Sept 14

Steve returned to practice full-time starting Sept 7. He's enjoying catching up with colleagues and patients.

August 12

We wanted to thank everyone again for your support! Steve continues to recover with occasional small setbacks. He's looking forward to returning to practice in Sept.

Aug 6

The meeting with Steve's surgeon went very well. Steve's wounds are healing well, his hematocrit is going up (meaning his anemia is getting better) and his white blood cell count is down to normal. They removed his feeding tube. Hooray! We'll see the surgeon again in another month. In the meantime, he wants Steve to start gaining weight. (Wouldn't most of us love those orders from our doctors?)

Aug 5

We meet with Steve's surgeon tomorrow and expect that the feeding tube will be removed (it hasn't been used since he was readmitted to the hospital). Steve is doing great! He brought home a slight sore throat and cough from the hospital that now has spread to some of the family. But everyone is doing fine.

Aug 3

Steve's bile duct stent was removed during the ERCP. The doctor also cleared the bile duct of precipated material that had accumulated while the stent was in place. So, the bile duct has healed. Because the procedure required conscious sedation, Steve has been pretty groggy the rest of the day.

Aug 2

The Sutter Health Wound Specialist visited today and was pleased with the healing of Steve's surgical incision. There remains only a 3 cm cavern that will need to be packed and changed daily. Tomorrow we will return to Stanford for a follow-up ERCP (Endoscopic Retrograde Cholangio-Pancreatogram). My understanding is that this procedure will confirm that bile is draining properly following the placement of the stent several weeks ago and the removal of the bile drainage tube a week ago.
Steve's energy is increasing and he's enjoying getting out, even in the cold SF summer.

Aug 1

Steve continues to improve. We took a walk to Ghiradelli Square today.

July 29

Starting to believe that Steve is home for good this time. He feels normal and is eating well. Ran only a slight fever for a few hours today.

July 28

Great news!! Steve was expelled from the hospital! His fevers are down, his energy is up, his abscess is gone and his surgical wounds are healing quite well. Steve was euphoric to walk through his neighborhood. He probably ambulated 3 miles at least today.

July 27

Steve's CT scan indicated that his abscess has drained, but he still has fluid surrounding his left lung. His teams are discussing whether or not to drain the fluid. In the meantime, Steve's fevers still are trending down (hooray!) They also have cultured out another strain of bacteria (this time anaerobic) from his abscess, so they've started him on the antibiotic Flagyl. Except for the fevers, Steve is feeling better and has more energy.

July 26

A good sign: Steve is getting tired of being in the hospital. He's still running a fever, but it tends to peak around 101, rather than 103. His white blood cell count is declining and his breathing capacity is increasing. He's scheduled for another CT tomorrow to confirm that the decreased output in his drainage tube is due to reduction / elimination of his abscess.

July 25

Steve remains in the hospital. He's still running a fever, although it seems to be a bit lower. His breathing is better so he doesn't require oxygen any more.

July 22

Steve's abscess continues to drain. He still spikes fevers and is on oxygen to maintain his oxygen saturation. His pulse has slowed somewhat - it had been elevated the past two weeks. They started him on a new antibiotic (ertapenem) today.

July 21

The good news is that the fluid accumulation is an abscess - probably the source of Steve's ongoing fevers. They inserted a drain today and identified the bacteria causing Steve's infections (gram negative rods - an example is E Coli). Although Steve's fever was elevated tonight, that was expected based on the fact that they "stirred up the bacteria". We are expecting that the team will identify the appropriate antibiotic to treat the infection - this might be complicated because he has been treated with so many antibiotics over the past two months.
This was a rough day for Steve, however. The procedure resulted in extremely painful spasms and feelings of shortness of breath.

July 20

Steve continues to run a fever. He has been moved to a private room. Tomorrow he will visit Interventional Radiology to drain a pocket of fluid in his abdomen.

July 19

Steve was readmitted to Stanford Hospital today (same room as his last visit, but a different bed). He got another CT scan that detected an abnormality at the base of his left lung, which could be pneumonia. Steve had developed a slight cough when he spoke over the last 10 days or so. Since his voice has been improving following his prolonged intubation, we attributed the cough to a healing process for his vocal cords. If pneumonia is the cause of his fever, that should be treated with the IV antibiotic (Zosyn) currently being administered. We'll look forward to seeing his fever trend down.

July 18

Steve's surgeon removed his drainage tube and bag Friday and although it was painful, it has been a huge relief for both of us. Steve can walk and sleep more easily now without having to deal with the pressure from the bag, and I'm happy not to have to empty it. They inserted a different tube along the tract and I just have to back it out of the tract about a centimeter a day, so the tract can drain and then heal.
Unfortunately, Steve's fevers have continued throughout the weekend despite the new round of antibiotics. His fevers started trending up this evening, so his surgeon will make arrangements to readmit him to the hospital tomorrow.

July 15

Steve has continued to have fevers this week. His surgeon has been very responsive to our questions and ordered different antibiotics Tuesday evening. A wound specialist visited on Wednesday and left us with some new wound treatments. Steve appreciates all the cards, emails and visits. He is getting stronger. Tomorrow we're following-up with Steve's surgeon at Stanford. The plan is to withdraw the drainage tube and eliminate the drainage bag. The hope is that his infection will resolve.

July 12

We met with Steve's surgeon at 8am at Stanford. Although Steve continues to have a low-grade fever, the infection appears under control with the oral antibiotics. The lack of output in Steve's drainage bag indicates that the bile duct is healing. Steve's surgeon pulled about an inch of tubing out of the drainage tract. Wow - this was an incredibly painful experience for Steve. Although this signifies positive progress forward, the whole experience (2 hours+ of driving, another hour of waiting, topped off by stabbing pain) was a bit draining. We have an appointment on Friday to fully remove the tubing and replace it with a very small tube. so overall, we're progressing forward.

July 11

This weekend has been touch and go, as Steve's drainage bag stopped draining and his fever has been up slightly(around 99.5 - 100). Our instructions have been to contact his physicians if his fever reaches 101. We're seeing his surgeon tomorrow at 8 am. In the meantime, Steve's appetite has increased and he has become more mobile (he did a total of 6 blocks this afternoon).

July 9

Steve returned home yesterday afternoon. The IV antibiotics were very effective and Steve feels much better now.

July 6

Steve was readmitted to the hospital tonight. Steve developed cellulitis (a skin infection) near one of his staple wounds and started running a fever yesterday. He started on oral antibiotics yesterday, but his fever increased overnight. This morning the area in question looked more swollen. Also, I noticed a change in the drainage bag contents from his damaged bile duct. Stanford asked us to show up for a Clinic visit and the surgical resident decided that they should start IV antibiotics while they culture out Steve's fluids and also do a CT scan of his abdomen because of the concerns about the drainage bag. (which meant he had to re-enter the hospital) They're also talking about having a wound specialist debride Steve's wound. So, we have a bit of a setback, but both Steve and I feel better to have him back in the hospital.

July 5

Steve is very grateful for the good wishes he has received. He enjoys having visitors. He wants his patients to know that he plans to return to his practice when he is able.

July 3

Belated and ongoing thanks to family, friends, patients, colleagues, neighbors and medical staff who have helped us in so many ways. We're blessed to have the support we have. Steve and I had a short, but nice, stroll in the sun along Green Street today. He is less anemic, so is able to sit up longer and feels stronger. In the household, things are returning to normal a bit as both girls are inviting friends over - the youthful energy benefits both Steve and me.

July 2

We've had a lot of support staff visit the house and a few visitors. Steve's energy is improving and he was able to deal with a few short visits from friends. He was able to get out and walk about 0.2 miles today.

June 30

Thank you everyone for your supportive wishes. Your good will is helping Steve heal. All of your e-mails, cards, blog comments, phone calls, letters, etc have meant a lot to him. Steve still is very weak, but growing stronger every day (the physical therapist had to slow him down today). Steve still is very anemic. The sutures for his draining tube unfortunately came out today, so we had to drive down to Stanford to have them replaced. His surgeon also did a thorough (and painful) cleaning of his incision to improve the healing.
The girls and I figured out the feeding tube protocol last night (unfortunately, there is a huge gap in training between the provider and the nursing staff). Overall things are moving forward.

June 28

Steve is home! He climbed the stairs from our garage and enjoyed sitting on the couch watching TV and talking with family (Steve's brother, sister-in-law, father and stepmother were also here). He enjoyed takeout from Betelnut. We're all very happy to have him home.

June 28

Steve will be coming home this afternoon!

June 27

Steve gets out of bed a lot and is walking without assistance. Steve's family (father , stepmother, brother and sister in law) visited again. Their presence raises everyones' spirits.

June 25

Steve took a trip to interventional radiology today to fix "the leak" that keeps draining into the remaining external drainage bag. It turns out that they will schedule a second endoscopic procedure tomorrow to insert a larger stent to deal with the drainage. In preparation for Steve's homecoming, I learned how to dress his incision and got preliminary training in setting up tube feedings. Steve spends a lot more time out of bed and takes longer and farther walks every day. He was hungry for lunch today, but at the very last minute (I really mean that - he had just put the salad dressing on his salad) - he was ordered not to eat because they would be taking him to interventional radiology - so he had to skip the lunch he was looking forward to.

June 24

Steve practiced doing stairs today in preparation for coming home Monday. A few things still need to get resolved over the weekend, particularly the fluid that continues to accumulate in the remaining external drain.

June 23

Steve continues to make slow progress forward. He's now on a normal diet. He's spending more time out of bed. The next goal is to get him home.

June 22

Steve's stent was inserted today. The procedure required conscious sedation. Steve was worn out after the procedure, but still was able to take a short walk around the floor.

June 21

Steve did a lap around his floor today! He is very motivated to get out of the hospital. He will undergo a procedure tomorrow to install a stent to drain his bile internally, rather than externally.

June 20

Happy Father's Day to all the fathers out there! The whole family came out to visit Steve today. We brought a "card", actually a poster, of pictures of his family, pets,plants and special places. The doctors gave an order to the nurses that Steve was allowed to go outside in a wheelchair with just his family, today. This meant a lot to Steve. I drove the wheelchair and bumped him around a few times. He wasn't too happy about that. He directed us to a shady courtyard. We spent about 30 minutes just talking outside. It was relaxing and a lot of fun for the whole family. After about 30 minutes, Steve got a little overheated, because it was so nice and hot outside. We decided to take him back in at that time.

June 19

Well since it is the weekend, the staff is reduced, so Steve conducted his own physical rehabilitation program. When Kendall and I showed up, he had already moved himself into a chair. Steve is doing well on all his therapies. His nurse, Myra, has been so very responsive.

June 18

Steve is benefitting from all the positive energy. He was able to sit in a wheelchair and go outside for some sun and fresh air for the first time today. He also enjoyed drinking milk and coffee. And he savored manicotti for lunch (so what if it's hospital fare - at least it has texture and flavor). Steve is working hard on all his physical rehabilitation and making slow, but steady progress.

June 17

Big Day today!! Steve was transferred out of the ICU at midnight last night. He is in a private room overlooking a lush courtyard. His swallowing is good, so he can eat pureed foods. He's still very weak, so sitting and standing are a real effort, but he's working on them. He got to see Kendall today for the first time in 3 1/2 weeks. Justine was able to visit him on Tuesday. It will be a while before Steve is strong enough to visit with his friends, but he appreciates all the supportive messages that have been sent to him.

June 16

Well, Steve didn't escape from the ICU today. He spiked a fever last night, so he's back on antibiotics. However, he's talking more clearly and he was able to stand twice.

June 15

Continued progress forward. Steve stood briefly and sat in a chair. He passed his sipping tests and now can drink ice-cold Hetch-Hetchy water whenever he pleases. His voice is getting stronger. He's still in the ICU, but should be moving out soon.

June 14

Steve made more progress today. He got to sit up and hang his legs over the side of the bed. A physical therapist helped him do stretching exercises. Steve tires easily and his voice is weak. Most of his pumps have been removed and his team is talking about moving him out of the ICU.

June 13

Steve continues to make progress. His breathing is great. He was able to enjoy a few sips of water today and suck on some ice chips. After having a tube down his throat for 2.5 weeks, he has to get used to swallowing again. His fever was a little higher today.

June 12

We crossed a big milestone today! Steve's breathing tube was removed and he has continued to breath steadily and deeply all day today - so it looks like the ventilator is gone for good. His fever is down, too. They have been unable to culture anything out of the latest drain, so have stopped the antibiotics. It will be awhile before Steve can have a conversation, because his voice is pretty weak. but he was able to ask about his daughters.

June 11

They had to sedate Steve today for a CT-guided drainage placement procedure, so he was pretty out-of-it today. They are draining a lot of fluid and sent a sample off for culture. He's on two anti-bacterial antibiotics and one anti-fungal medication. Steve still has a fever and elevated white blood cell count, but those counts haven't really changed since yesterday.

June 10

Today was spent adjusting Steve's sedative levels in order to have him more awake (but not uncomfortable or agitated) in preparation for removing his breathing tube. They want him to be alert enough to follow some basic commands. They've also angled his bed so gravity can pull his abdomen downward slightly to give him more room to expand his lungs. They're planning to insert an additional drain tomorrow. Overall he's still making slow progress forward. Steve still has a fever and elevated white blood cell count, but neither are as high as previous days.

June 9

I got a call this morning to authorize the insertion of a PICC (peripherally inserted central catheter) line. That will allow his team to remove the other central lines and IVs that could be potential sources of Steve's ongoing fevers. Last night and this morning Steve's fever was up, his white blood cell count was up and his blood pressure had dropped, requiring blood pressure medication. This turn of events led to the decision to do another CT to check on the status of Steve's abdomen. Tonight, Steve's surgeon relayed the good news that his colon looks good (the concern about the pneumatosis is gone), his white blood cell count has decreased to 21 from its earlier high of 27, his blood pressure is stabilized and his kidney function is looking better. All this is small forward movement.

June 8

Thanks for your supportive comments, everyone. They mean a lot to me and will mean a lot to Steve when he can read them. I talked with Steve's surgeon today and he said that Steve is "inching forward". They're getting more abdominal fluid out and Steve's abdominal pressure hovers around high normal. Steve is able to breath more on his own, since his diaphragm now has more room to expand. The biggest concern now is that Steve is still running a fever, his white blood cell count remains elevated and his platelet count is about twice normal. Steve remains on antibiotics and they've also added an anti-fungal medication. They haven't been able to culture any bacteria out of his blood or fluids.

June 6

Steve's fever spiked and his white blood cell count went up last night. He'll get another CT scan on Monday. His doctors are still worried about whether his colon is infected. His abdominal pressure remains elevated. We received the disappointing news that his portal vein remains clotted off, but his collateral veins can continue functioning as they had before the surgery.

June 4

Today was a recovery day. Steve remained heavily sedated. He is stable. His blood pressure is good, bladder pressure is good and his fever is a bit lower. His white blood cell count has increased a bit since the morning.

June 3

Steve returned to the operating room this morning. His surgeon made the decision for several reasons: 1) Steve's white blood cell count was going up, 2) Steve's abdominal pressure was still elevated and 3) the CT scan had suggested pneumatosis (which is a pocket of air) in the right colon, which could indicate that the colon might be injured and might need to be taken out. If the right colon were taken out, the additional surgery could put back Steve's recovery for several reasons. Fortunately, I don't have to describe those reasons, because Steve's colon looks fine. On the positive side, going back into the abdomen reduced the abdominal fluid pressure (at least temporarily) and allowed them to insert more drains. They also inserted a feeding tube into his intestines. His portal vein remains obstructed by clots, which they hope to dissolve when they start giving him heparin again. However, even if the portal vein remains obstructed, Steve has developed collateral blood vessels which are functioning to maintain blood supply.
As of this evening, Steve's white blood cell count is going down, his blood pressure is stable and his abdominal fluid pressure is low.

June 2

Not much has changed. Steve was transfused with one unit of blood. They haven't cultured anything out of his fluids, but he still has a fever and remains on antibiotics. His abdominal pressure is still elevated. And he still remains on the ventilator. His blood pressure remains stable.

June 1

Because Steve's blood pressure has stabilized, the team was able to use diuretics to increase fluid removal and removed about a liter and 1/2 of fluid. Steve's fever spiked last night, so they have sent more fluid samples off for culture and started new antibiotics. Today his team did a CT scan of his abdomen. So they had to stop the diuretic drug and increase his sedation. The report from his nurse tonight is that we're awaiting the final readout of his CT scan, but that his fever has dropped. The team is still concerned about his abdominal pressure and the health of his intestines.

May 31

Not much change today. Steve remains sedated and ventilated. His nurse said they collected about a liter of fluid off him yesterday and are hoping to double that today. Steve's dad was in the room when Steve's surgeon stopped by and got the encouraging news that Steve is "inching forward". Steve's liver and kidneys are working, his swelling is decreasing, but there is some concern about the swelling of his intestines.

May 30

Steve remains sedated and intubated. His fever is trending down. His blood pressure has stabilized, so he is off the blood pressure meds. They have started him on a diuretic-Lasix to help clear the excess fluid.

Update for May 29

Steve still remains on a ventilator. His abdomen remains distended and he has a fever. They have installed a central line so he'll start receiving nutrition. He has been moved onto an "air bed" which puts less pressure on his skin. Every day they unhook the ventilator for awhile to test his breathing rate, but his breathing is too shallow for them to make the call to extubate him. So, it looks like Steve's recovery will take awhile. Steve remains on blood pressure medication and heparin.

May 25 evening

To summarize, Steve's condition is improving, but his doctors remain vigilant. Steve remains intubated.
The major two concerns are:
1) Fluid build up in his abdomen. The pressure could shut down the blood flow to his internal organs.
2) Blood clots closing off his reconstructed portal vein.

They are treating him with heparin to reduce the likelihood of clotting and are monitoring his abdominal pressure and adjusting fluid volumes. If the abdominal fluid continues to accumulate, they may have to operate to relieve the pressure. That is why he has to remain intubated.

Steve finally went to the ICU last night at 2 am after a 16 hour surgery. They got all of the tumor, his spleen, gall bladder and half of his pancreas, but he got a new portal vein and 8 units of blood. Currently he is stable, but remains on a ventilator. He is not out of the woods yet, as there are several significant potential complications, but he had / has an incredible surgical team and postoperative team.

May 23

On May 24th at 8:10 am, Steve will be undergoing a subtotal pancreatectomy with portal vein reconstruction. The purpose is to remove a pancreatic neuroendocrine tumor. The surgery is anticipated to last 6-8 hours.