Update Oct 30th

Jimm is doing all right. Tube feeding has been restored, and the vent and dialysis remain constants.
There has been discussion about another facility, University Specialty Hospital on North Charles St, where Jimm may go in a couple weeks if he continues to be steady. I haven't looked the place up yet but will do so soon. It evidently will take patients for rehab who are still not as fully weaned from devices and treatments as some, which is the case with Jimm.

We hope that his message reported on Monday's blog will open the door to more long term recalling of things that have happened and been said. So far he is still quite responsive, and if anything is problematic, it may the lack of a positive and determined attitude that sometimes creeps in.

aw

*A Message From Jimm

Nothing like this has happened for four long months, but finally here it is. As an indicator of a possible major turning point in Jimm's recovery, he has requested.. through Laura.. for me to put the following on the blog:

"Please tell everyone I said thank you so much for all you're doing and I miss you all".



I'm pretty speechless..
this post is open for comments if you would like to respond or offer your thoughts.

Update Oct 28th

No news has been good news.. Jimm is still going along well. This weekend he has done some chair sitting, and yesterday he wore his Penn State hat for the first time! His mood is good and he is communicating actively.

Light vent continues, CT scan done earlier today to check something out having to do with starting up tube feeding again.. only IV feeding has been done the past few days. Another urologist has been called in to give an opinion on mysterious blood in urine. But now, at least that's the only place bleeding is still occurring.

We told him about the golf tournament going so well.. and got him an Oakmont Green hat(where the tourney was held in Hampstead, MD). Now that he seems to be wearing hats again, that's pretty good timing.

aw

Golf Tournament Note/Update

The following reprinted from the Funding page-
The Jimm Revelle Charity Golf Tournament has been a rousing success. The weather broke perfectly, as planned by John through a previous arrangement, and a good time was had by all. That is a judgment made after seeing John and Harry careening about in their cart, laughing hysterically and having more fun than should be legal.. and Tracy and George in their "refreshment cart", grinning ear to ear and showing off hilarious photos of players, and a tip jar bursting at the seams.

A further report and pictures will be coming up.
---------------------------------------------------------------------------------------------------
Jimm has been doing about the same, which is basically good news.. more details will be on the way today.

Events Updates

We have word from John Valente that 44 people have entered the Jimm Revelle Charity Golf Tournament. That is great news. See more about the tourney, going on today Saturday Oct 27th, on the JimmFund page.. and late word from John below...

Hi Everyone-

Golf event is a go at this point. Unless we have heavy rain in the late morning/early afternoon Saturday, everything is on. Please call my cell phone for follow up if you have any questions.

717-465-5723

John A. Valente
Mortgage Consultant
Prosperity Mortgage Company
MAC M4011-021
1444 Baltimore Street
Hanover, PA 17331
Work - (717)630-0020
FAX - (866)526-3885
Cell - (717)465-5723
john.a.valente@prosperitymortgage.com
http://www.johnvalente.com

The Jimm Revelle Benefit Racquetball Tournament will be held on Saturday, Nov 3rd.. and you can find details about it on the JimmRBall page. Official close for player registration is Friday Oct 26th. However, some late entries may be accepted.

Update Wed Oct 24th

Monday evening Jimm had some bleeding from his stomach. An endoscopy showed it was his ulcers. He had been getting an antacid drip, and that continues. Even though the jejunostomy tube goes in well below the stomach, they have stopped feeding through that for the time being and are concentrating on IV nutrition. Blood is still present in his urine- they are not sure of the origin.. and the vent is now on a very low assist setting, so the lung clot must not be much of a factor anymore.

There is once again talk of selecting a rehab facility. It would probably have to be a place that would take him with a few strings attached.. like the need for dialysis, ostomies, drains, and the ventilator. It seems unlikely that he will be able to shed all of these peripherals anytime soon.

Jimm spent more time Tuesday in the chair, and is pretty darn perky compared to a week and a half ago. Friends are urged to visit, especially on weekday afternoons. He is evidently talking his nurses' ears off at times.

aw

Update Oct 22nd

We're glad to report that Jimm continues to be much more "with it" as compared to last week. Today he sat up in his chair for four or five hours, had dialysis and so he will be tired tonight, and they are once again trying to wean him off the vent.

Deborah and her mom were able to spend some time with Jimm today, and Deborah is very happy that things are better. She is off to the Quarter Auction with her friends in Rosedale tonight.

aw

Update Oct 21st

The big news is that today Jimm has come out of his delirium-like non-communicative state. He has been waving, talking and interacting.. much to the relief of all concerned. What the cause of the strange behavior was is not known, and predictably Jimm doesn't remember any of it.
The tube has been taken out of his nose, bleeding veins in his belly have been successfully treated, and he is receiving an IV acid neutralizer for his stomach.

It's a good report.

aw

Update Oct 19th

Jimm has not been feeling well at all today, and has been sick often. Because no brain scan or other evidence of physical problems has been observed, for the time being they are treating his communication shut-down as delirium, and, in an attempt to improve matters, are trying to cleanse his body of as many drugs as possible while still keeping him reasonably comfortable.
Still wait and see on the clot, which is still there. Sounds like they will wait as long as necessary for it to dissipate by itself, especially since airflow is better and the vent is down to 40% assist.
No bug ID yet..but no temp either, and other vitals are solid. New jejunostomy is taking in food well and IV nutritional feeding is also being done.

aw

Update Oct 18th

No change. The clot is still about where it caused the trouble.. at the intersection of the two primary bronchi. Because it landed right in the middle, it was able to shut Jimm's air off completely on Tuesday stopping his heart momentarily. It has gotten smaller so that air is passing around it. As reported yesterday, it remains a wait and see situation.

Jimm's inability to communicate continues. Despite making eye contact, he does not talk or follow commands. A scan has found no sign of a stroke, so maybe Jimm has just taken a break for a few days. It is not thought to be a conscious choice, but the body works in strange and mysterious ways when it comes to protecting itself from stress. We just don't really know what's going on at this point.

The bug, and the source of the most recent infection, has not been found yet. If memory serves, the now famous MRSA has gone through Jimm at least once. It's a good guess that he has had every nosocomial super bug that exists.
Today a new dialysis line is being put in, and dialysis will be done this afternoon.

aw

2nd Update Oct 17th

They have been continuing efforts to dislodge the clot, by dissolving it, and by physically removing it. No success yet, but they are taking their time for now because Jimm is breathing OK with the vent turned down to about 70%.
If there is no further success with other methods, the thoracic surgeons will take over. Surgery will be a last resort considering the obvious inherent dangers. It is doubtful they will try it today unless Jimm gets worse.

Another new infection is being cultured to prepare an antibiotic, and Jimm's NG tube is still in place even though the new jejunum tube is feeding him at a good rate. Thankfully, he is stable for now.

aw

Update Oct 17th

Early review of last evening's alarming event:
Yesterday I got a call from Deborah at 5:10 PM. She said Jimm had a clot in his lungs and was in trouble, and that the family was being called in. In fact, she had been directly told by one of the doctors that his chances of survival were slim.
The update of Oct 16th at 5:30 PM was based on this call. The only info I could get from her in her hurried and distressed state was that they had something down in his lungs trying to get this stuff out, and that his heart had stopped once earlier during the crisis.
Thus, the mention of the pulmonary embolism, often a life-threatening occurrence, and not uncommon in patients like Jimm. In fact, a fairly rare thing had happened. A sizable mass of coagulated blood, a large clot, had built up somewhere higher in his throat and dislodged. It went down through his trachea to the bronchi and managed to shut off the airflow to both lungs causing his heart to stop for a short period. According to the docs, the 6 minute mark is seen as the danger point, but his stoppage lasted less than a minute. Most likely a bronchoscope was used to try and pull the largest clot out. They were successful enough to stabilize Jimm overnight with the vent working as hard as it ever has, but more needs to be done this morning. Also they will need to analyze where this mass came from. One early guess was that it may have come from the the problematic bloody tracheostomy tube. That will be discussed in a meeting of doctors today.
All I can say is that I am relieved for the time being.. I really thought that Laura's call at 9:15 last night was word that we had lost Jimm.
He had a tough day, and has had a tough four and a half months.. but he is still here.

Hang in there with me.. I'll see if I can get anything further later in the morning.
Thanks for being there.

aw

Second Update Oct 16th

Jimm is still with us.
He had a large clot in his airway down near his lungs that shut off the air to both lungs for less than a minute, but long enough for him to code and his heart to be restarted. That means there is a likelihood of no permanent organ or brain damage. He seems to have dodged the bullet.
The family has left the hospital for the night believing that Jimm is stable, and will see the morning. In the morning, docs will have a meeting to determine how to get the clot out completely.. since they were successful in getting only some pieces of it out tonight. They will also try to figure out where the thing came from.

More as we get it in the AM.
Get some sleep.

Update Oct 16th

A note about the following: a pulmonary embolism was not what actually happened to Jimm. From the emotional first report, that's what it sounded like.. but it turned out that the clot was not in an artery, but in the trachea.. cutting off air instead of blood supply. Both of course are dangerous, and Deborah was told this day that Jimm's chances of survival were slim.
This note is kept here as a record of how the event was recorded at the time.. a scary time to be sure. aw

Jimm has suffered a pulmonary embolism. This means that one or more clots have reached the lungs. Procedures are being done to try to remove them.
He is on the ventilator and his heart has already stopped once.

The family is coming in because things don't look good.
If you pray, do it now.

Update Oct 15th

Jimm's bleeding on his lower right side is still an issue, as is the anemia. He received two units of blood today. A CT scan will be done soon to determine the source of the problem.
The jejunostomy, which enables liquid food to be introduced into the intestine at a point close to the stomach, was completed Friday, and Jimm is being fed via that method now. It is hoped this will let the stomach rest and that it will begin to function better at a later time. He is still on the vent.

In the past few days Jimm has not always been communicating as willingly as before. It may be due to feeling low about the whole situation, and if that's it, he just needs to snap out of it. The family believes that reinforcement and encouragement from good friends is one of the best medicines Jimm can have right now.

Deborah has been given a list of possible rehab places to consider.. the thought being, if he keeps doing well, he could be out of the hospital in a few weeks.

aw (day 140)

Update Oct 12th

The stomach problems persist. Things won't stay down, and the bizarre greenish secretions continue. An external tube to provide nourishment going directly in somewhere below the stomach is being planned. Maybe a jejunostomy for enteral hyperalimentation no less. An NG tube has been used for all stomach feeding and aspirating up till now.
There is still evidence of blood in Jimm's urine, and that is thought to be from the constant use of a catheter. They are taking that out today. There is also blood coming from a drain on his lower right side. With all this leaking it's no wonder that Jimm has been anemic for some time. He was given one unit of blood today.
Lung issues are being addressed by the respiratory therapy folks and he remains on the vent most of the time.

Rehab is being looked at in one of the more comprehensive and aggressive places like Kernan, which is owned by the University of Maryland Medical System. Before going to such a facility, Jimm will have to continue to be stable for a couple more weeks, and make some progress in the gastro and respiratory areas.

Jimm is always dealing with negative feelings but he's been doing some sitting in the chair and actually stood by himself by the side of the bed for a few moments.. a big deal. Also, he recently got a ride down the elevator to the lobby. Reportedly, he was chatting away with his trach collar much of the time.
That had to feel good to him.

aw



.

Funding Update

We hope to have news on Jimm tomorrow.
In the meantime, please check out the impressive new totals in the Fund.

Thanks.

The Jimm Revelle Benefit Racquetball Tournament

The racquetball tournament for Jimm is near the close of registration and has its own page. Please go to http://jimmrball.blogspot.com to get more details.
This is an event that Jimm would love to be involved in and will definitely get a kick out of hearing about.
Please support it however you can.
Thanks.

Update Oct 10th

The only news we have so far is that Jimm spent some time sitting in the chair today, and that he is quite low and in need of friendly faces.. especially in the early to mid afternoon when the family is less likely to be there with him.
Go see him this week if you can.

Deborah will be there this evening.

aw

Update Oct 8th

Oxybutinin or Ditropan, an antispasmodic/anticholinergic drug for bladder issues, was causing Jimm to get the shakes a few days ago. It has been discontinued and he shakes a bit only when exerting himself lifting his arms. He is still quite weak.
Jimm's urinary bleeding was investigated with a cystoscopy today, and nothing substantive was found. However, urine will be sent to an outside lab for further testing.
The trachial bleeding has for the time being been blamed on the installation of a new downsized trach tube.. a positive step. But a complete endoscopy will be done soon to check his entire digestive tract. Of special interest is his stomach which has been problematic in a number of ways.
Today, in addition to the cystoscopy, he was dialysed and so is one tired cowboy right about now.
The temp spike on Friday was traced to an infection in his central line which was quickly removed and actually has not been replaced as of earlier today. With no mechanism to administer sleep meds, this led to a sleepless night Saturday. He is still getting insulin as needed.. pain meds as needed.. IV feeding of some sort(TPN or PPN), and is still on the vent which has been dialed back as much as possible. Getting off that device is seen as a necessary step in further improving Jimm's condition.

Jimm has been very tired the past few days and this has made it tougher for family members to communicate with him. He hardly moves his lips when fatigued like this. He does seem to better understand where he is, and he now fully realizes that he has an ostomy. He of course is not happy about that and has been depressed at times. Currently he has a good bunch of nurses who understand the situation and push Jimm to do more. At this point he needs that.

aw

Update Oct 6th

Our buddy has been more awake, and his mood pretty positive. He hasn't been sitting up in the chair anymore since earlier this week, but recently did enjoy a sit on the side of the bed for a while until he got tired.
No word yet on what caused that bleeding we mentioned earlier. The insulin drip has been replaced by occasional shots as needed following daily blood sugar tests. Jimm is still on the vent at low pressure, is on IV feeding because of continuing bad luck with tube feeding, gets dialysis every other day, and despite a temperature spike last night(it WAS Friday after all) is much improved today.

Jenna, who has always been a faithful weekend visitor to her dad, will not be there today.. so Deborah will keep him company.

aw

Update Oct 3rd

Yesterday and today there has been a bit of blood in his urine, there is also blood in his trach tube which they are going to investigate this afternoon. Jimm is regurgitating some of the fluid in the intestinal feeding tube.. not clear at this point why that is happening. He has had the shakes a bit, and that has led to a medication change we will get more info on.

The graft donor site looks good and the stomach grafts have continued to take quite well. And it is good to note that Jimm now has another key goal besides getting off the vent, and that is being able to sing happy birthday to Jenna on October 26th.

aw

Update Oct 1st

Jimm sat up in a chair yesterday for about 4 hours. He continues to do well, with very little pain, and is a bit sharper and seems to be remembering things better than he was on Friday. He spent some time off the vent and talking also yesterday.. and his tube feeding rate was increased.
He is a little depressed, but is exercising each day.. and, as mentioned before, is making a concerted effort to get off the ventilator.

aw