Return to normal

It was David's third day on room air only.  The oxygen is in reserve just in case but things have been going well without it.  He is using a cane to get around stores and when visiting but not in the house.  He is now remembering that cold hands have poor circulation and hence low O2 % and he warms up his hands before trying to monitor his O2.  Weight has been steady, no water gains or losses.  I've no idea when he can begin to walk 30 minutes again but will try to monitor him during my two weeks before the semester starts.  Since his kidneys have been on the edge of health, he is unable to take most pain killers.  He was taking Tylenol but his liver functions are now a problem so that is off the table. Mimi made him an oil extraction and I give him a couple of drops under his tongue about 9 pm and it should allow him to sleep.  His pain in the groin muscle seems to be gone completely.  I guess the only thing to watch out for are the liver functions which are going to be tested next week.  Then it is just building up to his 30 minutes of walking each day...and mine too.
Thanks for your prayers that allowed us to have a good close to 2016.

David's pain is gone.  He's been resting, using the oxygen and is totally bored.  I am decorating cookies like crazy and occasionally he will come over to admire them.  We tried to play Scrabble but he could not think of words.  To be fair he had no vowels.  I had no consonants.  I think we will try again this afternoon with a new game and really shake up those tiles.  Tomorrow he has his first PT and then sees our primary care doctor, Dr. Clemo.  If he feels OK after than, we'll swing by the Men's Wearhouse and pick up his suit, blazer and slacks that we bought before Thanksgiving but had to be altered.
His oxygen percent worries me.  The cannula doesn't stay in his nose but slips to his left cheek where he has no feeling.  I adjust it a lot.  He feels around for it and moves it to his nose when he thinks about it.  Low oxygen makes him sleepy.  We'll see what Dr. Clemo recommends.  He has two portable setups.  One is a small tank in a sling/pouch and the other one is a big tank on wheels.  I'm going to ask about getting the small tank refilled OR getting a small compressor like the big one we have in the house from Medicare.  I checked on Amazon and the portable ones go from $400 to several thousand dollars.  We'd need one with a battery with a several hours capacity that can be charged in the car.  With David using the walker, he is not able to negotiate the large tank on wheels too.  Even the small tank is heavy so a battery with the concentrator unit may be similar in weight.  I'd like to go to Ginter Gardens to see their outdoor (walk through) light display and anticipate using his wheelchair so I may be able to rig something for the oxygen tank on that.  We need a minivan to transport all of this stuff!!  I guess we will just take it as it comes.  Yesterday's readings were about patience and generosity so I am practicing.

Our former neighbor, Dr. Anne Truong has a rehabilitation practice and she saw David today.  Her background is sports medicine and rehab.  After reviewing the CT, other records, etc. she examined David and moved his leg like he was a 28 year old quarter back...namely pushed and pulled in 360 degrees and bent.  She said based on what did not hurt, the pain did not come from either arthritis or stenosis.  Another motion elicited a big reaction and she said AH, torn groin muscle.  We can treat it with aggressive physical therapy.  Stop the narcotics, they cause confusion in the elderly.  He can have lots of Tylenol and nothing else.  He will start PT with her group next Wednesday.  Meanwhile he is to rest and use heat on the area.  He has a hating pad on the area after three tylenols and is on the couch watching MSNBS...all good signe.  Both of us appreciate her approach and her diagnosis.  No other doctor examined him as thoroughly and with such confidence.  They treated him like fragile, antique China.  I'm looking forward to his recovery.  He sees Dr. Clemo next Wednesday too and we'll see about the O2 for the congestive heart failure which is a distinctly separate issue.  So far the heat and Tylenol are keeping him somewhat comfortable.  That's all we can do until the PT.

David was at Mary Washington hospital since Monday with severe leg pain, low oxygen and aspiration pneumonia.  He finally came home about 6:30 tonight expecting to have home health tomorrow with a nurse (coming mid day), Physical therapist (unknown time but probably coming) and home oxygen.  He had a little tank for the trip.  Along about 7:30 a guy from the oxygen supply company called and said they would be unable to deliver the oxygen because the doctor at the hospital wrote the order wrong and Medicare would not pay for it.  He assured me that David's oxygen was 100% on room oxygen when rest in.  I disagreed. We went back and forth. I said that David could die and that I was taking him back to the emergency room.  David had taken the oxygen off to go to the bathroom and his level dropped to 80% but went back up when we replaced the O2.  I hung up and the guy called back later offering to bring a tank for 75.00 that I would get back when the paperwork got straight tomorrow morning.  I declined because getting refunds is always a huge deal and I was exhausted and frustrated.  David went in to get a shower and the guy called back again offering to give me a tank if I met him in Stafford in an hour.  I declined because I couldn't leave David and finally caved and said I'd pay the money for a tank of O2.  So the service technician called me and said he lived in Chesterfield Va and it would be about 1 1/2 hours to get here.  I gave him directions.  He showed up with the entire set-up to compress room air and make it more concentrated with O2, two travel/emergency tanks and lots of tubing.  David can move 50 feet without moving the compressor.  The compressor has wheels so we can move it if necessary.  He was extremely nice and at 11:15 David had a reliable source of O2.  There is an adapter to moisturizer the air but we did not install it right away.  The valves are more complex than the gas for the grill but I got it figured out before the guy left.
The shower exhausted David and I had to use the wheelchair to get him back to the couch in the family room.  He just had his midnight pain medicine and is finishing up a recorded show.  I will get him into bed and then try to sleep myself.  The O2 compressor is actually kind of soothing.
Tomorrow we take the disk of his CT showing the stenosis of the spine and osteoarthritis (and him) to the Pain clinic for an evaluation and treatment plan.  The IV steroids helped the pain and the hospitalist thinks that steroid injections to the spine will be very useful to eliminate pain.  He is definitely not a candidate for surgery.  He is logarithmically better than when he left here in the ambulance on Monday and if he continues to improve this fast, he should be back doing 30 minute walks and going to Silver Sneakers before the new year.

After 24 hours of two acetaminophen with codeine every 8 hours, the pain has not subsided when he tries to use his leg.  He can be pain free in bed in a weird position.  He wanted me to call the doctor.  I got the one on call who predictably said, transport him to the hospital by ambulance.  He wants to wait until Monday and call Dr. Clemo.  So he remains in the weird position in bed.  I'm very worried.

New problem surfaced slowly progressed fast

For the last several months David has complained about a pain in his hip and taken Tylenol.  He mentioned it to Dr. Clemo and she OK'd the Tylenol every four hours.  That stopped being effective and he started needing a cane yesterday.  He saw Dr. Clemo again yesterday and she ordered X-Rays which he immediately got.  She also referred him to our old neighbor, Anne Truong, who is a pain and joint doctor.  Today he cannot put weight on his right leg and is in bed.  Sitting is equally painful.  He has an appointment with Dr. Truong on Tuesday.  Meanwhile the pain is terrible but he did not ask for additional pain meds yesterday.  So now he needs something and I called Dr. Clemo's office twice without success.  Finally her nurse called Tylenol with Codiene into Costso and I picked it up.  There is a faculty meeting out at Locust Grove (45 minutes away) and I've sent in my "excuse" for not attending and emailed a friend to give me info after the meeting.  With budget cuts in VA I wish that I could attend and participate in the discussion.  David comes first.
The X-ray did not show bone damage.  So we'll see what Dr. Truong can do.   Dr. Truong is the local guru for stem cell joint treatment and friends have recovered fully and easily from that compared to open surgery/replacement.  BUT insurance does not cover stem cell treatment.  It does cover the PT after the treatment and the protein rich platelet follow ups.  Plus you have to have some cartilage in the joint to be a candidate for the stem cell treatment.
He's had the new pain med and is in bed watching TV with the electric blanket on high.  I expect that he will take a nap.
So keep us in your prayers as David faces one more challenge with an aging body.

Endoscopy went well

This morning Dr. Lee did an endoscopy to see if David's ulcer healed.   It did.  He was in the door of the hospital at 6:30 and out of there at 9:20.  Shortest trip to Mary Washington Hospital EVER.  We have color photos of his feeding tube balloon in the stomach and of his esophagus, stomach and upper intestine.  All are squeaky clean.  Fantastic.

Endoscopy scheduled

The visit to Dr. Lee, the gastroenterologist, raised two concerns:
David's hemoglobin is 10ish when it should be 12.5.  So there might be a slow bleed at the site of his huge bleed that was repaired back in May.  Dr. Lee will do an endoscopy at Mary Washington hospital on Oct. 6 to take a look and make repairs in necessary.  I cancelled class that day.  My students are devastated!!
His bloodwork showed antibodies to Helicobacter pylori.  This is the bacteria that causes stomach ulcers and could cause stomach cancer.  So he will be on a two week dose of a couple of antibiotics to kill the bacteria.  David does not tolerate there drugs easily and we expect some terrible flow through issues....and have Imodium ready for when it starts.  So far, so good.
Otherwise, we walk and do the normal stuff for us.  He is getting his hearing aid adjusted this morning and his new glasses this after noon.  We plan to see a movie and shop this afternoon.   I'm am really looking forward to 9:30 Mass on Sunday.

All indicators are great.

It's been several weeks since I posted anything about David's health.  He is doing great.  We walk 30 minutes every day for a little over a mile.  Most days we try to walk very early in the Battlefield near the house but when the weather is hot or when the air quality is bad, we go to the Mall.  Once around our mall is 30 minutes and just over a mile.  David is also doing all the exercises that his physical therapist prescribed...most days.  His driving has progressed from local to 30 miles on I95 with impunity.  Today I drove up to Prince William Forest where we met Fred and walked about 40 minutes and then went for breakfast as usual at the Dumfries Diner.  After that David drove home while I watched him and kept my mouth shut (That was really hard.).  Traffic was moderately heavy but moving.  He kept up with it without any problems.  He stayed in his lane unless he changed lanes.  He got over to the right with plenty of time before our exit.  I declared him fine to drive himself to the Sunday walks and will be able to go to 9:30 Mass again.  I look forward to that.  I will use the treadmill on Sunday's to get in my exercise.  While I am not thrilled with walking, I recognize the necessity and the difference it makes in both of our everyday lives.  It also lets us enjoy a good night's sleep, especially if we go to bed early.  Getting up at 6 to walk doesn't seem like a good idea at 6 but it is manageable when I have adequate rest.  I'm still in the guest room while David has the Master BR.
David had a head CT in late Aug and the results last week.  There is no recurrence of his tumor according to Dr. Davidson at Georgetown who read the August scan against the March one and the one from a couple of years ago.  David HATES to get more radiation even though we all tell him that at his age (86) it is not a factor he should worry about.  He has an appointment with the GI doc on Tuesday but there is absolutely no evidence of bleeding.  His GI tube is a bit leaky and he deals with it by timing meals and coffee so that his stomach is not overly full when he does his PT exercises.
In my opinion David's physical and mental health is much better than it was before his first hospitalization back in May.  He is determined to get as healthy as possible.  After all he needs to sit at the polls all day in November after arriving earlier than the Republicans so that he has the best position for passing out sample ballots and displaying campaign signs.

Feeding Tube Chronicles

David's feeding tube has been problematic.  He had it replaced while in the hospital the last time but it started leaking about three weeks later and he had it replaced with a wider (26 mm diameter) tube last Thursday.  During that procedure he was told that there was only one wider tube available for him and he started to worry immediately.  He did not question them about what would happen and I was not at that particular appointment since Adam was here and accompanied him.  The new tube leaked the same day and the next day he came to MY medical appointment to ask for our doctor's opinion.  She ordered the 28 mm tube.  If and when that is leaky then she thought that the interventional radiologists would close the current opening to his stomach and make a new one.

Today he had the 28mm replacement.  I was there and we learned a few things.  They put more water than usual into the balloon inside the stomach that closes the opening there. There is a 30 mm tube available so he is not at the upper limit of sizes.  Other people have had worse enlarged openings compared to what David has right now.  There is the option to open a new feeding route but the current openings must heal before a new one can be made and that is a drastic move because healing takes several days.  He feels much better about the tube right now.

The new tube is NOT leaking after two meals and I have high hopes that it will remain secure.

Since the appointment required us to be at the hospital at 8:30, we did not do our usual walk today and will resume the "first thing in the morning" walk tomorrow as early as possible before the air quality degrades and the heat and humidity become unbearable.  I'm actually OK with walking and read email or news headlines during the walk because there is no need to be alert on the paved, dead-end road through the National Park.  We stop now and then for David to check his oxygen levels, allow him to breathe deeply until levels rise when the levels drop and continue.  My fall schedule has no morning classes so we will be able to continue this as the days shorten and cool.

Walking to Wake Up

That is what we are doing.  Rolling out of bed at the crack of dawn, hustling to the park 5 minutes away and then dong the 30 minute, or more, walk along the canopied road that we share with other walkers, dog walkers, cyclists and motorists.  Today it was 79 at 6:40 and we noticed fewer people sharing the walk.  The humidity was terrible and we turned around after 15 minutes.  This energizes David and exhausts me.  If I'm not teaching it's OK because I have some breakfast, iced coffee and after an hour am ready to do stuff.  David comes home raring to go.  His oxygen levels are fantastic.  He has lots of energy.  He does about an hour of exercises to give him strength and balance.  I help with the balance timing and he is improving daily.
Last Saturday he went to the temple alone and I stayed here and scrubbed the porch from the winter yuck and spring pollen.  That usually gets done in the spring but we were otherwise occupied.  I still drive David to Prince William forest for his weekly walk with Fred and Ali.  This week he and I kept pace with Fred.  He has not done that in about a year so the improvement in his health is obvious.
David gets his coffee via the feeding tube and is eating a little ice cream now and then by mouth.
I think that he will be able to enjoy Adam's impending visit and even go to Annapolis to Phoenix's brunch at St. John's.
So after about 2.5 months of medical issues and bottoming out, David's determination and positive attitude along with some excellent medical adjustments brought him back to activity, health and enjoying life.  Borray.

An uneventful week

No medical issues this week.  David and I are walking together these days and do it pretty early in the morning to avoid heat and ozone.  We don't walk fast, stop when he needs to and barely break a sweat.    Nonetheless, we are slowly going more steps.  We drive to Lee Drive, part of a small national park five minutes away, and then walk along the road.  There is a slight hill on the way out which means that the way back is downhill.  I saw some interesting mushrooms along the way after the big rain on Tuesday.  David is doing his exercises and trying to get better with balance.  I sometimes have to nag him about it.  They are boring.  He does love to walk so that is never an issue. Adam, Anne and Phoenix are coming to visit in a couple of weeks and we are starting to get ready for that, planning things to do, meals and such.  So all in all it's been a good week here at Hill House.  We got some Cold Stone cupcakes for the kids who helped us last week and gave the trash collection guy a thank you card with some cash.  Much less expensive than another trip to Mary Washington hospital when you consider personal wear and tear not money.  I thank everyone for your prayers and hope that it is now appropriate to direct them to others in need.

Mad dogs, Englishmen and David Hill

go out in the noon day sun.  So, he decided NOT to walk in the mall but to walk in the neighborhood and repeat the walk from yesterday.  (Why listen to your wife who is not physically fit?).  I was comfortably looking at email and web sites for Human Evolution and the doorbell rang followed by loud frantic knocking at the door.  A young man, Moses it turns out, from the trash collection company said, "There's an old man on the ground do you..." And I was out the door with my iPhone in a flash.  He told me that 911 had been called.  David was lying in the grass on the steepest yard two doors up, head down and beet red.  The lady of the house was surrounded by children, who found him.  He said he tried to call me.  HIs phone had no evidence of that.  I think he thought about calling me.  I got him up on his knees and Moses helped him stand but he was like jello and refused to sit down.  It is a very steep hill.  He wanted his walker.  I got it.  It did not work.  The fire department and the rescue squad came.  He successfully answered all their questions (name, date who is the president) said he did not pass out and adamantly refused to be transported to the hospital to be evaluated.  The rescue squad guy got a chair from our porch.  They sat him in the chair and four men carried the chair down the hill, down the street and into our house where David got up and walked to the couch.  The rescue squad guy saw that I was really upset and explained that David was lucid and that they could not transport him against his wishes but that I should call if ANYTHING happened.  I gave David some water through his feeding tube.  He went to the bathroom and is now sitting on the couch.  I left to keep an appointment he made to have the Prius inspected.  He half-heartedly offered to take it.  I declined.  He did not want to come along with me.  I made him promise not to drive, not to go outside and to limit his activities.  I'm at Affordable Automotive waiting for the inspection hoping that David listens to me.  He is so determined to push to get well.  He is sometimes clear as a bell but after this episode he is less sure about what really happened.  He admitted that he may have passed out.  I think the heat got to him and hope that the water and AC make him feel better.

He got up early today, did his thyroid medicine on his own, collected the trash and took the trash can to the street - all before I got up at 7 when I found him in the shower.  Things appeared to be getting back to normal.  Our mail was not delivered at all yesterday and package tracking indicated that two days passed without several packages being delivered.  He was planning on going to the Post office to complain and to collect his birthday package from Adam.  He was going to do that after going up to the lab for bloodwork.  I looked out about 9:30 and saw that the flag was down on the mailbox, went outside and collected four packages and a mess of mail, so that problem was solved.
About 9 the home health nurse had her last visit with him and was very happy with his physical condition and progress.  I think that those folks are a bit too ready with the praise for his determination to get stronger and then he tries to exceed their expectations, thinking that I am negative and pessimistic.  I think that he has two modes:  stop and full steam ahead.  Moderate is not one of his settings!
Tomorrow is his 86th birthday and we will celebrate very quietly.  Perhaps we will go to the temple for services.  Right now I don't know what to think or plan.  I'm scared for him.  I do not want him to give up but I want him to dial it down a few notches.  Once again I ask for your prayers.

July 6 post post-hospital doctor visits

Yesterday David saw Dr. Lynne Clemo, his primary care physician.  His lungs sound fine to her.  She ordered bloodwork to check on his hemoglobin and kidney function and many other things too.  She said that his risk for an embolism is much lower than his risk from a re-bleed of the ulcer or other bleed from his poor balance.  This means he will not be back on blood thinners for at least six months.  He is cleared to drive again but she wants him to stay off of the interstate until his balance improves.  She wants to see him again in 6 weeks and we made that appointment.

Today he saw Dr. Lee, the gastroenterologist.  He ordered blood work to check his hemoglobin AND to check for Helicobacter pylori a big factor in ulcers.  If that is positive then he will need two weeks of antibiotics.  If it is not and if the hemoglobin is rising then Dr. Lee does not want to do another endoscopy unless Drs. Clemo need that information to make a decision about David's treatment.  He would not do it for another 2 months and wants a follow-up visit then.  By that time we will have Dr. Clemons opinion about the endoscopy.

Today David got into his car and went to see his friend Zee, drove here and there and I think was happy to be in the car without me.  His concentration and focus is not optimal but is coming along.

He told me he wants nothing for his birthday.  Of course I cannot accept that because I love celebrating special occasions.  Than and I are trying to do SOMEthing David will enjoy and have come up empty so far.  Maybe a movie at the AMC theater in Potomac Mills where they have a very cool closed caption device that scrolls the CC across a narrow long screen that you place near the bottom of your viewing area of the screen.  No movies in Fredericksburg are AMC.  All AMC theaters have these in all the theaters.  He is not sure that he wants to see any of the movies that are playing there.  I'll keep trying.

July 2 progress

David is moving along at exponential speed both physically and mentally.  Yesterday he got his walking stick, walked down the driveway around the cul de sac and up the hill to the house (past the empty trash cans) and up the driveway.  He was really tired after that but managed to recover and come to Lowe's with me.  He walked around the store with his cane and associates were falling all over themselves asking him if he needed assistance.  His reply, "I'm with her."  Next he insisted on going to Cold Stone Creamery for ice cream and ate the top part of a scoop of vanilla.  He said that it definitely me his expectations.  The rest is in the freezer.    Yes, I know he is supposed to have nothing by mouth but he was extremely insistent that he does not aspirate so I gave in.  I had a Banana Split Decision for the first time in years.  When we got home I resumed deep cleaning the house that has been sorely neglected and David started to vacuum.  We both slept soundly last night.  Today I'm took him to the temple for services and then we went to Sears and Wegman's.   Tomorrow I will drive him to take a brief walk in Prince William Forrest and then breakfast at Dumfries.
Tuesday is his visit with Dr. Clemo, the primary care physician and we'll see if he is cleared to start driving again.  The physical therapist explained that home health care stops once he is able to leave the house and go places alone.  She suggested that he drive and I passenger the first time and that we take a short trip.  She suggested Costco.  I'm thinking the Lee's Hill shopping center - to donate at GoodWill and shop around.
Rachel, the Physical Therapist, showed him the app on his iPhone that counts steps as long as it is on him.  WELL this is now an obsession.   Yesterday he did somewhere around 3800 steps and today he is already up to about 2500.  He plans to vacuum the downstairs and will no doubt do a stroll around the cul de sac again trying to top yesterday's total.  He is building up to "passing" the evaluation that will determine if he is a fall risk on Tuesday when Rachel comes again.

June 28 Long, useful day

The day did not start well.  Optimistically I slept in the master bedroom only to be awakened at 2:30 and 4:30.  At 4:30 there was awful diarrhea and I got up to prepare the Imodium solution and put it into David's feeding tube.  He changed into fresh clothes and went to the family room to watch TV.  He has trouble with his hearing aids and the blue tooth and I told him that he had to go into the bedroom and watch TV but he didn't want to do that.  I finally figured out what he was doing wrong, fixed it and went into the guest room to sleep.  At 6 he knocked on the door for more Imodium.  I gave it to him and fell back into bed.  Anothe knock at 7 for more Imodium.  By then I just got up.  I went to the drug store to see if there was a stronger anti-diarrhea med.  Neither local one opened until 8 so I waited.  There is no stronger med; it's this or the generic, all the same strength.  I got more because we were running low.  The home health nurse came at 9.  She gave us a sample jar for a stool sample.  We had fun getting that!  Later the physical therapist came.  Amy left their company to move to PA to be near her mother (VA is not a bad place to move to be near your parents - hint) so her supervisor, Rachel, worked with David and was astonished to see his strength after 7 days in bed.  He lost almost no ground with this hospitalization and did the full round of exercises with her.  He has balance issues that she is going to work on.  She will also work on getting him to walk down our driveway to get mail and to take the trash cans to the curb.  She asked him if he is driving.  I was not happy with that particular question because it seemed to indicate that he is OK to drive.  He does not think that so I am relieved.
I took his car to the drug store because it has not moved since he entered the hospital on May 18.  I noticed that the state inspection is due this month and took it to the dealer for the inspection.  They give us free inspections because he bought the Corolla there.  The wait was estimated to be 2.5 hours so I got a ride home with Fred Wright who was visiting David BUT there was a miscommunication and Fred left to get me while David navigated out the door onto the porch and locked himself out!!!  He sat on the porch steps until we got home.  Than took me to collect the car later.
I watered all the plants on the two porches the deck and the patio, so of course it is finally raining.  I'm heading to bed early because I teach tomorrow between 9 and 2 and I am exhausted.  Laundry and unloading the dishwasher has to wait, along with myriad other stuff.  I'm keeping the essential things under control.  David is doing his best to get strong and stay informed.

June 27 Home

David was discharged today and we arrived home about 5:30 after the obligatory stop at Costco.  His lungs are unchanged so no worse.  His lung sounds better and blood work indicates that fluid retention is reduced.  The LaSIX has been doubled over last week to keep fluids off.  David came into the house, sat on the couch on his newest cushion, asked for a urinal just in case, turned on MSNBC and fell assleep.  I still have a lot of unpacking to do and put some mac&cheese from Costco into the oven that I will enjoy with four bean salad and tomatoes.  Now I'm just waiting for Home and Heart home medical care to call with their appointment times to reassess David and plan for his home recovery.  I got discharge information about the stages of heart failure, what to watch for and what to do if and when these things happen.  I think that David is relieved to be out of there and be home.  Me too.  Dr. Bernstein popped in right before we left, asked a bunch of questions, listened to David's lungs and noted that he was not any worse from when he was admitted, so all the antibiotics did no damage.  I prefer to think that they hoped for the best but treated for the worst.  If he had MRSA or C.dif, then his life would have been saved by their actions.  My only criticism was that samples were not cultured prior to starting the antibiotics.  I will remember that for the future.
Now we just concentrate on incremental strength building.  The Home and Heart health nurse and physical therapists called within the hour and have scheduled visits tomorrow morning.  The staff from that service is amazing.

June 26 update

Today the Clostridium difficille culture came back negative so it was possible to start Imodium today to stop the diarrhea.  The doctor said that his lungs sound better.  David will have an X-ray tomorrow to verify that the opacity is reduced and that the fluid reduction is working to compensate for the heart failure.  A repeat echocardiogram will not be useful right now.  Many of the drugs have been changed or discontinued, so another trip to Costco pharmacy may be necessary on the way home.

David is weak but is able to get to and form the bathroom without assistance or a cane.  I hope that he comes home tomorrow so that he can have a home nursing and home physical therapy evaluation on Tuesday when I am home all day.  If discharge is delayed until Tuesday then I may need to cancel Wednesday's class.  My students will be devastated.

I am confident that the heart failure is the source of all the recent medical issues, now that so many other things have been ruled out.  Hopefully this means it is all downhill from here on.

New information June 24 late

Dr. Bernstein is probably going to discontinue the Zosyn due to the negative cultures and unchanged X-ray as well as the really horrible diarrhea he is having.  His opinion on the x-ray is that the opacity is due to fluid in the lungs caused by heart failure. He told Dr. Kear to get the fluid under control.  I asked for a cardiology consult with Dr. Henry Clemo and he agreed and said he'd ask for it.  He said that the ejection fraction on the last echocardiogram was less than 25%.  That was a bit of a shock.  So, David will be the guest of Mary Washington hospital over the weekend trying to reduce the fluid load, get rid of diarrhea and get some strength back.  He is extremely bored and so I am going to take the MacBook and a lot of videos over this weekend.  We can also get movies from Apple TV, Amazon Plus and Netflix streaming.  He is reading the latest Kay Skarpetta novel and I just got him one written by Joe Hill, Fireman that is on the best seller list, so he has some interesting books.  I'm hoping that he can go for a walk and do a few exercises once the diarrhea is resolved.  I am optimistic that the cardiologist can give David a treatment plan to get him home and functioning again.  I miss him.

Negative cultures and no change in the X-ray

So the title says a lot.  The cultures were negative for fast growing bacteria and this morning's X-ray shows no change in opacity so the pneumonia has not improved.  The hospitalist still thinks that David should continue with the Zosyn.  I think that Vancomycin has been discontinued.  David has terrible diarrhea and that got cultured this morning for Clostridium difficile.  I am concerned about the antibiotic wiping out his friendly bacteria and the possibility of a secondary fungal infection as well as the diarrhea.  The diarrhea is so bad that it prevents him from moving, walking and exercising in addition to making him weak of its own accord.  I feel so sorry for him.  He's convinced that the diarrhea will go away if he goes back onto the blood thinners...don't know why.  I think that it is well established that Lomotil will stop the diarrhea and that it should be prescribed.
I asked the hospitalist how we would know if the antibiotics work if there is no bacterial culture that will show it, that his white count is normal.  The pneumonia has not budged and when do they expect that to change if the antibiotics are effective.  I also asked if they cultured for slower growing mycobacterium and fungi.  He didn't think so.  He pretty much said standard of care is to treat before the cultures are finished.  That is the difference between medicical science and objective science.  In a scientific setting I would be heavily criticized for taking that approach.  I am having a hard time understanding why antibiotics are still appropriate.  Dr. Kear said that I would be really unhappy if I told them to stop the antibiotics and then David got sicker.  This is true.
I went back to the reason for admission:  Low oxygen levels.  That resolved right away when IV LaSIX was initiated BUT they started antibiotics at the same time and are reluctant to stop either now.  David is weak, confused about what is happening to him and just wants to get better.  He is not clammoring to come home.
I think the plan is for him to come home tomorrow with IV antibiotics.  Medicare and supplemental will not cover the home IV antibiotics.  I'm still not sure how long they will be necessary.  If that is the treatment plan we all agree is the best, then we'll do it.  Being home is worth the cost of it.  I am waiting for the infectious disease guy, Dr. Bernstein, to call me to discuss it.  David will need to have interventional radiology install a port for the IV before he leaves the hospital.  I'm unsure about who will administer the IV drugs.  I can probably do it if they will allow it.  At 32.10 a day it is quite affordable if the duration is short.  With these side effects I'm not sure that David can tolerate an extended duration.
Please keep us in your prayers.

Wednesday is shower day

After teaching I headed to the hospital.  Dr. Bernstein and I spoke last night about 11 and he wanted to use different antibiotics.  He thought that David could have caught a bad bacteria in his throat mucus that then went to his lung and pneumonia.  He wanted to stay with Vancomycin but change the other two to Zosyn (a mixture of two antibiotics, piperacillin and tazobactan) IF the pharmacy would let him.  The drug is in short supply.  The awesome Richard Mainzer let me know that this is due to a plant closure in Italy causing a raw material shortage.  Happily the pharmacy filled the prescription and David got it today along with vancomycin.  The hospitalist spoke with us this afternoon and said that the course of the drugs would be 48 hours.  The social worker came in shortly thereafter to inquire about home health services and our preferred provider because David is probably going home at the end of the week.  I sure hope so because as I mentioned before nothing happens in the hospital on weekends.  I convinced the doctor that David is not a fall risk and the physical therapist finally got her report in confirming that.  So that led to a shower for him but without his usual hair care products so no conditioner, no mousse and no blow dryer.  He is still using the urinal because they are obsessed with measuring it.  When I come tomorrow I will bring clothes for him to go home.  Even if he has to stay until Friday it will represent hope.

Mary Washington Hospital once more

We are in the ER at the hospital waiting for David to go for a CT scan before going upstairs. Earlier today the physical therapist arrived to find David trembling with blue hands and nail beds and blue lips.  His oxygen level varied between 69% and 100%.  I called the doctor and was told that my first call should have been to 911.  I hung up and did that.  They came in under 5 minutes.  In the ER blood work was done and a chest X-ray too.  The ER Doctor said David had to stay and transferred him to the hospitalist, Dr. Torres (the male, straight version who is not on Gray's Anatomy).  He is concerned about the pneumonia on the chest X-ray causing the breathing issue and it being hospital acquired and is treating is aggressively with three, IV antibiotics:  Vancomycin, Ceftrisxolon and Azithromycin as well as aggressive breathing treatments to knock it out.  He will also have a CT scan to rule out a lung clot.  He will do this while a guest of MW hospital.  Sigh.  He is NOT happy about being here.  He has his cell phone and hearing aids with the Bluetooth connected to it but is not really into conversations.  Than brought a book he is reading, extra batteries for his hearing aids and his Kindle.  I am working on a list of stuff to bring tomorrow.  Than is here to help and our neighbors are pouring out with offers to do things.  There is really nothing anyone can do other than pray or come to see him if you are local.  The hospital rooms are small, cramped and uncomfortable.  Visitors are welcome in small groups for an hour or so at a time.  I haven't seen his room yet to see how many chairs are there.  The last time the room was a nice size with three chairs.  The first time it was not and there was a single chair. He looks great and feels good while in bed with oxygen.  The goal will be to have him look and feel great with normal activities and on room air.
There is a wonderful deli down the block where I can get any food I don't have from home and I can go there when others are visiting.  Teaching my class is an escape for me and I love my students and colleagues.  If you can think of something I am missing let me know.

This morning I woke up to the sound of David on the phone with Amazon talking about a problem with his Kindle Fire.  His voice was clear and articulate and he never once said, "Say again I didn't understand you."  So he is both hearing using the Bluetooth on his mobile phone and speaking without a lot of mucus and constriction.  Wow.  That is amazing, wonderful and made me very happy.  The issue about the Fire was not resolved and he terminated the call after almost one hour of increasingly loud conversation.  Those phone "help" folks are anything but.  He will call back this afternoon when he has more time.  History says that he will finally ask to speak with a supervisor and that person will quickly handle the issue and solve it.
 He was also dressed for the day, shaved and his hair was brushed.  What a surprise.  I am still going to do the driving today.  We are headed to the temple for 10:00 services and he can stay for Torah study if he likes.  Tomorrow he wants to go to Prince William Forrest to meet Fred and Allie, maybe try to walk a little with the walking stick and then go to the Dumfree's cafe for political conversation, so I will drive him there.  I think that driving is his next challenge and I will ask the Amy, the physical therapist, about it next week when she visits.
Yesterday the nurse was very pleased with is physical condition, no fluid in the lungs, BP and heart rate are great, not much swelling but still requires the dreaded compression stockings.  He gets a home nurse twice a week.  His weight seems to be creeping again but I will wait until Monday to see if the creep recedes or continues before calling Dr. Clemo, reporting it and then going back to 20 mg of LaSIX a day.
So we are poised for a nice weekend.  The weather is gorgeous and I hope to get out into Schrassic Park for some digging in the dirt.  Yesterday I had my first grape tomatoes ripen and ate 8 of them right off the vine - delicious.  The French Tarragon looks healthy and I want to use it in a potato dish tomorrow.  I think that there is enough basil for a good batch of pesto too.  And several colors of lilies are in bloom, white, yellow, red and verigated pink.

No walker; no cane

As you can see David is walking without assistance, most of the time.  He carries a cane and uses it when he gets tired.  He visited his primary care doctor yesterday and she indicated that blood thinners will not be forthcoming anytime soon and ordered lots of blood work.  Today the blood work came back with stable values but they are still not in the normal range for hemoglobin that remains 9.5.  His kidneys are no worse for the LaSIX.  She is titration get the LaSIX down.  Instead of 10 mg twice a day it is 10 mg. on alternate days with 20 mg. twice a day.  We will closely monitor his weight and he will continue with the home nurse twice a week and the physical therapist three times a week.  His exercises take about an hour each day.  He is getting back to his fighting strength and interested in being independently mobile.  Me too.  He must see the GI guy for an endoscopy and we'll arrange that appointment tomorrow morning before I leave for school.  Even if he is independently mobile, I want to be there to help with hearing all the pearls of wisdom from Dr. Lee.

Sleeping continues to be an issue and he wakes up to urinate and sometimes cannot go back to sleep.  He can watch TV in our bedroom with the old headphones that I hooked up to the new TV with an adapter and cord to an optical, digital output.  I did not figure this out myself but used Costco concierge services and they detailed it for me.  I think that his low hemoglobin eases him into maps during the day and lessens his need for a full 8 hours a night.  I am still in the guest room and am thinking this may last longer that I originally hoped.  At least I can get my 7 hours!

Day by day

All is well.  Today the nurse said that David's lungs are clear, his legs are a bit swollen but not bad.  We got a digital scale to accurately track his weight day to day to monitor fluid retention.  David has a huge set of exercises at stations throughout the house, standing in the kitchen, sitting in the dining room and prone on the bed.  His legs are still a bit weak and these should both loosen them up and strengthen them. We took a little trip to a medical supply place yesterday and got him a new seat cushion for the couch. So far it is relieving the pain in his tush.  Today we went to Costco to get a prescription filled and he walked around there.  I can't seem to get ambitious to work outside or clean.  The repair guy came yesterday to fix the dryer but has to order parts and he cannot do it until the 21st.  He keep trying to talk us into a new unit, but it is a stacked, connected washer dryer and while the repair is expensive, a new unit would be almost 3 times more and probably would be even more with delivery and installation.  I look forward to NOT running up and down stairs when doing laundry and having David resume doing his.  Today I'm just going to relax, read, watch TV and then tomorrow get back into getting this house clean and deadheading plants etc. in the garden.  Than will help get the fountain going and the bench and tables out on Sunday.

Ron visited this morning and Fred called him about visiting us Sunday.  So Sunday morning he and Fred will be here to visit David about 8:15 or so.  It is Ron's final goodbye before he leaves to drive to his new home in San Antonio TX.  It is very sad to say goodbye to Ron.  He has been a wonderful neighbor and better friend.

A window into our world

Today the home health nurse visited and noticed fluid in David's lungs and legs along with some wheezing.  I noticed a 3 - 5 pound weight gain over yesterday.  Water retention!!  We decided to increase the diuretic to morning and lunch to keep fluid down.  David argued about the weight gain saying he was dressed today whereas in previous day's he was in his nightshirt.  Since we have an analog scale, reading it is problematic.  We just ordered a digital scale from Amazon.  That will provide less subjectivity in the weight.  David wanted to go to Costco and I nixed that idea.  I had too much to do here.

I caved out of exhaustion and exasperation and we bought a new TV for the bedroom.  My goal is to have him stay in there, in bed when he wakes up in the middle of the night rather than wake me.  When he gets up without waking me, I am anxious in my sleep and hear him with the walker and wake up anyway.  He fell in the bathroom Sunday night and I am nervous if he is up when I am not available to help him if he falls.  Between us we were able to remember the PT's instructions about how to get up from a fall.  Additionally, once he gets out into the family room to watch TV, he turns his hearing aids onto the Bluetooth to get the sound directly there but cannot hear if the sound is off on the TV speakers and that wakes me up too. He tells me that he pressed mute but I think he double presses it and turns it off immediately after muting it.  With a TV in the master bedroom and my door closed in the guest room I should be insulated from noise and relaxed enough to sleep.  Than took the old TV to the dump; it was so old that GoodWill would not take it.  I finally had the time and patience to set up the new one this morning after the nurse's visit.  Now David wants me to explain all the features to him.  I declined and told him to find a tutorial online.  It has Internet access to myriad services BUT you have to be subscribed and enter your password for each of them.  I did NOT have the time and patience to do that today.  I should have skipped the wireless installation.  The TV is connected to the FIOS box and has access to broadcast TV, the DVR with our saved programs and FIOS on demand.  I think that is enough.

I have to do both of our laundry....in the downstairs machines because the upstairs dryer is broken.  The repair person is coming Thursday but our laundry was piling up.  I need to water the flowers on both porches and the deck and sweep the deck.  I have to sweep and mop the kitchen and dust other stuff as well as write an exam for my Bio class and prep for tomorrow's class.  Bring on the iced coffee.  Meanwhile David is napping on the couch with his legs propped up on the coffee table.  He did all of his exercises and I think that wore him out.  He has to do the entire set twice a day. The nurse told him to wear the compression stockings and elevate his feet as much as possible.  I think that he will feel better when that fluid is lessened.  We are still finding the sweet spot between water retention and dehydration.

All's quiet

So far, so good.  While David woke up during the night, he had his electronics and the TV controls and I was across the house in the guest room, sleeping.  This arrangement will work until he is strong enough to get around alone.  The home health nurse is coming today, don't know about PT or OT.  I am heading out about 3 to go to DC to the Teaching Professor conference to do a presentation. Than will hang out with David while I'm gone. David had a shower this morning, his breakfast, all his meds and is sitting on the couch dozing with his Fire in his hands and Morning Joe on TV.

Heading home via Coscto pharmacy

We will soon be heading home.  Dr. Ahmad, the hospitalist, said that David can go home this afternoon.  First he must have lunch, his first Jevity in five days.  Then the social worker has to come by to restart the home health folks that were interrupted by this particular hospital stay.  He will be off of the blood thinner until the Gastroenterologist does another endoscopy in two weeks and verifies that the ulcer is healed.  He also must follow up with both Dr. Clemos.  But the important thing is that he can come home and be comfortable there without IV lines, with what seems to be constant blood draws and beeps from various devices.  I may be able to go outside and weed or downstairs and prepare for the Teaching Professor's conference tomorrow through Sunday.  He will be able to watch TV and catch up on his computer.  If he had the strength he would be doing the happy dance.

Day two on proton inhibitor drip

David is on day 2 (out of 72 hours) on the Protinix drip.  His hemoglobin seems to be somewhat stable, but remains low at around 9 grams of hemoglobin per deciliter of blood.  It will take a few weeks to build back up.  If the hemoglobin drops that it means he is bleeding again and that they will need to go back in with the scope and cauterize the bleed.  They say that the risk of re-bleeding is highest in the first 72 hours.  I don't know when he can get out of here and have a list of questions for the doctor since I will be teaching tomorrow and Jeff is heading back home to OK.  David has his Kindle Fire, his mini-iPad and his iPhone and all the Chargers associated with those in addition to a hospital phone and the TV control cords.  His beds get tangled up with cords but nothing runs out of power;}. It is nice to post an uneventful day and I am hopeful that he will be home soon, then back on his feet and feeling good.  The only pain he's experienced has been from the frequent blood draws and IV lines.  His arms are a black and blue mess.

Three more days in the hospital

David had an endoscopy just now.  The doctor found a large ulcer in the small intestine with active bleeding and clots.  They cauterized it but are worried about the position and the possibility of re-bleeding and so will give him two units of blood, watch him carefully, give him IV proteomics for 72 hours and blood work periodically to see if the hemoglobin goes up.  So he could go home Thursday or Friday.  He is very lucky that we got him here.  The blood thinners made the ulcer much worse that it would have been but we don't know what caused it.  The gastroenterologist, Dr. Lee, is deferring to the cardiologist, Dr. Clemo, to decide about continuing the blood thinners.  Blood thinners prevent clots due to atrial fibrillation, which David has had for sometime.  So the risks to weigh are clots (stroke, pulmonary embolism, heart attack) vs. GI bleeds.  So a cardio consult is probably going to happen today too.

As always more when I know more.

Endoscopy?

David's hemoglobin dropped 2.5% in a day so it looks like there is definitely a GI bleed.  He is on a clear diet and gets broth and apple juice through his feeding tube.  He is off the blood thinner for now and on a reduced LaSIX regemin.  His urine output is being measured and recorded.  It is still high so the fluid retention should be abating.  Tomorrow morning it looks like the endoscopy will be evaluated.  His mouth opening is much less wide that most due to his surgeries and radiation.  His lungs appear to be clear with a chronic (residual) area that today's Doctor did not call pneumonia.  I got here about 11 and Rabbi Weisblatt was here.  Than and Katya came by en route to a beer and cook-out on Lake Anne in Reston and Jeff is on his way from BWI en route back home to OK.  David tried to watch the Global Public Square that we can play on my iPad Pro but he fell assleep and I turned it off.  He is napping peacefully and has his hearing aids off.  It is really quiet here and I hope he gets some good rest.
In other news the upstairs dryer is not producing heat.  Luckily there is a downstairs dryer that is producing heat.

Overnight just turned into two days

Since it is not possible to do an endoscopy until a patient has been without the blood thinner for two days, Dr. Lee cannot scope David until Monday unless there is an emergency.  If David's hematocrit drops too low that will be an emergency and they will go in, find the bleed and close it.  Since his stool was black not bloody red, it seems to come from further up the digestive tract allowing the undigested food to mix with it in creating the feces.  His feces tested positive for blood.  The ER doc did an exam and showed us.  Sometimes David appears to understand but really didn't hear it and I repeat it.  Up here in the room the nurses are amazing.   They read off the meds that were ordered and the hospitalist ordered a drug that caused an interaction with another one, plus it cannot go into the feeding tube.  That drug was changed almost immediately when he was admitted the last time.  I keep a list of everything and brought all the current meds in their original bottles.  The nurse called the hospitalist and it has been corrected.  Poor David.
On the other hand the room is big and well appointed.  He has a nice view and it is off the main circle of the wing next to a conference room, so it is very quiet and restful.  I have the iPad Pro set up to connect with our DVR at home so that David will be able to watch CNN, Fareed Zakaria tomorrow, as well as all of the other talking head shows he so loves.  Jeff called and is coming down from Boston tomorrow to see his dad and Nathaniel comes every day to be with us and does whatever he can to help.

Back in the hospital for observation

This morning we were happy to see the LaSIX working as he was two pounds lighter.  That mood changed rapidly when he used the bathroom and there was blood in his stools.  Since he is on a blood thinner the home nurse sent us to the ER because he is high risk for GI bleeding.  So off we go.  They took lots of blood and his levels have not varied since he was here last Tuesday so they will just watch him overnight and then he can come home....I think.  He looks good and is impatient to get up to his room where he can control the temperature of the room.  It is freezing in the ER.  The nurses brought me a warm blanket and hot tea.  David has four hot blankets, (three pillows, a urinal and a bedside commode).  I brought his food and meds and so far gave him lunch and 2:00 LaSIX.  I'm experienced with the overworked staff here.  They are all on overdrive so that the hospital investors can see a profit.  Georgetown was better staffed.  Of course he was in critical care there not observation so it could be the standard of care for patients in for observation.

Crazy day ups and downs. - literally

Started off good.  Although David still cannot sleep very much, I managed to get into deep sleep after each bout of into or out of the family room to bed.  At 5:30 I told him I had to sleep and was getting him situated until I woke up.  Then I got 2 more hours of slumber.  We did our routines,  meds, breakfast, surgical knee highs, dressed, got to the doctor's office by 1:10 and waited to be seen.  Dr. Clemo answered all the questions, changed a problematic medication, discussed sleep.  She declined a sleeping pill for David and offered me something.  I declined.  I have no trouble sleeping except when he needs me and then I WANT to be awake.  Next stop was the home health place for a new egg carton cushion for David to sit on and a call to the physical therapist who could get to the those shortly after we did.  Good so far, right?

At home David got out of the car, used his walker to approach the one step to the house, pulled himself onto the step using the grab bar on his mega-tool chest that Than and I located adjacent to the door and then.  Well and then he tried to step up into the house but the grab bar was too low so he reached for the door frame and the rolling walker.  I watched with grave concern as his hand slid down the door frame and he came onto his knees.  To make a long story short, he ended up prone on the hall floor, declined my help or ideas to get up, so I got him a pillow and we waited for the physical therapist.

Amy, the physical therapist is the incarnation of Mary Poppins.  On, she said, what a great opportunity to show you how to get up by yourself from a fall.  She talked him through what to do and he was up on the first try.  No one saw the stain on the knee of his jeans.  He sat on the chair and chatted away.  Finally I asked her advice on grad bar installation and commode holds.  We walked through the house and decided on one additional bar in the master shower (We had two.), two bars on either side of the garage door entrance and a modification of the commode so that he can raise and lower himself onto it.  Next she "walked" us through how to get him into the shower, shower and out.

A neighbor brough dinner (for eight) and volunteered to do anything we need.  The temple's former president called to see if she could come tomorrow to light Shabbat candles, drink wine and eat challah ( YES).  The rabbi showed up, a week after I spoke with him and told him that David was hospitalized.  Neumiro came by, got the supplies at Lowe's and installed the grab bars and toilet handles.  Nancy and Bill asked to bring grilling stuff on Monday and cook for us.  Than was here to help us by keeping David company so that I could do a quick grocery run and agreed to be here so that I can present two sessions at a conference in DC next weekend.  David spoke with Adam, Jeff and Lorrie.

I was feeling a lot better about recovery, support from friends and family, full of chicken and salad from our neighbor Mary and some iced white wine.  Then we tried the shower.  As David was undressing he mentioned that it looked like there was blood on the knee of his jeans.  Well, yes it was blood from two large scrapes from the fall.  The shower hurt but he persisted.  I installed a huge gauze patch over antibiotic ointment.  He is now in bed dozing with a book.  Tomorrow he has another doctor's appointment at 11 and then we plan to go to Costco and Wegmans.  He may end up sitting in the car with the AC running while I pick up some things like his new prescriptions and some melatonin to try to get him more sleep.  Well, the washer is done with this evening's load of towels & underwear.  We go through a lot of both and he has very few large sizes left.  He was wearing small before he started this massive water retention.  Luckily some larges were hidden on the bottom of drawers and he can wear them now and be a lot more comfortable.  He's gained about 20 pounds of water weight around his midsection and legs, hence the surgical/compression knee highs.  I really hope that the LaSIX is going to be effective, reduce the swelling in his legs and allow him to walk easily again.

It is not all bad but that does seem to be the things that knaw on me.  Hoping for sweet, peaceful dreams for David tonight.

Home safe and sound

We arrived home about 6:50 with a big bag of prescription medications from Costco and a walker from a medical supply place.  A four-legged cane and an additional pair of compression stockings are coming from Amazon tomorrow.  A nurse, a physical therapist and an occupational therapist are coming tomorrow and/or Thursday.  David has appointments with Dr. Lynne Clemo on Thursday and Dr. Henry Clemo on Friday to discuss progress/ medications and future tests.
Than was a huge help getting David into the house and then working with him to make a safe, workable place on the couch with his electronics, papers and such.  We did a dry run to be sure David and I could manage alone.  We can.  He had dinner and evening meds and then used the bathroom and went to bed.  Using the bathroom is a puzzle and I hope to get grab bars into both upstairs bathrooms by the toilets.  We have then in our walk-in shower.  No shower until I get home tomorrow.  His good friend, Fred, is coming to visit with him while I work tomorrow...just to be safe. David already seems stronger here at home.  He is in bed with the electric blanket on full blast and will undoubtedly have a wonderful night's sleep without anyone interested in taking his vitals, his blood or for tests.
Mary Washington Hospital's staff did a great job of puzzling through all the issues affecting his health and addressing them.  The hospitalist a were superb and the nurses are overworked.  I think that the facility is understaffed for the patient load they experienced during David's seven day stay.  Good night everyone.

David is coming home

Dr Akbarzadeh is discharging David later today.  More when he gets home.  Borray.

Monday morning the sun is out

So David does have congestive heart failure.  His lungs are full of fluid from that.  Additionally there is a pneumonia indicator on the X-rays for which he is getting antibiotics.  He got Lasix, IV, about 4 and will get more tomorrow morning.  It is causing him to urinate a lot and he is less bloated and is not wheezing at all when he goes into the bathroom.  Yesterday he wheezed a lot.  After the Lasix tomorrow, he will walk again and they will try it without oxygen.  If he does OK on the walk, with our without oxygen, he will be able to come home.  We will get home health care with a nurse, a physical therapist and an occupational therapist.  They will advise us (and authorize through Medicare) a grab bar for the bathroom, a walker, and one of those chairs that stands you up.  Although Medicare will pay only for the mechanical parts of the chair and we will be responsible for the rest of it.  I hope that we have selections that are not hideous.
In addition to improved breathing, he seems to be stronger overall and have better fine motor skills today.  Yesterday he could not open the feeding tube cap, today he can.  He is also grabbing and using the urinal without shaking a lot.  He is extremely tired but cannot nap for long due to the busy hospital.
Jeff, Mimi and Adam called him today and he enjoyed that a lot.  Than and Katya came for a visit, as well as the across-the-street neighbor who brought a vase of flowers.  I left my phone on during my class and answered it when he called - 4 times.  I think that he was bored.  Whatever, it worked out and I am confident that we will work it out when he comes home.  I am just so relieved that he is improving and coming home.  Not quite ready to party, just relaxed and happyl

David does FaceTime

Just Facetimed with David on his cell phone.  He already had a new chest X-ray this morning (He was the first one of the day) to see what is going on there.  Don't know who ordered it. He also had a nebulizer treatment last night. The night nurse taped the oxygen line to his face so that it does not fall out.  He looked and sounded good.  He did not appear to be short of breath or wheezing but he was laying down.  He also had a successful trip to the bathroom this morning "like he has at home" so that is working again.

Nothing happens in the hospital on Sunday

Nothing new.  David waited all day for an enema, got some prune juice after hours of waiting for that and once the enema was ordered, was able to use the bathroom successfully.  That made him feel much better.  Otherwise it's been a dull day medically.  He had a walk this morning and was asked to stop when his oxygen (with oxygen being administered) dropped below 93.  It happened a lot.  They put him back to bed and did not walk him again today.  His nurse just ordered another nebulizer treatment for the wheezing.  It is very bad.  Albuterol did seem to help last night but the therapist said it could be that he was just recovered from exertion of being up trying to use the bathroom.  Whatever, I just want them to help him.  Than was here most of the afternoon and this evening our friend Nancy was here for a few hours.  He got to talk politics with them and that made him wheeze too.
A side note:  Than & Katya went to Mass at St. Mary's.  I went to Mass at St. Jude's.  Both priests gave the same homily, complete with the same joke.  I guess there is a dioscean sermon generator just like college Profs can get canned PowerPoints with lecture notes!!  It was still a good homily about the importance of relationships and that relationships are the only things that really matter.

Tomorrow I teach until 1:45.  I will ask David to FaceTime me when doctors come and I will interrupt the class for his calls.  It's the best I can do under the circumstances.

We want a diagnosis and  a prognosis.  I hope that it possible.

Saturday evening at Mary Washington Hospital

David has had his dinner and is reading the local paper.  He had a good walk around the floor about 200 steps.  He did need oxygen to do it and will have to come home with oxygen.  It looks like he has fluid around his lungs and Lasix was prescribed to reduce fluid retention.  Otherwise he's had several breathing treatments with Albuterol but that does not seem to give the dramatic, immediate results that would indicate bronchial constriction.  By process of elimination it is looking like fluid retention, maybe heart failure, that can be treated so that he can come home tomorrow.  I have to teach on Monday between 8:30 and 2:30 so he will be on his own then but with a cell phone, a walker or cane and lots of urinal bottles strategically placed.  I almost prefer that he wait until late Monday to come home so that we could have all day Tuesday to get a routine established.  I only teach Monday and Wednesday in the summer, so I will be around a lot.

Saturday morning May 21

The pulmonologist ordered tests to rule out a blood clot in the lungs:  blood work and a special X-ray.  Imaging our surprise when the guy from across the street that we've known since he was a little child in elementary school came to take him down.  Yesterday the radiologist was Dr. Neil Green from the temple and the urologist is also a member of the temple.  This makes David feel very confident in the institution and in the overall results.  He will not be able to walk again until these tests are evaluated.  His care board indicates that discharge planning is on the agenda for today.  His arms are covered with bruises for all the blood work stabs.

I brought the MacBook and connected to HBO on the go so that we can watch shows he's missed.  He was really disappointed to miss Real Time last night.  We are binging on VEEP right now  I also brought five DVDs so the hospital TV won't be his only source of entertainment.

Discharge delayed

The plan was to discharge David today after 3.  Prior to discharging David they took him on a walk up the hall.  He was short of breath, fell into the bed and his oxygen level was very low.  They immediately put him on oxygen and the levels returned to normal.  His doctor wants him to stay and be evaluated by a pulmonologist and perhaps go home with oxygen.  The ultrasound of his kidneys and bladder that showed no damage that would cause blood in the urine.  There is currently no blood in the urine, that was Monday.  His bladder is emptying fine.  His lungs show a little bit of "effusion?" But not much.  The pulmonologist will look at all of the labs, etc. tomorrow.  His heart beat has normalized after the medication prescribed two weeks ago.  His swallow test indicates that he is swallowing fine, with no aspiration.  The only reason that makes sense for the dizziness and fainting is the medication interaction and that has been changed.
The reason he went to see Dr. Clemo was he is so tired/exhausted and thought it was due to sleep interruption from getting up to urinate so many times at night.  Since then he has become progressively more tired, then not feeling right, then dizzy.  About a month ago he had trouble walking a block without stopping to rest.  Last Sunday in the park, he walked about 15 steps and then had to stop and rest.  He would wheeze when he stopped.  This is what happened today walking up the hall at the hospital and the nurses reacted quickly with oxygen.  Right now he is sitting up in a reclines with oxygen and dozing off.
David really, really wanted to come home today.  I wanted to take him home but Dr. Yusufi ( a good friend of David's good friend Zee) told me that it was risky and may result in me bringing him back here, so we decided to extend his stay until he is evaluated to be safe to return home.  I will bring my MacBook with some DVD movies tomorrow because Saturday TV is terrible.  We may be able to watch some of the ABC shows on the iPad today.
I feel much better today after a good night's sleep.  Now I need to write email messages to the students whose class starts on Monday at 9 so that they have the right book and Internet access...or maybe just wait and have them do it in class on Monday. Either will work.
Than is coming over later as well as Zee.

Updates:
 David will be at the hospital overnight and have a swallowing test in the morning. All his meds with the exception of the Pradaxa can be administered through his feeding tube and not taken with water. Dr. Hoffman, a urologist (and the Moyle at the temple) visited and to combat the drug interaction he is replacing the Flowmax with another drug,  He also ordered ultrasound of kidneys and bladder and while David was down for that he had a chest X-ray.
David is getting IV fluids and a stool softener.
 Dr. Davidson , the surgeon from Georgetown, called. The differential diagnosis is that the head CT changes are radiological in nature, from all the radiation he had his bones reacted. The advice is to wait 3 months and repeat the CT to track any changes before doing further tests. It doesn't look like a cancer to anyone there. Whew! I want to celebrate - by getting 8 hours of sleep tonight. Too bad David won't because of the nursing staff taking his vitals and waking him up.  I'm hoping that he will be able to come home tomorrow after his swallowing test.  He is struggling to breath and wheezing but his oxygen levels remain high so...?

Thanks for all the prayers.

David met with Dr. Henry Clemo, his cardiologist, who discontinued the Carvidiol and believes that it interacted with another drug to cause the symptoms. He and his wife, Dr. Lynne Clemo, are going to discuss another medication to replace the Carvidiol. David also had another echocardiogram and Dr. Henry will compare that one to the one David had last week. He has the room set at 75 degrees and wants the door closed to keep the heat in the room. They gave him a walker and he uses that to get to the bathroom. He did get his medications this morning but not breakfast. I gave him the Jevity about 11. I also brought more Jevity for additional meals today in are he has to stay here. More when I know more.

By the way, David has his cell phone with him and it gets excellent reception in his room.  The times on this blog are Pacific Daylight Savings time, not Eastern Daylight Savings time.  I may have to tweet the settings when I have the time and mental capacity to do so.

Day 2 MWH morning

The hospitalist came about 2:15 a.m.  David got to the ER at 5 p.m. And so this was a nine hour wait.  We were both sleeping when he came.  He asked the same questions that all the other staff asked and wrote things down on some sheets of paper.  Why can't they use computers to centralize all of this information stuff?  I came home and finally turned out my light at 3:45 a.m.  I woke up to the phone.  Then I called David and he was in a echocardiogram.  I'm getting ready to head over there because he has not yet had his breakfast and the urinal bottle is out of reach and he is not supposed to get out of bed.  I'm having some yogurt and coffee and then going over there.  I'm clean but not well groomed.  I got all of the stuff he wants:  fresh hearing aid batteries, socks, clothes, more Jevity, syringes, bottles but not the living will.  I can't take time to dig it up.  They probably have one there but we'll need a notary.  More updates as information emerges.

From room # 2043 on 2 South

Yea!  David has a room.  It is quiet, dimly lit with a very nice nursing staff.  We are still waiting for the hospitalist to visit.  David is doing a lot better and got to the bathroom with only one person helping...and a lot of grab bars.  They may get him a walker to help.  One of the nursing staff wanted to get him oxygen because he is having trouble breathing and wheezing but his oxygen cons is nearly 100% so that is more oxygen is not going to be useful.  We brought his iPhone, iPad and Fire.  Both the iPhone and Fire are charging so he is using the iPad.  My iPad is down to 17% and I have no additional charger here.  I have a recliner that is a lot more comfy than the chairs in the ER but not as good as the one at home.  He is not clammoring to come home and is in a very good mood.  Go figure.  By the time anyone reads this it will be daylight and I will be home in bed.

Mary Washington Hospital ER

About 2 this afternoon I was happily eating lunch and planning the next couple of semesters of water sampling, David was dizzy, fell, hit his head and couldn't get up.  He was sitting on the floor when I came home looking confused and wanted me to help him get up.  After a lot of maneuvering with the ottoman and coffee table, we got him to the couch.  I took his b.p. Then I called Dr. Clemo.  She came to the phone right away, listened to me and said to call an ambulance to take him to the hospital.  We're in the ER waiting for results from a heat CT and a lot of blood work.  This doctor identified two issues:  damage from the fall and the dizziness that preceded the fall.

The nurse got me stuff to crush his meds and give him his Jevity for this evening.  He has one more pill to take for sure and possibly another one, pending the doctor's decision after the test results are in.  David is in a good mood, clear headed and happily using his Kindle Fire on the hospital's WiFi to read his blogs, podcasts, check the weather and email.  The TV doesn't have MSNBC and that doesn't make him happy.  He's going to miss Rachael and Chris but I've got them being recorded at home.

His head CT showed no change and the blood work showed a little kidney damage that is also unchanged over the last few visits here.  He will be monitored overnight and probably released tomorrow afternoon.  They are admitting him into a room upstairs and once he is comfortable, I will go home.  I will update when there is news.

Bladder infection
David and I met with Dr. Lynne Clelmo today.  She is our internist.  David had blood in his urine this morning and so called her.  Since the prostate is enlarged but does not appear to be inflamed, she believes it is a bladder infection and will culture his urine.  She prescribed a sulfa drug to treat it rather an an antibiotic to prevent any interaction with the Flecainade for the arrhythmia.   Then she mentioned the CT scans and I told her that David is seeing the pulmonologist and that Dr. Davidson is taking his case with the head and neck growths to the differential diagnosis committee.  She was relieved that we know about the results and are already dealing with it.  She really hopes that the urine culture comes back with an infection.  A UTI can explain his having no energy and needing more sleep.  He is gone to a political meeting tonight so his mood has certainly improved. He has another one on Wednesday and then one to choose delegates to the national Democratic convention.  He is a delegate to the Virginia convention.  He does love politics.

Today I got up at 6 and by 6:35 was driving David to Prince William Forest for his "weekly walk" and breakfast with Fred.  Fred started his walk before we arrived.  David and I walked for 19 minutes with stops as necessary.  Fred got to our car just after we did and David was in the passenger's seat getting the dog treats out.  Ali jumped into the driver's seat to get her treats.  She was extremely excited to see David and strained to get to him (and the treat).  We went to the Dumfries' Diner for breakfast.  Fred and I ate.  David had his meal before we left home.  One of the frequent patrons came over to the table and commented that there were no raised voices.  Fred, David and I calmly disagreed about the presidential race.  Fred mentioned Fox News' reports of "The Energizer" who supposedly is having an affair with Bill Clinton as well as owning an energy company and getting $$ from Clinton's foundation and the government.  David was a bit quiet and not arguing.  Fred did not get upset either.  We talked about water quality, pandemics and Ron's going away party.  I had some good coffee, french toast and bacon.  We got back home about 9:30.  I got all the newspapers for recycling into David's trunk and he headed off to the temple to recycle the and go inside for more conversations.  He had his walking stick throughout the walk, stopped and started and was wheezing but not short of breath once he stopped.  He seemed to move more easily to day compared to yesterday when we were in Alexandria; however, when I asked him if he felt stronger/better he said no, it is about the same.  Nonetheless, he had the energy to go out to the temple after we got home so I do see an improvement in his overall physical and mental state.

New info about CT

We just spoke with Dr. Davidson from Georgetown.  He thinks that the mass in David's head looks like a mucoid growth, not a recurrence of the ameloblastoma.  He plans to take this to his differential diagnosis group next Thursday for their input about the diagnosis and follow up tests.  He said that an MRI will be difficult with the kind of pacemaker David has so he is thinking that a PET scan will be the next step. That will be able to detect cancer.  The two enlarged lymph nodes could be due to an infection but will be clarified with the PET.  This sounds a LOT better than the radiological report.  Dr. Davidson is a rock star and an expert on ameloblastoma, so I believe him that it isn't that.  He is going to call us at the end of next week with his recommendation.
David continues to be easily fatigued.  He took the recycling can to the street and that wore him out.  At the library he could not walk from the car to the door without stopping to rest.  I think that the lung problem may be the culprit.  He sees Dr. Goyal on the 25th.  I think I will call his office early in the week and ask to get fit in if there is a cancellation.
Otherwise, keep up the prayers.

CT of chest, neck and head

David had a CT of the chest, neck and head yesterday.  Today he went to the Imaging place and got a copy of the radiologist's findings.  

The head CT showed soft tissue growth suggestive of a recurrent tumor in the left side of the head, as well as enlarged supraclavicular (around the collarbone) right and left lymph nodes.  The radiologist suggested a follow-up MRI.  David called Georgetown to discuss their MRI that he can have with the pacemaker and is waiting for a call back.

The chest CT indicates atelectasis in the right lower lung with small left and small to moderate right pleural effusions.  Pneumonitis is not excluded.  I looked up atelectasis and can mean a partially collapsed lung.  He has a call in to the pulmonologist about this one and is waiting for a call back.

He is really tired and wheezing with not enough energy to go to the Silver Sneakers classes, walk in the mall or, today, even stop by GoodWill to make a donation.  He has been taking his new medications religiously, hoping to regulate the heartbeat and reduce the number of times he wakes up each night to use the bathroom.

We are scheduled to meet Lorrie, Richard and David for lunch on Saturday and we are both looking forward to that get together.

I write more once appointments are set and when we learn more about what all of this means.  Prayers are really appreciated.

Cardiologist on board

David saw Dr. Henry Clemo (his wife Dr. Lynne Clemo is his internist.) the cardiologist today on the advice of his internist because he is tired and short of breath. His heart if "throwing" extra beats causing the pacemaker to be ineffective.  He prescribed a medication to try to regularize the beat and did an echocardiogram.  David will see him again in two weeks to see how the meds work and discuss the results of the echocardiogram.  Side effects can be numb extremeties, vivid dreams, dizziness, fainting.  If he can't tolerate them he can halve the pills.  He is not happy about it but wants to regularize his heart so he'll do it.  Next Tuesday is his lung and neck CT to see what's going on with his lungs, as well as a routine follow-up from the cancer surgeries.  Stay tuned.

MId-April review

The pollen around here is impressive.  Golden dust covers everything, including our lungs.  Still, David feels better every day and is able to get out and do whatever he wants.  He saw the dermatologist this week and the surgeries removing the cancers from his head healed nicely.  She froze a spot on his face where the actinokeritinoses slowly come back over the last 20 years.  She froze a spot on his ear and then froze a wart on his finger.  The wart developed a huge blister under it.  Apparently that is a good result and he was instructed to take a sterile needle and puncture it.  He did and it is now covered with a band-aid.  On Monday he starts applying the wart removal medicine.  It's always something but these are minor bumps that are easy for both of us to handle.

I saw my endocrinologist last week and my thyroid levels are good so I just continue with the medication level for the Graves/Hashimoto combo.  The semester is winding down towards graduation and I'm looking forward to going to TX for Grace's First Communion on April 30.  David will be on his own because Than has a conference in Williamsburg that weekend.  I'm sure he will be fine and we will FaceTime several times.

Slow improvement

Today David got up early, went to his usual meeting with Fred and Ron.  He said he walked a little and then went to Harry and Cathy's Dumfree's Diner for political discourse.  The temple was closed so he came home and took a nap for a couple of hours.  Next we got into the car and drove to Reston. He walked about three blocks from the parking garage to the Apple Store and was exhausted.  We walked about a block to Chicos where he rested while I tried on stuff.  He could not walk the couple of blocks to the car and I got it and picked him up.
He coughed a lot on the way home and cleared out his throat.  This allowed him to speak more clearly.  He is hearing me in the car without my using a microphone.  He is still very cold and uses the parabolic heater while sitting on the couch and watching TV.  He is staying warm and resting when he needs to.  Nose bleeds continue to plague him.  He seems to run out of steam but I think that he is slowly improving.

Something new about David's health

Because David had a sore throat we went to see the doctor again today.  Dr. Clemo, our internist, is on vacation and so he saw another doctor in the same practice.  After reviewing all the records, etc. we learned that the sputum cultures were negative for mycobacterium.  (According to the pulmonologist sputum is not indicative if negative, the bronchoscopy goes down to the lower lung where the gunk is, to get a good sample.  Even then, this stuff does not easily grow and there is only a 50% chance it will be detected. ). Anyway Dr. Ameen, the substitute internist, is treating for a yeast infection with flluconazole for five days and said to gargle with salt water.  IMHO the evidence is all pointing to an aspiration-caused pneumonia blocking gas exchange but not an infection per se.  I guess we'll see.  We left the doctor's office and went to Costco for the prescription and shopped for Easter stuff to.  Now we are home watching recorded shows...only David is napping while sitting on the couch.  I hate to wake him up to go into the bed for some real rest.

Good news at Georgetown Hospital

David saw Dr. Davidson at Georgetown earlier today. He examined him thoroughly and scoped his nose, nasopharyngeal down through the vocal cords. I got to see it on the color monitor and was fascinated.  It is all pink and shiny with no signs of a cancer of other problem.  His throat is irritated and there was some mucous probably from coughing.  Nothing at all to worry about.  We are both relieved about that area.  Now he waits until the end of April to see the pulmonologist, Dr. Goyal and will probably have another CT in May to see what is happening with his lungs.  When he has that Dr. Davidson ordered a neck CT with contrast for the usual follow up but does not need to see David relative to that until next March.
While we were waiting there were several children there.  That can't be good.  They were these thinly little kids who no doubt had huge problems.  One mom was clearly on edge and talked to me about not being able to find parking in the garage and not knowing what to do before the appointment.  The parking attendant told her to find another garage with parking and she told me she had no idea how to do that and then find her way to the otolaryngologist' a office.  Eventually she followed someone to their car and took that space.  (I did that too...just like I do at the mall.)  I felt sorry for her being the only parent with this little guy who got referred to Dr. D.
On the way home we stopped by Costco and the audiologist adjusted David's hearing aides and made a new mold for one ear so that is is more securely placed in the ear.  It sometimes gets loose and then he gets terrible whining feedback.

Revised date for Georgetown

Due to scheduling issues, Dr. Davidson's office moved David from tomorrow to next Wednesday at noon.  So, until then, there will likely be no new posts.

Pulmonary report

David saw Dr. Goyal today about his lung issues.  After a thorough medical history and exam the decision is to observe David but not treat anything yet.  If he has trouble we need to call right away.  He needs to do a bronchoscope to get a sample from the lower right lung and then see if it can be cultured.  It could be one of those atypical mycobacterium or it could be a fungus.  Both take a year or longer on several drugs to clear.
David's lungs seem to be improving with almost no blood in the mucus that he coughs up when taking pills.  (The doctor verified that this is because he is aspirating water while trying to swallow.). David is having a lot of trouble speaking.  His voice is very strained so that he asked me to answer out of Dr. Gyal's questions and that concerned Dr. Goyal who recommended that David see his otolaryngologist soon and have him scope his larynx.  We called Georgetown right away and have an appointment tomorrow at 12:45 with Dr. Davidson. We'll leave early in case there are interesting things going on I95!!
Lorrie has been doing distance Healing Touch work on him an overall David seems much better, has more energy, is not coughing much and is not wheezy.
We are both looking forward to seeing Jeff next week and doing as much as possible while he is here.  I think that they plan a trip to a museum in Richmond and the temple is having a Purim dinner and Schpiel.   I will post more after we see Dr. Davidson tomorrow.

Friday news

No big changes.  After a hiatus from Pradaxa for four days, he began it again yesterday and the bloody coughing has not increased.  Today he got up about 5, took the trash cans down to the street, made coffee and came back to bed for a few hours.  He went to Silver Sneakers but is not pushing it and took a nap this afternoon so that we can watch TV together tonight. Unfortunately, I am in the 7th week of a 10 week class and had to make a video, add closed captioning and upload it into the Course Management System. Three hours later I have a 5 minute video submitted.  Now we can watch TV for an hour.  Saturday I'm signed up for a short seminar on campus and he plans to go to Torrah study.   He submitted two sputum samples, one Tuesday and one Wednesday.  Once they are cultured and characterized, the pulmonary Doctor will know how it can be treated.  David is worried and anxious to get that information.  I appreciate your prayers and healing touch work.

David's Leap Day update

After yesterday's bloody sputum started and continued this morning, David saw Dr. Clemo this morning.  She agreed that stopping Pradaxa yesterday was good and said to stay off of it for the next three days and call her if anything gets worse or if he is still coughing blood after three days.  She also gave him sputum sampling cups and he is to get a sample to day, take it to the lab and a sample tomorrow and take it to the lab.  She said that these cultures take a few weeks.  He feels much better after seeing her and her calm attitude.  The fact that he has no fever and that his bp is low/normal indicates that whatever is going on is not urgent.
He is scheduled to work the polls tomorrow for four hours (It is Super Tuesday in VA) to lobby for anti-gerrymandering.  The doctor recommended cutting it back to two hours.
So he is back to the house with me.  I had no classes scheduled today or tomorrow since I assigned an online exam and the students can use their class time to take it but not in the classroom.  That was really convenient this morning.

It's been a long time.  Since David's pneumonia has not resolved since Christmas Eve the following has happened.
Prior to the pneumonia diagnosis he had a lot of issues with hearing in his left ear and took a course of antibiotics and then the dreaded prednisone for ten days.  I think that the prednisone opened the door for the development of pneumonia.  Boo Dr. Franz.

OK so finall in January I dragged David, kicking and screaming to see Dr. Clemo who gave him ampicillin for a week.  She said if he didn't feel better to do a chest X-ray and blood work.  He is reluctant to expose himself to more radiation, with perfect reason and thought he was doing better after a week of antibiotics.  However, the NEXT week he had to stop on his weekly walk.  He had to stop four times, came home and fell asleep.  The next day he had the x-ray and the following day the Dr.'s office called with the pneumonia diagnosis and an appointment.  She examined him and prescribed augmentin.  He had a terrible GI reaction to it.  Since it is the ONLY plausible outpatient treatment, we split the dose into four times a day and added Imodium AD.  He seemed to feel better but was still coughing so a CT was ordered.  Now it gets complicated.

The CT showed pneumonia had not improved AND that the pattern and densities indicate an atypical mycobacterial infection.  He has no fever, no chills (he is ALWAYS cold) and seemed to feel OK so Dr. Clemo referred him to the local pulmonary practice where he has an apt March 10.  She also said she encouraged activity and that he can walk.  So today he went on the Sunday walk for the first time in three weeks.  Then he came home, showered and had lunch and we went up to Alexandria to visit with his cousins at La Madeline.  On the way home I95 was a parking lot and we took Rt. 1 (double time and lots of lights).  He starts coughing...up....blood and was freezing cold.  He declined to go to the emergency room. At home he continues to cough bloody mucous, but his bp and heart rate is normal.  His temperature is low, not high.  But he has very little energy and asked me to crush his pills and pour out his Jevity. I gave him the meds and Jevity but we decided to forego the Pradaxa since he is bleeding.  I will call Dr. Clemo, his internist, in the morning at 8 and hope that she can see him and possibly fast track the pulmonologist apt.  I am extremely concerned and wonder if it is not an atypical mycobacterial and is bleeding in his lungs from Pradaxa.  Hoping and praying that he gets better.