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.