Update/Note June 30th

Jimm's surgical site was checked out, cleaned, and redressed in the room this morning. He is more conscious than usual, and unfortunately this can lead to a bit of flailing around(that bad boy thing again). It seems he tore out a line that had been inserted under his arm to avoid just such a thing.. but hey, it was the central line they were going to remove today anyway.. so they couldn't yell at him too much.

Blog note: Please see the revamped post *Contributions/Fundraising in the right hand archive section.

Thanks
aw

Update June 29th

Blood note: On Monday the dialysis machine got a little clapped up and withheld a bit of Jimm's blood. He was given about a pint to replace it. This is the first blood he has been given since the initial operations were done something like two weeks ago. All things considered, his blood needs have been relatively small.

General condition- back down to earth a bit.. The ventilator that was shut off was reactivated after about 7 hours. And, even though use of the 24 hour dialysis machine has been eliminated, he is put on a regular machine from time to time. His kidneys are making urine much better now.. but not enough to detoxify his blood to the necessary degree. The central line is going to be taken out. Blood glucose testing will now be done by finger prick. Jimm has contracted VRE* and is being treated for it. Because of this, gloves and gowns are worn by all who step into his room, for their protection. His blistered left arm(the result of an infected IV site) has been debrided, which means the devitalized skin has been removed. Grafting may be held off so it is done along with the abdominal grafting.. which will occur after the washouts are finished. We're not there yet. One was done yesterday and unfortunately it will not be the last. Word is that Jimm's recovery may take more than 6 months.. maybe 9. The abdominal site will have to be closed twice. Once initially, and several months later, opened and closed again. This of course will lengthen the time needed for thorough healing.

Depressing time frame estimates aside, the doctors say that Jimm's recovery is going as expected.

Jimm still opens his eyes every so often, and actually smiled at his daughter Jenna once. Needless to say, it made her day.

Generosity prevails from all corners. A luncheon and bake sale was held by Deborah's fellow associates at Wall Mart, and the proceeds presented to her.. and friends of Jenna got together and bought her a Wawa gift certificate, a welcome item since she is traveling so often from the Philadelphia area to spend time with her dad.

* http://www.cdc.gov/ncidod/dhqp/ar_VRE_publicFAQ.html

Jimm Update June 27th

Some additional good news: Jimm has been taken off the 24 hour dialysis machine.. and the ventilator. Talk continues about closing him up(no more operations) ,but no final decision has been made on that yet. Deborah was very happy yesterday to have him nod yes as a direct answer to a question. All these are very encouraging.

aw

Jimm Update June 25th- Racquetball & Blog Notes

In a nutshell.. BP steady, fluids nicely down, new feeding tube inserted, possible end to surgery in sight, pancreas continues doing better, getting mild physical therapy, picked up new infection and put on new antibiotic, will need plastic surgery including skin grafts for left arm.

Kathy and Joe Cornell, old friends and racquetball experts, are thinking of putting together a benefit tournament for Jimm.
More details soon.

Also, am planning a photo blog with bunches of JimmPics. Send one or more to aweebster@gmail.com and I'll put it up. It will be good to remember Jimm healthy.. as he will be again!

Blog note: am trying more posts on a page.. currently they can all be viewed by just scrolling down- without changing pages. If this is bad for anyone let me know in comments.

Thnx,
aw

Jimm Update June 23rd- Plus Notes

Correction to yesterday's post.. he is not completely off the sedative. He got a little perturbed last time they lightened him up too much and he pulled his central line out(bad boy!).. now it's under his arm.
Breathing is good because he is exceeding the ventilator's assist to a good degree. BP is again holding up.. so they had plans to take some more fluids off. Stomach feeding has been stepped up slightly.
His arm is wrapped again(they had been exposing it to the air)but is said to be improving.. and the hand support is spreading his fingers out so they don't get clumped up, as well as holding his wrist up.

Jimm still halfway opens his eyes at times, and it is thought he hears us because he will usually wiggle his toes when asked. In other words.. things are much the same with some noteable improvements.
Unknown when next operation will be done.

Post note:
Please see Modified Note On Expenses.. below.

Blog note:
All posts that contain important info and are worthy of revisiting now have asterisks(*)
aw

June 22nd Update

Early today another cleaning procedure was done. Jimm is no longer on BP meds, and today more fluid was drained off. He is also off sedatives and only pain meds remain. White cell count is down to 22.. a positive sign. His left arm that had been pretty rough- is noticeably better. Oxygen input is down a bit from 55 to 40%.. the smaller the number the better.

A note on the lung collapse mentioned in last update: It's good to report that his lung reinflated itself quickly after the incident and has been OK since.

More tomorrow.
aw

*June 21- Notes On Blood, Visits, Mailing Address

Blood---
Kathie Rumbley, who is A negative(Jimm's type), was planning on donating blood for Jimm. Unfortunately, she is under the weather and won't be able to do that right now. But for anyone else who is considering a donation, Kathie says:
> Here's the telephone number for people if they
> want to contact the Red Cross about blood
> donations for Jimm.
>
> 410-764-7000 ex 4626

Note: If you call you will need info on Jimm's whereabouts-
James Revelle
Gudelsky 4 Rm 22
University of Maryland Medical Center
22 S. Greene Street
Baltimore, MD 21201 --This address is also good for getting cards, etc. to Jimm.

Thank you Kathie.. get better soon.

P.S. Kathie also has some financial input you can see in the comments section of the "Expenses" post.
__________________________________________________________________

Visits--
Some of you have been asking about visiting Jimm, and it is still too early. He is not conscious, and the staff still prefers family only at this point. As soon as this changes, I will immediately pass the word along.
Thanks,
aw

June 21st Addition To Last Update

I got some additional info today that indicates a small portion of Jimm's pancreas was in fact taken out during the last procedure.. but that overall the organ was looking much better and less swollen.

aw

Jimm Update June 20th

More mixed results.
A wash out was done on Monday and during a turning of his body for cleaning he incurred a mucus plug which lead to a bronchoscopy and a partially collapsed left lung. It was successfully reinflated. A member of the surgical team said that his lungs are in less than ideal shape and will be watched carefully.

Another wash out was performed today in his room. . the usual damaged tissue was removed, but still no parts of the pancreas have been excised. It is good to hear that the pancreas is calming down a bit. This may be an indication that the inflammation is slightly lessening and the self-destruction abating. Let's hope.

Rather extensive blistering on his left arm is being treated with Silvadene.. a topical antimicrobial drug often used for burn victims to prevent wound sepsis, and a splint has been put on his left hand.. perhaps to avoid wrist drop, which can result in hand problems later. One bedsore remains but is healing(sounds like the fancy moving bed is working). Some parts of Jimm's body are puffy, but his BP has been high enough so that the dyalisis machine has been used to drive off some of the excess body fluid.
The feeding tube food volume has been cut back and is being made up by IV nutrients. His white blood cell count is still up indicating continuing infection.. but on the good side, he is putting out more urine.

Jimm continues to open his eyes from time to time, but is still basically unconscious. All our cards have been put on the bulletin board he usually faces, so when he wakes up enough he will see them right away. Maybe he even sees them now. I'd like to think that is the case.

Will try for another update on Friday.
aw

Jimm Update June 16th- With Additional Note

Simply put: Things are much the same regarding Jimm's condition with minor but positive shifts. His eyes open every so often, but no one is home quite yet. The next steps up will be self-breathing, and then later, being awake enough to talk. No one has a solid idea of how soon that will be.

More technically: He remains on intimate terms with Ativan (lorazepam) and fentanyl, a sedative and pain med mix that is heavier on the latter. He is being given just enough to make him comfortable and not much more.. the thinking being, the closer he is to consciousness, the better his body can heal itself.
His ventilator has been shifted from a more long inhale-short exhale cycle, to the opposite, which is more like normal breathing and keeps the lungs inflated to a lesser degree. A good sign.
He had two wash outs last week.. Tuesday and Thursday, and will have another this Monday. No additional word from the surgical team, except that septic damage is cleaned out each time and things are checked out carefully. At least one CT scan with a contrast agent has been done to help them see organ and other details more clearly. The pancreas is still troubled, and this event has had a detrimental effect on the kidneys(which we know about)and also the liver, which is working harder to compensate- but should rebound OK. Some jaundice, or yellowing of the skin and eyes, has been expected due to improper processing of bilirubin in the weakened liver, but this has not occurred yet. The 24 hour dialysis machine continues to do a great job, and could be used more heavily in draining off tissue-bound fluids if they become a problem. So far they are not, and BP is staying up without the extensive use of vasoconstrictors like Levophed.

Regarding blood donations. This has proven to be a confusing topic. The hospital no longer takes blood donations, but rather directs folks to the Red Cross for that. Jimm is A negative. If you have A negative or O negative blood and would like to donate, from what we have heard, there is a chance that- with the proper paperwork and routing, etc.- your blood may make it to Jimm after it is thoroughly screened. This screening would take about a week by some estimates.
http://www.my-redcross.org/index.cfm/p/Contact-Us
This is the website for the local Red Cross blood services office. The 'specialized patient service department', which deals with specific recipients, is open during normal business hours so they could not be reached on Saturday. Since I am unable to give blood because of blood pressure issues, and am not Rh negative anyway, I will leave it up to those interested to look into it further and pass along what they find out. Questions and comments would be welcome at.. aweebster@gmail.com
Thanks.


A note on this blog: To facilitate loading I have put 7 posts on each page. To keep moving to previous messages just click on 'Older Posts' at the bottom of the current page and you will go to the next page of 7 posts. The best way to go to any desired post(for instance, 'Please Send A Greeting To Jimm')is to spot it in the archive list to the right of the current posts and select it directly.
BTW: Thanks to all of you who have written greetings.. they are fantastic! Please keep it up.. Jimm will love them. And it's great for all of us to see who has been checking in.. we've become sort of a community.
Thanks again.

-aw

Jimm Update June 14th

The wash out was done Tuesday night and none of the pancreas was removed. The tracheotomy was performed while he was in the OR, but he is still going to be assisted by the ventilator a while longer. Fluid buildup is a concern but no agressive removal of it has begun because blood pressure and other factors are not indicating a need for that just yet. Besides that, things are quiet and numbers steady.

aw

Jimm Update June 12th

Jimm's surgery was evidently bumped this morning by more more needy Shock Trauma patients, and had not been done at mid afternoon(Shock Trauma and Surgical Critical Care share OR's).

Some positive things today.. he opened his eyes for Deborah last night which is a sign of a lightening of his sedative and pain med levels. To compliment that, they are fine tuning the ventilator in order to ween him off and insert a trach, a tube put into the trachea to facilitate breathing.. instead of the more invasive endo tracheal tube he has had, and they are tube feeding him directly into the stomach.. a big step up in nourishment as compared to IV feeding. He was starting to get a bed sore, so they now have him in a new high-tech bed that moves him around constantly and automatically. His tissue swelling, which was dramatic following the first procedure last week, has continued to reduce itself nicely and he looks much more like himself again (I didn't mention this bizarre phenomenon earlier because we were getting enough bad news at the time). Finally, Deborah says the night and day nurses are doing an effective tag-team act, alternating back and forth so that information on Jimm's condition is transferred between just two people.. resulting in the best possible care.

He remains on a gentle 24 hour dyalisis machine by his bedside that detoxifies his blood in a way that helps to keep blood pressure steady. Also, a doctor on the team has been asked about blood donations, and he will get back to the family soon about how to proceed. Jimm has needed a total of 8 pints to this point (see below).

Jimm Note On Blood June 12th

A couple folks have brought up the subject of donating blood. Since Jimm has needed several pints already, and will of course need more, I will try to find out what's involved in donating blood at University and see if his friends could help if they would like to.
More on this today hopefully.. as well as an update on his most recent clean up that I believe was supposed to happen this morning....

ps- a pint is pretty close to what's in each bag or 'unit' that is dispensed to the patient.. and the average adult has about ten pints in their body.

As noted in June 12th Update above, Dr. Lissauer has been asked about blood donations for Jimm, and he will get back to the family soon with info on how that can best be done.
Thanks to all friends interested in helping out in this way. Stay tuned.
aw

Jimm Update June 10th

Our friend remains in surgical critical care in the Gudelsky Building at University. The level of care that Jimm is receiving is phenomenal. First, I'll mention that he has been stable today and is resting quietly. He was able to slightly wiggle his toes for his nurse Karin.. but this was all he would do. Too far into la-la-land I guess. His nurse has him as her only patient for a 12 hour shift. She tends to only him and his every need, one on one. I have come to understand that this hospital, with this excellent team in attendance, is one of the best centers in the country at treating pancreatic problems. Jimm could not be receiving better care.

In the last post I referred to an operative procedure which is called a wash out. Jimm received his first on Thursday morning. At this time a large abdominal incision was made to facilitate checking the pancreas and other areas for damage, to clean out tissue that is compromised due to sepsis, and to relieve pressure of excess fluids that had built up. Before he was moved back to the room, tubes were inserted for drainage and the incision was covered and protected carefully.. but will remain open for easy access. A second round was completed Friday in the AM. During this one they found a small portion of Jimm's pancreas that is in pretty bad shape. When they go in again Tuesday they will decide whether to remove this or not. The pancreas is still very fragile and inflamed, and distressingly, still doing damage to itself pumping out digestive enzymes that are not going where they should. The doctors are hoping this will stop soon. Due to the surgeries Jimm has had about 7 units of blood replaced so far. As mentioned earlier, it is thought that numerous wash outs will have to be performed.

Due to the advanced stage of Jimm's ailment, and the fact that the procedures I have just described will make for very slow healing of the wound site and possibly call for skin grafts, recovery will be long-term. Current estimates seem to fall into the area of 3 months in the hospital.. and an additional 3 months in a combination of skilled nursing care facilities, rehab and home. A long trek.

On a good note, Dr. Johnson(see last post)says he is not too worried that Jimm's kidneys are just putting out a minimal amount.. at least it's something. The kidneys seem to stick their heads in the sand and shut down during trauma, but often restore themselves when it passes.. we'll see.

More soon.

aw

Jimm Update June 8th

They operated on Jimm Thursday morning. The procedure relieved the pressure that fluid had put on the lungs and diaphragm, preventing full breaths from being taken. It is hoped that this will also help the kidneys and other organs to function more normally. Drains have been inserted to prevent further build up of fluids. Today he has been stable.

Another follow up operation will be done tomorrow morning to clean up some more of the damage that the infections and malfunctioning pancreas have done. These two will most likely be the first of many such procedures. Jimm's surgeon is among the best.. Dr. Steven Johnson, Professor of Surgery and Chief of Surgical Critical Care.
http://www.umm.edu/doctors/steven_b_johnson.html
____________________________________________________________________

Thanks for all the greetings and get well wishes you all have entered in the 'Greetings' post. Please keep them coming.. Jimm and the family need us more than ever.

aw

Jimm Update June 6

Deborah, at the hospital this evening with her mom and daughters Mandi and Laura, reports that although Jimm had a bad night, at least today has been quieter because Jimm is exhausted and slept much of the time. This is probably partly due to the uncomfortable night, and partly due to high toxin levels in the blood that his body is doing battle with. The toxins are present because his blood pressure has been too low for dialysis, and in fact they are planning on hooking him up to a new device that will be performing dialysis on a 24 hour basis. He needs it because the old kidneys are still not pumping much at all(hemodialysis tends to lower the BP so they actually like it to be a bit high before they start the process).

Although a little dehydrated, his temp has been good and sedatives have been cut back in favor of more pain meds. The breathing tube has gone from 30% assist to just giving a little kick. Small steps Ellie.

No more word on surgery.. CT scans are being analyzed to determine what's next.

aw

Update June 5th- Move To Surgery

Jimm was moved from his location in MICU to a surgical ICU in another building early this morning. He is still heavily sedated, and continues with mouth tubes for breathing assist, drainage, etc. which would actually gag the hell out of him if he were fully conscious. He can't speak, and barely knows who's there.. even if it does register, we're told he will not remember much or any of it. Jenna is learning to read his lips pretty well though. His temperature, which spiked yesterday, is under control again and, as always, vital signs are being closely monitored.. and he is again stable.

In this new location the staff is even more friendly and interested in the wellbeing of the patient's family, as well as the patient himself. With this and other factors in mind they are not as open to non-family visits here, and encourage instead good thoughts, prayers, and the occasional card. On this floor they have the option to take him efficiently to the OR if that is deemed necessary. At this time they are still in a waiting and analyzing mode, and no such decision has been made.

Unfortunately, to keep things as calm as possible, no one is even mentioning his birthday for the time being. He'll still be sixty when he gets better, and will be more able to celebrate risk-free then.
I guess it's kind of time for all of us to remind ourselves that this is not going to be a quick fix, but a long arduous process.. and patience is the watchword.

The new address for cards is:
James Revelle
Gudelsky 4 Rm 22
University of Maryland Medical Center
22 S. Greene Street
Baltimore, MD 21201

If you sent anything to the previous room it will be thrown out.
Just kidding.. they will find him.

More soon
aw

From the Beginning- A Review of Previous Jimm Messages

Message #1 sent Wednesday May 30.

Hi all,
Jimm failed to show for RBall this morning and we
were all wondering where he was. The bad news is,
he is suffering from pancreatitis. He had another
stomach pain episode and went to the hospital
last night and is presently(5:30PM)being
transported from wherever he was, to Upper
Chesapeake Hospital(closer to Jimm and
Deborah's). I don't know too many more details,
but Deborah said the doctor said that he is "very
sick". The cause, and whether it is acute or
chronic, is unknown(see:
http://digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis/
for more details on the condition)
I asked Deb to call me when things settle down
and she can talk more.
I'll pass along info as it comes in.

UPPER CHESAPEAKE MEDICAL CENTER
500 Upper Chesapeake Drive
Bel Air, Maryland 21014
443-643-1000
aw
_________________________________________________
Message #2 sent later Wednesday May 30

Jimm is at Upper Chesapeake in ICU room 241. At
this point it's thought his stay will be several
days.
More soon.
aw
_________________________________________________
Message #3 Sent Thurs May 31

I spoke with Jimm today. He is very groggy and it
isn't easy for him to talk, but he said his
daughter Jenna was there and had spent the day
with him, and that he was finally able to get
some sleep today.. much needed I'm sure.

Evidently he went to Upper Chesapeake first, then to University of Md Hospital
for some tests.. then was moved back to Upper Chesapeake where
he is now. Did not get any clear info on his
condition. More from Deborah soon I hope.
-a
__________________________________________________
Message #4.. from Lee Ziemski- Later Thurs May 31

Lee here,
I just called Jimms room. I did talk to Laura. (Deborah's daughter). She said that right now Jimm is having a hard time breathing / catching his breath.
She said that the docs fear that " it " may have worked its way up into his lungs. I did ask if that is a real bad thing and she said yes. Jimm will be in the ICU room for at least 1 or 2 more days.

__________________________________________________
Message #5 Sent Friday June 1

Additional news tonight from Jimm's stepdaughter
Laura.

Thursday evening, as a result of his pancreatitis
and widening complications, Jimm was having
trouble breathing and was subsequently taken out
of his ICU room at Upper Chesapeake to be treated
for a very high fever. Things worsened and this
evening(Friday)he is in critical condition and
has been flown to University of Maryland Medical
Center in Baltimore. There, because his kidneys
and other organs are shutting down, he will be
given hemodialysis and undergo other procedures
to attempt to improve his condition. Lets hope
that happens fast.

_________________________________________________
Message #6 Sent later Friday June 1
(This one was a reiteration of the latest news for some MPT folks and others who had not been in the loop previously)

Jimm is very sick. He has contracted
pancreatitis, thought to have been caused by a
gallstone blockage, and is suffering from
complications including the beginnings of major
organ shutdown. He had been at Upper Chesapeake
Medical Center near his home in Abingdon since
Tuesday evening, but tonight(Friday) he's in
critical condition and has been flown to
University of Maryland Medical Center in
Baltimore for hemodialysis and other procedures
to stabilize him.

I will let you know more as I learn about it.
Pass this news along to anyone else who may want
to know.
Thanks,

Alec

__________________________________________________
Message #7 Sent Saturday June 2

Further Info on The University of Maryland
Medical Center-

General website:
http://www.umm.edu/
Directions:
http://www.umm.edu/gethere/
Map of Campus:
http://www.umm.edu/gethere/campus.htm

Information numbers:
General
410-328-8667

Patient
410-328-6971

Please note that the following information in this message
no longer applies. Thanks, aw 6/5/07

Jimm is in MICU, the medical ICU in the main
hospital building.
To send a letter or card:
Jimm Revelle
W7A Rm11
University of Maryland Medical Center
22 S. Greene Street
Baltimore, MD 21201

To visit:
Checking ahead on his status might be a good
idea-
You can call general patient info at 410-328-6971
and confirm his location.. they will connect you
with the appropriate nurses station.
When I called this morning he was in Weinberg 7A,
room 11. The nurse I spoke with seemed open to
non-family visitors after 11AM.. but only two at
a time are allowed in the room, so you may have
to wait to get in.
Rounds had not been completed when I called, so I
have no update on his condition.

aw
___________________________________________________
Message #8 Sent Sunday June 3

Jimm Update:
Erle, Lee and I visited Jimm today and were
encouraged by what we saw. His "numbers" are
good, with the exception of his kidneys which are
still not up to snuff.. so dialysis continues as
needed. Liver function is good, and the word is
that not enough damage has been sustained by the
pancreas to warrant surgery. Obviously, the
problematic stones have been removed from the
bile duct and that has helped things a lot. He is
still on a stiff dose of sedatives, but they plan
to lighten them soon. He has a breathing tube in
place and they are giving him fluids and
nourishment intravenously so that the digestive
system can rest. Antibiotics are dealing well
with the infection, so his temp is down to nearly
normal.

The folks at University seem to know what they are doing,
and the plan is to keep him comfortable and let
the body heal itself as much as possible. He is
being carefully monitored.. even when the nurse
is in the adjacent room, Jimm's stats appear on
the screen in there too. Essentially he is doing
about as well as a "critical" patient can do.

Ironically, his 60th birthday is Tuesday.. and
I'm glad to report it seems he will see that day,
and hopefully many more of them!

More soon,
aw
___________________________________________________
That brings us up to the June 4 blog post.

Jimm Update June 4th

I spoke with Deborah today and she reports that Jimm had a setback and spiked a high fever last night. The docs are talking about moving him to a surgical floor, which may indicate the need to go in and repair something.. probably the pancreas itself. No detailed account of the possibilities had been received by Deborah at the time we spoke, and that has left her worried and frustrated. Also, the hopes that his sedatives would be lightened have been lowered for the time being.
We are not out of the woods yet.. there are things in there still nipping at our heels. It's a little like a roller coaster ride, says Deborah.. and not a fun one.

I was planning to visit him on his birthday tomorrow(Tues), but will have to see how things are first.