DR visits

Saw the radiation oncologist this am. He didn't seem too concerned about the inflamation and pain in my right "breast" because the burn is healed. He did disagree with Dr. Boob trying to further expand that side this afternoon. I return to him in 6 months. (Left Jim alone with strict instructions not to get out of bed except to use the bedside commode.)

Saw Dr. Boob this afternoon. (A Transitions volunteer watched him.) Dr. Boob didn't want to expand the right side either, because with the inflammation, it already was larger than the left. He did a fill on the left to make them the same size. I had to sign a consent for the use of silicon implants in the final surgery. He said he would make a four inch incision on the outside of each "breast" to remove the expander implant and put in the permanent ones. I will not have surgical drains (YEAH!).

We talked about the nipples. I told him I wanted "low beams." He said it's almost surgically impossible to do high beams. He said that the nipples might seem high beam at first, but that they flatten over time. The whole approach for creating nipples is something like a french knot. The surgeon will gather up a bunch of skin and form it into a mound. Later, there is a tattooing process to make the nipples a "normal" color.

The last couple of days Jim's appetite has been off and he's had alot of abdominal gas (with cramps). I didn't give him lactulose this morning. I just put him to bed (4:30 pm) with a Prevacid. Looks like it might be another night without dinner.

He sees his GP tomorrow and we are going to have the PICC line fight, I am sure. Then we go to visit the Adult Day Care. Jim said he hopes that works out for him so that he can go outside and sit on a bench and I can work. Jim also spoke today with the clinical director of Compassionate Care Hospice. He felt alot better about the organization, and after we hung up, he said "OK, you win. We'll use them."

If and when we ever hear from Jim's case manager at St. Francis Home Health (she didn't show up today, instead another nurse was sent), we will have some idea of the timing for going to into Hospice. I still hope that after we see Jim's GP tomorrow and his GI guy on Tuesday we will be closer to understanding what it means to go into Hospice (in terms of what kind of "aggressive" treatment we would be sacrificing). We aren't giving up on Jim having quality of life, and that is the one thing the clinical director stressed to him today--they are 100% behind that. She actually said: "We don't want you lying in a hospital room somewhere. We want you out enjoying yourself at Delaware Park." (Which is a race track, slots gambling place that we would never go to, but we got the point.)

The thing is, I don't see much "aggressive, potentially curative" treatment for end-stage liver disease other than a transplant. And the GI guy already told us Jim is not sick enough for a transplant, and Jim didn't want to do the advance testing for when he did get sick enough. The things he's been through already--sepsis with IV antibiotics and low platelet count with blood transfusions--this Hospice said they would support as care to make Jim comfortable.

Anyway, again sorry to drone on.