton Baptist, where we have been since Aug. 30.

The church is searching for a fulltime bi-vocational pastor. Jim was called to be its interim pastor Sept. 27. For the past 3 to 4 weeks, we have considered applying for the open position.

It wasn't until today, Jim felt a tugging from the Lord.  Of the several devotionals he reads, it was from Oswald Chambers'  "My Utmost for His Highest" that he thought God had given him an answer.
I have included it here in its entirety:

"By Myself have I sworn, with the Lord, for because thou has done this thing ... that in blessing I will bless thee..." Genesis 22:15-19

Abraham had reached the place where he is in touch with the very nature of God, he understands now the Reality of God. 

"My goal is God Himself ...
At any cost, dear Lord, by any road." 

"At any cost, by any road" means nothing self-chosen in the way God brings us to the goal.

There is no possibility of questioning when God speaks if He speaks to His own nature in me; prompt obedience is the only result. When Jesus says - "Come," I simply come; when He says - "Let go," I let go; when He says-"Trust in God in this matter," I do trust. The whole working out is the evidence that the nature of God is in me.

God's revelation of Himself to me is determined by my character, not by God's character.

"'Tis because I am mean,
Thy ways so oft look mean to me."

By the discipline of obedience I get to the place where Abraham was and I see Who God is. I never have a real God until I have come face to face with Him in Jesus Christ, then I know that "in all the world, my God, there is none but Thee, there is not but Thee."

The promises of God are of no value to us until by obedience we understand the nature of God. We read some things in the Bible three hundred and sixty-five times and they mean nothing to us, then all of a sudden we see what God means, because in some particular we have obeyed God, and instantly His nature is opened up. "All the promises of God in Him are yea, and in Him Amen." The "yea" must be born of obedience; when by the obedience of our lives we say "Amen" to a promise, then that promise is ours.

 We spent the afternoon in Wilton. Today we learned the pastor search committee has invited a man to come in view of a call. He will be preaching Dec. 6. Today Jim shared he was interested in the position.

So it is up to God, as it always is. His will be done.

We covet your prayers for His will, not anyone's wishes, but simply His will.

Updates - Day 183

We'll start with Wednesday, Nov. 4 - Jim had his infected tooth that was diagnosed Nov. 2 removed this morning. Has had no problems with it since.

The following Wednesday, Nov. 11 - Jim had a CT scan of his chest, followed by a 3-month followup visit (even though it has been 6 months since the cancer surgery) with Dr. Parekh at UIHC. Results of the CT scan were good - no apparent reoccuring cancer. That is a blessing. His blood pressure is improving - 97/52. He is to return in 6 months and after that, yearly visits.

Today, Nov. 12 - he had an endoscopy to see how the ulcer was healing. Dr. Gerke said it was not healing, and it may never heal, but he was not overly concerned about it. It's not bleeding either, and as long as it stays that way, good. Perhaps this is what you call an inactive ulcer? He recommends Jim stay on 40 mg of Pantoprazole, once a day, to help it heal.  

Appointments - Day 174

The first of many appointments today was a visit with his primary care physician, Dr. Todd Butler. Weight is 128.6 pounds with clothes on. Blood pressure is 70/46. Jim's plan of action to reduce the frequency of taking Midodrine was curtailed by Dr. Butler, who said he really needs to be taking it three times a daily so it will last all day and raise his blood pressure. Otherwise the medicine only lasts a few hours and is of little benefit. Results of blood work drawn indicated his thyroid is fine and he is a little anemic.

The consultation with his dentist, Dr. John McGrane, resulted in an appointment Wednesday morning at 11:10 to remove the infected tooth. Then, on Tuesday, Nov. 17, at 11 a.m., he will have two fillings repaired.  

Another infected tooth - Day 173

Today, Monday, Nov. 2, Jim had a dental appointment. There was no indication it would be anything but normal, but something was wrong when the hour appointment stretched into 1 1/2 hours. When he returned home, he said he had another infected tooth - upper right this time. Jim said they took 21
x-rays. The tooth needs to come out soon, so we are having a consultation with Dr. McGrane at 2 p.m. Tuesday to determine exactly what to do and when to do it. Another expense.

We spent a good share of the day in Wilton, where we visited with Ron and Jim had an interview with a reporter from the weekly newspaper, Wilton-Durant Advocate News.

Last Tuesday, Oct. 27, Jim had a colonoscopy. He had one tiny polyp, which Dr. Gerke removed. He is to return in 5 years.

He has reduced the frequency of taking the Midodrine (which raises his blood pressure) from three 1/2 tabs daily to one 1/2 tab. He thought the medicine was causing a decrease in potty flow. It appears this plan has helped as the BP has remained good, with no dizziness, and potty flow has increased.

In addition to the 3-month clinic visit with Dr. Parekh on Nov. 11, Jim is scheduled to have an endoscopy Nov. 12 to see how the ulcer is healing.

Second opinion informative - Day 164

Today is Saturday, the 164th day after Jim's esophageal cancer surgery. It has been a mostly quiet day, except for the occasional beep of the heart monitor he is to wear for the next 29 days.

Yesterday - Friday, he had a second opinion appointment with Dr. Stephen Bailin, a cardiologist at UIHC. We like Dr. Bailin - he explains things so you understand what's going on and what isn't and he doesn't give you the impression whatever he says is what you should do. He listens to the patient and the family. He's going to be Jim's new cardiologist going forward. Good-bye Dr. Li.

We arrived 30 minutes early for our appointment. Weight and blood pressure were taken right away - 129 pounds fully clothed and BP was low.... 78/43. The EKG was normal.

We discussed not resuming the Coumadin - he has been off it since Oct. 1, when he was diagnosed with a bleeding ulcer that resulted in another 5-day stay in the hospital. The multiple periods of dizziness and lightheadedness in a given day have been absent. He was feeling better. There have been two brief moments of dizziness, however, in recent days - one was Oct. 18, the other Oct. 19. If there were others, Jim hasn't said.

It was determined even though he had one episode of a stroke (ischemic), he has not been in AFib since his June surgery for the bowel obstruction. It was decided he didn't need to be on Coumadin, just a baby aspirin.

We discussed an alternative medicine to the Flomax taken for the prostate. Flomax can cause low blood pressure / dizziness too. Even though he has been on the medicine for a long time, it may possibly be causing problems in his body now.  So the medicine Alfuzoin was considered as one less likely to cause hypotension. But we didn't end up going that route, at least not right now.

Another potential medicine is Midodrine which can raise blood pressure. Dr. Bailin asked if Jim had had an ultrasound. He did have an endoscopic ultrasound March 31. Apparently Jim has a congenital defect, with a flap-like opening in the wall of the heart. Usually this flap closes at birth, but there are some cases where it stays open. It appears Jim is one of those "cases."

Jim had his blood pressure taken laying down (84/49), sitting up (76/43) and standing (80/45). Then he had blood drawn for a cortisol stimulation test, which shows an excess or deficient amount of cortisol and how the adrenal glands are functioning. I'm not sure what his results mean. The preliminary numbers were 8.4. On Monday, Oct. 26, we found the final numbers to be 22.0 - elevated from the standard range.  By Friday, Oct. 30, we learned the numbers were not abnormal, so I'm guessing the adrenal glands are functioning just fine.

The doctor wants to try him on the Midodrine, the smallest dose of 2 1/2 mg 2 to 3 times a day - morning, noon and supper time. The round pills are very hard to cut in half, even with a pill splitter.

Also, Jim is to be on a heart monitor for 30 days to see how he is doing. Records will automatically transmit to UIHC. Whenever he has an episode (dizziness, lightheadedness, shortness of breath), he is is push the button on the monitor.

Interim Pastorate
Jim began serving as interim pastor at Wilton (Iowa) Baptist Church in October. We started traveling to the Wilton area Tuesday, Oct. 13, to visit church members. The next time was Wednesday, Oct. 21, and Jim went by himself. He did just fine driving to and from.

Sunday, Oct. 18, was Pastor Appreciation Day. All pastors who have ever served at Wilton Baptist were invited to a luncheon after worship. On this day, besides Jim and me, there was Mike and Ginny Roberts. Mike used to serve in the Cedar Rapids area, but now is in southeast Iowa as director of missions. Craig Horning, a former Cedar Rapidian and Immanuel member, who now lives in Deming, N.M., came with us. I had the afternoon off from work, so was able to enjoy more of the festivities.

Sunday, Oct. 25, Jim will preach from 1 Peter: 2:11-25 on "The Nitty-Gritty of Every Day."

Awana and Canning
Wednesdays are special - we take our grandson to Awana - Austin, who will be 4 in a few short weeks, is in Cubbies. He seems to enjoy the time there and is learning about Jesus.

Jim often is tired. I can't imagine why sometimes - he has taken up the art of canning and has come to be pretty good at it, via instructions from the internet. On Oct. 14, he canned 4 pints of tomatoes and 2 pints of applesauce. On Tuesday, Oct. 20, while I did Gazette work at home for six hours, Jim made homemade vegetable beef soup and homemade bread. We delivered the homemade goodies, including applesauce, to Cathy's adopted mommy, Miss Anna, and had a nice visit.

Follow-up visit Nov. 11
Jim's 3-month follow-up visit with Dr. Parekh, his cancer surgeon, has been scheduled for Nov. 11. It may be his 3-month visit, but it's 6 months after surgery.

His next appointment with Dr. Bailin, his new cardiologist, is Jan. 15, 2016.
   

Questions - Day 153

We have more questions than answers re:  Jim's health care after three hospital stays and two surgeries.

Jim was released from UIHC at 4:45 p.m. Monday, Oct. 5, after a five-day stay for internal bleeding / bleeding ulcer.

In my readings,  I have found an ulcer is a hole generally in the stomach or small intestine, but can be anywhere in the gastrointestinal tract.  Jim's ulcer formed at the juncture of the esophagus (1-2 inches) and stomach, where he had his esohagectomy May 12.

His thoracic surgeon, Dr. Parekh, says the tissue is still new and fresh and not healed,  leaving it more susceptible to problems. His primary care physician, Dr. Butler, whom Jim saw Oct. 8,  says it's been 5 months ... it should be healed!

In our visit with Dr. Butler, he made these comments:
**Coumadin does not cause dizziness
**Coumadin does not cause bleeding. It can cause you to bleed more, but not to start
**You can have reflux from stomach back up even if you do not have heartburn, therefore, you should be on pantoprazole.
**An acid blocker could heal the ulcer
**Some other medicine Jim is on causes the dizziness, such as Flomax or Benedryl.

Our unanswered questions:
**Why did Jimmy have dizziness when on Coumadin (June - September), but since being off of it (Oct. 1), there is none?
**Why is dizziness listed as a side effect of taking coumadin if that is not so?
**Why has it been said coumadin can cause low blood pressure which can result in dizziness?
**Why hasn't the tissue area healed where the esophagus and stomach were sutured?
**Why is he on Pepcid, an acid blocker?
**Why is there no clear cut direction from more than one doctor re: pantoprazole?
**How do you know the ulcer is a result of acid ... is it not possible it is because of bacteria?
**What would an endoscopial ultrasound show? He had one in March before the cancer surgery.  He has had two endoscopies since Oct. 1. He is supposed to have an CATscan - is it not possible this would show ulcers or healing process?
**How do you determine normal readings for hemoglobin?  We've been told 10 is normal for Jim, yet before the May 12 surgery it was 13.5. After 2 pints of blood were given between Oct. 1-5, it remained stable at 8.8. The lowest reading was 6.8. Dr. Butler says 8.8 is still low, 10 is low.

On Oct. 8 visit with Butler, Jim's BP was 90/42, which is normal for him. Weight with clothes on was 133 pounds. No scale is the same.

The next appointment coming up is Oct. 23 when Jim sees a cardiologist for a second opinion at UIHC.


My writings:

Questions
So many
agreement
between
doctors
missing
Answers
not found
We listen
We read
Nothing consistent
What one says
is fact
another says
is not
Who are we
to believe?

Our minds
in a
quandry
confusion
and frustration
take hold
We are obsessed
with knowing
what is
true and correct

I remember
The Lord
said
He would be with us
He would bring us through it
He would guide us
not just part of the way
but every step
That means
even through
the complications
and in retrospect,
not just through Jim's cancer
and the various side effects
but even my own
health issues

No more
We have too much
Take it away
Take it away Lord
Yet God says
in His word
He will not give us more than we can handle
What does He know
What does He see

He is wirh us
He guides us
If we are close
closer to Him
We will hear
in the stillness
His Holy Spirit

The answers
we seek
we find
in the solace
of our Lord Jesus

He hears our prayers
He knows our concerns
He answers
but are we listening
did we hear His response
or are we unsure

Doctors do not agree
have not agreed
say this and that
and another

Jim has been off
the coumadin
12 days
There is no dizziness

Is this God's answer?

Coming Home - Day 146

One of us had a good night's sleep - and that would be me. Slept 6 1/2 hours through.

Of course that means Jim didn't have a good night's sleep, unless you count the time between 11 p.m. and 2 a.m. His roommate's IV started beeping at 2, and it took 20 minutes for anyone to come in and stop it. Then at 4, his nurse came in to get Jim's BP, which was 80/40. Decided that was too low, so they tried the other arm. Then they hooked him up to an IV, probably with salt in it to boost the numbers. IV was in for an hour, then it beeped. Then labs done. By that time it was 6 a.m.

But there was good news with the morning ....

**Hemoglobin remains normal at 8.8.

**He could have a full regular diet, starting with breakfast.

**He could cancel Oct. 23 2nd opinion appointment with cardiologist -- he would not resume taking Warfarin / Coumadin - and report would be (hopefully) sent to local cardiologist Dr. Li

**He  could come home early afternoon.

A few things on this list didn't quite happen as well as hoped.

One, we really need to keep the Oct. 23 appointment with UI cardiology, and
Two, early afternoon became early evening - we left UIHC at 4:45 p.m.

Differing opinions between doctors

We have heard a differing of opinions again between doctors. Can't seem to get everybody on the same page. So who do we listen to?

**One doctor said Jim should be off Coumadin, he should cancel the second opinion appointment with UI Cardiology.

**Zachary Smith, the gastro-intestinal doctor who has been treating him these past few days, said he is to be off aspirin and Coumadin until his appointment with his primary care physician (Dr. Todd Butler, Oct. 8), who is to make the determining decision.

Dr. Smith believed Jim should be on a blood thinner because of stroke in 2012 and because of being in Afib. He is under the mistaken belief that Jim has had multiple strokes, when he has had only one mini stroke.

He also thought Jim should be on omeprazole or pantoprazole because of acid reflux.

**Dr. Parekh, the surgeon, weighed in with his opinion.
I had called Joan, the thoracic coordinator, soon after visiting with Dr. Smith and asked her a couple of questions to speak to Dr. Parekh about:

1. What caused the ulcer? How did it form?
2. Why would omeprazole be prescribed when the cancer surgery did away with the need for it?

His answers --
The ulcer formed where it did - at the juncture of  the reattached esophagus and stomach (esophagectomy) - because the tissue is still new (4+ months), fresh and healing. The bleeding was brought on by the Coumadin. Symptoms from the loss of blood (which could have been revealing itself for some time since Jim has complained of dizziness for months) reared its head big time on Wednesday, Sept. 30, when shortness of breath, extreme dizziness, extreme tiredness and weaknesss and black stools were evident.

Dr. Parekh  reiterated what he indicated at the one-month clinic visit on July 1 - with the esophagectomy, there should be no heartburn or acid reflux problems. Taking omeprazole or pantoprazole will not change anything.

We are inclined to go along with his thinking. Why be prescribed medicine for a problem that was corrected in May? Jim did have acid reflux and Barrett's Esophagus, but he doesn't anymore.
He was put on Coumadin because he acquired Afib as a result of the May 12 surgery. By June 11, when he had the second surgery, Afib was no longer a problem, yet ....  Coumadin remains a problem.

The GI doctors want another endoscopy performed to see how the ulcer is healing.
When Jim has his 3-month check-up with Dr. Parekh, he also will need a CATscan.

Stable - Day 145

Jim called at 7:15 to wake me from an unrestful sleep. His BP was normal. Blood was drawn for the hemoglobin, but results weren't known until 8:50 a.m., when he called again. It is 8.5 - still good. It would appear the bleeding has been stopped. The doctors were in. He may be able to eat regular food - he is eager to have breakfast. Said apple juice just doesn't do much for his appetite... lol.

It's shortly after noon now - still on liquid diet. Didn't have anything for breakfast because nothing appealed to him. Did take a shower, and had some shortness of breath, which could be attributed to the fact he didn't haven't anything in his tummy. He'll order chicken broth for lunch. 

Up and down - Day 144

Jim called at 7:30 a.m. His phone kept cutting out, so we didn't have a very clear connection. He called 3 times to finish one call.

He said another blood draw was taken a couple hours after the transfusion was complete - that must have been around midnight. At that time it was 9.2. But when it was checked again a few hours later, it was back down to 7.  Based on those readings, there is internal bleeding somewhere - we need to figure out where and stop it.

He is waiting for doctors to come in.

My thoughts:

Do not do
the natural thing
Do not
let your feelings
define you

Trust in the Lord
He who will lift you up
up above
the difficulties
you fight to conquer

Be thankful
for what you have
for where you are

Follow His lead
Do not run ahead
He gives us
what we can handle - not more,
although we tend to disagree,
- and not less
He knows what we can do
with His guidance

It is His guidance
we need to rely on,
not our own
We will falter
every time
if we look
to ourselves
for the answer

"His blood will purify our consciences from useless rituals, so that we serve the living God." ~ Hebrews 9:14b

Is it perhaps uselessness
on our part
when we do
what we think we must

Perhaps God is trying to show us
something different
and we just don't see it

He gives us rest
He instructs us to rest

We think we have no time
We have much to accomplish

So He brings about
a situation

God wants us to recuperate
to rest
to look to Him
and not everywhere else

He gives us opportunities
to serve,
but not to go overboard

Look to Him
Seek Him
with your questions
and wait for His answers

Don't fall down
and fail to look up!
(c) Cathy Orrick Luders


It's 10 a.m. and Jim called. Hemoglobin just checked again and is now 8.8. A good sign. He is to be moved to a regular room and have something to eat. Hemoglobin will continue to be checked throughout the day. If it is stable, we are moving in the right direction.

1:05 p.m. - Jim has been moved to a regular room - he is on the 6th floor - Room 6058 - Bed 1. Phone number is (319) 353-9711. If you visit, take Elevator D.

Jim called at 4:15 p.m. He was having jello and lemon ice, which made him cold, so he had more blankets piled on. He's planning on having chicken broth for supper. He said the doctors want to see how he tolerates food - liquid, soft and regular diet, and of course, he has to have a regular bowel movement. There have been no further checks of hemoglobin throughout the day because there are no signs indicating it necessary. He has had no shortness of breath and for the first time since forever, was able to stand without dizziness.  He said they may do a hemoglobin re-check yet today or tomorrow and they may do another scope.  It appears the bleeding was a result of the ulcer and nowhere else. The doctors are looking at a likely Monday release date. Hallalujah!

I made it down to see him by 7:40 p.m. It was a busy day workwise and after work, had lots of calls on the landline and the cell phone from folks who wanted to know how things were going. His BP was checked shortly after 8 and it was 106/57. He continues to be able to get up without dizziness. The hemoglobin will be rechecked in the morning. He is looking forward to going home on Monday. Pray that is God's plan as well as ours.

Waiting Game - Day 143

Jim didn't sleep well. He couldn't receive anything to help him sleep, had a headache (was given a Tylenol suppository for that) and numerous folk coming in and out throughout the early morning hours.  He called me at 7. Of course I didn't sleep well either. Took 2 hours to update yesterday's blog post and then when I went to bed, woke intermittently. Even in sleep, we do better together.

His hemoglobin continues to go up. His blood pressure was down some - 88/40. Doctors came and went and discussed the endoscopy, but no exact time was given for the procedure to move forward.

At one point I called the unit and asked if the procedure was underway, but the unit clerk I talked with, wasn't very helpful. He couldn't answer my question, couldn't find a nurse and couldn't patch me through to Jim. Geeze!

At 11:15 a.m., Jim called. Procedure remains yet to happen.

At 2:05 p.m., Jim called again. If it wasn't for him calling me, I do believe I would know nothing. He had the procedure - around noon or therafter.  He was groggy. I called back to the unit desk and talked to a nurse (not his though), who said another endoscopy followed right after Jim's. She assured me the doctor would call me when they were done with the second patient.

The ICU Fellow (I have no clue as to what his name is, other than I can't pronounce it), who did the procedure, called at 2:30 p.m. He said the ulcer is not currently active, but it may rebleed. To help prevent rebleeding, they put 2 clips in. Jim will stay in the MICU today and possibly tomorrow - he will be monitored for signs of possible rebleeding - the symtoms he had earlier - low hemoglobin, black stool. Also will monitor his blood pressure. If he remains stable, he may be able to return home early part of next week. If his hemoglobin drops again, another endoscopy will be done and go from there.

We request prayers for the hemoglobin to continue to increase and no black stool or any other telltale sign of rebleeding going on. We pray there will be no more complications, that Jim be on the mend toward complete healing, strengthened in body and soul.

At 3:30 p.m., nurse practitioner Dana Fowler called and gave me more complete information re: the procedure. She said the doctor clamped the blood vessel with 2 clips to prevent the ulcer from rebleeding. Jim will be watched for 48 hours, will remain in MICU today, and probably will be moved out on Saturday. His hemoglobin at last check was 8.2 and normal for Jim is 10. She said he was doing well. The hemoglobin will be checked again at 4 p.m.

Learned at 5:15 p.m. Jim's hemoglobin had dropped to 6. He will be given another unit of blood and have hemoglobin redrawn. They are not sure the 6.0 figure is correct. If the second draw still shows low, it is possible he will go to interventional radiology to determine where else the bleed may be. When talking to his sister the nurse, she thought perhaps the scope didn't show enough detail.

I arrived at Jim's bedside at 6:45 p.m. He had just started receiving another pint (unit) of blood - it takes 3 hours, so around 10 (which is what it is now that I'm back home), the transfusion should be completed. Two different labs were actually taken of his hemoglobin around 6 p.m. - one was 6.8 and the other, 7.1. Lower than the 8.2 taken earlier, but certainly not as low as the 6.0 taken at 4 p.m. Around 11 p.m., his hemoglobin will be checked again. Jim called at 10:30 p.m. to tell me the hemoglobin was checked a little while ago in a different vein and numbers remain low - at 6.8. It should have been up, given he had just received new blood. Doctor was in, suggesting Jim may need more units of blood. Hemoglobin will be checked again at 4 a.m. Saturday, if not sooner. If still low or lower, he will be heading to interventional radiology to see where another bleed may be.

It would be good if there is no new bleed and that hemoglobin numbers go up and stay up. He may be able to start a liquid diet on Saturday. His blood pressure has remained stable, in the 90s.

I lucked out with free parking in the ramp tonight. The ATM was down and since I didn't have $3 in cash to pay, I got free parking. How nice.

On the Hilltop / In the Valley - Day 142

After our weekend in Northeast Missouri, Jim returned to Wilton Baptist Sept. 20. He is going through the book of I Peter. His message was "Be All That You Can be" from I Peter 1: 10-16.

On Tuesday, Sept. 22, Jim visited his lone hospice client in Central City, and the following night, took grandson Austin to Awana / Cubbies while we went to Bible Study / prayer.

Friday, Sept. 25, dizziness and lightheadedness were still a constant, although he did mow the back and front yard, with rest and lunch inbetween.

Sunday, Sept. 27, Jim's message to the fine folk of Wilton Baptist was "The Precious Blood of Christ" from 1 Peter 1: 17-25. A business meeting was held following the service and among items discussed / considered was asking Jim to be interim.

Monday and Tuesday, Sept. 28-29, were days off for me and busy for both of us. On the 28th, a hot, sunny day, we drove to Central City so Jim could visit with his hospice client and I could take his wife to a doctor's appointment in Marion. Later in the day we picked up the Cooks - Christina, Austin and James - Austin played for awhile at the playground at Noelridge Park and then all of us went to the Farmers Market. We came away with a huge head of cabbage, zucchini, white sweet corn, plus Christina bought six pumpkins. On the 29th, it was rainy and much cooler. Jim complained of his legs feeling weak, but thought perhaps it was just the weather. We drove up to Waterloo to visit Paulette Titus and get some tomatoes, red and green delicious apples, a hubbard squash and a few peppers - mostly for us, but also to share with the Cooks. We also had a good visit with Jim's aunt Effie. We stopped at Family Christian and Jim purchased a NKJV that he thought he would preach from at WBC.  Then he drove home. He was only normal tired. And we saw the movie "War Room" too.

On Wednesday, Sept. 30, everything changed. Jim complained of shortness of breath. Just getting up from a sitting position, he was worn out. His dizziness was more extreme, as was his weakness and tiredness. He commented he had black stools. (He said they started on Monday; he was telling me about them today.) He was cold, so we turned the furnace on in the afternoon. I didn't go into the office, deciding it was better to work from home. We thought it was a 24-hour bug. He slept throughout the afternoon. We went to Awana that night, taking Austin. Many commented Jim looked pale. Pastor Dan annointed us with oil and prayed for both of us. When we got home, we took his blood pressure, which was normal. His pulse was high, just below 100. We thought perhaps he was in AFIB.

Today, Thursday, Oct. 1 - we got up at 6 a.m., decided we would go to the ER at St. Luke's Hospital.
We got there around 7:15 a.m. Did labs, an EKG - he was not in AFIB. After the doctor heard all the symtoms - the black stool was apparently a telltale sign - it appeared he had a bleed and it was thought to probably be an ulcer. His hemoglobin (red cell count) was low - 7.5 and that had dropped 3 points just in a short time. The need for a blood transfusion was a definite posibility. He had lost weight - with clothes, 128.5 pounds. The doctor said he would discontinue taking warfarin/coumadin as that puts him at high risk for bleeding.

I left to go home shortly after 9 a.m., since I had to work. When I next talked to Jim, it was almost 11 a.m. He was on fifth floor in the Critical Care Unit and was getting plasma. I learned from Jim's sister, Dianne, the RN, that plasma reverses the INR, which has to do with coumadin. (Later, after he was admitted to UIHC, I was told his INR had been 3.9.)

After receiving the plasma, Jim received a pint of B- blood (we have the same blood type) and then the endoscopy was done right in his room at St. Luke's. The nurse called at 12:30 p.m. and I talked to the surgeon. He said there was a big ulcer at the juncture of the stomach and esophagus where he had had the cancer surgery in May. It was currently not bleeding. He said the ulcer was not a result of the May surgery, but a complication, and he prefers to refer Jim to UIHC and Dr. Parekh, the doctor who performed the original surgery.

At 2:50 p.m., Jim was transferred to UIHC via ambulance. He arrived around 4 p.m.and by 4:25 p.m. was situated on the Medical ICU unit, 5th Floor East, Bed 5. The MICU does not have room numbers, but bed numbers. This location is only temporary. But for now, if you want to talk to him, call (319) 356-3441 and ask for him or Bed 5. It is a private room with a view (but not of Kinnick Stadium)!

I arrived shortly after 6 p.m. Jim will have another endoscopy in the morning to see what the ulcer is doing, to determine further steps. It is possible nothing will be done and they'll let the ulcer heal on its own. Jim's hemoglobin is up - from 7.5 to 7.7, a good sign, although still low. I learned his weight (with just a gown on) is even lower - 125 pounds! It took him so long to add weight, and how he's lost 8 more pounds. He is to have his hemoglobin checked again at midnight.

Tomorrow I believe Jim also will talk to a cardiologist about staying off of the warfarin. He was to have a second opinion visit Oct. 23.

It is also possible Jim may be released on Saturday. But I'm not going to hold my breath there. We've heard that line before.

I will be working again tomorrow from home so it will be evening before I will get up or down to see him. I'll update blog, Facebook or send an email as I'm able.

I've made countless calls today, and had many return them. Pastor Dan came by this morning and called late this afternoon. We are being prayed for all over the country, including in Tanzania. We appreciate the sentiments that God heal Jim without surgery. We appreciate every prayer lifted up on his and our behalf. I read to Jim an email received from Lorraine Kappmeyer - the line we aim to try and remember is "Every setback is a setup for a comeback!" God has this covered. We should never forget.

Onward we go - Day 130

As Jim gets better (still has occasional dizziness and gaining weight is a very slow process), I have gone the opposite direction, trying to get out from under so much that is keeping me feeling rather poorly.

We enjoy the time God has allowed us to be at Wilton Baptist Church. We don't know how long that will continue, being the congregation does have need of full-time pastoral leadership.  During September Jim has preached there the 6th and will again the 20th. He is hopeful for following weeks as well as he already has sermon ideas. We plan to visit some of the folks in the hospital or recuperating at home in coming weeks.

In thinking of all the places where we have served and of all the events of this past year, I jotted down this prayer request -- "To be sent wherever God leads. To be used wherever needed. To recognize needs. To be open to staying places and filling roles for however long the Lord desires. To have those who desire our aid to be open, not hiding, not pretending, not being false or fake."

Jim was rather listless over Labor Day weekend. He has watched the Jerry Lewis Muscular Dystrophy Telethon for years - last year it was on TV only 3 hours and this year, not at all.  He didn't quite know what to do with himself. On Monday, Sept. 7, he remembered a DVD he put together last year from episodes that were on youtube.com and watched it.

AWANA at Immanuel began Wednesday, Sept. 2 - we started coming Sept. 9, bringing grandson Austin to participate in Cubbies, the preschool class, to learn about Jesus. I go in to work earlier and get off by 5:30 so we can all get to church on time and have supper too.

We took our second mini-trip to Northeast Missouri (LaGrange and Hannibal) Sept. 12-14, and it was enjoyable as always. We stopped at HLG and visited with Jim's friend, Ray Carty, who is vice president of something (LOL). He gave us a personal tour of the new science building that opened the end of August. We bought gas in Hannibal for $1.99, a huge decrease from the $2.29 we paid in Cedar Rapids before heading south.

On Tuesday, Sept. 15, Jim got a flu shot at HyVee Drug Town, and it apparently made him very tired, as he slept much of the afternoon, and we both went to bed early that night.

On Thursday, Sept. 17, Jim and I and Christina and our grandsons, Austin and James, went to Waterloo to attend the Cattle Congress fair. We weren't sure how the day was going to end up, being it was raining in Waterloo in the morning, then raining here and still raining when we headed north at noon. Fortunately, the rains stopped and the skies remained dry, although a little cloudy, the rest of the day and into early evening. We saw lots and did lots of things, everybody (except James) got in lots of walking ... and Jim has more stamina ... and I think Austin had fun. I'll include some photos at the end of this post.

Today is Saturday, Sept. 19. A nice sunny day, a bit on the cool side, but considerably better than Friday's downpour. This morning Jim and Rocky worked for an hour or two on cleaning the garage -it's a vast improvement.  Jim printed off his sermon - 11 pages - guess God gave him much to talk about!  His message for Sunday is "Be All You Can Be" and Scripture is I Peter 1:10-16.

 Upcoming appointments: 

• Friday, Oct. 23 - 3 p.m., Jim meets with Dr. Bailin, a cardiologist at UIHC, for a second opinion re: use of coumadin for surgery-related afib.

• Tuesday, Oct. 27 - 10:30 a.m., Jim has colonoscopy with Dr. Gerke at UIHC

• Friday, Oct. 30 - 9:30 a.m., Cathy meets with Dr. Gerke re: digestive issues begun Aug. 5

Photos taken at Cattle Congress in Waterloo: 

Improvements continue - Day 115

How the days fly by ... 115 days now since Jim's cancer surgery.  He is getting stronger and he does not have as many dizzy spells.  Perhaps the Coumadin is more agreeable to his system  -  he has been taking it for nearly 4 months.  But of course he still has the lower than normal blood pressure.  We have not yet heard  from UIHC re: seeing a cardiologist there for a second opinion.

Tuesday, Sept. 1, was a tiring day  -  probably all those pain pills he took following oral surgery  -  so he slept, and when he wasn't sleeping,  he worked on his sermon.

Wednesday, Sept. 2, was the first night for Awana at church and they were offering a group for grandson Austin's age group  -  Cubbies.  We were hoping to take him, however, a few things prevented that ....

One, my sister, Helen's mother-in-law, Lorraine Snell, passed away on Sunday, and we decided to go to the visitation Wednesday after I got off work.

Two,  I had a sore on my right hip area that opened during the day.  So after visitation, we went to Urgent Care in Marion.  The doctor diagnosed it as a yeast infection, possibly a result of the antibiotics I have been on since Aug. 27 (for digestive issues) and the heat.  I have a cream to use twice a day.  After the first day, I noticed improvement.  But just because it is better doesn't mean I'm to stop taking it.  (On a side note, re: the digestive concerns, my primary doctor is working on getting me an appointment with Dr. Gerke,  the gastroenterologist at UIHC.)

Jim was really feeling better on Wednesday  -  he made meatloaf, mashed potatoes and veggies and homemade rolls (partially using the bread machine) for supper that night.

Jim will be preaching this Sunday at Wilton Baptist.  He has prepared a Labor Day message, "Laborers for Christ,"  taken from Ecclesiastes 5:18-20  and I Corinthians 3:8-10.  Communion will follow.

We are planning a 3-day trip to Northeast Missouri Sept. 12-14,  but  it may have to be postponed. We'll find out on Thursday, Sept. 10.  A co-worker's mother-in-law is having a procedure done in Indiana that day to shock her heart back into rhythm.  She has a heart condition and also cancer, and the cardiologist apparently won't allow the surgeon to operate until her heart is stable.

Prayers for that situation and for Jim and of course, probably me too, are very much appreciated.

God is good all the time -- Days 110-111

Sunday, Aug. 30, was Day 110.  We had a good night's sleep, most beneficial, especially when it is a day you are to deliver God's message to His children.  We hadn't been at Wilton Baptist since March 15, but were finally able to return today.  It was such a blessing for us and for them to see each other after such a long absence.  These are among the many who prayed for us, sent cards and visited while Jim was in the hospital.

Jim's message, from Hebrews 10:19-39, was "Are you a FAT Christian?" - FAT stands for Faithful,  Available and Teachable.

His sore throat, a result of summertime allergies, remained with him, although as he continued preaching, his voice got stronger.

A potluck was held after the service.  Such a tasty meal.  Afterward we were both ready for naps, but only one of us had the opportunity.  I drove back home and Jim, tired from preaching and eating, slept from Tipton to Cedar Rapids.

We are returning next Sunday, Sept. 6.  Jim is planning a Labor Day message, plus we will have communion.

Wilton reminds us of Immanuel, especially its friendliness.

Today is Monday, Aug. 31 - Day 111. Jim has oral surgery this afternoon to remove a molar, after complaining of left jaw pain on May 26.   His dentist said his left lower molar was internally dying and needed to be pulled.  It is good the pain of the first few days decreased and there has been no pain for months. The pain came after the tooth was pulled. From about 3:30 to 10 p.m., there was bleeding. He used gauze and moist tea bags to try to get it to stop and at one point, called the dentist, who said if things were not better in the morning, to come in and they'd have a look. He took hydrocodone Acetaminophen for pain.

Dr. Butler's office called. Jim's INR (blood drawn Saturday morning) level is 2.6. He is to continue on the Coumadin for 4 weeks, then have blood drawn again.

God is good, so good, all the time, even during those times we fail to see His goodness. 

Updates: Days 96 - 109

Sunday, Aug. 16, was Day 96.  Jim preached at First Federated Church in Lisbon for the third week in a row. Then we were told someone else would be coming Aug. 23 and it was unknown about Aug. 30. When we received a call from the church in July and again after the first service on Aug. 2 when we met with the pulpit committee, we were only told to let them know if we could not come.

Don't know what that is/was all about, but of course God does. Have to let Him control the reins and lead us in the way He would have us go.

So we called Ron at Wilton Baptist. Jim has preached there before, off and on, since last fall, and had called Ron in July letting him know he would be available to preach by August. Ron had called earlier in August asking, but by then, we were committed to First Federated. So we called him back, since we had August dates open. We were invited to come Aug. 30.

Thursday, Aug. 20, was Day 100.   Today was a day of rest. Jim went to the pet store and got dizzy just getting out of the car. He spent most of the afternoon sleeping.

Wednesday, Aug. 26, was Day 106.  Jim worked in earnest on his sermon for this coming Sunday. His message will be "Are you a FAT Christian?" FAT stands for Faithful, Available and Teachable. Scripture is from Hebrews 10:19-39.

Thursday, Aug. 27, was Day 107.  Jim had an early morning appointment with his cardiologist, Dr. Li, at PCI. His blood pressure was 80/46 and his weight, 132.3 pounds. His weight seems to fluctuate within a pound every time he sees any doctor. Who knows what his real weight is. Also had an EKG. He told Dr. Li he wanted to get off Warfarin/Coumadin. Her recommended alternatives to being off the blood thinner was to monitor blood pressure and pulse rate daily.

Side effects Jim has from taking the Warfarin/Coumadin are dizziness and lower blood pressure. Dr. Li said it is rare for Coumadin to lower BP. She suggested drinking more water (60 ounces verses the 24 ounces he currently drinks - and that is more than he has ever drank!) or gatorade and increasing salt intake would help to raise his BP.  She said the dizziness could possibly be prevented if he moved his legs up and down before walking.

We both believe the Coumadin is the primary cause of these problems. He didn't have dizziness before taking it and his blood pressure was usually in the 90s to 100s, never as low as 80 or less.

Dr. Li said we could get a second opinion. Jim told her no, it wasn't necessary, but when we talked later, he said he was going to looking into it down at UIHC in Iowa City. We are currently waiting for a return call on a referral.

Thursday evening, after I got off work, we had dinner with a friend, Joan. Jim took care of her husband, Bill, more than 8 years ago when he worked for St. Luke's Home Care / Hospice. It was a very enjoyable evening.

Saturday, Aug. 29, was Day 109.  This morning when Jim woke up he complained of a sore throat. His voice has been deeper in the last couple days and apparently his throat was somewhat sore during the week, but this morning it was more bothersome. At first we thought he had developed a cold. But then I remembered his allergies were not just seasonal, but also mold and mildew (which is present indoors and outdoors) and we have been around mold much of this week.

Since he had to go to MedLabs to have blood drawn  (he has to stop Coumadin today because he's having oral surgery on Monday), I suggested he also stop at Urgent Care in Hiawatha. The result of that visit indicated he didn't have a cold or strep throat, but allergies. Allergies that cause sore throats, as mold and mildew can. So he has two meds - Flonase nasal spray and a mouthwash that he says tastes awful. Worse than the hot tea (Throat Coat) with slippery elm, licorice, etc., with a teaspoon of honey in it that I gave him this morning. He says the Flonase appears to be helping.

Our prayers are for answers to the Coumadin issue, getting that second opinion, getting necessary rest, gaining weight and more strength in body and voice.

Day 95

I sometimes think, albeit wrongly, the road traveled is ours alone. No one knows the trouble I / we've seen, and perhaps that is true, but we all have known trouble, for God said it would be so. From the days when Adam and Eve lived in the Garden and chose their own way over obedience to the Lord, trouble has been a constant.

This morning I reviewed previous posts ...

• Today Jim commented his right elbow hurt. It has hurt before, not constantly, but now and then. The last time he mentioned it that I noted it was a month ago on July 15. Before any of the surgeries he complained of it too and his primary physician called it tennis elbow.  Who knows why it hurts. When sleeping, he keeps his arm on a pillow and that helps.

• The dizziness continues. That has been a bother since May 22 -- 10 days after his cancer surgery. Getting up from bed, from the chair, from the floor or just turning around can bring on dizziness. He has mentioned it to countless medical personnel, and although it is listed as a side effect of taking Warfarin (Coumadin),  no one seems to think it is any big deal. NOTE: Jim acquired AFib as a result of the May 12 surgery; his heart did not return to normal sinus rhythm until June 11, the day of his bowel obstruction surgery.  

•  In conjunction with the dizziness is the abnormally low blood pressure. Jim has always had a low BP, and when we first married, both of us had the same systolic reading at 110 (I don't remember what the lower number was). For the last 15 years or more, his readings have been in the 90s/50s. However, since starting on the Coumadin, his BP has been much lower, with the lowest reading taken at 68/30.  Of course Coumadim can't be the culprit. It doesn't cause low blood pressure -- that's what we hear!
  
  Just because these side effects are not common does not mean they should be buried and not considered at all.
   
• The tiredness remains. He needs to be mindful that recovery will take months, not just days or weeks. Often he will discover what his mind wants to do, his body is just not able. He needs to sit and rest. He thinks because he can drive again, he can go anywhere and do anything, but that isn't quite true. It was a blessing when we learned Ormal, Pat and Mike Williams were driving to Anamosa Wednesday morning to attend Art Baker's funeral service and that there was room for Jim. If Jim had gone by himself, the exhaustion he felt would have been much worse. As it was he slept much of the afternoon.
  
  Along those lines, I do wish he would be more specific of how he is feeling ... instead of  "just tired." 

Tomorrow, Aug. 16, will be week 3 at First Federated Church in Lisbon. It is a conservative Bible-preaching church with a small congregation, mostly age 50 and older.  Jim's sermon the Lord has given him is "The Blood of Jesus" from I Peter 1:17-25. Please pray for strength of body and voice.

Day 92

Jim is getting stronger, although still has moments of extreme tiredness and times when he doesn't sleep well through the night. The dizziness remains with him as does the lower than normal low blood pressure. So until one of his doctors believe his report that the coumadin is causing this (he didn't have dizziness and extra low blood pressure before he started taking this new medicine), it appears he is stuck with it.

Jim is back to cooking. On Saturday, Aug. 8, he froze 7 ears of sweet corn. When his sister came to visit on the 3rd, she brought a dozen big ears. We made our way through 5 ears and then decided we'd be tired of them before we got through the whole dozen. I suggested freezing them. So Jim did that while I did Gazette work. We should probably get some more, so we can have some this fall.

On Sunday, Aug. 9, Jim preached his second sermon at First Federated Church in Lisbon. It is not non-denominational, but rather Evangelical Bible. His message, taken from Hebrews 13: 7-16, was "Praise Be To God." We will be returning there in an interim role until the Lord determines otherwise.

For a couple years now we have talked about re-painting the garage door and other areas that needed it. On Tuesday, Aug. 11, it was finally accomplished through the efforts of Rocky and Christina. It was a busy afternoon, with the whole family here, working and playing.

Here are some photos:

Rocky and Christina painting first coat on garage door

 

Rocky and Jim scraping the trim by the front door; Austin is playing

Papa Jim (James) holding his adopted grandson and namesake, James

                                     

Papa Jim and firstborn adopted grandson Austin being silly 

The newly painted garage door. Looks great!  

On Wednesday, Aug. 12, Jim decided to buy some new jeans. For years he has worn size 33x36 or 34x36, but since he has lost so much weight since his May 12 surgery, he is now down to a 32x34. 

Day 87

Jim had his blood drawn this morning and although I don't know what his INR level was, he doesn't have to return to the lab for another drawing for a whole month! The exception is when he has oral surgery Aug. 31 - he has to stop taking Coumadin two days before and have blood drawn the day before. Otherwise, he will continue taking 4 1/2 mg Coumadin nightly until further notice.

Opportunities - Day 85

Today was my first full day at The Gazette office -- Jim took me and then drove to Central City to see Waldo, his hospice client. He has been visiting with him via phone since May. This is only the second day Jim has driven by himself.

Yesterday, Aug. 4, Jim had his consultation with Dr. Morio at Morgan & Morio Oral Dentistry re: pulling #18 molar. That event is now scheduled for Aug. 31. 

We have been attending Vacation Bible School this week at Immanuel.  Yesterday, just before supper we received a call from First Federated Church in Lisbon. It is non-denominational I think. They would like Jim to continue preaching - just to let them know when we wouldn't be available. What a journey the Lord has put us on this year. Up and down. And what a learning experience in faith and trust. 

We have 4 1/2 cases of Osmolite 1.2 cal nutrition drink that will be making its way to southern Illinois this weekend via friend Marla. She is taking it for possible use by her brother, Gene, who is battling stomach and esophageal cancer. If he's unable to use it and no one else is in need of it, she'll bring it back to us.

Doctor's visit - Day 83

Today Jim had an appointment with his primary care physician, Dr. Butler. His BP remains on the low side, at 74/44, but his weight appears to be increasing. Fully dressed, he weighs 135, so I'm guessing without his shoes, he's probably at 132 to 133 pounds. Up is so much better than down.
His INR from Friday's blood draw was 1.4, so he's to take 4.5 mg nightly and be rechecked on Friday.

Dr. Butler and one of his nurses said coumadin (warfarin) does not cause low blood pressure or dizziness, but Jim and I have both read articles where low blood pressure and dizziness can be side effects of taking it.

A link on EHealthMe may be found here: Could Warfarin Sodium cause Low Blood Pressure (Hypotension)?

His blood pressure was low before taking Coumadin, but not this low. And he did not have dizzy spells before either.

Jim's sister, Dianne, who lives in Ankeny, spent the afternoon with us. We had a picnic at Ellis Park, enjoying foil dinners of hamburger, potato, carrots, onion and zucchini. For dessert, we had sweet and goey smores, with those giant marshmallows. It was such a splendid afternoon, low 80s, no humidity.

Updates - Day 81

More than a week has passed, being my last post was July 23, nine days ago.

On Friday, July 24, we received a call from First Federated Church of Lisbon re: pulpit supply. We learned the congregation's former pastor was let go because they could not continue to financially support him, and so were looking into other avenues. Hence, Jim was asked to preach Sunday, Aug. 2, and possibly future Sundays.  The worship service begins at 10:30 a.m. Jim's message is "The Knowledge of Salvation" and is taken from 1 John 5:10-21. When we returned this past Friday, July 31, from the Cedar Falls Bible Conference (CFBC), two of the 13 phone messages were from members of the church. One of them was an invitation to join them for dinner after the service.

We began 10 days of vacation on Sunday, July 26 (6 days off work). That day, before getting out of bed, we prayed the Lord would help us finish packing and be on the road by 9:30. We got that accomplished - the car was packed by 9:20 and we were on the road by 9:25! The morning service at the CFBC started at 11 and we arrived at 10:35.

Dizziness continued to be a daily problem through the week, but fortunately, it did not last long. He also had two episodes of indigestion after the evening meal - possibly because of either eating too fast or too much - but after a few hours, the problem subsided.

We stayed in a 2-story building called The Retreat Center, but it is like dormitory-living, and updating the mattresses is a slow process. So our room, with a double bed, had a very thin mattress, which made for rather sore backs.  The best part of our stay in the building is the fellowship. This is our third year to stay there and are among 11 residents. All of us are repeat attendees to the conference - I have been coming since 1989 or 1990 and Jim many years before that. Seven of us live in the Cedar Rapids/Marion area. Everyone brings their own food and also shares with others.

There was only one day (Tuesday, July 28) when the weather was very wet and very cold, which made the air-conditioning in the Tabernacle (events center) and at The Retreat Center seem even colder. Sweaters and sweatshirts were the garb of choice most of the time.

We enjoyed renewing friendships, making new friends and visiting with family - we had lunch with Jim's aunt Effie on Thursday, eating at the Golden China restaurant near where she lives.

Early on Friday morning, July 31, Jim complained of pain on his right side, so he moved to his back. He complained of the same early the next morning. We plan to wait and see if there are more episodes and if so, to possibly call the on-call thoracic fellow at UIHC to see if there is something to be concerned about.

We so enjoy going to the Bible Conference every year and are glad the Lord enabled us to do so this year. It runs for a full 7 days, Sunday to Sunday, and everything is accomplished through love offerings/donations. This year was their 94th year. I generally sing in the choir and this year was no different.

My chief complaint for the week was soreness - sore hip, sore thigh, sore low back, sore legs, sore shoulder, making balance issues front and center. Holding onto Jim's arm was of considerable help. I often wondered if I should return to using my cane or at the  very least, visit my doctor.

Our bunny, Bandy, stayed home during the week, and let it be known he was not happy we were gone. His aunt Jani came over nightly to take care of him and he was so contankerous - he refused to let her pick him up.

On Monday, Jim visits his primary care doctor, and then that afternoon, his sister, Dianne, is coming from Ankeny for a visit. On Tuesday, he finally sees Morgan & Morio Oral Surgeons for a consultation visit regarding another molar that needs to be pulled. 

Heart Catherization - Day 72

We got up shortly after 6 this morning  to allow time for Bible study, getting dressed and me to eat.

Abnormal results showed up on a stress test Jim had last week, so a heart catherization was scheduled for July 23 -- and that's today! 10:30 at St. Luke's Hospital in Cedar Rapids. Dr. Hajj (pronounced Hodge) from PCI Cardiology will do the honors. We're leaving the house at 8 for an 8:30 arrival.

We pray there is no blockage, but only God knows for sure, and He's not telling at the moment.

Your prayers are appreciated.

Will update later.

My devotional reading was from John 8:12 --

"Jesus spoke, saying, I am the light of the world. He who follows Me shall not walk in darkness but have the light of life." 

My writings --

Jesus is the Light of the world
When I became a child of the King
His Presence - as the Holy Spirit
came to live within me
and I His Light-bearer
brightening up the world around me
reflecting His glorious Presence
within me
to you.
(c) Cathy Orrick Luders)

The procedure was delayed by 1 1/2 hours - there was an emergency so the catherization wasn't started until noon. It lasted 45 minutes and there were no blockages! Praise the Lord!

I had this feeling there would be no blockage, that this was a test. I'm sure patience and trust are  definitely two things we are both to learn. I tend to think God will bring other tests and He, who is far more patient with us than we are with ourselves, will bring us through each difficulty with more of Him reflecting in us. I am thankful He never fails, never gives up on us.

Before the procedure was started, his blood pressure and weight were taken. BP was of course low - 95/52, but his weight -- he gained a pound! He's on the upward swing at 130.5.

An IV was started (took forever to find a vein) in his left hand/wrist area. Early on Jim was told he could leave on his underwear and socks. But somewhere along the way, it was determined he should have taken off his undershirt. Getting it off after you have IV tubes, etc., attached, is rather tricky.

Pastor Dan arrived at 11:15 - wasn't that a miracle! To come late, but just in time. Jim's sister, Dianne, called shortly before noon, but of course, Jim was just about to head down the hall to the OR.

For the procedure itself, a catheter was inserted into his right wrist (incision was the size of a pin). Contrast dye was injected through the catheter so that X-ray videos of his valves, coronary arteries and heart chambers could be created and the doctor could see how well the heart was working.  Jim was not knocked out for the procedure, just the area the doctor was working on. It was amazing to see Jim conscious and talking.

After the procedure, but still in the OR, an inflation/deflation band was placed over his wrist -- the band holds pressure on the incision site so it doesn't bleed. Once he was back in his room, air was removed from it every few minutes until the band was eventually removed (2:15 p.m.).
Once the band was taken off (he could theoretically leave the hospital an hour later), an immobilizer was put on. It has to stay on at least 6 hours, but he could leave it on overnight, or he could leave it on all 5 days. He has elected to leave it on at least overnight and perhaps longer, because it reminds him of what he shouldn't do - no bending or twisting of wrist, no using his hand to get up, etc. He can't even use the cane in his right hand.  

Dr. Hajj said Jim had the heart of an 18-year-old. How nice to have some part that is young! No blockages, everything is fine. He said about 10 percent of the time the abnormal readings showing on stress tests are wrong.

He said Jim could not lift anything over a gallon of milk (about 10 pounds) for 5 days.
He can resume taking the Coumadin tonight -- he would still like to get off this medicine. He has follow-up appointment with Dr. Li at the end of August, so perhaps his concerns can be addressed then.

The Nassif Heart Center provided heart-healthy sack lunches for both of us around 1:30 p.m. and Jim was released from the hospital at 4 p.m. 

Day 70

Four days have passed since my last post.
Jim continues to be tired in the midst of doing or not doing and has dizzy spells at least once a day. The dizziness comes whenever and wherever. He doesn't have to be on the floor or sitting; he could be on his feet and moving a different direction and the room would be spinning. One such episode happened Sunday at church when he went upstairs to deliver some Sunday School materials. He became dizzy and the pastor helped him downstairs. He also continues to not drink very much water.

On Monday, I had a much needed massage - wish I could afford to have one every day! - and after lunch, we took the Mazda 5 over to Firestone to see why the check engine light came on. That took the better part of the afternoon only to find the problem required a part to be ordered direct from the dealer and wouldn't arrive until late Wednesday morning.  So we left Firestone around 4, finished a few of our ongoing endless list of errands, had blood drawn for the heart cath on Thursday and went home.

On Tuesday, I received a phone call from Dr. Li's office (cardiology) to tell us Jim's thyroid levels were still somewhat elevated. I was surprised by this particular phone call and asked the nurse why thyroid levels were checked. He was supposed to get labs for the heart cath on Thursday. Somewhere along the line, MedLabs didn't pull the correct report. Thyroid levels were to be checked the end of August, not July. And then of course, Dr. Li's office did not have the report sent earlier in the month from Dr. Parekh's office at UIHC about discontinuing the Amiodarone. It had been faxed July 6 and refaxed again today.

This morning, Jim decided he wanted the grass in the backyard to be shorter than it was, and since it was much less humid than in previous days, determined he was going to mow it. It took him an hour to do it, in addition to trimming weeds. He spent the afternoon resting. It is probably not the smartest decision, but it was his.

On Wednesday morning, we will get moving a tad earlier - take the car to Firestone for them to repair it, then come home so I can do Gazette work, then pick up the car before it closes - hopefully, there'll be someone who can give us a ride over there. Jim is still not driving by himself. 

Tests scheduled and rescheduled - Day 66

I made the last of 4 phone calls to various medical agencies by 8:40 this morning and all but one had called back before 9:30.

The colonoscopy scheduled for July 21 at UIHC is rescheduled for Oct. 27

The heart (cardiac) catherization (also called a coronary angiogram) at St. Luke's Hospital is scheduled for Thursday, July 23

What is a heart catherization?
According to WebMD,  it is an invasive imaging procedure that allows the doctor to "see" how well the heart is supplied by blood vessels. A long, narrow tube, called a catheter, is inserted into a blood vessel in your arm or groin and guided to your heart with the aide of a special X-ray machine. Contrast dye is injected through the catheter so that X-ray videos of your valves, coronary arteries and heart chambers can be created.
(I was born with a congenital heart murmur and had this procedure done when I was 12 years old. The catheter was inserted into my right arm.)

What is purpose of a heart catherization? 

• To evaluate or confirm the presence of heart disease, such as coronary artery disease, heart valve disease or disease of the aorta
• To evaluate heart muscle function
• To determine the need for further treatment, such as interventional procedure (stent placement) or bypass surgery.

Dr. Butler's office is to call and let us know when to stop and restart the coumadin before the upcoming heart cath procedure.  PCI Cardiology said usually you stop the coumadin 3 to 4 days before.  Dr. Butler's office did not call, so we decided to go with the recommended stop time.

Instructions from PCI Cardiology ...
Jim is to start taking baby aspirin today.  Labs to be done Monday afternoon,  July 20.  He is not to eat or drink anything after midnight Wednesday, July 22, except for morning meds with a sip of water.  We need to be at the hospital at 8:30 a.m.,  2 hours before the procedure.

PCI Cardiology also said the abnormal results of the stress test reveal a large reversible defect.  It could be related to the left anterior fascicular block showing abnormal on the EKG taken July 1 at UIHC.  When Joan, the nurse coordinator for Dr. Parekh (Jim's thoracic surgeon),  returned my call, she said it is doubtful this new heart problem is related to the May 12 surgery,  because Jim was monitored throughout and there were no problems.

My writings today ...

Stop!
Listen!
You are Mine
yet you withdraw from My Presence
presuming yourself
more knowing
than anything
I have to say

You are weak
and you will remain weak
until you put your selfishness
behind you
and settle your focus
on Me

You live in the world
yet the world is not your answer
You run toward it
eager for something new
yet the world does not provide
what you need

I AM the Answer
I AM what you need

When will you return to Me
When will you stop running away

I have given you what you need
Why do you fail to believe
you have the best
There is nothing better
than to sit at the feet of My Son,
Jesus

Be filled with My Presence
Open your heart
to all and every blessing
I have set before you

See the good around you
instead of every wrong.
(c) Cathy Orrick Luders

New dilemmas - Day 65

I made two calls this morning - one to Jim's primary care physician, Dr. Butler, and another to the Center for Digestive Diseases at UIHC.  It was too bad the nurse from UIHC didn't call first, because now I've had to call Dr. Butler's office a second time.

Jim is scheduled to have a colonoscopy next Tuesday, July 21, per orders from Dr. Parekh, his thoracic surgeon.  We didn't have prep instructions, thus requiring a call.

We have plans to attend the Cedar Falls Bible Conference July 26-31 (reservations were made and paid earlier this year), but now I question the reality of those plans.

So the nurse from the Center for Digestive Diseases called back late morning.

This colonoscopy is not your typical procedure, with prep being done the day before.

Prep begins:

•  today - no corn, popcorn, iron or multivitamin. No Problem!
• Friday (4 days before procedure) - he is to stop taking Coumadin - unless of course the doctor managing this med thinks otherwise.  Hence, my second call to Dr. Butler's office to find out if indeed he is to stop 4 days ahead, when he is to restart, and what to do about the INR  re-check currently scheduled for July 24. 
• Sunday, July 19 - after supper, he takes the bottle of clear magnesium citrate.  Nothing red.  No jello.  Begins clear liquids and continues on that through Monday.
• Monday, July 20 - between 3 and 4 p.m., drink the jug of lovely tasting stuff (not!) - Nothing after midnight

And then we received a call before 1 p.m. from PCI Cardiology - Dr. Li's office,with results of the stress test Jim took on Monday and Tuesday of this week.  The nurse said it was abnormal.  She didn't say what specifically was abnormal, only that it was.  She asked if Jim had had any chest pain and he said no.  A cardiac catherization aka angiogram is to be scheduled, and she hoped to have called us back today with a date and time, but that didn't happen.

If there is blockage, a stent will be put in.  The nurse said if there is no blockage,  the procedure would last 30 minutes;  otherwise, it could take up to 1 1/2 hours.  He would need to be at the hospital two hours before.

Then I called the nurse coordinator for Dr. Parekh at UIHC because we thought it a good idea if he received the stress test result report and any other information.  I wondered if the surgery could have caused this problem.  We haven't received a call back from her either.

So I stayed home and worked, waiting for return phone calls.  Tomorrow morning we will have to get up earlier and make phone calls earlier as well.

Jim and I went grocery shopping after supper and we were talking about things Dr. Parekh said during our 4-week clinic visit with him July 1.  When we got home, I started looking through previous notes.  At that clinic visit Jim had an EKG and results showed normal sinus rhythm but abnormal left anterior fascicular block.  Nobody seemed to know what the latter meant, but results were to be sent to Dr. Li,  Jim's cardiologist.

So I did a google search on Left Anterior Fascicular Block.  I found the following of interest:

• It is a medical name indicative of scarring or other blockage that causes portions of the heart's left ventricle to shrink or constrict. 
• Lifestyle choices and genetics may have much to do with why the blockage happens
• Chest pain is not always present
• Dizziness can be a symptom of a defect in cardiac function.  Unconsciousness may occur.
• Stay away from refined carbohydrates

Dizziness ... has been bothering Jim since taking Coumadin, which can lower blood pressure,  and Jim's BP is definitely dropping. 

Refined carbs ... we have one doctor who tells him to eat whatever you want, need to add fat.  And we have another doctor who tells him to avoid foods high in carbs and starch. 

I talked to Jim's sister, Dianne, the RN.  She suggested we call Dr. Gerke's office in the morning and reschedule the colonoscopy. Take care of the heart first. Also to call the cardiologist and find out exactly what was abnormal about the stress test. 

I know the Lord is in control.
I know He will take care of us.
He is taking us down paths for His purpose.
He will bring us through it.
We must stay strong in Him,
because without Him, we are so weak.
Sometimes our weakness overwhelms us
We seek His guidance.
We seek the prayers of His followers across the seas.
We seek a place of quiet refuge
to be comforted by the One
who knows us so well.
(c) Cathy Orrick Luders   

Dizziness - Day 64

Today I forgot it was July. A month behind I am.

Jim had his blood drawn today at MedLabs. Two people tried 4 times total before success came. A patient man. I would not be so. I can't handle needles ... once is too much for me!

He still talks about being off coumadin and hopes his cardiologist calls sometime soon with results of the Stress Test taken Monday and Tuesday. He wants to discontinue coumadin. He doesn't see his cardiologist until the end of September.

I was thinking today ... The Lord knew this was coming - the complication of AFib, the medicine to take, the blood draws. What is the purpose? Why did, does He allow it? What are we to learn? There is something. God always has something for us to learn. We are to trust Him, no matter what. He'll never steer us wrong.

Jim is improving daily. I pray that continues. He took the trash out to the curb today and started a load of laundry .. things I had been doing before this week.

He needs to be careful though. When he was downstairs, he said he was on the floor and in getting up, was dizzy, the room spinning. Perhaps he should begin taking his cell phone with him (turned on, of course), in case he happens to fall because of low blood pressure, or if he finds himself unable to get up. I probably shouldn't be thinking about this, but instead praying it won't happen, that the Lord will give him needed strength.

The doctor's office called around 5, Jim said, and his INR reading was 2.6. He's to continue with 3 mg coumadin nightly. He told the nurse he has been dizzy, but that didn't seem to faze her.

My writings ...

You walk with the Lord
-- you read and study and meditate
on His word daily
-- you listen to His instruction
and strive to be obedient to His command

The Lord carries you along paths
He has purposely chosen for you

He asks that you stay close to Him
to not become disenchanted
and follow your own thoughts, ideas and plans
Stay close
Look to Him for strength and direction
where He takes you will bring glory to Him

Perhaps we think
we don't need to be where we are,
but God has allowed it
He knows something we do not.
He has a reason

Someday He will share the reason
but not yet, not today

He wants us to learn something
perhaps obedience
no matter what crosses our path

Discard the anxiety, the frustration
Follow Him
Do as He directs
Seek wisdom and He will give you
what you need
you are weak, you are tired
Ask Him for strength
Ask Him for stamina
He will give you what you need
But you must ask
All that He has for you
remains hidden from you
when you do not ask or seek.
(c) Cathy Orrick Luders

"...My strength is made perfect in weakness.  Therefore most gladly I (Paul) will rather boast in my infirmities, that the power of Christ may rest upon me. Therefore I take pleasure in infirmities, in reproaches, in needs, in persecutions, in distresses, for Christ's sake, for when I am weak, then I am strong."   (II Corinthians 12:9b-10)

The stress of stress tests - Day 63

Yesterday Jim had the "rest" part of the two-part Stress Test at PCI Cardiology. He had his weight taken -- he is 4 pounds lighter, down to 129. Geez, I don't remember when I last weighed that!
The tech injected meds, then told him to get something to eat and be back in an hour. Jim thought we could walk to Wendy's rather than drive. He also thought it was closer. Walking over in the humidity wasn't too bad. Walking back seemed to take 3x longer, as I stopped frequently, but we made it back to PCI inside an hour. Then Jim had pictures taken with the gamma camera.

Today Jim had the "stress" part of the Stress Test. That required walking on the treadmill. The plan was to walk on it 5 minutes. His blood pressure before exertion was 82/52. The tech was somewhat concerned, because after injecting more meds, his BP would definitely drop. But he proceded, doing his best. He walked 1 1/2 - 2 minutes before getting light-headed and dizzy. His BP dropped to 68/41. He had to sit/lay down and it took 10 minutes or so before his BP rose to 90/51. The gamma camera was available, so pictures were taken then rather than waiting until later.

He hadn't been this dizzy until he came home from the hospital the second time, so we're wondering if some medicine he's taking is causing the problem. The only new one he is on is coumadin.  We checked that out on the Internet and discovered, yes, low blood pressure is a known side affect of Coumadin. Interesting.  The whole reason he is on Coumadin is because he acquired A Fib as a complication from his Esophageal cancer surgery May 12. His heart has stayed in rhythm since his second surgery June 11. 

Moving On - Day 61

It has been 5 days since I last posted anything here.  I didn't have much to report about Jim and I was wary of saying much about me.

Thursday, July 9, was D-Day .... Disaster Day I believe would be an appropriate title.

We had to get up early for an 8 a.m. urology appointment Jim had at PCI Urology. The appointment was two-fold -- one, to discuss issues he had with not being able to produce No. 1 or No. 2 (problems began late June 27 and rectified themselves to normal June 30), and two, a follow-up visit following his recent surgeries.

The visit did not go well. At least not from my standpoint. The problems began with a 45-minute wait before we saw the doctor, who didn't think an explanation was warranted. It continued when the nurse assumed Jim was a new patient, when he has been a patient of Hoxie's for several years. When the nurse asked for a current list of meds, which Jim provided, I said this list was very current. So she made a copy and then proceeded to ask if he was taking a baby aspirin ... are you taking a multi-vitamin -- meds that were not on the list. I repeated twice, "the list you have is current."

To her I was being rude. To me she was not listening very well. So when we left I apologized for stating facts. There are obviously some doctors and nurses who believe they can do or say no wrong.

By the time we left the doctor's office and the building, it was after 9, and I wasn't doing very well. Didn't feel well, was frustrated over the top. I called it a melt-down, maybe it was something else. Jim just held me.

 I was going to post on here, but I thought who would want to know what's going on with me. I was going to post on Facebook and decided not to. I told Jim no. I don't know what to say. If he wanted to do anything, it was up to him.

He did do something. He sent a prayer request to Immanuel folk just for me. I didn't know if anyone saw it because I didn't see it. But by sometime Friday, I was feeling better. I decided even if no one saw the email, God heard it, and He was answering my need. I could feel calmness settle over me.

This is Jimmy's request:
Please lift Cathy up to our Lord in prayer. She will be returning to the Gazette building to work this afternoon. Cathy has been taking care of me and my needs since my first surgery on May 12. So much has been on her, at times it seems to be overwhelming. I myself love her and fully realize all she has been through. We are reminded of God's love for us, and She needs an extra dose of His love and the power of His grace to be heaped upon her.
I appreciate the prayers that have been said for me. But please pray for Cathy.

That afternoon was my first back at the downtown office. I have been working from home since mid-May. I couldn't find a  place to park nearby with a 10-hour meter, so ended up walking four blocks after finding a 4-hour meter. I was exhausted. My ankles hurt because of arthritis, my balance poor because of painful bursitis. I considered turning around and going back home to work.

I got through the day. When I left, I found 10-hour meters so I wouldn't have this same problem on Friday. I was glad to be home.

Friday was a better day. Jim had blood drawn in the morning.  On the way home I stopped at CVS to pick up prescriptions and other meds that cost a small fortune. At the house, the Cooks were here, we were having spaghetti, Rocky was mowing the yard, we took pictures, and in the mail was a card from Ron and Carla Dunnahoo / Wilton Baptist Church. The card was perfect. A picture of Jesus with children .. the verse said -

"One of the greatest privileges of knowing

 Jesus is going to Him in prayer.

There's never a question about 

whether or not He's listening -- He always is.

There's never a question about 

whether or not He has our best at heart -- 

He always does."

Thank you so very much for sending this card to us at this time.

Today is Sunday. A fellow Christian brother was gone because his own brother had passed away, so Jim stepped up to the plate -- from 8:30 a.m. for choir practice/sound check to 9:30 Sunday school, filling in as substitute teacher, to 10:45 worship in the sound booth. He even warmed up Sunday dinner (made meatloaf, mashed potatoes and green beans on Saturday). He was tired and fell asleep this afternoon while I worked, but he is getting better.

Tomorrow we have a busy day. Three appointments, including the first part of a stress test from 11:30  a.m. to 1:30 p.m. The second part of the stress test will be on Tuesday.