Tuesday Update

Everything is progressing slowly as far as digestion. He is now on full liquids, but is still having problems with digestion. He is eating very little as he has no hunger. His surgeon is pleased with his progress and keeps telling us it just takes time. Today they are slowly lowering his dosage on the epidural pain control as it has to be removed tomorrow. He will be on IV morphine as needed. They also have to remove his catheter tomorrow. Guess a week is the limit on those two things. They had to change his IV line to his right arm as it came out last night. The lower part of his incision is now open with a drain line as he had an infection. He is on IV antibiotics until the infection clears up. The biggest concern is his heart rate which at rest is now going up to the 140's and when he is up has gone as high as 180. That is why they have left the epidural pain control and catheter as long as they have to keep him from getting up so much. The cardiologist is coming by today, but we don't think there is much he can do at this point. Right now they will not let him walk and he needs to walk to help with digestion - catch 22! His heart rate is just out of control and even if the surgeon would release him, he will go no where until his heart rate is controlled or out of a-fib! Still no pathology report - maybe this afternoon. We pretty much know what it will say, so will not be surprised.

Update

Ralph had a really good day yesterday. The cardiologist changed some meds and his heart was slowing down a bit and he was allowed to walk in his room. The cardiologist is hoping that by today his heart rate will be better controlled and he will be allowed to walk the hallways which is what the surgeon wants. He was awake most the day and up and down frequently. His digestive system is beginning to rumble, at times very loud! Yesterday after a rough few hours with nausea in the morning, he was fine and had no anti nausea meds all day. Only problem was a small amount of bleeding at the bottom of the incision and that was from so much movement and stopped very quickly. He is also receiving anti-clotting shots every 8 hours which can add to bleeding problems. Yesterday I said that they found nothing unexpected in surgery. More specifically that meant that they were able to section the colon back to good tissue, removed the lymph nodes from that area and found some of them to be firm which means they very likely have cancer cells in them and all other organs looked and felt normal including his liver. Tests will not be back until sometime this week. The cardiologist feels that they need to do his heart ablation sooner than later and they will work with the onocologist to make that happen - wow, doctors can work together! Besides having terrible "people skills", his GI doctor didn't seem to want to work with any other doctors, so we will not be using him again!

Surgery Update

Ralph's surgery went fine on Wednesday. The surgeon did not find anything un expected and his bleeding was minimal. He was moved to the surgery floor that evening and our fun began. Let's just say that the nurses on a surgery floor are there because they do not want to work and are for the most part just putting in their time until retirement. He was at the end of 2 hallways and for most of any day I could roll a bowling ball in any direction and hit no one! You could never find anyone to help you and then Thursday we got "the witch"! They had not given him any of his heart meds because "his blood pressure is to low". OK, so that is hospital protocol, but I requested several times they call his cardiologist and they would not do that cause that was work. Asked them to call his surgeon since they said one of the meds had not even been ordered. Wouldn't do that. Finally I made so much noise I got the charge nurse who did give him his meds, but that was in the evening and the med in question had been ordered, just not signed by the surgeon and should have been given! He has nausea from the epidural pain meds and the shots they were giving him did not work, but that is all they would do. Yesterday we had a floating nurse from another floor and she was great and got the ball rolling on everything and found another anti-nausea med that worked. Late yesterday, the surgeon went to the head of nursing and he was moved to the progressive floor last evening where he has been before and will receive very good care! His cardiologist will be in this morning to see if there is anything they can do to get his heart to quit spiking to over 140 when he sits up since they want and he needs to get up and moving. His heart rate was well controlled until he did not get the meds for that day and now his stubborn heart doesn't want to slow down! He is still on nothing by mouth since his digestion needs to begin working again and to get that working he needs to move and to move he needs his heart rate controlled - a merry-go-round!

Surgery

Ralph will have surgery Wed. Sept. 23. He will check in at 10:30am, surgery is at 12:30pm and will take about 2 1/2 hours and then recovery for about 2 hours. He will be in the hospital for 5 to 7 days, depending on when his digestive system begins to function again. As the surgeon said, the "heart boys" will be close by during surgery just in case, but they do not expect any problems with his a-fib. The surgery is a sigmoid resection and is fairly straight forward and in a good place for the resection. They will also look at a very small spot on his liver that they are sure is benign, but since they are doing the surgery anyway, they will take a closer peek. We will have test results on the tissue and lymph nodes in 3 to 5 days. The surgeon says as far as he is concerned, they can do the ablation on his heart 2 weeks after surgery, but the doctor doing it may want longer. For now we are going to enjoy the summer weather here - supposed to be 80 by Monday!!

Latest News

Ralph was released from the hospital this afternoon. The doctors feel that they have his heart rate regulated, but it was a tough job! With a-fib you do not have a steady heart rate - it can fluctuate greatly. He was spiking to over 140 and they wanted those spikes to be no higher than 110. He was running a marathon 24/7 and that was not good going into surgery. We meet the surgeon on Thursday and will know when surgery will be after that. The doctors think probably the following Monday, but we will see. He has an excellent prognosis - there were no cancer cells detected in his lymph nodes on the CT scan, so they know it has not spread anywhere else. There may still be some cancer cells in the lymph nodes when they test them after surgery however. To show on the CT scan, it has to be very involved to be detected. He had been getting a regular colonoscopy and we thought this was his 10 year recall. Then we found out his 10 years was last summer. But, if he had it last summer, they would not have found this tumor - it grew in a year or less. Then if he had not had the a-fib with blood thinners that caused the bleeding, he would have waited for his next recall and we would have a very different outcome. It paid for us to lose that year!

Worse News But Some Good

Ralph was diagnosed with colon cancer this morning. Adenoma carcinoma is the type of tumor and has according to the surgeon been there for about a year. A CT scan shows no evidence of cancer anywhere in the adominal or pelvic area - that is the good news. We have a surgeon that we have met with and he will have surgery in 7 to 10 days. They have to let the plavix clear his system. In the meantime, his a-fib is on the "back burner", but his heart rate must be controlled with meds. We have a new cardiologist that is not so busy and can work with his meds more closely. He will be in the hospital until his heart rate is under control. They just changed his meds this evening, so may take some experimenting to find the right combination of meds that will also provide the best outcome for surgery and his coronary heart disease. We are hoping he will be home on Friday at the latest and then back for 4 to 7 days for surgery. During surgery they will remove lymph nodes for testing and will know how much of the colon wall is involved. Chemotherapy after surgery will depend on the outcome of those 2 things, but chemo has improved and he will not be sick. The surgeon said the outcome is very good with his otherwise good health. We will be spending the winter here in Washington at the park in Mount Vernon.

WOW! What A Summer for Ralph

As I had posted, he went back into a-fib. Then late yesterday he had serious GI bleeding and the nurse-line advised him to go to the ER. So off to the ER and triaged ahead of a waiting room full of people (according to the staff most without insurance and really should not be in the ER). Yes, he is in a-fib again. They reversed his blood thinners with Vitamin K and admitted him to the hospital at 12:30am this morning. With the blood thinners out of his system, the bleeding has stopped this morning. The hospitalist doctor had hoped to get the GI and cardiologist doctors talking so that something can be done instead of the run around we have been getting and doctors not talking. So far the GI doctor has been in to see him and with no communication with the cardiologist has scheduled a colonoscopy for sometime tomorrow to see if they can find the source of the bleeding. In the past the cardiologist has said no to any other procedures, so will be interesting to see what happens. The GI doctor agrees with us that cardio has not and is not working so they need to find something else and they need to manage his blood thinners differently. They are trying to manage his heart rate with a drug that has not and is still not working - it lowers his blood pressure but not his heart rate. We told the ER that it has not worked, but they continue to give it to him, so we all agree that they need to look at some other meds. So, after tomorrow we will either know what is causing the bleeding or they will find no cause and we go from there. Then once the cardiologist sees him, we may know what they will try next!

Crazy Pulse------Again!

Judging by Ralph's "funky" pulse, he is more than likely back in a-fib. His heart just seems to prefer a-fib, despite what they try. Nothing to do until Tuesday, since he is still on all the meds. We will call on Tuesday and see when the cardiologist can see him and what next. Stay tuned........

Ralph's Back

After 72 hours of sotalol (rhythmic drug), he did not convert on his own - came real close though. So, they scheduled cardio for Sunday morning. Then his INR level dropped to low, so no cardio that day. Monday morning he was scheduled for a TE&E (camera down his throat to check for clots and his valves) and then if no clots cardio. Well, we waited and waited! His cardiologist was having a bad day - if it could go wrong it had gone wrong and he was way behind. He finally called another cardiologist to do the procedures so Ralph could out of the hospital. No clots, valve not that bad, so they converted him (shock) and he was back in his room at 4pm. His cardiologist finally got up to see him after 5pm and ordered a shot to thin his blood before discharge. We knew that would take 2 hours to get it sent from the pharmacy, so we shared his dinner and a little after 7pm he had his shot and papers and we were out of there. Of course it helped that the nurse doing the discharge was off work at 7pm so she was eager to get him out the door! Now, you never leave the hospital without several prescriptions that have to be filled cause you need them that night. They had faxed them to WalMart, but WalMart never worries about faxes and it would be the normal WalMart wait of 1 to 2 hours. We have had enough of that, so we went to Safeway, got flu shots, prescriptions and groceries in less time than waiting at WalMart. Got back to the rig after 9pm - one long day! Today, we moved to a park Mount Vernon. It is a beautiful little park with a great manager and friendly people. And, we are 15 minutes from the doctors instead of 40+ minutes. We are glad they made us leave and find a new place. It was just stressful with Ralph in the hospital. He then had to get another INR test today to be sure his blood was thin enough and he wouldn't need more of those expensive shots in the stomach. For the 2 days after cardio you are at a higher risk of clots, so they want to be sure the blood is thin and his was finally thin enough!! No more shots! Yea!!! Now we can do some relaxing and hope he stays in normal rhythm this time!