Updates - Day 183

We'll start with Wednesday, Nov. 4 - Jim had his infected tooth that was diagnosed Nov. 2 removed this morning. Has had no problems with it since.

The following Wednesday, Nov. 11 - Jim had a CT scan of his chest, followed by a 3-month followup visit (even though it has been 6 months since the cancer surgery) with Dr. Parekh at UIHC. Results of the CT scan were good - no apparent reoccuring cancer. That is a blessing. His blood pressure is improving - 97/52. He is to return in 6 months and after that, yearly visits.

Today, Nov. 12 - he had an endoscopy to see how the ulcer was healing. Dr. Gerke said it was not healing, and it may never heal, but he was not overly concerned about it. It's not bleeding either, and as long as it stays that way, good. Perhaps this is what you call an inactive ulcer? He recommends Jim stay on 40 mg of Pantoprazole, once a day, to help it heal.  

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?

Coming Home - Day 146

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.

Indigestion - Day 47

Today at 4 a.m. I woke suddenly, then fell back asleep. Jim also woke up, went potty and came back to bed. Then he got up again (something I didn't realize) and moved to the recliner, where he managed to fall asleep. When I got up at 6:30, I discovered all this and that he took a pain pill for back pain and indigestion.

I told him he needed to tell me when things were not right, rather than just think he could deal with it himself.  We can pray together.

He had several BMs yesterday and one was loose, so decided last night not to take any Senna.

I called his sister, Dianne, the nurse. She said he needed to take 1 Senna nightly and that a call should be made to UIHC on-call. After all he has had 2 surgeries. Jim didn't want to call. He didn't want to return to the hospital. But he finally agreed to let me call.

In talking with the thoracic fellow on-call, we have come to find out that foods with red sauces, like pizza or pasta with tomato sauce or red wines (that's not a problem with us, considering we don't drink alcohol) can cause more indigestion.

He asked if Jim was taking omeprazole. Well, he was taking pantoprazole before surgery, but was taken off it and had not resumed it. The doctor said he should be on it, as it helps with acid.  He was taking 40 mg twice daily, 30 minutes before breakfast and supper meals.

So, we found a bottle and he has taken a pill before breakfast. It's 7:30 now, and he has had another BM, which is good. He feels a little bit better.

Yesterday, he was hoping to make it to Sunday School today, but now that today is here, that appears very unlikely. His goal is church.

He has been resting since 8. It is now nearly 10. We will leave soon.

I WILL NOT LEAVE YOU UNTIL ... 
Yesterday's devotional writings were a result of readings in Psalm 143:8 and Genesis 28:15.

Psalm 143:8 says ...
"Cause me to hear Your lovingkindness in the morning
For in You do I trust;
Cause me to know the way in which I should walk,
For I lift up my soul to You." 

Genesis 28:15 says ...
"Behold, I AM with you and will keep you wherever you go, and will bring you back to the land; for I will not leave you until I have done what I have spoken to you." 

This last part particularly caught my attention - "I will not leave you until I have done what I have spoken to you."

I thought on it yesterday periodically and again last night when we watched the Christian movie, "End of the Harvest."  God said this to Jacob in a dream. This is a promise made. ...

Is this also a promise to those of us who follow His Son in the current age? What do you think it means? Does it have to do with callings received from the Lord ... like being called to write a book,
to be a teacher, to preach His word ... in season, out of season, when it is convenient, when it is not. Or is it something else?

Today's devotional read was a reminder from Isaiah 55:8 -- "For My thoughts are not your thoughts, nor are your ways My ways, says the Lord." 

and my writings ...

Do not doubt
Do not give in
to "me" thoughts and "me" ways
Do not give up
being aware of Me

Along every road block
I AM with you
whatever this life throws at you
I AM your protector
your refuge
your confidante

See Me
in the midst
of your pain-full days
and pain-free days
I will bring you
through it all

My Ways, My Thoughts
Do not doubt

Live and Love
and Proclaim My Truths
I WILL guide you.
(c) CMOL

GOD'S SIGN
I return to Saturday's devotional reading and read it again.

Rest in the Lord for a while
for you have journeyed along a path
steep and rugged
in days not long ago.

The days ahead,
the way,
is covered with uncertainty.

Wow, it dawned on me -
God was giving me a sign
we, Jim and I
we were to rest in Him
and not get caught up
in all that which draws us down
and away from Him.

The indigestion -
all the discomfort it brings -
and whatever else in its wake
is the uncertainty.
Trust Jesus in every step
He will lead us
through the valley
up and down the hills.
Pick us up Lord
Pick us up and carry us.
Give us strength
through every life moment.
Come to his aid Lord.
In your name I pray.
(c) CMOL

FIFTH SUNDAY FELLOWSHIP 
Through the Lord's intervention, I managed to get done with work shortly after 4:30 p.m., so Jim and I could go with friends Bob and Lorraine to the Fifth Sunday Fellowship at First Baptist Church, Dunkerton. We hadn't been up there since mid-February. The program started at 5 and we arrived at 5:30 p.m. Many FBC members we'd hoped to see were absent, but it was good to visit with those present.

Tummy ache problems erupted again for Jim and he wanted me to call UIHC on-call around 10. The doctor said he needed to give the pantoprazole time to work - a few days.

Jim also is having urinary problems again - not voiding very much and not getting intended results when self-cathing. The UIHC doctor said to drink water more frequently throughout the day.

And, when getting ready for bed, taking out his hearing aids and contacts, he had problems again with the left contact being up high behind his eye. This problem arose the last day he was in the hospital - June 17 - and was corrected with a visit to the eye clinic. This time, he went to sleep with the problem, hoping to get it corrected in the morning.