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

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 31^st:

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. 1^st..  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

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...

---

July 5th

Dad got his hearing aids cleaned today.  Guess there is a filter that needs to be changed regularly.  Tom got a box of those.  Tom and Dad walked 31 minutes last night around Tom’s neighborhood.  That was a stretch for Dad and nearly too much.  Tom and Dad were just by here.  They have a doctor appt with Rose this afternoon to check on his ear.  The subject of driving came up and Tom and I aired our concerns.  Even with the cleaned hearing aids I would say our opinions fell on deaf ears, except for the fact that Dad will ruminate over some of the things we said and maybe take them to heart.  Tom was going to have him drive home from here to get him back in the swing of things (it’s been what 6-8 weeks since he’s driven?)

Dr. Rose:

Just got off the phone with Tom who had been to see Dr. Rose.  There are signs the infection is returning.  She doesn’t know if it’s related to the lymphoma and does not recall ever having a case like this.  They put Dad on another oral antibiotic and the plan is to have Dr. Trang come in and excise the ear to see what is going on in there.  If Dr. Trang does not do it then Dr. Rose will (Does anyone else get the feeling this is what Dr. Rose wanted to have happen when she admitted Dad to the hospital 6 weeks ago?)

Anyway, there are only a few details.  Tom was heading from Costco (for the antibiotic) to Dr. Rose’s to fill out some paperwork.  The procedure will last about an hour and require a general anesthetic.  It will be done next Tuesday and we think it will happen in the morning.  The location has not been finalized.

Dad was running out of gas so Tom took him home and is doing the running around.  Thanks for that, Tom.

May 16, 2011 Update

Dad’s home health nurse came by. It was a different person, Donna. The wound is closing up quickly now. She could barely get any wicking material in the incision. She also was able to forego the large pad bandage and just use the 4x4 gauze pads. Dad is talking about playing tennis soon. We see Dr. Nichol at 7:45 am tomorrow. Look for the next report then.

Love,

John

May 13, 2011 Update

Yep, I can make the Tuesday appt. I'll talk to Dad this weekend and see if
he wants to meet there or have me pick him up.

Thanks again, Jim for being around this week.

John

-----Original Message-----
From: Jim Harrer
Sent: Friday, May 13, 2011 2:04 PM
To: John Harrer; Tom Harrer; Bill;
Subject: Dad update...

Dad and I just finished another long walk. He's doing great. He
really wants to be in good condition for the Boston trip, so he's
motivated to stay on a program.

Dr. Nichols had an emergency with a patient today and couldn't see us.
I rescheduled for:

5-17-2011 @ 7:45am - assuming John could make that. I know it's
early, so if you would like another time their number is 323-8477.

The only question I really had for Dr. Nichols is how often he wants
the packing changed and how deep he wants it based on what the home
nurse is saying (ie. don't use so much and don't clean as deep with
the q-tip). The home nurse from Mercy used way more than I use, so I'm
not sure which procedure is correct. I see both points. We need to
find out what is best. One question I was going to ask is, if the
packing only needs to be re-packed once a day, then Dad could change
the outter dressing himself.

Central Methology called to remind us of an appointment on 5-17-2011 @
2:15pm. Dad doesn't know what this is for? Is this the kidney
follow-up that we want to cancel?

Dad is eating great, he's been eating three meals a day with me and
likes being on a schedule. I have been teaching him my old routine on
how to cook for one. He has been a good student and open to new
ideas. He has really been wonderful to be around ALL week. I just
have to be careful to not waite on him too much, he doesn't like it.

Let me know if I missed anything or if you have any questions.

Love,

...Jim

May 11, 2011 Update

Dad is going GREAT!

Medicare has agreed to pay for Optimum Health Care to come by Mon,
Wed, Fri at 8:30am to change his dressings and repack. The male nurse
who came by today said he will be the same person who comes by each
time. His name is Manuel. He left his cell # with Dad and told him
he could also call him 24x7 if he needed help. He seems to think he
won't need to come by for more than 2 weeks - but said Medicare will
pay for as long as Dad needs him. Optimum has John, Tom and my cell #
numbers as contacts.

Dad is eating great, and doing well. We went and had coffee with this
tennis buddies today at 9:30am and everyone was happy to see him.

The next follow-up appt is Friday with Dr. Nichols.

I honestly think Dad could easily get to a point where he changed his
dressing (not packing) once a day and you just change the packing
daily if you wanted to go to that schedule after I leave. That would
get you down to one visit a day if you wanted. Whatever Tom and the
doctors decide is fine by me, I'm just throwing that idea out there
since the nurse seem to think twice a day (at this point) may be a bit
overkill. I do think the top dressing should be changed more often
then he suggested however.

Hope this helps. Like I said, he is doing well. He also told me he
did go to the dentist recently, but couldn't tell me exactly when. He
changed dentist when the last one charged hum $1,000 for a deep
cleaning - that was 18 months ago. A call to his current dentist
might be in order just to check the facts. I'll try and dig more.

...Jim

May 9, 2011 Update

Hi Everyone,

Dad is home and is looking awesome. His energy level is improving
daily. He's glad to be home, however he's already bitching about
missing Mary's cooking.

Today's doctor appointment with Dr. Nichols went well. Dr. Nichols
gave dad a full exam and redressed his incision and re-packed the
wicking. He told Tom that he has done an amazing job being a male
nurse and if it wants to make $38/hour - he's welcome to join his
medical staff. Tom's retirement is looking solid!

All kidding aside, now that I have watched the clean-up procedures
twice, I have a better understanding of what is going on. Tom has
achieved rock star status in my book.

Dad's vitals were good, BP 126/74, temp 97.2. He's in good spirits,
not in a lot of pain, more discomfort than anything. The swelling is
doing better but still has a way to go. Dr. Nichols asked to see him
again Friday at 11:45am.

Dr. Nichols said he wasn't too concerned over Dad's kidneys. He said
he didn't feel his elevated levels were in the dialysis range. He
also was blunt about the suggestion we place him on a new diet. He
said it is common for people to want to listen to a nutritionist and
try to fix things. He said, at 87 let him enjoy what he enjoys. To
Tom's point however, living on cookies and cereal is simply not
healthy. I get it though, cooking for one, especially for guys, is
pretty boring. I did go shopping last night and restocked his
kitchen. I totally understand a lot of it may go to waste - but I just
couldn't stand to see no real food in the house. Tom/Mary have done a
great job of making us aware of this; I'm not sure what the solution
is. I'm fearful if we have food deliver, he'll simply not eat it and
it will stack up. It might be a good idea to go grocery shopping for
him every 2 weeks anyway and also throw the dated stuff out. If it's
here, he might make better choices.

He's glad to be home, he wants to go to Grant's last baseball game
tonight (which Tom has green lighted) so things are looking good. He
gets to taste some of my home cookin tonight, so the pressure is on me
to deliver. I better go, I have to go turn on the food channel.

Love,

...Jim

Feb 1, 2011 Update

Attached are the notes from yesterday’s doctor visit. You will see that he ordered several blood test again, the main one rechecking the kidney. He is also checking on dad’s anemia and if it is too low he will order a blood transfusion for dad.

Dad is primarily concerned with his control problems and told the doctor that the stream is better sometimes, but that the frequency is not. The doctor told him that it might take time for the swelling to go down and see some improvements in the frequency.

He reviewed all his medications and told him to continue all the prescription meds.
Dad was given a cream for the rash on his back, but the doctor was unsure as to what caused the rash.

The doctor also told dad that he has swollen limp nodes about 1 inch around. These were detected on the CAT scan they did of his kidney a few days before his surgery. The doctor told us that to evaluate them they would have to open him up from his belly and work their way to the back to biopsy them, they are located near his back, but there is no easy way to go in from his back. If it is cancer, then the chemo treatment would have to be sever to have a chance of killing them.

The doctor also discussed his anemia stating that they would like to go into his bone marrow in his thigh to see why it is not making enough red blood cells.

Dad refused both procedures and told the doctor, fix the frequency problem first and we can talk about what is next.

We did talk dad into trying a sleeping pill at night to see if he can sleep better. Dad wrote down every time he got up the night before his doctors appointment and it was at least once per hour. He did try 1/2 pill last night and said it wasn’t much better, but he didn’t get up until Tom went over at 9:45 am and did have a 2 1/2 hour period where he didn’t wake up.

Dad’s next steps are:- Blood test again the week of Feb 28th.- Drs appointment on March 7th at 2:45 pm with Dr Nichols- Follow up with Dr Chang on April 25th at 11:40 am.Tom, let me know if I missed anything.

Love to all,

Bill