Hebrews 12:1-2a

"Let us lay aside every weight,
and the sin which so easily ensnares us,
and let us run with Endurance
the race that is set before us,
looking unto Jesus,
the author and finisher of our faith."
Hebrews 12:1-2a
Showing posts with label Afib. Show all posts
Showing posts with label Afib. Show all posts

Wednesday, July 1, 2015

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.


Monday, June 22, 2015

Appointments - Day 41

Early to bed, early to rise, makes a boy (or girl) healthy, wealthy and wise. ... tired is more like it.

Jim's first appointment was at 8:30 with Dr. WeiWei Li at PCI Cardiology. He weighs 135.6 pounds without shoes. His blood pressure was taken twice, 10 minutes apart -- first it showed 68/30 and then 80/50.

An EKG was taken. Some of the meds were discussed, particularly the Amiodarone, which is taken to help control the AFib. We were told the medicine can affect the thyroid and liver and with long-term use, side effects increase.

Dr. Li was not sure how long Jim would be on Warfarin (Coumadin). The doctors at UIHC said he would probably be on it for several months and if his heart stayed in rythym, he could probably go off it. Before Jim was released May 21 after his cancer surgery and through his second release  June 17 after a 10-day stint at UIHC, his heart remained in rythym. I got the distinct impression from Dr. Li that because Jim had an ischemic stroke 3 years ago, he might go in and out of AFib and never know it, and that might be reason enough to remain on the medicine. It makes more sense to me to pray about what God would have him / us do. Listen to the doctors and then determine.

Dr. Li wanted a pulmonary function test and nuclear stress test done - the pulmonary function test wll be Tuesday, July 7, at St. Luke's, and the nuclear stress test, July 13 and 14, at PCI Cardiology.

Next we attempted to make an appointment with Dr. Hoxie, his urologist. They are kind of booked up, so will call us to let us know when they can get Jim in. PCI Urology called back at 2 p.m. and we now have an appointment for Tuesday afternoon, July 14.

Third stop was MedLabs in Hiawatha.... for blood drawn for INR  readings and a thyroid check requested by Dr. Li.

Jim's second appointment and fourth stop was UnityPoint Clinic in Hiawatha to see Dr. Todd Butler, Jim's primary care physician. Dr. Butler et.al. manages Jim's coumadin, although he says the pharmacy or cardiology department could also manage it.  Blood pressure results were 88/58. Dr. Butler said he would appreciate knowing when Jim is off the coumadin. He wasn't too happy with communication from UIHC. We are to return for a follow-up visit in two months - Monday, Aug. 3.

Jim is feeling better, more energy, but still tiredness sets in. He is currently working with Craig trying to figure out why the kitchen light switch (es) aren't working. That project has bit the dust. The two of them decided it takes more know-how than they have.

He has not taken any pain meds since 10 o'clock last night.

Jane from Dr. Butler's office called and said Jim's INR level is at 3.0, so 3 mg. Coumadin tonight and another blood draw tomorrow.

Jim is eating more and the food is digesting fine.

Thursday, May 14, 2015

Recovery - Day 2

At the 7 a.m. call I learned Jim had a not-so fun night. His blood pressure was really high and pulse was racing. He had an EKG. He said he has Afib as a result of the surgery - the doctors apparently told him it was common with this type of surgery and would go away. He is on medicine right now, but won't be lifelong, like I am.

At 10 a.m., he had a test with dye contrast. Results indicated things were good.

Most of the day was spent napping - even he and I managed a one-hour cuddle nap, then he took a walk down to the exit sign and back. His longtime friend, Joel Russell, returned for another visit and they reminisced more about HLG Days. Jeremy Hudson, one of the chaplains here, also came up with Joel to visit. Jeremy was a chaplain at St. Luke's Hospice when Jim was a hospice aide there.

The nutrition for the tube feedings will be delivered at our home by UnityPoint Home Medical Saturday afternoon.

An x-ray of the stomach is scheduled Friday morning. If results are good there as well, tube feedings will commence Friday afternoon.

The goal is still to go home Sunday afternoon and if that indeed happens, someone from UnityPoint Home Health will meet us at home to bring the feeding pump and instructions.

The Post-Esophagectomy Surgery Eating Protocol has changed a few times. The one below appears to be the one we're going to follow.

Post-Op Day 15-17 (May 27-29)
In addition to continuous J-tube feedings, he starts with clear liquids - grape juice first, then clear liquids (5-6 small meals per day).

-- What to watch for:
profuse or prolonged coughing
neck drainage

Post-Op Day 18-20 (May 30-June 1)
In addition to continuous J-tube feedings, start full liquids (5-6 small meals per day).

Post-Op Day 21-22 (June 2-3)
In addition to continuous J-tube feedings, start soft mushy diet (5-6 small meals per day - can be as small as 3-4 Tablespoons)

-- What to watch for:
 feeling full easily
decrease portions if needed

Post-Op Day 23-25 (June 4-6)
Continue soft mushy diet, cycle J-tube feedings from 10 p.m. to 7 a.m., flush and after, disconnect in the morning. May take medications orally.

Post-Op Day 26 until follow-up clinic visit (June 7 - )
Continue soft mushy diet, stop J-tube feedings, flush J-tube 3 to 4 times per day