Suspect Terrain

Dad's been a bit unsteady on his feet for a while now.

It all started when his neurologist took him off his Parkinson's meds when she decided that he didn't actually have Parkinson's. (Go back to  "Well He's Got That Going For Him" posted last February.) One of the meds was to help with his balance and he's been a bit wobbly ever since.

That, and the stress of the last year with all the pacemaker surgeries make him seem a little more like 90 and a little less like 80. AND he's still walking with the cane.

At some point during the summer he started complaining about a pain in his leg. He even went to see Dr. Wiggins who referred him to a specialist. X-rays and scans showed nothing, but the pain persisted.

I know of one fall. It was at church on the anniversary of Mom's death. He went up onto the marble floor around the altar to take pictures of the flowers. Marla picked one of the flowers from the display and gave it to Dad to take out to the garden where we had interred Mom's ashes. Dad took off on a diagonal toward the open stained glass doors.

"Watch out for the..." I was about to say "step," when he missed the step, falling head over heels into the railing of the first pew. His cane made an awful clatter bouncing on the marble floor. Everyone who was in the church was around him in a second. He paused a moment, then popped right up.

Needless to say, everyone was quite concerned. Expecting the worst, offers were made to call an ambulance, bring up a chair, find the nurse, and a priest was right there....

Of course Dad insisted he was fine and dusted himself off, straightened his jacket and went out to place the flower.

But the pain in his leg became worse. Now it was confused with bruising from the fall. Attempting to go the fair was a big issue. We skipped the first symphony concert of the season because of the walking distance. He skipped going to the first service with the new interim rector because of the walking.

Maybe it's bruising. Maybe it's just life in his nineties, but he seems to have lost a step.

BUT, he's enrolling in a new physical therapy for the problem leg. AND there's one thing we've all learned: Don't rule the DeeDon out!

Dreams and Memories

This picture David posted of Daddy putting one of the St. Michael altar flowers on Mother's spot made me cry. Whenever I'm at St. Michael, I look out those windows and think of Mother sitting next to me on the pew making sotto voce comments about the sermon. And beaming when one of the Waddingtons walked down the aisle.
Then I saw this online:Mount Desert Islander: Luminaria shine light of hope for hundreds.
Evidently, our dear friend Doris Walton lit a luminaria in Mother's memory.
Not a day goes by I'm not aware of her absence.

Check Up Time!

Dad and one of his Committee Members paid a visit to the cardiologist today for a three month checkup with Dr. D. the pacemaker specialist. Yes it's been three months since Dr. Musselman said the improvement in cardiac performance provided by the new device was sufficient to curtail the need for mitral valve surgery. It feels like longer than that.

There was his family 90th birthday celebration followed by an amazing weekend of 90th birthday celebrations with family and friends from coast to coast, from deserts to mountains. June was the Month of the Cousins. Schanches and Waddingtons one weekend, then Osbornes and Waddingtons two weeks later in the Methow Valley in the Cascades. Then Helen took Dad on a wonderful trip (with Susan and Travis) to visit Mr. J T Lemley, the KING of the EAST TEXAS TOMATO.

Through it all Dad has been feeling great.

That was borne out by the performance of his heart on the EKG  and the technical readouts from his pacemaker which is doing great. Of course his lifestyle and exercise regimen keep him sharp and in such great shape.

He goes back in six months.

And Now for Some Even BETTER NEWS!

Dad and his support team met with Dr Musselman (the cardiologist) this morning to discuss the results of last week's TEE diagnostic test. The reader might recall that it was the impression of Doctor Huang (who administered the test) that the outcome was positive.

And today, Dr. Musselman confirmed that finding. In spades!

The new pacemaker and the third lead to the ventricle have improved the pumping performance of the heart and reduced the mitral valve regurgitation to moderate from severe. He does not recommend surgery at this time. Dad is to go back for a checkup in four months. And of course, call if the symptoms worsen.

Big smiles all around!                       

And Now for Some GOOD NEWS!!!

As has been noted, Dad has been feeling improved since receiving new pacemaker with the defibrillator and third lead to the left ventricle. He saw Dr. Musselman, his cardiologist last week who thought it was time to do another Transesophageal Echocardiogram and take a look at how the heart is performing.

Remember that the TEE is a test where a sensor is inserted down the esophagus where it can get super close to the bottom of the heart and get a much better image of how the heart is functioning. It was the TEE exam in early February that showed the severe leakage in the mitral valve that was to be surgically repaired.

It was a foggy early morning in Dallas today as we drove through the grey darkness to the hospital. Walnut Hill Medical is a brand new, tiny, private hospital adjacent to the Texas Healthcare Presbyterian Hospital (yeah, the one famous for Ebola.) Dad barely had time to complain about the wait before they came to take him away and the test was over quickly.

The results were much improved today. The leakage was less severe, mitigated by the stronger impulses generated by the new lead from the pacemaker. One of the acute symptoms Dad was feeling when all this started was waking up at night in a panic caused by the poor blood flow and resulting loss of oxygen. He has been sleeping through the night since coming home from the hospital.

Dr. Huang, who is the TEE specialist and who performed the earlier test said the improvement was significant. and in her judgment put the need for mitral valve surgery in question. If Dad is feeling better, is the major surgery worth the risk and hardship at his age?

Dad will meet with Dr. Musselman in the coming weeks and they will make the final decision. But for now Dad just intends to party on!

Hearsay

Just got a message from Helen: She went with Dad to the cardiologist (Dr. Musselman) today. He wants another TEE, so Dad's scheduled for Monday. They don't mess around when it comes to prompt scheduling.
I talked to Dad this morning: He said Musselman was pleased that Dad has evidently improved since they put the second lead in his Pacemaker; perhaps that has relieved the burden on the iffy valve.
Dad always went to his regular doctor, Dave Wiggins, who said Dad was in amazing health for his age. So Dad was feeling pretty pumped. (No heart pun intended.) As well he should.

Heading Into May

Once again it's been a couple of weeks since the last post and that's a good thing. Dad's feeling pretty good and is getting back to his old schedule, working out five days a week several dinners out with friends every week, not to mention his church activities. It's enough to tire a young man out.

He saw the pacemaker doctor last week. Everything looks good and they are starting him back on Coumadin (blood thinner.) At some point I suspect they will talk about mitral valve replacement, but as of now he does not have an appointment with his cardiologist.

The important thing is that he is feeling better. After his last doctor visit  I asked him if he was feeling better. He said he was but that he still gets tired very easily.

I asked him if he remembered how exhausted and out of breath he was when he bent over to tie his shoes when we saw the surgeon and scheduled the valve replacement. From that day's blog entry:

"The most important factor is that Dad wants to proceed. He was out of breath after bending over and tying one shoe.

"All I know is that I just can't go on like this!"

Dad said he remembered and I asked him if still got that exhausted and frustrated and he said, "No."

In addition to the shortness of breath, the other major symptom of mitral regurgitation is waking up at night unable to breath. Dad described it as waking up panicked. (Because the ventricle can't push the blood all the way through the valve, the valve lies open when in the horizontal position. Blood can't get to the lung and oxygen can't get to the body.) I asked him he was sleeping better. He said yes, he was not waking up panicked.

The sum of these points is that the third lead to the ventricle has improved, if not cured the leaky valve. That will give him the full time necessary to recover from the two surgeries. That should take at least a couple of months.

So now we're making plans for his 90th birthday celebration in June. Should be a glorious affair. If you're reading this, consider yourself invited!

Mary was in town this weekend. Here's a picture of her and Dad standing on the spot in the garden where we buried Mom's ashes, so I guess she's in the picture too.

On Dad's Being Tired

In my experience it takes at least 4-6 weeks after surgery to regain a sense of normal strength. I've read the true length of time after anesthesia is six months for full recovery. It's gotta be longer for a nonagenarian!

Dad had back-to-back two hour surgeries just three weeks ago. And before that he was flat on his back for week with a major infection of his whole body. Then he was confined to his apartment for two weeks with rehab sessions twice a week which exhausted him.

Yeah, I guess he's tired!!!

I think he's supposed to be tired!

But he's continually surprised. And angered. And determined to go on with his life.

Damn Straight, I say. Full-speed ahead!

Looks Like There's Some Catching Up To Do

I was certainly surprised to see that the last post was entered right after we met with the surgeons after they installed his new pacemaker. Sorry about that!

He did not have a peaceful night as expected. He was extremely uncomfortable and he couldn't move his left arm without a pain. And with good reason. The sight of the incision was extremely swollen and surrounded by dark hematoma. Evidently he had been bleeding around the pacemaker. They wound up taking him back into surgery that afternoon and took a couple of hours cauterizing every tiny blood vessel they could find and packed the incision with a tight compression bandage. They must have done a good job, Dad felt better immediately. Everything was in good order the next morning and eventually Dad was discharged.

That was about three weeks ago and Dad is still doing fine. He is still recovering his strength and is going back to his exercise classes, but is still using a cane for dizziness and wobbly legs. We talked about today. Some of the Parkinson's meds that he is no longer taking were for dizziness and wobbliness and he thinks that is the cause. He will ask his neurologist about it on his next visit. Of course the other theory is that he just needs to regain his strength and endurance after almost a month of inactivity.

Today we saw Dr. D, the pacemaker specialist and the new device is working fine. The ventricle seems stronger. The incision site has swollen again, but there is no pain and no hematoma. He'll see Dr. D in another week and see what's up. The wound itself is just about healed.

No talk of rescheduling the valve surgery yet. They want to give him plenty of time to adjust to the new pacemaker and fully recover from the surgery.

He did get the new bedside pacemaker communicator. They hooked up the wires and checked it out. All Dad has to do is plug it into the telephone and plug into the electrical outlet. He'll take the old unit back to Dr. D on his visit next week.

And that's the latest!

ACTION THURSDAY

We checked into the Walnut Hill Medical Center right at 6am and at 7:35 they wheeled Dad off to the OR. Dr D expects it will take two to three hours to install the new pacemaker/defibrillator.

I'm not sure that another cup of coffee is what I need right now, but...

Now it's 11:44. Helen and I have met with Dr. D and Dad's in recovery. The surgery went well. Evidently it was a little tricky threading the wiring through the blood vessels, but it's securely in place. He now has a defibrillator so if the heart slows down it will zap it back. He x should be discharged Friday morning.

Then we'll see what happens next.

More NEWS!

Dr. D (pacemaker specialist) had nurse call Dad yesterday, (she left a message with me as well.) They are going to install a third lead from the pacemaker to the left ventricle next Thursday, April 2 at 8:00 am. It should be a relatively quick procedure with a small incision and light anesthesia. They'll need a little time to test and tune and put the pacemaker through its paces. I would imagine he would be dismissed Friday. He will check into the still brand new (opened Spring, 2014) Walnut Hill Medical Center, an acute care surgical center.

Dad is enjoying being released from his house arrest. He went to one of his exercise classes yesterday, then ran a few errands. When I talked to him he was heating some of his leftover braised short ribs and feeling pretty good!

Finally, a Visit With the Cardiologist

Dad and his entourage just emerged from a visit with Dr. Musselman, his cardiologist. And...

And...

The report from Dr. Hasan, the infectious disease specialist, was negative. The blood cultures showed no sign of infection and he is released for surgery. The wounds on his legs are much, much better, though he still has some swelling. (His physical therapist has suggested compression socks and Musselman agrees.)

The report downloaded from his pacemaker along with the EKG showed additional deterioration of the strength of the left ventricle. This could be remedied by the addition of a third lead from the pacemaker to the left ventricle.

Also under consideration is switching the pacemaker to a unit with a defibrillator. The performance of the heart is near the borderline and then there is the question of Medicare qualification. The matter is under discussion between Musselman and Dr. D. (the pacemaker specialist.)

Dr. M thinks it's a good idea to do the pacemaker work before the heart surgery. He prefers "optimizing the performance of the heart" and advises "not to take this surgery lightly, after all, he is what 89 and three quarters." We agreed.

So, Dad expects a call this afternoon scheduling the pacemaker update. It will involve a small incision to install the lead and run it to the heart. An overnight stay will be required for observation and fine tuning.

The new lead will give a new syncopation to the heart rhythm. Dr. M said there is a slight chance this will improve the mitral regurgitation, but he also said he's not expecting the improvement. but he DID mention it.

A timetable for the valve surgery was not discussed. Dr. M. did say that while the leaking is serious and needs attention, it is not an emergency. Dad should be able to return to his normal life in the interim.

still waiting... and waiting, and...

For those of us who are antsy and wanting to know what's going on, we will know something tomorrow and that's a fact.

Dad has a 9:00 appointment Wednesday with the cardiologist and we fully expect to know which way the path will go from here.

I don't have all the details, but there were some issues with  his pacemaker review session last week but I expect to have these issues clarified tomorrow as well as the details from the blood culture grown last week.

So, tune in tomorrow!

Still Nothin'

Still playing the waiting game.

Talked to Dad every day this week. He doesn't seem too anxious and says he got stuff done around the apartment which is a change. He's usually complaining how he never has time to get anything done. Nurses coming and going. Kind of a routine has been established.

He did call doctors looking for results yesterday and finally called the right one, Dr. Hasan who is the infectious disease specialist. The nurse he spoke with was evidently friendly and patient with him. They are running a 5 day culture and the blood got to the lab on Tuesday, so it sounds like we should expect news on Monday. She did say that it was a good sign that the test was going the full five days. If an infection had bloomed, the news would have spread quickly.

Dad is staying put at the apartment and out of general circulation, but seems in good spirits. Phone calls are welcome. (214.696.1271)

I'll post as soon we know anything.

Confusing But Productive

We knew the confusion was there. It was discussed at dinner Friday night and persisted through the weekend.

So I showed up at Dad's halfway expecting to meet the home nurse who was to take blood samples. Then we were going to head to the cardiologist. Or maybe were going to the cardiologist at 9 and coming home to meet the home nurse. (The confusion!)

So there was Dad waiting to get in the car with a third option and we went to an 8 o'clock appointment, only to be greeted, "Honey, you're several hours early!"

His only appointment for today was this afternoon for a routine pacemaker check. So home we went and waited.

Finally both the nurse and physical therapist came at the same time. Dad got a good workout, his PT test (much better numbers) and blood was drawn for the cultures to test for the infection.

And it's the first warm sunny day in Big D in an unusually long time.

Not Don news

Thanks for the recent post, Dave.  Just thought I'd post this which is off the subject, so you and Susan, Michael, etc. would know. I heard from Wlodek last night: Abby has been in the hospital since January 11. It's hard to get exactly what the overall problem is but it started with an infection from dialysis and since being admitted, she has had a stroke, a heart attack, a misdiagnosed heart attack, several surgeries and some botched procedures and a host of other problems. She's in Clements right now.

Eye of Calm

Sorry for the silence. It's been a while between posts and I've received a couple of emails asking "What's up?"

Dad has spent the last couple of weeks since his discharge from the hospital at his apartment waiting to see if his infections flared. He went a week of IV antibiotics in the hospital, then a week of oral antibiotics at home, followed by a week with no antibiotics. The good news is that he has shown no sign of infection. And the infectious wound (scrape) on his left shin is healing as well.

The Man is getting restless, with two weeks under what amounts to house arrest. Helen has been spending nights. Nursing care and rehab has been provided by the hospital. Much support (meals and phone calls) has been received from the church community. Nancy Nichols and Amy Severson brought dinner fixed by Chef 'Sevy' of Sevy's Grill last week: Double Manhattans, linguini with lobster and strip steaks with pie and crème brulees for dessert. He's doin' alright.

Action resumes tomorrow.

He has two appointments with his cardiologist, one for his PT test (aka pro time, or prothrombin time test) and one to meet with Dr. Musselman.

He also has an appointment to get a blood draw which will be sent to the infectious wound specialist who will grow a culture to check for infections. Results won't be known for at least 24 hours.

Obviously the next hurdle is to make sure he's clear of infection, then we can begin to discuss rescheduling the heart surgery to repair/replace the valve.

Episode 2.18: A Quick Update

As Dallas heads into another bout with frozen precipitation, I just checked in with Dad.

Last night was wound crisis night. Helen called and we were at a loss for exact instructions on caring for the leg wound (red and swollen after a day on his feet messing around the apartment) as well as the IV puncture started bleeding again. It stopped after applying a second compression bandage.

Three nurses came this afternoon. The leg is looking better, he says (and evidently they say.) The bleeding from the IV spot is another matter. They called various doctors and nurses and decided to back off on the heparin injections until the spot clots and heals. His INR is still low, 1.4, but he just keeps bleeding when the compression is eased.

His spirits are good. Food deliveries continue on schedule and the fridge is filling up.

Apartment bound with a full larder will be a good way to spend the next couple of days!

Recap of a Busy Day

We can close some issues. Others remain ongoing.

1.  Some blood showed in a stool at one point last week. Coupled with slight anemia, there was some concern about bleeding (ulcers?) Which would require endoscopy. Tests were negative and convert here has been ruled out.

2.  Evidently the TEE performed Friday was not as clean as we had been led to believe. The aortic repair, the replaced valve and the pacemaker leads were all clear with no sign of infection. However, there was a spot on the leaf of the mitral valve that is probably the tear causing the leakage, but the possibility that it was vegetative (infection) could not be ruled out. So the final decision tested with Dr. Hasan, the infectious disease specialist.

Dr. Hasan feels confident the infection is currently at bay and that the spot is a tear. However, if it is infection, it will flair up quickly once he transitions from IV to oral antibiotic. Dad will have to keep close tabs on his temperature to watch out for fever.

3.  Dad's INR blood viscosity has not responded quickly, it is still at 1, it needs to be between 2 and 3. He will need two Lovenox infections a day for the next few days. Home health will visit in the mornings to do vital signs and P.T. and can administer one injection. Dad will have to learn to inject himself.

Which he just did!

AND we are discharged!

More later.

Second Monday

Today is Dad's second Monday in the hospital.

We just met with the committee of Internists, headed up by Dr. Gill. They are satisfied with Dad's condition and see no reason he could not be discharged today. Except for two things.

First, his blood is not thin enough. Currently it is one, the level should be between 2 and 3. He needs another two or three days of heparin injections before he can rely on oral medication alone. Home injections would have to be arranged.

Second, the ultimate decision rests with Dr. Hasan, whom we have yet to see. Dad is currently receiving another dose of IV antibiotic.

More news as it happens!

A Quick Visit

Stopped by the hospital on my way to work today.

Dad was surprised to see me. He'd been watching the news and weather reports and thought everything was a frozen sheet of ice. By the time I was out, it was starting to drizzle and the temperature was starting to climb. The thaw was underway.

No news to report. He was in good spirits and is ready to go home, but not yet anxious about it. They are still using heparin to thin his blood, but gave him some warfarin this morning, so they are starting the transition.

It was kind of an embarrassing visit. I just sat there and dozed on and off. Dad was polite about it.

Some relief

Helen just texted me that the TEE showed no infection of the heart. So Dad can go home Monday on oral antibiotics for a week, then a week free and clear, then back to Dr. Platt the heart surgeon to schedule the valve replacement that started all this. Hoo. Ray. I mean that.

At Last, Some News

It's another cold day in Dallas as I arrived at the hospital around 7 this morning. Winter mix is on the way, so they say.

 

(Pause in the time line.)

 

Make that snow! Coming down at a reasonable clip. Dad was in as good as his spirits can be when you keep the man from his breakfast.

We heard the big news earlier, first from his nurse, then from the internist. The Gallium screens came back negative, showing no signs of further infection. That's the big news we've been waiting to hear!

 

Not only that but no culture has grown from the blood draw they took yesterday. Previous blood draws earlier in the week had grown cultures within the first 12 hours. More good news!

 

Now the TEE just has to show clean images of the  artificial parts of his heart. I left him in the preop and hope to hear results this morning.

 

The next step will be getting him off of heparin and stabilized on Coumadin. And then there's the future course of followup antibiotics. He'll stay in the hospital through the weekend.

Leaving temporarily

Daddy finally got a good night's sleep last night after a busy day—lots of visitors, phone calls, consultations.
He spent a lot of the day sitting up and took some walks and exercises. He's intent on trying to maintain his strength especially after one nurse helpfully pointed out that "it takes 3 days of activity to catch up with one day spent in bed."
We learned a lot from a conversation with the occupational therapist—advice for allowing Dad to remain independent in his own apartment as long as possible.
His strength, acuity and general health, which were his strong points headed into this surgery, have been hugely sapped by the infection.
Today he goes for his last galium scan. Tomorrow the TEE and, one doctor has told us, possibly some actual information, i.e. test results.
Until then, we're in limbo.

Wednesday Late

After a long day today and another long tomorrow, a few words for those who might be following.

Really, nothing new to report today.

He had his first gallium screening today, more to follow. He had a sonogram of his kidneys today. He is doing some physical therapy, walking and such. He's in better spirits and seems to be responding to the antibiotics. That's good news and might be a sign that the infection is not widely spread. If it were, he would probably not be recovering as quickly.

So, just another day.

Michael and Laura summed things up in our conversation last night, "How lucky we are that the infection surfaced and he didn't carry it through into open heart surgery." I mentioned this to Dad and Mary today. The conversation went on.

A few minutes later, Dad smiled and shook his head. "They were  really right!" He said with a smile. It was a real positive realization.

So, we're in a holding pattern until we know the extent of the infection.

Mary is flying back to Utah Thursday morning.

Mary and Helen, Susan and myself met for a dinner of restorative curries at Royal Thai to review the week and discuss the future.

Last word on Tuesday

A parade of doctors, residents (they say Daddy's is a "very interesting" case), nurses and new procedures left us with better best-case and worse worst-case scenarios.

The strep infection in the leg is in the bloodstream.

The rapidity of Dad's response to the antibiotics might indicate that the infection has not colonized any other part of the body, particularly the previous heart surgeries which would be especially vulnerable. Theoretically, if the infection were in the artificial valve and Pacemaker sites, it should be more resistant. So maybe he will be infection-free fairly soon and the surgeons can proceed with the new valve replacement.

However, if the infection is in the sites of the previous surgeries, they will take longer to recover from the strep and may mean that the Pacemaker and the valve put in four years ago will have to replaced on top of doing the new valve replacement.

Making it a hell of an operation.

The docs are doing a gallium screening (radioactive dye traces the sources of inflammation) over the next few days, plus another TEE to find out the answers.

Daddy will probably be in the hospital until Saturday at least. I will return to SLC on Thursday and possibly come back to Dallas when the surgery is rescheduled.

Meanwhile, Daddy is more cheerful and clearer than yesterday. Will brought him BBQ for dinner tonight: a good sign.

The surest sign of health in a Waddington

is appetite.
Last night, Dad couldn't even eat a bite of the beef stew David brought him.
Today for lunch, he ate a whole container full. WITH a bread and butter sandwich, followed by a black and white cookie from Lilly's bakery in Brooklyn.
Yes, he is feeling better.

I never knew...

...that cleaning a wound with hydrogen peroxide has not been recommended by wound specialists for ten years.

We learned this from Presby's wound specialist when he came to look at Daddy's leg. So Daddy, who had cleaned the scrape on his leg with hydrogen peroxide and bandaged it with neosporin, which is exactly what I would have done, shouldna done that. 

Soap and water is what you want. 

Daddy's leg was photographed—all wounds are photographed and attached to patient records—then a patch of Medihoney was applied and a loose elastic open weave bandage. 

Honey! It's manuka honey, pretty much exclusively from New Zealand bees who feed on flowers from the manuka plant which is related to myrtle. It has osmotic properties and draws out the fluid from the infection and it also has anti-bacterial properties. 

We also learned that silver has anti-bacterial properties: In modern times it was first used to help combat foot rot in Vietnam soldiers and now they use it in burn and wound bandaging. 

Good news for me, obviously. I wear 16 silver rings most of the time.

And good news for Susan—I see a whole line of silver jewelry designed to be worn over healing tattoos. An upsell for tattoo parlors...

I guess copper bracelets are so out now. 

Some questions answered

Daddy had a good night even with all the frequent wake-ups. His blood-pressure dipped again and they gave him fluids to bring it up, but he slept well. (So did I, especially after I ate some of Dave's fantastic stew—with a little Chimayo chile in the beef dredge—and a big glass of the  wonderful red.)

His white count is down but he still has a low fever. But the big news is that the blood cultures came back and they know what the bug is now: streptococcus G group. (They swabbed last night for MRSA which I have learned to be very afraid of, so streptococcus sounded better than staph to me.) It's one that is responsive to antibiotics (duh, that's why his white count is down.)

They believe now the infection came from the leg injury.

Dr. Platt came by and explained his main concern: The strep bacteria can travel in the bloodstream and "colonize" other parts of the body, and the replaced valve is especially susceptible to infection. So he wants to be absolutely sure that it is gone before he even thinks of the heart surgery.

They're sending an infectious disease specialist in today, and Dr. Musselman will come by too.

Although the prognosis is good, Daddy will be in the hospital for awhile. He needs IV antibiotics and he is still very unsteady—needs a walker to walk. The physical therapist came by today and is working on that.

Meanwhile, the antibiotics are wreaking havoc on his digestion. And the main challenge is to Dad's spirits—he hates the hospital, is uncomfortable in the bed and is bored, bored, bored.

See What Tomorrow Brings

Dad finally got into a room mid-afternoon in the Hamon wing which is for cardiac patients. His temperature immediately rose to 102. He was given some Tylenol, the fever broke and dropped to 100. He had some chicken noodle soup and stabilized.

After a long day with Dad at the hospital, Mary went back to the apartment to gather some things. (In the rush, Dad left without his glasses!) When she returned, Helen who had been there much of the day, left and went home. Mary planned to stay the night.

I spent the day making a beef stew (quite delicious if I say so myself!) I took servings to Mary and Dad at the hospital and smuggled in the remnants of a rockin' bottle of red wine. Much appreciated especially by Mary, who, like her Mother, starves herself in times of crisis and above all does NOT eat hospital food. Mom would always bring homemade meals to Dad which he always relished. The fact that he did not feel up to even a bite of the stew is a crisis of appetite that could only be described by the great P.G. Wodehouse himself.

Needless to say they continue to run tests. Confirmed symptoms include:

• Fever
• Low Blood Pressure
• Elevated Liver Enzymes
• High white blood cell count

Negative tests include:

• Simple influenza test
• CT scan of the liver
• Chest x-rays

Tests in progress include:

• A more in depth influenza test
• Culture for staph infection
• Culture for MRSA

And I might be forgetting something, but I think I got it right.

We had a good visit and he was resting comfortably when we left. Hopefully we'll learn more when the doctors make their morning rounds.

And Here's the Latest...

Latest news from the hospital:

Dad is feeling somewhat better. He is on antibiotics and is waiting in Emergency for a room to open where he will be admitted. Due to today's onslaught of Thundersleet, schools are closed and staffs are short-handed. Also patients are not leaving who would otherwise be leaving. So if you think hospital time moves slowly...

The urinary tract has been ruled out as a cause of infection, which is too bad because uti's are easily and quickly treated. He does have some congestion in the bottom of his lungs. When they asked him if he'd had a cold he said no, but I told Mary he'd had at least three, on one of which he went back to his primary caregiver for a second dose of Amoxicillin. Tests are underway. Currently the cause of the infection is undiagnosed.

Surgery has been postponed indefinitely.

Oops! Didnt' See THAT Coming!

The week following Dad's decision to undergo mitral valve surgery was relatively uneventful. His breathlessness seems to be worsening a rapid rate. His resolve to repair the issue is very strong. And that's huge.

Susan and I left Friday for a quick weekend together in New York City. And had a fabulous time, thank you very much. Well documented on Facebook. So we were out of the pre-surgery weekend picture.

Mary flew down from Salt Lake Saturday to be here for the week. They were scheduled to go for some pre-surgery tests this morning (Monday.) The weather threw the first punch by bringing in an inch of sleet in the early morning hours. Much better than freezing rain which is debilitating.

Dad threw the second punch by waking up with shaking spasms and a high fever. He woke Mary up who called an ambulance and took him to the emergency room. I spoke to her about 7 this morning and it looks like he has an urinary tract infection. A little rare in men, but he showed blood in his urine a couple of days ago. His doctors were somewhat laissez-faire since he was going into the hospital in just a couple of days. I'm not sure I totally understand that rationale since he was going in for heart surgery, but our inclination is always to trust the doctors.

Usually UTIs clear up quick with IV antibiotics. No decision had been made regarding postponing surgery when I talked with Mary this morning,

I'll post more as information becomes available.

Episode 2.3: A Meeting with the Surgeon. GAME ON!!!

In a zealous display of enthusiasm reminiscent of the late, great Ernie Banks, Dad has decided "Let's do TWO!" Two replacement valves that is. The 3-4 hour surgery is slated to be scheduled for Tuesday, 24 Feb at 7:30 am.  The final go-ahead will come after Dr. Platt reviews the images from a CT scan that Dad should be finishing right about now. He wants to make sure that things are just as him left them when he sewed Dad up back in July, 2011. It will also let him check on scar tissue.

Needless to say, our appointment went well yesterday. Dr. Platt is no nonsense, but listens well and has a dry, understated sense of humor. He is the surgeon who deemed Mom's cancer inoperable and who did Dad's heart surgery. We liked him then and we like him now.

The tone of the visit was set when he asked Dad, who was sitting on the examination table, to lift up his legs and lie down. Dad pivoted and swung his legs up and onto the table in perfect form, straight legs, feet together, toes down, just like a gymnast mounting a pommel horse.

"Well, you're certainly fit and in good shape!" noted the Doctor.

He only works out five times a week, we explained.

Several pertinent facts came out during the examination:

• Dad's heart is left-dominant, meaning that the heart itself is supplied by the arteries from the left side of the heart. Fairly rare.
• He has no blockages, the vessels are extremely clean.
• The replacement valve is working perfectly.
• The left ventricle has not diminished in strength since the last surgery. It was weakened then to the same degree that it is weakened now.
• He had moderate mitral regurgitation at the time of the last surgery, graded 2+.
• The leakage is worse now, graded 4+.
• He did not address the mitral valve then because the aortic valve and the aneurysm were more demanding problems. He thought that three procedures would have been to much to address in one surgery.

The plan is to use the same incision and route of entry as the last surgery. While he always looks to repair, he anticipates that the best course will probably be to replace the 90 year old valve. A replacement should work for at least  10 years. Dr. Platt sees no reason not to procede. Dad is in great shape, much better shape than most of his patients who are younger.

The most important factor is that Dad wants to procede. He was out of breath after bending over and tying one shoe.

"All I know is that I just can't go on like this!"

Warning: Contains Graphic Descriptons

If, like me, you have been browsing "mitral regurgitation repair" you have been seeing the term minimally invasive thrown about as a quicker low impact form of heart surgery. The term suggests something like an overnight or even a day surgery arthroscope of a knee or an elbow. In heart surgery land it just means that they don't 'crack' open the chest. To repair a valve, the surgeon has to get inside the heart and the only way to get there is to cut. Maybe less invasive is a better term than minimal.

If you want an illustrated step by step on "Minimally invasive valve sparring valve repair" just click.

We meet with the surgeon in a couple of hours and will certainly know more then.

Episode 2.2: A Visit With the Cardiologist

This morning we had our big meeting with Dr. Musselman to discuss the new diagnosis of 'mitral regurgitation' and what to do about it.

He said that when Dad first complained about shortness of breath, which was last fall, by his notes, he could hear a heart murmur, which was the first sign of leakiness. Last week the murmur had changed considerably which was why he ordered the TEE test on Monday.

The test revealed several things.

• The aortic valve which was replaced several years ago is working fine.
• The quality of the left ventricle muscle has declined.
• The leaking of the left mitral valve is severe.

What that means is that the left ventricle muscle is pumping but the valve is letting the blood pour back into the chamber. It requires multiple contractions to move the amount of blood that should be moved with one contraction.

There are several ways that medication can help mitigate the situation. He has added those medications and Dad said they seem to be helping.

The other treatment is surgical. Sometimes the valve can be repaired and sometimes it has to be replaced.

Without treatment, the condition gradually (or rapidly) deteriorates into congestive heart failure, heart attack or stroke.

Dr. Musselman indicated that he feels that surgery is possible and that a return to Dad's present level of health is possible. He recommended Dr. Platt, who did Dad's previous surgery, and said that he would provide information and details to him. We are to meet with Musselman again after meeting with Platt. And that was that.

Dr. Platt's office contacted Dad the same day and the appointment was set for Thurs, Feb 12 at 2:30.

We all remember Dr. Platt to be a formidable presence who doesn't mince words. It will be interesting to hear what he has to say. I was struck by the difference in opinion between the Doctor with whom I spoke Monday and Dr Musselman today. She was so pessimistic and Musselman seemed optimistic. I wonder if he is just letting Platt play the role of the bad cop and deliver the harsh news. We'll see.

I approach surgery with great trepidation. Surgery is discussed with a cavalier and commonplace attitude, like it is no big deal. But major surgery is a huge trauma. Dad doesn't remember how hard his recovery was three and a half years ago, but I think we do. It was extremely hard for him and it took a long time for him to fully recover to the point where he could really live by himself. I have my doubts.
     

Well, He's Got That Goin' For Him!

Dad saw his neurologist a couple of weeks ago.

"What's the deal with this Parkinson's?" he asked. "It never has gotten any worse."

"Well, there are your tremors," she said. "Hold out your hand."

He held out his left hand. Stiff as a board.

She put him through a number of the standard physical tests. And then told him about a new test which measures the dopamine output in the parts of the brain suspected of causing Parkinson's. Evidently the test has been used for some time in Europe, but was only approved two years ago by the FDA. It is most useful for distinguishing between 'essential tremor' and Parkinson's. And so she scheduled a Dat Scan.

And now he doesn't have Parkinson's. She is slowing weaning him off his medications.

AND, he's got THAT goin' for him!!!

Episode 2.1: Several Months Later, the Plot Thickens

Well, the pacemaker was a great success. Dad felt great and went on his Honor Flight to Washington D.C. In retrospect, I think that trip means more to him now than he thought it would. They are an aggressive group, they've stayed in touch with him, had him back to a reunion group.

Dad was never one to talk about his war experiences. All I ever heard about was that he lived on a beach in the Philippines, he had a monkey and his group had a house boy and they drank too much Tuber, the indigenous fermented coconut milk. Shades of MASH. Since then, more stories have come out, like he navigated the voyage home from the Philippines on an LST because he had gone to Georgia Tech. And instead of taking leave of the services in San Francisco, he helped pilot the craft down through the Panama Canal all the way to the Atlantic Coast. I think he left the service in Charleston. He said the cost of transportation home was cheaper and he got paid.

He went with us to Santa Fe after the New Year. It was there that he really started complaining of shortness of breath and exhaustion. I didn't pay much attention, chalking his complaints off to the altitude and cold, dry weather. It was rough on all of us.

We all had continual colds through January. None of us could breath, all anyone could do was cough.

But Dad's shortness of breath persisted.

He complained at one of his exercise classes, they did a EKG (they keep one on hand!) and he contacted Dr. Musselman, his cardiologist. They did a read out of his pacemaker and did more in depth EKG scans.

The way Dad tells the story, it was almost as an afterthought that Musselman asked him if he had ever had a TEE (Transesophageal Echocardiogram.)

Of course Dad said, "No."

"Well maybe we ought to consider one in the next few months. Think about and give me a call." Dad remembers Musselman saying.

And the next thing Dad knows, he's signed up for the test the very next Monday! He asked Helen to take him to the hospital for the test and he asked me to pick him up. He was vague about what was going on, except that Musselman had made it seem casual and routine.

Monday morning I received a message from Helen saying that the Doctor performing the test would be ready to see me at 9:30. This was earlier than Dad had suggested, so I hurried over to the hospital and got there about 9:45. I spoke to the Doctor on the telephone. She described the procedure and said that the test showed "moderate to severe" leaking on his heart valve. She described the heart muscle as severely weakened and probably too weak especially when combined with Dad's age for surgery to be an option, but that we needed to make an appointment with Dr. Musselman as soon as possible."

Needless to say I was floored.

I went back into Dad's room. I asked him if the Doctor had spoken to him. He said, "No."

I decided I was not the one to deliver such a grim diagnosis and just told him it looked like there might be some valve leakage,  that we needed to make an appointment and talk with Dr. Musselman.

He agreed. Eventually he was discharged and we went across town to the Circle Grill, where people don't look like they're from Dallas (they're not, they are from Garland, Mesquite and East Dallas.) After eggs, sausages, grits and hashbrowns, we felt much, much better.

And he made an appointment with Musselman for Wednesday morning. (Feb 11)