Minus Thirteen

There is nothing much in the way of news today, and that is a good thing. As of this morning, Charlie had lost thirteen pounds since entering the hospital on Friday. The doctors switched the Lasix delivery today to oral from intravenous in anticipation of returning home within the next couple of days. The wound looks better and smaller. On the negative side, a considerable amount of discomfort and inability to find a completely pain-free position continues.

Still Losing

The treatment continues to be the same, and Charlie lost a couple more pounds on the scale. As seen in the frequent blood tests, he is tolerating the Lasix well. If that continues, the doctors may increase the dosage again tomorrow. He is still uncomfortable. While the look of his legs is no longer elephantine, it would be hard to say they are anything but huge. In answer to my question this morning, the fellow said that Charlie would probably remain in the hospital until most of the fluid is gone.

Minus Seven and Counting

The more aggressive treatment is producing results. Charlie has lost seven pounds since he entered the hospital yesterday. He is not yet comfortable, but the loss is encouraging. Being in the hospital where his blood profile can be tested as often as needed, the doctors are able to give him larger doses of the diuretic Lasix. (Lasix is widely used in horse racing and is often thought to be performance enhancing, so this regimen has been the subject of a few bad family jokes.)

Another very good medical development is that the incision wound has healed to such an extent that use of the wound V.A.C. is no longer necessary or even feasible. This means the wound is well on the way to being completely healed. An additional bonus is that Charlie no longer has any external equipment to carry around with him.

Back in Room 1937

We had a regular appointment with Dr. Jarnagin this morning, and he recommended hospitalizing Charlie again for a couple of days to treat his continuing edema and other related issues more aggressively than is possible at home. He will also receive a transfusion for the anemia he has had ever since last March. Unlike previous returns to the hospital characterized as setbacks, detours or bumps in the road, this one is really to put him on a faster track to full recovery and make him more comfortable. Continuing to carry thirty plus pounds of excess fluid is very unpleasant, so Charlie is actually happy to be readmitted. By coincidence, he is in the very same room he had last time, 1937.

Hooray!

Charlie and I spent the day at MSK, and all the news was good. An ultrasound and blood work showed his kidney function is fine, so the diuretic dosage could be quadrupled to help rid his body of the thirty or so pounds of fluid he is carrying. The remaining staples were removed from the incision, it was not as painful as last time, and the infection is healing well. (They estimate that the wound V.A.C. has already saved him two to three weeks of healing time versus the old-fashioned dressing.) His abdominal cavity has dried out and the drain was removed--no more plastic bag to pin inside his clothing when he goes out. Ultrasound of his legs revealed no new blood clots. All of his blood work was favorable.

We feel pretty good tonight. It looks like Charlie has turned the corner after the infection detour. (But have I picked up Dr. Jarnagin's cliché habit?)

A Challenge

When I am working with my trainer at the gym and tell him something I am doing is hard, he always replies that the exercise is a challenge for me. Evidently, a trainer learns never to allow a characterization of "hard" on the theory that "challenge" is more positive and will keep the client motivated. Keeping this in mind, I would say that being at home with the drain and the wound V.A.C. is a challenge for Charlie and for me as the primary "caregiver." Nonetheless, Charlie seems to be making gradual progress. The interventional radiologist will evaluate where we are with the drain on Monday. Charlie definitely looks better to me, and he is now out for his third four-block walk of the day.

This afternoon, we watched some of the Saratoga horse races on television. Charlie and David are looking forward to the Giants preseason game against the Bears this evening.

The Visiting Nurse

We finally left the hospital in the early afternoon. I had arrived at 7:00 a.m. for an early departure, but a couple of snags kept us there in rather ill humor until 1:00 p.m.

Amazingly, things brightened considerably with the arrival of a nurse from the Visiting Nurse Service of New York. A few of our previous contacts with VNS had not made us especially hopeful for anything beyond a person with technical competence to use the V.A.C. wound therapy machine. But the nurse assigned to Charlie's case, Phil Leon, proved to be knowledgeable, kind, helpful and professional. He demonstrated his "can do" attitude when we found the box of supplies provided by the V.A.C. machine rental company did not include a crucial type of wound dressing. He called another client and arranged to go to his home and borrow what was needed to install the V.A.C. today and then returned to finish the job. He gave some great suggestions for getting more protein and calories into Charlie's diet, and he volunteered to arrange for in-home physical therapy to help with the back pain situation. Charlie and I both felt relieved and optimistic when he left. He is scheduled for visits three times a week, but he offered to stop by tomorrow to check on how Charlie is doing and to see if there are any problems with the V.A.C.