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. 

Slow going - Day 56

Jim IS getting stronger, but he struggles.  He feels he is always tired and sometimes when he is very tired, he gets frustrated and confused.  But don't we all?   He wants to do things, and we are doing things.  But then he doesn't understand why he is so tired.  He is tired of being tired.

Our second adopted grandson, James David Cook, was born Monday afternoon, July 6, at UIHC.  We were there with our family.  Jim loved being there, holding his new grandson, his namesake, when he was only 2 hours old.  A special feeling he has for this little boy, just like the special bond he and firstborn grandson, Austin Lee, share.  He is glad, we are glad God brought us all together. 

I am tired of not knowing what is going on with Jim.  He fails to share or when he finally does, I am nearing frustration myself.  I have told him we need to trust the Lord. Look to Him and not ourselves. When we only look at ourselves, we become discouraged and depressed, and we don't need to go there.  I know the Lord will take care of us;  He showed us so much during all that time Jim was in the hospital.  He will continue to show us, if we're paying attention to Him and following His instructions. 

We need to stop feeling sorry for where we are not and go with whatever God gives us.  God gives us every ounce of strength we need to face whatever comes.  We must rely on Him alone.

Isaiah 41:10 -- "Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand." 

I Chronicles 16:11 -- "Seek the LORD and His strength; see His presence continually!" 

Isaiah 40:28-31 -- "Have you not known? Have you not heard? The LORD is the everlasting God, the Creator of the ends of the earth. He does not faint or grow weary; his understanding is unsearchable. He gives power to the faint, and to him who has no might he increases strength. Even youths shall faint and be weary, and young men shall fall exhausted; but they who wait for the LORD shall renew their strength; they shall mount up with wings like eagles; they shall run and not be weary; they shall walk and not faint." 

PHOTOS FROM JULY 6, 2015

Papa Jim and Grandma Cathy

with second adopted grandson, James.

Papa Jim and James

Our adopted grandsons, Austin and James

Today in the mail we received a check from Wellmark Blue Cross Blue Shield for use of the ambulance Jim required June 7.  The check was for $689, which we delivered to Area Ambulance Service.  We now owe them $413.  We plan to appeal the claim from Wellmark. 

Another thing that only adds to our frustration is the bill we received for the emergency room service at UnityPoint - St. Luke's on June 7. The bill went to Medicare instead of Blue Cross because UnityPoint - St. Luke's does not pay attention to what we have repeatedly told them. 

At supper tonight I asked Jim where his pain is that makes it necessary for him to take the pain medication. I said we had some narcotic meds that are not as strong as the hydromorphone, and he was all for taking them. The pain is primarily in his back. He said it burns. Sometimes his incisions hurt. He mostly lies on his back when sleeping. He tries to lie on his side, but then his incisions hurt, so he returns to his back. I don't know what causes the burning. 

Your continued prayers are appreciated. 

Recovery Continues - Day 54

Today was the first Sunday we made it to Sunday School and worship. We had planned it in weeks past, but it didn't pan out. It was nice to be there and to participate in the Lord's Supper as well.

Jim is getting stronger little by little and his voice is stronger as well. More of his preaching voice is returning.

I probably will not be posting daily updates going forward (I didn't post an update yesterday), unless there's something we think you all should know about.

He is still tired, but not as much so.  He still takes a narcotic pain med, but only needs it once a day. He is still having blood drawn .

I still work from home, but plan to start working weekday afternoons in the office beginning this coming Thursday.

Tomorrow we will meet our new grandson, James David Cook, who is to be born mid-morning in Iowa City at UIHC. Continued prayers for our adopted family, Christina, Rocky, Austin and James, appreciated.

Recovery Continues - Day 52

Today is Friday, but it seems like Saturday. Our house guest, Craig, left this morning. I made breakfast - eggs, bacon and toast - for the three of us, and then we took him to the bus depot out by The Eastern Iowa Airport. He is taking the bus to St. Louis and the train to Deming, N.M., with planned arrival at 3:18 p.m. Sunday.

Jim was energetic enough to work on a few projects, but soon tired after cleaning the lawn mower. Mind you, he didn't do any mowing. The Cooks had come over and Rocky mowed. Jim is resting now.

A tiring day - Day 51

Today Jim has been more tired. Perhaps it was all the activity of this week. He was often tired after just a few minutes of doing something and even when watching TV, would fall asleep.
So, outside of the extreme tiredness, he's been fine. No indigestion and no problems with regular bathroom duties.

Clinic Visit - Day 50

Today's Scripture readings were from Psalm 37:4-5.

Delight in Me, the Lord says
Commit your way to Me
Trust in Me.
His desires to become the desires of my heart
as I live in the light of His love
And He will give
And it shall be...
(c) CMOL


This morning Jim had blood drawn at MedLabs. Dr. Butler's office called at 12:40 p.m., with results - INR reading is 2.7. He is to take a 3 mg tab nightly the rest of the week and have it checked again on Monday.

We arrived at UIHC for Jim's 4-week clinic with his surgeon, Dr. Parekh, a few minutes early for our 2:30 p.m. appointment.
Vitals:
weight - 133.6 pounds (without shoes)
blood pressure - 91/53
pulse - 63

Dr. Parekh gave us 10-15 minutes of his time, which is doing pretty good for a surgeon. We were satisfied with the answers he gave to our questions.

When Jim was having problems with severe indigestion late Saturday/Sunday/Monday, June 6-8, and we ended up calling the thoracic fellow on-call at UIHC early Sunday, we were told Jim needed to be on pantoprazole (Jim was on this medicine prior to the May 12 surgery.). The on-call doctor said pantoprazole helps with acid reflux.

Well, Dr. Parekh said Jim didn't need pantoprazole. With the esophagectomy, there should be no heartburn or acid reflux problems. I think he said the glands were taken out that produce acid, so there is no point in taking the medication.

So we asked him about dicyclomine, another medicine taken before but not continued after surgery. Dicyclomine is for irritable bowel syndrome. Dr. Parekh recommended he resume taking it.

Jim asked what he could eat. The on-call doctor said to avoid red sauces because of the acid it produces. Dr. Parekh said it's not the red sauces, but things like bread. He said to avoid high carb and high starch foods. Jim will have to experiment with foods over the next few months to determine what he can or can't eat without getting sick.

And then we asked about AFib, that lovely little problem he acquired after the first surgery, when he was put on Amiodarone and Coumadin. His heart has stayed in rhythm since the second surgery June 11 for the small bowel obstruction and was in rhythm today when checked. Dr. Parekh said to stop the Amiodarone. No need to take that. He also thought there was no need to take the coumadin either, since his heart was in rhythm, but ordered an EKG. Preliminary results showed sinus rhythm normal, but left anterior fascicular block was abnormal - whatever that means. We are to go with whatever the cardiologist thinks, but also said if we wanted to change doctors, we could come to UIHC.

I remember when Jim first started seeing Dr. Li, the cardiologist, on June 22, she said Amiodarone can affect the thyroid and liver and that with longterm use of the medication, side effects increase. My thinking was then why is he taking it?!

Dr. Parekh's nurse, Joan, will fax information to Dr. Li about changes in medication and EKG results. I think I will ask her to also send information to Jim's primary care doctor.

Also, on a side note, the doctor said some of his patients have lost as much as 30 to 40 pounds with this surgery -- Jim can't afford to lose that much! Pray he stops losing and starts gaining.

Jim is to come back in October for his three-month checkup.

Jim was able to produce No. 2 before bedtime.