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?

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.

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.

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. 

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.

A step forward, a step back - Day 48

Jim woke intermittently, beginning at 2 a.m. I thought it should have been later. We finally got out of bed at 7 a.m. He said his tummy felt okay. No BM, but he did have gas. He wondered if discontinuation/completion of the antibiotic for urinary tract infection had anything to do with  why he couldn't do No. 1. He had been able to go on his own for a few days prior to Sunday, but then on Sunday, he couldn't do much - on his own or using the catheter. Today, it remained the same.

He had blood drawn today at MedLabs, then went to Klauer Optical to see what could be done about his buried contact - the contact was removed and he is to rest the eye, putting the contact in later today or possibly tomorrow.

While at Klauer, I called his friendly urologist's office to see if his appointment with Dr. Logan Hoxie on July 14 could be sooner. We are waiting for a call back to see if that is possible. The urology appointment has been rescheduled for Thursday, July 9, at 8 a.m.

We had like 30-35 minutes to get to Lemstone Christian bookstore, which is closing its doors Tuesday, because its owners were retiring. This is the first time we'd been able to get there all month and there wasn't much left, but we did find some good buys. Items were 50 percent off.

And then off to the dentist to get a permanent filling on the tooth that was repaired with root canal on May 4 and to do a cleaning. Jim still has another tooth that needs pulled, but that appointment hasn't yet been rescheduled.

Today's devotional reading had to do with anxiety and how we should and should not handle it.

"I can do all things through Christ who strengthens me." (Philippians 4:13)

My writings ...

Anxiety looms
and dooms us
Can I handle it?
Don't ask
Forget the me in you,
my child.
Focus on Me,
My Presence in you
for I AM with you always
and it is through Me
you are strengthened.

The question
to ask
is not
what you can handle
but instead,
what you and I
can handle
together

for without Me
you are weak

without Me
fear and uncertainty and anxiety
are your compass

Focus on Me
Be aware of Me
Remind yourself
of My Presence
with you always

You, My child,
and Me, your Lord and Savior,
we can accomplish great things
when we do it Together.
(c) CMOL

Dr. Butler's office called with INR readings, which are up quite a bit, at 4.7. Jim is not to take any coumadin tonight or Tuesday night and then have a recheck Wednesday morning.

In today's mail, we received a bill from Area Ambulance Service - for $1,102.31. Wow!
We received a letter from them as well indicating Wellmark Blue Cross/Blue Shield will send payment directly to us and we in turn pay the ambulance service. I hope there are no issues.

Recovery Continues - Day 43

We both slept well, waking at 7:10 a.m. Jim had a small BM this morning and said more is coming. He takes a stool softener for this - has been taking it since his first stay in the hospital. He also takes Milk of Magnesia and started taking Senna last night. At nearly 9 we went to MedLabs, where Jim had blood drawn, then came home. I will soon start Gazette work for the day.

It was a hectic day for me, with work and all sorts of phone calls - most work-related, but also medical re: Jim's appointments or bills billed to the wrong place, and then one that was spam.

Dr. Butler's office called with INR readings. It is now 3.0, so he's to take more Coumadin tonight, less tomorrow night and then he visits the lab on Friday morning. He is glad he doesn't have to go anywhere tomorrow morning.

Dr. Li's (cardiology) office called too and said his thyroid level was up a bit. Thyroid problems are one of the side effects of taking Amiodarone, so for the next 2 months, he'll be taking one-half tab of it and then have it rechecked.

Recovery Continues - Day 42

Jim had blood drawn again this morning. He is getting very tired of this. It is nearly 3 p.m. now and we have not heard back from the doctor's office on what his INR readings are. His doctor did say he could resume taking generic Allegro for his allergies.

The project Jim and Craig worked on yesterday with the kitchen light switches was continued this morning, and later after Jim and I left to go to my eye appointment, Craig got it working. It certainly was not an easy fix.

We visited Miss Anna, who was very glad to see Jim, but we didn't stay long. He was really tired and his incisions were hurting big time. Now that he is home and in more comfortable clothes, he's going to take a pain pill and rest.

Dr. Butler's office called around 5 p.m. Jim's INR readings today are at 3.3 - they're going up, instead of down, yet doc wants him to continue with one 3 mg. tab of Coumadin and you know, do the blood draw thing again tomorrow. It's getting old for both of us.

Jim has reduced how much and how often he takes pain pills. He still has issues with bowel movement.

We have two prayer concerns at this point:
1) the INR readings level off and Jim doesn't have to visit MedLabs so often
2) become regular with BM

We may have to call UIHC again because of problems with the latter... however, he does have gas. Funny, how that can be a good thing. 

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.