Dave had another ERCP procedure on June 28, 2011 to replace the stent in his bile duct. As Dr. Hutchins had explained before, he would continually need to replace the stents every 6 to 8 weeks as they pose a risk for infection. He had considered a metal stent for this procedure to increase time between ERCP's to 3 months. Dr. Hutchins had decided, however, that a metal stent would be too risky to place and opted for side-by-side plastic stents to dilate the duct passage. He also said that a future surgery would be needed to permanately correct the constricted duct. During the scope procedure, Dr. Hutchins found the the existing stent had migrated out of the constricted area and the duct had remained open, so he did not stent the duct at all! So, as long as the duct remains dilated, Dave will not need to repeat these ERCP's in the future. Dr. Hutchins said that only 5% of stents will migrate and in his procedures this percentage is even less. We find it truly amazing that the result of this ERCP was totally unexpected and that God has chosen to work in a way completely different than ours! (Romans 11:33-36) Praise God for His wisdom!

Dave had an appointment with Dr. Stothert on June 3, 2011 at UNMC. He had an ultrasound ordered to check the size of the 2 pseudo cysts (see 4/22/201 post) on the pancreas. By comparing previous scans, Dr. Stothert determined that the cysts have reduced in size! This is a tremendous praise item since enlargement of the cysts could mean problems in the future and require surgery. Also, we were told that these cysts can remain the same size and not cause problems, but rarely do the cysts shrink in size. Thank you for your prayers.

Dave had his ERCP done on Friday, May 13th and was only in the hospital over night! What a huge blessing and answered prayer. Dr. Hutchins took out the stent and replaced it with a stent that has a larger diameter. He said that this ERCP was a challenge where the T-tube was placed in 2008 is like a cork screw and constricted also and will need repaired in the future as well as the bile duct in the pancreas. He talked with Dr. Grant about possibilities. They decided it would be best to present Dave's case to a group of doctors (from liver transplant) to come up with the best option for him. That may happen as early as Monday the 16th or possibly the 23rd. Please be praying for wisdom for the doctors. Dave's WBC started to climb, so they sent him home on antibiotics. He will have to have this stent changed in 6 to 8 weeks. He has an appointment on June 3rd to have an ultrasound of his pseudo cysts and to see Dr. Stothert.

Dave's appointment went well on May 5th. His labs continue to improve. Dr. Grant decided that he is healthy now and it is time to take out the stent. They do not want to take a chance of it getting infected. We were very surprised that they want to do this procedure on such a short notice. Dave asked if it could be done later and they just felt now is the right time. Dr. Hutchins will be doing the ERCP. He is the doctor that did the first ERCP in 2008 for Dave. This is scheduled for this Friday, the 13th at 2:30. (It is good that we are not superstitious!!) The decision as to what needs to be done to take care of the constricted bile duct will be decided during the procedure. Please pray for wisdom for the doctors and that Dave will not get pancreatitis again.

Dave had his appointment today at UNMC. His CT scan revealed that he has 2 golf ball sized pseudo cysts on his pancreas. Dr. Stothert said hopefully they will not become a problem. Occasionally pseudo cysts are not a problem; however, if they do become a problem Dave will need a surgery to attach the cysts to his stomach or intestine so they can drain. The pseudo cysts are filled with pancreatic fluid. Dr. Stothert gave Dave the go ahead for a normal "bland" diet. Yeah!!!! Dave was excited to hear this news. And no more TPN! Dave will have another appointment on May 5th. Thank you for your continued prayers! Happy Easter! We are so thankful we celebrate a risen Savior!

Dave got a phone call from the doctors at UNMC, he gets to be on a full liquid diet, and he is really excited!!! That means cream of wheat, tomato soup, milk, yogurt, and lots of other yummy foods! So far so good. He is still receiving IV nutrition at night. The CT scan is still scheduled for Friday. Thank you for your continued prayers. We serve a mighty God!

Dave had an appointment in Omaha today. His labs have continued to improve. With the physical exam Dr. Stothert felt a rather large hard area that could be a pseudo cyst. Dave will have a CT scan next Friday, April 22nd, to take a good look at the pancreas again. They have allowed Dave to start on clear liquids! He had a Sprite in hand before we were out of Omaha! His pancreas has tolerated the liquids just fine, PTL! He still is on IV nutrition at night and has lost 15 lbs. We will let you know the results of his appointment and CT scan.

Dave is home! His home health care nurse has been here for 6 hours and just walked out the door(its 11:30pm). Within the PICC line, there are two lines. One of those is clogged, probably from Dave's last dose of lipids. She has been trying to get it unclogged. It isn't a problem at this point, just more of a inconvenience as Diane will have to stop the TPN and give him the antibiotic and then start the TPN back up again. If both lines were working, the antibiotic and TPN could be done simultaneously. Hopefully tomorrow at 7:30am when she comes back, the line will be cleared. Dave has a check up appointment scheduled next Thursday at UNMC. He will be monitored by the doctors at UNMC on Monday, Wednesday, and Friday by labs taken by the home healthcare nurse. It will be decided at a later date what the permanent solution will be. Thank you so much for your prayers.

Dave gets to go home tomorrow, PTL!!!!! He will continue with the IV nutrition; therefore, arrangements need to be made for home healthcare. His WBC is at 19,000 - headed in the right direction! Pancreas enzymes are high, but stable. He will have blood draws done by home health and will follow up with an appointment at UNMC a week after discharge. Praise the Lord for such great news! Thank you for your prayers!

It was mentioned today that if Dave remains stable, he could possibly go home! He would still have the TPN (liquid nutrition through PICC line) and a home health care nurse would come out every day. Dave will likely have the TPN for a few more weeks to allow the pancreas more time for healing. Dave went outside for 30 minutes today. Although it was windy, it was still very enjoyable.

Please continue to pray for the healing of Dave's pancreas.

Praise Dave is making great progress and is still hiccup free.

Monday, April 4th

Dave felt good today! He does not have the hiccups and has not had any breathing episodes since Saturday night. Yea! Not having hiccups/breathing episodes is also greatly appreciated by the nurses since every time he had one, his heart rate dropped to 50, which set off his heart monitor alarm and always made the nurses scurry around. Dave has lost the 25 pounds of extra fluid. His white blood count is 26,000. His pancreas numbers are still high, but have not increased. The doctors have decided that Dave no longer needs the heart monitor and blood draws are now being done every other day! All good news!

Dave's white blood count is down slightly to 31,000, all other labs remain unchanged. The last two days, Dave has been nauseous and dry heaves a couple of times a day. Throughout the day, Dave's temp was 99, but it slipped back up to 101 this evening. The doctors allowed Dave to unhook from his heart monitor for 30 minutes so he was able to go outside and enjoy the beautiful weather. Dave really enjoyed it and is planning on going outside again tomorrow.

Please continue to pray for healing of Dave's pancreas.

Praise that Dave did not have the hiccups as often today.

Dave wanted us to post a note from him....

Thank you for all your responses to my blog. They are a tremendous source of encouragement to me, to know that my Christian friends and relatives and people I do not even know are praying daily for me. God is giving me a positive attitude to get through this as I know that pancreatitis will take time to heal. God bless each of you.

Dave

Thank you for your prayers, we truly appreciate them and believe in the power of prayer!! Please pray for Dave's mom, she was admitted to the hospital last night in Lincoln. Please pray for Inie's healing, she is pretty weak and found out she must be on dialysis.

After this morning's x-rays the doctors said Dave needs to be on TPN for a minimum of 2 weeks. That means no more food by mouth (only water) and they had to put the PICC line back in. This news was pretty discouraging for Dave. The doctors feel food taken orally only disturbs the pancreas more and it just needs a break in order to heal. They are doing this so they hopefully don't have to do surgery on the pancreas. Dave's WBC is down today to 33,000. The doctors said the TPN can be administered at home IF Dave's WBC, pancreas enzymes, and other important "numbers" become more stable at a normal level.

Praise!

• Dave was able to get some uninterrupted/rarely interrupted sleep this afternoon!
• Dave didn't have as many breathing episodes today!

Prayer Requests:

• Dave's mom will regain her strength.
• Dave's pancreatitis will settle down.
• Dave will only be on his 'TPN diet' for 2 weeks.

Dave had an x-ray of his stomach and lungs and a CAT scan has been ordered for later today. They are wanting to monitor his infection and are concerned a pseudo-cyst is forming around his pancreas. His pancreas enzymes have increased since he started eating, which means his pancreas is not reacting well. Dave is a little down this morning. The trauma team said the food intake is not going as well as they had hoped. He is not nauseous, but he is not able to consume as much food as he needs to sustain his infected body and will most likely have to have another PICC line. The food is making his already distended belly even more taut. This morning he ate about 2/3 cup of cream of wheat and 4 ounces of grape juice. Dave continues to have the breathing episodes and they are increasing in frequency. His white blood count is holding around 30,000, the doctors are pleased it is not increasing (normal is 4,000-11,000). Thank you for your prayers and kind words. It is so encouraging to our family, especially Dave and Diane as they wait on the Lord's timing.

Prayer Requests:

• Dave will be able to eat enough calories orally to not require another PICC line.


• Dave's breathing episodes will diminish.


• Dave will have good results from the tests today.


• Wisdom for the doctors as they determine the best plan of treatment for Dave.


• Strength for Diane as she faithfully stays by Dave's side.


• Strength, healing, and a positive attitude for Dave.

Morning... Last night at 12:30 Dave called Diane to let her know they were moving him. He now has a private room because they cultured C. diff (bacterial infection). He has a nice big room with a great view! It looks over one of the pretty gardens! Once diagnosed with C. diff the rest of your hospital stay is in a private room, not too shabby! Dave also had this diagnosis 3 years ago. The restrictions with this diagnosis mostly affect the hospital staff. They must wear a yellow gown when in Dave's room and Dave has to wear a yellow gown when outside of his room. He is still allowed to go on walks and it doesn't affect visitors. Thanks for your continued prayers!

Dave got approved for a liquid diet today. He ate 1 1/2 Cups of broth and 2 bites of jello. He was able to keep it all down!!! The first food in over a week! If Dave can tolerate enough food to sustain himself he will not need another PICC line. Please pray Dave's body will tolerate food by mouth. Dave continues to have the hiccups and has started having the "breathing episodes" that he had 3 years ago. These "breathing episodes" are family named. They only occur when Dave has the hiccups and the spasms from the hiccups are strong enough to knock the wind out of him making him unable to breath for a short time. As you can imagine this is very scary. They checked for blood clots in Dave's legs, we will get the results from the ultrasound tomorrow.

Please pray that:

• Dave's body will tolerate food.
• Dave will not have the hiccups or breathing episodes. Dave's pancreas will heal.

Praise:

• Dave was able to keep food down today!

Thank you so much for your continued prayers. Dave is feeling better and he looks good, despite his bloated belly. Last night his temp was 101.2, so they ran the 2nd chect x-ray of the day. The lower left lobe of his lung is still partially collapsed. The best treatment at this point is still walking. Dave goes on walks a couple of times a day. They also did blood draws and urine analysis. We found out late last night that the blood culture from a few days ago did finally show a bacterial infection in the blood. They switched Dave's antibiotic (again). They are going to take out Dave's PICC line today and put in a peripheral IV. Due to the procedure, Dave will be without TPN (liquid nutrition) for 24 hours. Please pray that the PICC line is the source of the infection and that the new antibiotic will take care of it quickly. If the PICC line is not the culprit of the bacterial infection in the blood, we will have to look into more complicated solutions. Please continue to pray for Dave's pancreatitis. Dave's temperature was down to 100.3 this morning and his white blood count, liver, and pancreas numbers remain basically unchanged from yesterday.

Once again, Dave has the doctors puzzled. His white blood count has increased again. It is now at 55,500 and normal is 4,000-11,000. Dave's liver and pancreas numbers are continuing to improve. The CT scan that was done yesterday shows that Dave's pancreas is 'impressive' as Dr Nelson stated today. They are puzzled as to why the pancreas looks so horrible, yet the numbers are improving. Two options they have come up with: 1) He is on the tail end of pancreatitis, so his numbers are better, but the pancreas still needs to settle down or 2) Necrotizing pancreatitis, which could mean various things - sloughing off, psudocyst, or that the pancreas is shutting down. The doctors don't seem terribly concerned at this point, they are going to keep monitoring the situation. They are changing Dave's antibiotic in hopes to decrease any possible infection. They increased Dave's insulin and also increased the amount of water he could drink. Dave was excited! Dave is still struggling with the hiccups. Please pray for healing for Dave's pancreas. Although the doctors don't have all the answers now, we rest in the fact that our Great Physician has Dave in His hand.

Thanks for your continued care, concern, and prayers. Dave has gained 25 pounds since arriving here. It is mostly in his abdomen, but his legs are also swollen. His stomach is stretched tight, but we are thankful that he is not in pain. Dave's white blood count had increased to 45,000 and is running a temperature again so the doctors decided to do a CT scan of his liver and abdomen to make sure there are not any pockets of infection. They did not see any today, but will run another CT scan in a day or so. They did note that his pancreas is still 'angry' and that Dave has pancreatitis, which is most likely the culprit of the high white blood count and fever. In an attempt to control the pancreatitis, he is back to 8 ounces of water (no green tea) per day and still no food just TPN solution through the IV. Dave is thirsty, so this was disappointing. They did increase his IV fluid so hopefully that will help with the thirst. Since the pancreas is not fully functional, it is unable to completely process the TPN, so Dave is receiving insulin four times a day. Dave has had the hiccups numerous times in the last 24 hours.

Praise:

• Dave's liver numbers continue to improve.
• Dave's rash is gone.
• Dave's eyes are almost white again!

Please pray that:

• Dave's pancreas will settle down.
• Dave's temperature will return to normal.
• Dave's hiccups will just be hiccups and not turn into not being able to breath as happened in 2008.

Friday, March 25

It snowed a couple inches last night, CRAZY!!! Dave continues to feel pretty good, but his stomach is still bloated. He has a little bit of a temperature, they are culturing his blood to determine the culprit, and he is on 3 different antibiotics to get rid of the infection. He has permission to drink 16 oz of fluids in 24 hours, not a lot but better than nothing! Dr. Grant stopped by and told Dave after he gets rid of the infection they will do some tests prior to him being discharged that will help determine what the next step will be. If possible they would like to balloon the bile duct opposed to performing surgery. Dave had a hernia repair surgery 2 years ago when they placed a large sheet of goretex in his abdomen, cutting through the goretex would increase the chance of his hernias reoccurring. Thank you for your prayers!

Thursday, March 24

Dave's white blood count is still high, but has not changed since yesterday. One lobe of Dave's lung is slightly collapsed or has some fluid in it. They have told him the best thing to do is walk. His rash is getting a little better and is less itchy. Dave's stomach is still bloated, but the nurse said his intestines are starting to function. Dave has permission to drink 8 oz of water in 24 hours, baby steps, but we'll take it. Dave has gone on two short walks this morning.

Wednesday, March 23

Evening Update...............Dave continues to run a fever, but has been able to get some rest. They ran a chest x-ray, they are concerned about pneumonia because of his fever spike, white blood count and elevated heart rate. Thank you for your continued prayers.

Afternoon Update...............Dave had a pretty good afternoon. They still have not cleared him to have any water or ice chips yet, which makes for an uncomfortable dry mouth. Because Dave's pancreas is still 'angry' it can not fully break down the nutrition being fed through the PICC line, so Dave as been receiving a little bit of insulin. Dave's white blood count is elevated and he is running a fever of about 101 degrees. He is still on antibiotics, and the doctors are keeping a close eye on him so they can catch any possible infection early. Dave went on a walk this afternoon or as the nurses called it a 'sprint'. The sprint raised his heart rate quite a bit, so they only let him do one lap and then they did an EKG to make sure everything was ok. Later on, when he wanted to go again, they thought it would be best to use a wheel chair. :) They are keeping a close watch on his heart rate, but are not too concerned at this time.

Please pray for:

• the rash to diminish, it is pretty uncomfortable
• continued peace and healing

Morning Update................Huge praise, although Dave wasn't able to get much sleep, he did have a good night! His pain is manageable now, his liver numbers are better as well as his pancreas numbers; indicating that pancreatitis is improving. They took his NG tube out this morning. He hasn't had any actual food or water yet, just liquid nutrition from the PICC line. Dave is looking forward to ice chips. They are waiting to make sure he tolerates not having an NG tube first. Dave is taking medication for his heart rate and blood pressure, but they look are looking good. Thank you for your prayers.

Tuesday, March 22

Evening update....................................Dave's pain continued to stabilize this afternoon. This evening Dave started the nutrition drink through his PICC line. Dave is running a low grade fever. Tomorrow we hope to discuss the long-term solutions with the doctors. Thank you for your continued prayers.

Afternoon update....................................Thank you for your faithful prayers! Dave has been more comfortable this afternoon. Right now, his pain is at a 3 out of 10, and that is with no pain medication! We have not heard anything back on the x-rays, in this situation, we figure no news is good news. He has been able to catch a few naps here and there. Mom was also able to get a little rest. Doctors have stopped by, but no plans have been discussed for long-term solutions. Dave was able to walk around the halls and take a shower. Please pray for relief from the rash.

Morning update....................................To be completely honest, Dave had an absolutely horrible night last night. He rated his pain at a 10 out of 10 and if you know Dave, he is a pretty tough guy. He wasn't able to sleep at all as the abdominal pressure and pain was unbearable. At 3:15am Dave's blood pressure was 209/102! At 4:35am Dave was given pain medication and felt immediate relief (7 out of 10). We tried to explain to the doctors and nurses that this is NOT Dave and that he has never been in this much pain, but for some reason, they didn't really 'get it'. I guess they are not used to having such tough patients. :) Dave's pancreatic enzymes are elevated, indicating he does have pancreatitis. We are unsure at this point how much of the pain is caused by the pancreatitis and how much is caused by air being trapped in the abdomen from the ERCP. Dave did have an abdominal x-ray around 5am and then again at 9:30am because the 5am one was not clear. Dave is currently getting a PICC line since he hasn't had a meal since Thursday.

Praise:

• Dave's temperature is normal which indicates the infection caused by the constricted bile duct is clearing up. It appears that the stint is working properly.
• Dave no longer has a headache.
• Dave's blood pressure is now down to 173/84.

Please pray for:

• Wisdom for the doctors as they assess the best treatment for Dave now and long-term.
• Comfort for Dave.
• Pancreatitis to subside.
• Rest and strength for mom, she was up all night with dad.

Monday, March 21

Evening update.............................11:30pm Thank you for your prayers. A member of the trauma team came to visit Dave around 9:30pm. He said that often with an ERCP air is introduced into the stomach and can be very, very uncomfortable. Thankfully, Dave did not experience this on his two previous ERCPs in 2008. Dave was able to get some medication. Eventually the burning sensation subsided as well as the nausea; however, it was replaced with a feeling of extreme pressure and bloating. Dave is still very uncomfortable. He is not vomiting as frequently. Also, we are thankful that his headache is gone. Dave now has a NG tube, which should eliminate the vomiting and release some stomach pressure.

Please pray for:

• Comfort for Dave
• That Dave will not develop pancreatitis (he developed a very severe case in 2008 following an ERCP)
• Wisdom for the doctors in deciding on a long-term solution for the repair of the bile duct
• Strength and rest for our family

Evening update.............................9:00pm Please pray for Dave. After the surgery he was feeling fairly good, but very recently he has become nauseous and has a burning sensation in his stomach. He has thrown up and is VERY uncomfortable. Please pray that he feels relief very soon and that the pain he is feeling is a result of switching to a liquid diet and that this is not a complication from the surgery.

Afternoon update.........................Thank you for your prayers. Unfortunately the procedure didn't go as we had hoped. The best case scenario would have been a stone or sediment blocking the bile duct but this was not the case, Dave's bile duct is very constricted due to external pressure cause by the scar tissue that resulted from his pancreatitis 2008. This is not where the bile duct was severed in 2008, that area looks great, Praise the Lord! The constricted portion of his bile duct is approximately 9 cm. This area is very infected and will be closely monitored the next couple of days. The stint is only a short term solution and we'll have to discuss long-term solutions with Dr. Grant over the next couple days. Please continue to pray for Dave's healing and wisdom as we make decisions about the best solutions for Dave long-term.

Morning update...................It has been a busy morning. The ERCP was originally scheduled for today, then it was cancelled and on the agenda for tomorrow. 30minutes ago we were told that it is back on schedule for today. All 3 teams are in agreement that the ERCP is the best choice to remove the stone or sludge causing the blockage. Today Dave seems to be doing a little better. He does seem to be having a slight allergic reaction (rash) to the antibiotic, but is otherwise responding well. His fever is down, white blood count is down, and headache is at times a little more manageable. Please pray that the procedure is successful.

Sunday, March 20

Sunday Evening.......... The nurse just informed us Dave is scheduled for the ERCP tomorrow at 1:15pm. This was the first we had heard about a decision being made, so imagine our surprise! She assured us we would get to talk with the doctors before they take him for the ERCP, that made us feel much better. Dave continues to fight a fever, but seems to be fairly comfortable at the moment, PTL! Please continue to pray for Dave's headache, which has been persistent since yesterday. The doctors had pity on him and allowed him 2 Extra Strength Tylenol, this seemed to help! Thank you for your continued prayers for Dave, our family, and the doctors.

Sunday Afternoon.......... Thank you so much for all your prayers. The results of the MRI show that there is a blockage of some sort in the bile duct. They think it may be a stone or sediment. The trauma team is working with a few other teams to make a decision on the best way to address the blocked duct. They will come to a conclusion in the next day or so and the procedure will take place shortly after. The options discussed at this time are an ERCP (scope) or surgery. Pray for wisdom for the doctors as the different teams have varying opinions on the best course of action.
Because the liver is not working properly, Dave has an infection resulting in a fever of 102 degrees, a severe headache, and nausea. The nausea is mostly being controlled by medication. However, he is unable to take Tylenol (because of his liver) and can not take Ibuprofen (because of his kidneys). Please pray for relief from the headache.
The doctors are encouraging Dave to get up and walk around when he is able. The highlight of his day was walking to the elevator to see his grandson Titus. Dave and the family are in fairly good spirits. Although the thought of another surgery or procedure isn't too exciting, we know our almighty God is in control and we are trusting in Him.

Saturday, March 19

Thankfully, it has been awhile since we have updated the blog! Earlier this week Dave came down with a cold and then on Thursday he had flu like symptoms. We didn't think too much of it until early Saturday morning when he appeared jaundiced. His family doctor sent him on to his old stomping grounds; UNMC in Omaha. After testing at UNMC, they have found that Dave's white blood count is high, indicating an infection and his liver counts are elevated as well. An ultrasound indicates that the bile duct is probably at least partially blocked. It is difficult to determine as the bile duct is already compromised from his previous injuries. Dave is going to start on antibiotics and will have an MRI tonight. The MRI will be read tomorrow and a decision will be made at that time as to what the next step will be. They have said surgery may be a possibility. Please pray for wisdom for the doctors, peace for our family, and comfort for Dave.