Showing posts with label Trevor. Show all posts
Showing posts with label Trevor. Show all posts

Wednesday, August 8, 2012

Aug 8 Dad Update

Just a quick update from today on Dad.
Overall he did much better today, but he also slept a lot today too. We didn’t have the emotional swings that I have seen in previous days. He ate fairly well tonight, another positive sight.
We did see Trevor at Dr Nichols office today. He is changing Dad’s pain meds again, giving Dad a stronger pain med, but he shouldn’t have to take it as often. He is also putting Dad on a diuretic called lasic that he is hoping will help keep the fluids down in Dad’s lungs, abdomen and feet. Dad will also have a chest x-ray tomorrow and a ultra sound of his abdomen to see how the fluids are doing.
Trevor said Dad was not positive for the Herpes virus or Shingles, which he believed was the underlying cause for the Bells Palsy. He agreed with the course of action and will see Dad next Wednesday.
Also, the results for the c-diff will not be available until Friday at the earliest. Trevor expects that it will take at least 3 months for the facial paralysis to get better and could take up to a year. In a few cases sometime the facial nerves do not recover.
That is about it for now. We will meet with the infectious disease doctor tomorrow.
Love to all,
Bill

Wednesday, August 1, 2012

August 1 Medications

Catie's Notes

Medications – William Harrer – August 1-2012  (after seeing Dr. Nguyen and Trevor in Dr. Nichols office)

With notes and questions (if any)

Beginning at 7 pm on July 31st:

1.       Prednisone, 20mg as follows – 3 tabs once a day on Tuesday and Wednesday evenings, with dinner – On Thursday (Aug. 2), Friday and Saturday (8/4) he will take 2 tabs once a day, then on Sunday (8/5), and Monday (8/6) he will take 1 pill at dinner. He will be out of the prednisone on Monday (8/6)

2.     Metronidazole, 250mg, 1 tablet 3 times per day – I do not see that he is taking this any longer.  He only has 2 pills left in the bottle, but none were in the pill case, so I know he has not taken them since I have been here.  Dr. Nguyen – Should he still be taking this?

3.      Atenolol, 50mg, 1 per day, 90 days

4.      Sodium Bicarb, 650mg, 1 tabs, 2 per day,

5.    Vitamin D - One a day

6.     Vitamin B supplement  2 times per day.

7.   L-Lysine – 500 mg Capsule – 4 times per day (this is intended to help with the virus infection) –
Dr. Nguyen – is it okay if he takes this? Is there any risk to his kidneys or liver? 

8.  Lexapro 10mg – for mood.  We will wait to give him these until he settles in with this latest round of prednisone as to determine how he is reacting to the prednisone in relation to mood and energy level.

9.  Valtrex – 1 gram (it is HUGE).  He will begin taking this after seeing Dr. Trevor on Wed. Aug. 1st..  One of the side effects of Valtrex is DEPRESSION – so.. be aware.. I have taken it several times and I have had severe depression when on it.  It can also cause dizziness.  This is for the viral infection – which could be the underlying issue with the Bell’s Palsy. 

10.  Lacri-Lube (over the counter ointment for eye) He needs this at night, then cover eye with tape.  He also needs to use artificial tears throughout the day. This is really important to ensure his eye does not get ulcerated. 

In Addition:

Inhaler, Proair, HFA 90 MCG IWAK, Albuterol Sulfa, 2 puffs as needed.

Questions:
?? Should he be using the ear drops still?  The ciprodex?? I have a full prescription, but have not been giving it to him. 

Stopped per Dr. Nguyen:
Allopurinol, 100mg, 1 per day, 30 days
Augmenten – which was prescribed by Dr. Rabinov.
Furosemide

Tuesday, July 31, 2012

July 31 Update

On Tue, Jul 31, 2012 at 3:36 PM, cate praggastis  wrote:
Okay... I will see if I can fill all that went on today... so far..

First off, when I got here yesterday (Monday), both Tom and John had told me about the droop on Dad's face. John had done some research and suspected Bell's Palsy. Today, specifically this morning, when dad woke up.. he was distraught.. his speech was slurred and his droop was very pronounced. He said.. "I think I have had a stroke". I said okay, called John .. who called Tom.. I got some food in Dad's belly while they were talking.. and then I called Dr. Nichols and took Dad there. We saw Trevor, the PA (smart guy). He suspected Bell's Palsy right away because of the multiple involvement of Dad's eyes and mouth. We have an MRI at 4 pm to rule out stroke.

Trevor had blood drawn to find out if Dad has a virus. Since he has a history of herpes (cold sores), it is suspected that the virus is acute and causing the Bell's. We see Dr. Nichols again tomorrow at 10.30 am for the results. In the meantime, he (Trevor) put dad on Prednesone and Valtrex, which would help with the virus and eventually work on the Bell's Palsy.

In addition, because Dad cannot close his left eye.. Trevor ordered Lacri-Lube Eye Ointment. There is concern that he MUST lubricate the eye regularly, to prevent blindness.. since he cannot blink at all. He has to sleep with his eye taped closed. I worry this might offset his balance a bit.
Dad cannot chew on his left side. He ate eggs and a bit of cottage cheese last night, and some watermelon.. and had 1 egg this morning. He had some Ensure this afternoon.

We then went to see Nguyen as well this afternoon. Dr. Nguyen has a good manner with dad. He was concerned about the Bell's and the virus.. so he has suspended any treatment of CHEMO until the results are confirmed and dad is feeling better. He does NOT want Dad taking the Augmentan that Dr. Rose prescribed. He thinks it is playing havoc on his stomach and not working on the ear infection, which is likely in the mastoid bone.

Which brings me to Dr. Trang (the ear surgeon). Dad has an appointment with Dr. Trang on Tuesday, Aug. 7th at 10:30 in the morning. (The office just called to confirm that time, Tom - so whatever you have from Dr. Rose is not current). Dr. Nguyen will confer with Dr. Trang AND Dr. Nichols office on the best road to travel. (stay to the right of the building, go around the back side and enter through the door that says "Surgery Center")

Dr. Nguyen was in support of the Trevor's plan for treatment for the Virus, also felt like it was Bell's Palsy, has piggy backed on the blood draw from Dr. Nichols office today to check his vitamin levels and anemia. He was kind and gentle with dad and could see that Dad is distraught and depressed. I suggested a mild anti-depressant that got me through the loss of mom... It is called Lexapro. Dad will begin taking it tonight. Dr. Nguyen felt it might help Dad. He wants Dad to feel like he can move around, get around and have a bit of energy. He is a very compassionate doctor.

Dr. Nguyen wants to ensure the Furosemide and Allopurinol are STOPPED. He said to give Dad 500 mg of Tylenol every 6 hours instead of the Tylenol with Codeine, as that is making him too tired and could be exacerbating his depression - plus Dad hates how he feels on it. He said Dad SHOULD not take aspirin or Advil.. which I didn't know.. so that was a good update for me.

Dr. Nguyen said, after he looks over all the tests and confers with the other doctors, he needs to see Dad next week (Tuesday, August 7th at 3pm)- Tom or John.. you can likely change that if you want to set them up back to back with Dr. Trang. He, at that point will discuss how to proceed with the Chemo, and the possibility of putting Dad on and appetite stimulant to enhance his food intake. I had a friend tell me that she is on medical marijuana in pill form.. and that it has helped her mood and her appetite, while also controlling some of her pain from the chemo and infections that she has. She is also undergoing chemo for Cancer, but not lymphoma.

Dad said everything tastes salty, that he always has a salty feeling in his mouth.

Dad is resting now, for about another 15 minutes, then we will go to the Radiology place for the MRI. We will not know the results of that until we meet with Trevor tomorrow morning. Let me know if you have any questions.. or if it seems like I left something out. Love you all...




Wednesday, July 18, 2012

July 18th


Tom, Dad and I saw Dr. Nguyen this morning at 9am.

 The doctor said he had a little fluid on his right side, but not enough to warrant a drainage.  He said he believes the body will heal that problem on its own, however we should watch it.

He went through all the drugs he's on and removed the Furosemide and lowered the dose of the Allopurinol and Sodium Bicarb.  See the attached sheet for more details on his medications.

He said the prednisone is on a cycle, 1 week on, 2 weeks off, following each chemo treatment.  He said dad should have more energy when on the prednisone and may have difficulty sleeping.  2-3 days after his last dosage, which will be tonight, Dad should want to sleep more at night, like 10 to 12 hours.  This is normal and to be expected.  However, after 12 hours, it is best if he gets up and around.

Tom asked the doctor if someone should stay with dad now, or around the chemo treatments.  He turned to Dad and ask him if he knew how to use a phone, in an up-beat, non-sarcastic tone, and dad said yes.  The Dr. then turned to us and said, I see no reason why he can't continue to live alone if that is what he wants. Tom asked if he could drive while on these medications and he replied yes.  At Costco, while we were waiting for his perscription, I mentioned I would be happy to stay through the weekend and that both Cate and Billy said they would be more than happy to come back down as well. He smiled and said he would be fine, and got a little teared up.  He knows we love him.


Note: His next office visit is 8-1-12 @ 3:40pm, he will likely get his next chemo treatment the following day.  He will be back on the prednisone and should be fine for traveling down to San Diego.


We're headed to Dr. Nichols at 2:45pm today.


...Jim

Afternoon:

Trevor at Dr. Nichols was who we saw.  He came in prepared, had read all the previous notes and was well informed.

Key points:

1) He ordered the blood work and cc: all the doctors.  They took Dad's blood while we were there.

2) He doesn't feel they should have taken him off the Furosemide 40mg. This is for swelling, which Dad showed a little of in his legs.  As a compromise, Dad purchased some compression knee-high socks for $40 that he should wear when around the house. He should also use a pillow when in his chair to elevate his legs.  Therefore, I did not discard his Furosemide, just in case they decide to put him back on it. They're good until Feb 2013.

3) He made an appoint for dad to follow-up with Dr. Aziz, his Pulmonologists. Note the appointment is for 7/25/12 @ 1pm. That was the only time they had available.  The goal is for Dr. Aziz to monitor Dad's breathing and to establish a relationship with this Dr. on all issues related to his lungs.

4) Trevor said that Dr. Nguyen is the captain of the ship, with Dr. Aziz, Dr. Saiki & Rabinov as running backs.  He said he didn't see any reason to make Dad to continue follow-ups and asked to see him again in 3 months.  Note, Dad's next appt with Dr. Nichols is 10/17/12 @ 3:45pm.  He said if we need him, just call and they'll get dad right in.

5) Trevor said he thought Dad's lungs sounded great, just a small amount of fluid on his right side.  He checked his ear also and said it was looking great.

I think it's good we have a follow-up appt with Dr. Aziz.  As the Prednisone leaves his system over the next 2-3 days, if he has trouble breathing we have a follow-up with a lung doctor next Wednesday.

Dad's spirits are good.  He's tired, probably from beating me at 5-straight.  Becky called, she coming over tomorrow to get a few tips from the master before her 5-straight arrives from Amazon.


His medications are becoming a bit tricky. I'll restock his pill case after dinner, he'll need help restocking it before it runs out a week from tomorrow.


Let me know if I missed anything.  Whenever I wake-up tomorrow, I'll be heading back to Bend.

Love,

...Jim

Tuesday, May 17, 2011

May 17, 2011 Update

We saw Trevor the PA at Dr. Nichols office. He had some interesting insights on Dad’s health issues. After describing Dad’s health status before the biopsy and his status now, he did seem to agree that the information we could have determined from the tests was not worth the procedure. His feeling is that a bone marrow biopsy is needed and the two main diseases that could be determined from that are not treatable, so why bother.

Dad’s wound is healing nicely. The HH nurse yesterday had to use the wooden end of the Q-tip to get the wicking material in. Tonight we remove the wicking material for good and see what happens. The HH nurse is scheduled for tomorrow morning and I’ll be there to see if we might be able to discontinue that service. Dad is anxious to get back to tennis and with the nurse coming M-W-F that is difficult. The PA prescribed one more week on antibiotics as insurance against another abscess.

On the anemia front, while Dad’s numbers are low, they are not catastrophic. If they do get low enough for him to have a transfusion, then a nephrologist (kidney specialist) would prescribe epoitein(?), a hormone to stimulate the bone marrow to produce more red blood cells. The PA’s feeling was that the anemia is caused by Dad’s renal insufficiency. We will monitor Dad’s Red Blood Cells and kidney functions every three months. As for future doctor visits, he has one with Dr. Chang near the end of the month. No more with Dr. Nichols (unless the wound starts acting up again) for three months.

We got to spend some time in conversation while waiting for the doctor. Dad says he is eating well. He is feeling good and wants to get back to his routine. I think he is looking forward to living and not constantly going to the doctor. He is looking forward to the Boston trip in the fall. And, as a by-the-way, feels that Boston Rob did a great job on Survivor and deserved to win the million bucks.

Love,

John