Settled in for the Winter

We moved to a larger site last Sunday since we will be here for awhile. Sure is much nicer to have neighbors a bit further away! We met with his cardiologist this past week. At first he didn't feel they should do anything since the meds were controlling his heart rate. That was before he looked at the EKG and the meds he is taking. His heart rate is still high and he raised one of the meds another 120mgs a day. He is now taking enough of these meds to control an elephant! So now he is sleeping 24/7 instead of 20/7! We meet with the electrophysiologist on Nov. 6. He is the doctor that does the procedures, so will see what he recommends. The cardiologist feels the problem is in the AV node and if they fix that he will likely have to have a pacemaker. Then off to the surgeon to have his incision checked. He has had a hole at the bottom to drain an infection. The infection is gone, but needed to see what to do next. Just let it grow together and will be fine now. Yea - no more packing, just bandage everyday! Since we were there the surgeon decided we should schedule his surgery to put in a power port for chemo so he can start taking warfarin again for his heart. So yesterday we spent 4 hours at the hospital and he now has a sporty port below his collar bone on the left! The first time he has been at the hospital for a procedure and actually got to come home afterwards! This week is a CT scan and followed in a couple of days with another meeting with the oncologist to schedule his chemo. All the ducks are finally lining up in a row and we are making progress toward an eventual full recovery! We will have lots of company in this park for the winter - they only have a few empty sites!

Long Term Plan

We met with the oncologist this morning. This doctor had worked at MD Anderson Cancer Center in Houston TX (a leading cancer center in the US) and after talking to him about various treatments Ralph has decided to stay here. The protocol for his cancer would be the same anywhere and the only difference would be if he wanted a clinical trial. This oncologist is the head of oncology at Skagit Valley Hospital and is part of the Seattle Cancer Alliance which includes the University of Washington and Fred Hutchison Cancer Center. His treatment will be 2 days on infusions and 12 days off for a total of 12 cycles (6 months). There are practically no side affects to these drugs. His 2 day infusions start at the center for about 4 hours and then continue at home for a total of 48 hours. He will have a baseline CT scan and then meet with this oncologist for a start date. After treatment they will do another CT scan and then every 6 months. He will have another colonoscopy next August and then every 3 to 5 years for that. The oncologist will work with our travel schedule for follow-up appointments. His a-fib will not affect his chemo schedule which they like to start no sooner than 4 weeks from surgery and no later than 6 weeks from surgery. He will be closer to the 6 weeks since they would like to give his wound as much time as possible to heal. So, cardiologist is next Tuesday and hopefully we will have a time for the ablation. The 27th is the surgeon for followup and consult on a "port" then a CT scan and the oncologist is on the 30th. We will be staying at our wonderful little RV park here in Mount Vernon just 10 minutes from the medical centers! We are getting ready for winter and will be warm and comfortable in our little house on wheels!

Home

Ralph came home Sunday afternoon. He is still moving a bit slow, but getting out and around. He still has a hole at the bottom of his incision that has to be packed and bandaged. Not sure what the long term plan for that is since his surgeon is on vacation and another surgeon saw him in the hospital. He takes naps, but more because of his heart than surgery. Everyday is better!!!!

Coming Home Soon

It has been a difficult few days to get his digestion working again. They finally had to put an IV "pick-line" in his arm and feed him nutrients that way for 2 days. Friday they started on liquids again and he did well on them. Over night they weaned him off the nutrients and yesterday he had solid food and did well. He still has a hole at the bottom of his incision from when he had an infection. Now to get it to heal, they are doing some minor work on it today - they said it needs to wake up again and realize it needs to grow together. Our bodies are amazing! His heart is now between 100 - 140 with very high doses of meds. Cardiology was supposed to see him yesterday and no one came - surprise! Everyone just wants to know what meds he is to take at home. The path report was about what we expected given the surgeons report after surgery. When removing the tumor, they went far enough to get to clean and cancer free tissue. About 1/2 the lymph nodes removed had cancer cells. He will be ungoing chemotherapy at some point. The timeline for everything is a bit fuzzy right now given his heart rate and the need for ablation to correct that. They said he might get home today, but his surgeon on Friday noted in his chart that he would be released probably Monday. They may want to watch the wound for 24 hours to make sure it is OK.

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!