Sunday, July 24, 2011
We met with Dr. Loftus for well over an hour on Monday, discussing his history and treatment options for the future. On Tuesday, Dr. Devine said he was VERY pleased with how well Alex is healing after surgery. We talked with him a bit about his expectations regarding weight gain and then were back over the meet with Dr. Loftus regarding some concerning bloodwork from the day before. Alex's liver enzymes are elevated, which could be from residual inflammation in his biliary duct around where his ulcer is located in the duodenum OR it could be a result of Tylenol use, medications and dehydration. After some further testing (ultrasound), Dr. Loftus determined that it was difficult to tell which was the culprit. His biliary duct is slightly dilated/more open than when they measured it in the hospital, but not by much. There was no obvious obstruction, so he wants Alex to get frequent bloodwork, stop taking Tylenol and one of his medications and see how his labs look in the next few weeks. If that takes care of the problem, we won't need to return to MN until around early November. If the bloodwork is still of concern, we may need to return in the next few weeks.
Alex is having a great birthday so far. We ate at his favorite breakfast joint, First Watch, this morning after church. Lydia has given him an extra dose of birthday "muah's" (kisses) all day. He is taking advantage of Lydia's naptime with a little birthday nap of his own. ;) We will be coming back to KC tomorrow and plan on staying put for a while! It will be so nice to be home! Alex plans on starting back at work in a couple of weeks. I know he looks forward to getting back into the swing of things.
So sorry again for the gap in updates! We hope to have more good news to come as Alex continues to heal and recover.
Love and blessings to you all!
Sunday, July 10, 2011
Short update, just wanted to let you all know we are almost home!!!!
Love to you all :)
Wednesday, July 6, 2011
Sunday, July 3, 2011
Lydia came by for a quick visit yesterday, but was fast asleep by the time she got up to the room. She was SO excited when she woke up and saw Daddy right next to her! Below are some pictures of her signing his Mayo Clinic pillow (which happened to include her shirt, unfortunately!) and giving it to Daddy.
Dr. Devine was in this morning and was very pleased with the way his incision appears to be healing. They are planning to clamp his NG tube (that is currently draining his stomach) tomorrow. Depending how he tolerates that, they will decide whether he is ready to start on some liquids and may even remove the tube then as well.
Alex continues to feel pretty good. He is starting to get very hungry and is really looking forward to being able to drink some tomorrow.
More later...I am being sent on a paper run :). Love to you all...
Saturday, July 2, 2011
Alex is doing great this morning! He had oxygen and several other tubes removed this morning before he went on his first walk. He did great, walking at least 200 yards round trip!
Now he is sitting in his chair reading the newspaper!
Lydia should be up with Carol and Brett any minute now, so hopefully I can add some pictures of them as well. Dr. Devine and his team came by this morning to check on him. Everything is going very well. His pain is well-controlled with his IV pain medications. He will switch back to oral meds once he starts drinking liquids again on Sunday or Monday. Dr. Devine just reiterated that we are going to "take it very slow"...which sounds like a great idea!
Friday, July 1, 2011
Dr. Devine also said we would be taking things very slowly for the next few days. He will stay on his TPN, waiting until Sunday or Monday to try liquids for the first time. This is when he may start to get nauseated, depending on how he tolerates the liquids passing through the new anastomosis (connection). From there they will just slowly increase his diet until he is tolerating soft solids well. At this point, they will decide if he is able to stop the TPN and get enough of his nutrition orally.
Prayer requests now include LOTS of praise for a successful surgery!!! Also, quick and thorough healing, management of any pain, and (heck, let's go for it...) NO nausea. Thank you so much to all of Alex's prayer warriors out there. You are all so dear to us and essential to Alex's healing!
He was brought to recovery @ 6:30. They said he would be in recovery for about 2 hours, so I am expecting him back up in the room in another 30-45 minutes. I got one update at about 5:15 from the "communicating nurse" (Sarah) that just said the doctor reported that all was going well and that Dr. Devine was proceeding as planned. Sarah said that hearing less is more from Dr. Devine...that he typically only sends lots of updates out if there are unplanned events. If we don't hear much, that we should assume that all is going great and things are going as planned.
More to come after I speak with the Dr...
Yesterday, as I was leaving the hospital, the song "It is Well with My Soul" was playing on the radio. Peace surrounded my heart as I listened. The whole hymn is a great one, but these beginning words seemed to resonate the most-
"When peace, like a river, attendeth my way
When sorrows like sea billows roll;
Whatever my lot, Thou has taught me to say,
It is well, it is well, with my soul"
"...though trials should come,
Let this blessed assurance control,
That Christ has regarded my helpless estate,
And hath shed his own blood for my soul."
Here's one version by Chris Rice...
What a great hymn. We have an awesome small group at our church and one of the ladies who is a part of that group is a singer with a beautiful voice. She sang "Give me Jesus" at our last meeting as a prayer for Alex and I. It was awesome. As I listened to this song yesterday, I couldn't help but hear her voice singing as if she was right there with us. Thank you, Vernia.
Thank you again for all of your prayers. Maybe we should add strength, focus and discernment for Dr. Devine and his team since it sounds like Alex will be following an unanticipatedly complicated case.
We will keep you updated as to when he heads into surgery.
Love to you all!
Thursday, June 30, 2011
Alex is scheduled for diversion surgery tomorrow morning with Dr. Devine and Dr. Erben. They will be attaching his jejunum (just below his duodenum) to another place on his stomach. This will allow things to bypass the area of inflammation/stenosis all together. While he is in surgery already, they will also attempt "stricturoplasty" on the strictures that Cleveland and Alex's KC GI doctor have been dilating endoscopically. They have been requiring dilation approximately every 6 wks, so this part of the surgery would allow those places in his small bowel to stay open without continual repetitive dilations. Here's the picture the surgeon drew for us regarding the diversion part of the surgery...
So, now to look for the blessings in all of this...Alex's surgeon, Dr. Devine, is an extremely talented surgeon, specializing in these types of surgeries for people with severe inflammatory bowel disease. He is not a man of many words, but he does seem to be very thorough. Our nurse's mother had surgery with him and she said over and over again that he was "the best of the best". The surgeons have very clearly communicated that this surgery is not without major risk. The duodenum is behind the rest of your small bowel, resting just over the spine. It is not "free-floating" like the rest of the small intestine, either. Alex has had multiple abdominal surgeries, so scar tissue and adhesions could make it difficult to get into the abdominal cavity in the first place. The duodenum is also where all of your bile, pancreatic and other "digestive juices" are dumped, so they will have to be very careful not to disturb all of those ducts (another reason they are diverting and not just removing the duodenum). Finally, healing could be difficult due to the immunosuppressive nature of the medications he has been taking for quite some time now.
Alex is overall doing pretty well. He knows this is what is necessary for him to get better and get back to living. I had a great time recalling Wooderson quotes (Dazed and Confused, circa early '90's) with Alex while he was in recovery from a procedure today. Here was his favorite...
"You just gotta keep livin' man...L-I-V-I-N". :) :) :)
Not quite as profound as scripture, but it definitely made him giggle (more than once) today.
Surgeon was just in. Alex will be the second case in the morning. We will transfer to Methodist hospital for the surgery (still Mayo) with surgery starting somewhere are 10am-12. Dr. Devine said it would probably take between 2-3 hours.
Thank you all for your prayers. Specific prayer requests are...
1. Successful surgery with as little intestine involved as possible.
2. Wisdom and guidance for the surgeons.
3. Calm, peace and faith as he goes into surgery tomorrow.
Wednesday, June 29, 2011
The colorectal surgeons and GI doctors were both in and out yesterday. The surgeons were in first to get history, past surgical reports/records and discuss potential surgical options. Then the GI doctor, Dr. Alexander (great name, huh?), was in to discuss the overall treatment plan. He was very nice and helpful, discussing "one step at a time" treatment options, which is much less overwhelming. Dr. Alexander said his role is really to address Alex's current needs of resolving the obstruction. He stated that Dr. Loftus has more experience with the long-term treatment options, so he will be determining the future treatment plan with us on an outpatient basis (as previously planned).
Dr. Loftus and Dr. Alexander went over Alex's case yesterday and came up with this plan together-Dr. Alexander will be doing an EGD (esophagogastroduodenoscopy...you can see why they abbreviate!) this morning to assess how his stomach and duodenum look after they drained or "decompressed" with the NG tube and treated with several rounds of IV antacid medications. He will be assessing if the obstructed area is inflammation from the ulcer, a stricture or both. From there he can determine what we should do to correct it (meds, dilation, surgery or a combination). We really have no way of knowing how long Alex will be in the hospital until we know more from the endoscopy.
Again, thank you all for your prayers. I think Alex will feel better once there is a concrete plan in the works. Please continue to pray for the previous requests-Peace, calm and comfort for Alex and wisdom and guidance for the doctors. All of the doctors have been great about giving us time to ask questions and voice concerns about potential treatment plans. It is such a blessing to have providers who listen well and explain treatments thoroughly.
Love to you all...
Tuesday, June 28, 2011
Basically, we found out that the inflammation in his duodenum is not allowing much, if anything, to pass through and his stomach was therefore stretching out (distending) to a VERY abnormal size...VERY abnormal. The doc showed us the CT images and it easily took up 3 quarters of his abdomen. He said it was the largest stomach he had ever seen. So they placed an NG tube (tube through nose to tummy) to drain all of the excess fluid/residue that was not able to otherwise pass. Alex was not very excited about this, but it was absolutely necessary. He has had an NG tube in the past, but was not awake when they placed it. He got through it and I think feels much better now that there has been LOTS of fluid drained out of his tummy. The GI doctors will be in this morning to help come up with a plan for the area of obstruction.
Meanwhile, Lydia seems to be having a fantastic time on her Minnesota vaca with Nana. They went on the BUS to Walmart (fun!), played in the sand, saw ducks, went on walks, etc, etc, etc yesterday. She got a new bib that says "I'm a hoot!" with a picture of an owl :) :) :) "Owl" is her new favorite word and she's a little obsessed with birds in general (all of which she calls "owls" now), so it was very fitting! We are staying in an apartment that is just a couple of miles from the hospital. It has 2 bedrooms, a full kitchen and plenty of room for her to explore. It has been tremendously helpful to have Carol here to watch her while Alex and I are at the hospital!
Our only prayer requests right now are peace, calm and decreased anxiety for Alex and wisdom and guidance for the doctors who will decide on next treatment steps. Oh...and Alex's room number...316 :). A nice reminder of a favorite verse :).
Thank you all for your continued prayers and support. We should know more by the middle-end of the day today. Love to you all...
Tuesday, June 21, 2011
Alex is tolerating his TPN very well, and has even had it changed to where it runs for only 14 hours now instead of 18. If his labs from today check out okay, they may move him down to a 12 hour cycle on Thursday. He continues to have trouble tolerating food. He was discharged from the hospital with a regular diet and has been taking it very slow on eating. He eats about one small snack/meal a day. He is trying to stick with the "white" things that the doctor suggested-white potatoes, white bread, white rice, cereals, etc. You know...all of those things that the rest of us are trying to avoid in an effort to be "healthy" ;). He definitely cannot have any "whole grain" breads, fruits or veggies as they are just too hard to digest. His difficulty digesting even these small snacks indicates that he is still having too much inflammation to pass food through his digestive tract efficiently. As far as we know now, the most severe inflammation is in the very first part of the small intestine where it meets the stomach (the duodenum). This is where the most recent endoscopy and the upper GI test showed the newest and most significant areas of inflammation and ulceration.
So...specific prayer requests for tonight are...
1. Decreased swelling, increased nutrition, and overall healing of Alex's body, spirit and mind. He is so strong and fighting so hard, but I know all of this takes much more than just a physical toll on him.
2. That Dr. Loftus will quickly be able to review all of the information and understand the urgency and importance of squeezing Alex into an earlier appointment time.
3. Confidence, trust and peace that God is in control...keeping fear, worry and anxiety at bay.
Thank you all so much for your continued support. Love to you all!
Monday, June 13, 2011
Alex felt okay today. Right now his TPN runs from 8pm-2pm, but they will slowly "ramp up" the infusion time to where he is only hooked up for 12 hours at a time (at night). He seemed more fatigued today when he wasn't "hooked up" and had a bit of a headache in the early evening. He did feel up to going to the grocery store this afternoon, but was pretty worn out by the time we got home. It was your typical hot and humid Kansas day, so I think the heat just zapped him! The nurses are coming by the house tomorrow to change his dressing and draw blood for labs, so we will ask them about the fatigue then.
Mom (Donita) has been here helping with Lydia since last week, which has been so nice. Dale came in town to help with a few things around the house and just to visit over the weekend as well. I think they both enjoyed their 1:1 time with Lydia a lot...and so did she :). Dad (Jim) will be here from Wednesday night to Friday to visit and help out, so he will get his fill of giggles, wagon rides and bubble blowing, too! Brett, Carol and Abbey have always been so helpful lending a hand to watch Lydia and we have a ton of sweet, sweet friends who have offered to do the same. We have had offers for dinners, yard work, babysitting, prayers, etc, etc...
At our church, our pastor often talks about who your "stretcher bearers" will be when it comes to times of crisis in your life. He is referring to the Biblical story (Mark 2 is my favorite version) of the paralyzed man whose friends carried him on a stretcher to be healed by Jesus. Only when they got to the home where Jesus was preaching, it was too crowded for them to actually reach Jesus. The man's friends then carried their paralyzed friend to the roof of the house, tore through the roof and lowered him right in front of Jesus...the only man who they knew could heal him. Jesus was "amazed by their faith" and healed the man on the spot. Not the faith of the paralyzed man, but the faith of his friends was responsible for this man's healing. We are so very blessed to have so many awesome "stretcher bearers" to carry Alex through to his healing, too.
So....thank you, again, to all of you for your continued faith that Alex's "Road to Recovery" will end in healing and restoration.
Saturday, June 11, 2011
A good majority of Alex's recent records along with a timeline of his history since diagnosis have been sent to Mayo. His KC doctor also put in a call to the doctor at Mayo last week. Hopefully we will hear something from them early next week.
Thank you to all of you who have offered meals, prayers and just your kind supportive words. We are so blessed to have so many caring people in our lives!
More to come...and hopefully from home!
Monday, June 6, 2011
Alex was admitted to the hospital during our last visit to Cleveland in early March. Dr. Shen dilated some strictures in his small intestine and then admitted him for blood transfusions because of severe anemia. He also administered IV Ig-a blood product that he felt would increase Alex's endurance and overall energy. Unexpected hospital admissions are never fun....
Upon returning to KC, Alex's local GI doc (Dr. Doumit) initiated a new Crohn's medication that is similar to the Remicade that Alex has taken before. Some patients who do not respond to Remicade will respond to Humira. He also added another medication after his latest scopes for a more aggressive approach to medical treament. This is similar to the combination of drugs Alex was on in March of '09 when his disease was well-controlled and he felt so good.
For the lasts several months, we have been alternating between scopes in Cleveland and scopes here in KC about every 6 weeks or so to manage the dilation of the strictures and monitor disease activity with biopsies. Alex had a follow-up scope in late May (just recently) with Dr. Doumit. He was not tolerating food as well as he had been in the past, but had assumed it was due to his recurring strictures needing dilation again. Dr. Doumit actually discovered an ulcer in his lower stomach/upper intestine that was affecting his ability to empty his stomach and digest food effectively. He recommended a liquid diet and addition of medication to attempt to heal the ulcer. He also spoke with us at length about receiving another opinion as he felt like Dr. Shen had exhasted all treatment options as well. He has said several times that Alex's case is severe, likely the most complicated case even the doctors in Cleveland have seen.
After much discussion, research and prayer, Alex has decided that Mayo is the best choice, so it is off to Minnesota we go! We are awaiting an appointment with Dr. Loftus at Mayo, but in the meantime have initiated TPN (IV nutrition) at the hospital where our family practice doctor is located (Menorah Medical Center). Alex has maintained his weight with the liquid diet, but even this has been a struggle. He is very thin and any additional weight loss would not be good. The TPN will hopefully bulk him up a bit and give him the needed energy that he has lost since the liquid diet started.
Alex and I both want to say thank you for all of your many thoughts, prayers and kind words over the last couple of weeks as we have needed to make some big decisions. We cannot thank you enough for all of your support, love and kindness. We will start updating the blog more frequently...maybe then the posts won't have to include so much info-like this one!
Many of you have wanted to know what to pray for specifically, so here it is...
-Tolerance of the TPN so Alex can return home and manage it safely there
-Quick scheduling with Dr. Loftus
-Wisdom, clarity and guidance for us and the doctors as it is likely that even more big decisions are to come
Thank you again for everyone's support. We love you all! Oh, and Alex would like to add prayers for a future filled with Z-mans and fries at Oklahoma Joe's BBQ sooner rather than later :). If I didn't know better, I would swear smoked meat is the only thing he thinks about sometimes...