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.
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.
