If it's not one thing, it's another ...

I updated the blog just Saturday, and two days later, I'm doing it again.

If this gets too graphic for you, I suggest you stop reading now. Otherwise, dive in.

Since the last time Jim had blood in the stool (that brought on the internal bleeding in October 2015), he has determined that if he ever had blood in the stool again, he would tell me.

So, this morning, guess what?! Blood in the stool. Lots of blood. He said there was a little Sunday morning, mostly on the tissue, but thought it could be because of straining. But this morning was a different story.

I called nurse friend, Lorraine (AKA Lori), who suggested we call our gastroenterologist (Dr. Gerke) in Iowa City, so I did. When the GI nurse returned the call, she suggested we go to the ER.
It was already late morning and I had appointments at 1:30 and 3, so we decided we'd go to St. Luke's after my last apointment.  Hence we became part of the sit and wait, go and do, and sit and wait some more crowd from 4:30 to 8:30 p.m.

Jim's blood pressure was actually high. Of course, medical staff was concerned over how low his readings were. The first reading was 80 over ? with an adult cuff, second reading was 88 over ? with pediatric cuff, and when he got his own room, a recheck showed it was 96/46.  It has never been this high in the 9 months he has been taking midodrine to raise his blood pressure. At least not that I can remember. He has gained another pound to boot, coming in at 137 pounds fully clothed.

Jim had the pleasure (NOT!) of having a rectal exam, then he had blood work, then a CT scan of his rectum.

At 7:50 p.m., Tina, physician's assistant, came in with the findings ...

• CT scan showed no obstruction 
• He does have constipation 
• The bleeding could be a tear as a result of straining
• There appears to be area of pancreatic duct that is dilated
• Prostate is enlarged
• Bladder is distended
• Hemoglobin count is 9.6 

Other details going forward ...

• The blood pressure was 102/54 when last checked at 8:07 p.m., and it was thought it was because he was getting fluids. So he still needs to drink more water than he does. 
• The hemoglobin count is near the point where a blood transfusion might be necessary. 8.0 is the magic number he doesn't want to reach.
• He took a capful of Miralax (a more gentle stool softener/laxative) at 9:55 p.m.
• Make appointment with Dr. Hoxie, his urologist, to follow up on abnormal bladder findings
• Make appointment with Dr. Butler, his primary, to see if bleeding has subsided and do a repeat of CBCs
• Call Dr. Gerke's office and advice him of details
• Return to St. Luke's ER if he has worsening symptoms, which includes dizziness and shortness of breath
  
  That's all folks. 

Thank you Lord for getting the answers we needed quickly, even though it seemed so slow and we are not very patient.

Thank you Lord for enabling us to go home, not having to spend the night at St. Luke's or have to drive to University Hospitals in Iowa City.

Thank you Lord for all you do for us. We are so undeserving, but without you, we would be thankful for nothing. 

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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.