August 14, 2012 Update

Dad had a real good day today.  He was up at 8:30 to get ready for his doctors appointment and only took a one nap and a couple of short 20 minute naps.  His energy level was a little low in the evening, but we had the kids and grandkids here which makes it a little hard. 

Other good news, Dad test for C-Diff came back negative.

We did see Dr Trang today who noticed a big improvement in his mood and mentioned that he could see Dad's left ear drum for the first time.  He told Dad that he would be on the antibiotics for at LEAST 6 weeks and probably longer.  Dr Trang wants to see Dad in two weeks.  His pain level was 2 almost all day, he is eating good and sleeping good.  His weight today was 167 lbs up 2 lbs from last week.

Dr Nguyen called today to check up on Dad and Tom told him that he is doing better but sleeping a lot of the time and tired a good portion of the time he is awake.  He asked Dad to come in for a Procrit (EPO) shot, which we did after Dr Trang's office visit.  This will help with his anemia and hopefully give him a little more energy.  We asked Dr Nguyen about the Lasix and he said Dad could take it (Trevor would order it for the fluid in Dad lung/abdomen as well as the swelling of his feet/ankles and Dr Nguyen would take him off of it).  Dr Nguyen also said he would prefer that we keep Dad on the Lexapro (anti-depressant) and cut back on the pain meds.  We tried putting Dad on 1/2 tablet on Hydrocondone 4 x today and he said he pain was ok.  We are hoping that the antibiotics are starting to kick in.

Dad has enjoyed his visits with Amelia, Will, Krys and Sarah.  He hasn't been able to enjoy the smaller kids too much, but it sure has helped me having the little ones here and the energy they bring.

We see Trevor at Dr Nichols office tomorrow at 1:00.

Love to all,

Bill

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 17th

I called all the doctors, here the schedule:
 

Tomorrow (Wed)

9am - Dr. Nygene (Cancer Doctor)
3pm - Dr. Nichols

July 26th (Thursday)
1pm - Dr. Siaki

July 27th (Friday)

4:30pm - Dr. Rabinov

Dad lost his right hearing aid. We'll need to deal with this at some point. With any luck, he'll be able to wear it after the 27th.

Medications - Here are his current meds:

- Prednisone, 50mg, twice a day through tomorrow only.

- Allopurinol, 300mg, 1 per day, 30 days

- Metronidazole, 250mg, 3 per day, 9 days

- Furosemide, 40mg, 1 per day, 30 days

- Atenolol, 50mg, 1 per day, 90 days

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

- Ciprofloxacin - Ear Drops

- Vitamin D - One a day

Let me know if you have any questions.

Love,

...Jim

July 6th

Tom texted me Dad’s new prescription - Rifampin. It appears to be a strong one, sometimes used to treat MRSA, which is a bad bacteria. There are the typical side effects – itching, flushing, headache, drowsiness. At least it is an oral one….

John

May 18th

I don’t know if they call this “managed” healthcare or not, but I sure don’t. So here is where we are at at 10:40 am Friday. Since my last update, Dr Kitt, an infectious disease specialist came in sometime during the middle of the night. They did start Dad on Vancomycin about 3:00 am and he was done with this IV by about 8:45 when I came in. Dr Rose arrived at the same time and we did talk for awhile. She said they were getting ready Dad for a MRI and that she wanted him to also have a special scan. I asked why the MRI and she said one of the other doctors ordered it along with blood and urine samples. Since they took both in the middle of the night I let those go. That is all they have done so far. Dad’s pain level is currently an 8 out of 10, with 10 being unbearable. This is higher than at anytime yesterday, but not as bad as Wednesday. I just talked with his nurse and they are getting him pain medication. He is getting tylenol with codeine. Dad was just started on two different anti-biotics shortly, they are Cefepime, an injection given through his IV very slowly and Zyvox 600 mg, a pill. These were suggested by the contagious disease specialist. I did ask Dr Rose if they were concerned about Mersa and she said no. Her main concern is whether he has an ear infection that is affecting he mastoid or whether he has a mastoid infection that is affecting his ears. She said treatment would be different depending on what they find. Dr Trang is expected in around 4:00 today. He is an ENT that specializes more in ear problems and is also an ear surgeon. Dr Rose has been consulting with him on Dad’s case. John, I did tell them about Dr Saike and the Aransp injections that he is getting. They said they will inform his doctor and that it is up to the doctor to contact Dr Saike. His red blood count was at 2.85, if that means anything to you and that his calcium is low too. His blood pressure is high, around 160/80. Things move slowly in the hospital, but I do believe we are moving forward. Dad is resting right now. I will let you know if anything else changes. Bill

According to John, Dad received an EPO (Procrit) shot today.

This was not Procrit, but something similar call Aransz and I think the dose was 60 mcg. - John

According to Dr Rose's patient notes:

Dad will have a CT scan today, verbal reporton CT - right and left mastoid opacification, left ME largely opacified, left can filled with tissue, not bony erosion.

May 16th

To bring everyone up-to-date, Dad has been struggling with an ear infection in his left ear.  The drops they were giving him had no effect on the bacteria and so the Dr. changed to oral administration.  According to Mary, the Dr. is considering iv administration as the next step but first she wants to do a CT scan of the ear.  Dad says the earache can be quite painful at times, especially in the evening after dinner.  The ear canal is completely closed up and he cannot get new hearing aids until this is cleared up.  Thankfully the folks at the hearing aid company he goes to had a “demo” amplifier they could put into his right ear and that has improved things.

I played tennis with him this am and he’s tired of these inconveniences but he still keeps plugging along.  He walked up the slope to the tennis courts slowly but without stopping as far as I could tell.  He can’t see the ball for $%$#, but he still managed some good shots.  He had courtside conversations with the other players telling them about Nedra who has sprained her ankle.  He had a fall, I think out of bed, and bumped his head.  There is a half dollar size bruise and it looks like it’s healing okay.

Mary is taking him to the ear Dr. on Thursday, I’m not sure when the CT scan is (it was just scheduled), he gets blood tested today, and another EPO shot on Tuesday.  Bill is considering coming down for a visit next week.

According to Dr Rose's patient notes Dad was seen today, his canal is slightly less edematous (filled with blood) but she still cannot see the ear drum.  Dr Rose added a prescription for tylenol with Codeine.

May 11, 2012 Update

According to Dr Rose's office notes, Dad was seen today.  The wick in his left ear was removed, there was discharge present, medial half of canal still very edematous.  Dr Rose added rifampin 300 mg Cap to augmentin.  Staph is resistent to cipro and gent, no ear drops at this time.

Jan 11, 2011

Hi Everyone,

He are some notes on Dad's visit today with Dr Chang.

Dad had a visit with Dr Chang today, two days after his surgery. Prior to the appointment, last night, dad pulled out his catheter during the night because it was leaking where the tube exited his body.

Both the doctor and nurse examined the catheter and made sure that all of it was removed, and it was. The doctor asked Dad if his flow was any better and he said it was the same as before the surgery. The doctor said that it was normal and that it might be due to swelling and that it could take a couple of weeks for the swelling to go down.

Dad was told not to drive for another week, and that he shouldn't play tennis or do any dancing for about 4 more weeks - so as to give himself time to heal properly. He was told that walking is good, but only in moderation, not walking more than one mile at a time. He should also be drinking more water than normal, but he does not have to drink large quantities. Dad need to be cautious, not doing anything strenuous, and was told to avoid heavy lifting.

Dad was given three meds when he left the hospital. Vicodin for general pain from the surgery; Toviaz (4mg) for frequency of urination or bladder spasms; Pyridium (200mg) for burning when urinating. All three are to be used as needed.

I then asked the doctor about the procedure and what he should be expecting. The doctor took another 10 minutes and told dad that some patients have a full urine stream within 48 hours, but it is not uncommon for men not to have a normal stream. Dr Chang said it could take 2 -3 weeks for the stream to return to normal because of swelling, if the laser surgery was successful. BTW, Dad only had the laser portion of TURP, not the portion where they use a tool to scrape the wall of the urethra. The doctor brought in some props and drew some drawing explaining the procedure further. He mentioned that while the prostate enlargement covers a broader area than the portion they removed. In the picture below, the area that they removed the tissue with the laser is approximately from the points of the ejaculatory duct to the prostatic utricle. The doctor explained that going below that there is a greater concern for incontinence. Generally when they relieve the swelling of the upper portion it also helps the lower area, but in some cases, and not way to predict which ones, removing the swelling in the upper portion causes the lower portion to become worse.

Dad will be re-evaluated at a follow up appointment on April 25 at 11:40 am with Dr Chang. Anytime during the week before that he needs call and go into Dr Chang's office for a uroflow test. This will basically test how strong a stream he has. The flow will take about 3 hours and most can be done at home, but the office needs to know when he is coming in. Dad has an instruction sheet on the procedure at home.

If Dad is still having problems urinating at his April appointment, they will probably schedule him for a TURP where they use a cutting blade to remove the swelling around the lower portion of the prostate, typically between Prostatic utricle and Prostatic Urethra portion of the prostate. This is a trickier area to cut around, thus the a more precise tool.

Dad also needs to repeat his Kidney test in about a month, the end of February. The doctor is looking to see if his kidney function is better, the same or worse. He said it should be the same or better, just not worse.

Toviaz side effects; dry eyes, insomnia and urinary tract infections and should not drink any alcohol. Constipation, and nausea and heartburn are also common side effects. The most common issue is that you feel you have dry mouth.
Vicodin side effects; vision, dizziness, shortness of breadth and constipation problems are typical.

Pyridium side effects; headache, stomach upset and dizziness are the most common side effects.

All three also says sever allergic reaction would be a rash or shortness of breadth.

Dad has information sheets on all three medications.

Please let me know if this is not clear.

Bill