Ren’s Health History in 2010

by Kathy

For those of you who have been wondering what happened to our vigorous, youthful Ren, below is a timeline of events describing his health decline. The bottom line is that he needed two hernia surgeries to live, and two surgeries were just too much for his body to handle given his heart and kidney problems. If he had not had the hernia, he would still be with us today. It’s agonizing for me to even write that down. I keep asking the universe, why did he have to get a hernia just at the point where we were both hopeful that we had found a way for him to lead a productive life despite some new physical limitations?

 
Before 2010 Ren is healthy except for high blood pressure, which is controlled with medications. He also had a pacemaker put in the late 1980’s because of a slow pulse. It is working fine. He sees a cardiologist (Dr. Wohlgelernter) in Santa Monica regularly to check the pacemaker and the heart. Everything looks good.

Prior to the move to Colorado Springs in 2009, Dr. Wohlgelernter refers Ren to a cardiologist in the Springs area: Dr. Brian Metz.
 
April 2010 Dr. Curry at Memorial Hospital in Colorado Springs replaces Ren’spacemaker due to a dying battery.This outpatient surgery goes smoothly with no problems. Ren recovers very quickly.
 
May 4, 2010 First heart attack at home about 5 am. Kathy calls 911.Ren is hospitalized with Dr. Metz in charge.
 
May 10, 2010 Double bypass surgery is performed by Dr. Mehan.No problems and Ren recovers on typical schedule.
 
June, 2010 Ren goes to heart rehab three days a week. Drives himself. Uses the elliptical machine at home and walks in the park behind our house. He’s back doing all the cooking and house chores.
 
July 2010 Progress slows down in rehab. Problems with fatigue, shortness of breath, swelling of abdomen and legs. Dr. Metz diagnoses it as congestive heart failure and compromised kidney function. Bypass is working fine and his heart is pumping strong. Diuretic is prescribed.
 
October 2010 Second heart attack (smaller than the first) while walking in park behind our home.Ren is hospitalized and given additional meds; Dr. Metz advises less strenuous exercise.
 
November 2010 Small heart “event” after helping Kathy do some wall painting.Ren is hospitalized and given additional meds, including nitro emergency tablets to put under tongue when feeling chest pain or pressure. Dr. Metz advises less activity where arm is raised above heart level.
 
Early December 2010 Regular check up with Dr. Metz. Concerns about fluid retention lead to prescription of increased dose of diuretic.
 
Early December, 2010 Ren explores alternative health solutions. Starts kidney-friendly diet (asparagus, red bell peppers, cabbage, etc.). Begins seeing an alternative chiropractor, Dr. Gamm, who uses a special NUCCA method.
 
December 23, 2010 In addition to increasing problems with fluid retention (swollen abdomen, legs) which leads to fatigue and shortness of breath, Ren has another “chest pressure” event. He is hospitalized for 10 days while they struggle to figure out how to reduce the swelling. “They” are Dr. Satran and Dr. Metz (cardiology), and Dr. Cook (nephrology).
 
January 4, 2011 Home from hospital. Lost about 30 pounds of water in the hospital and is getting stronger day by day. Physical therapist comes to the house, and Ren diligently does his exercises. But now Ren is having stomach and intestine discomfort.
 
January 18, 2011 Check up with Dr. Metz. He identifies a large hernia in Ren’s groin area. He says that this likely explains the stomach discomfort. He refers us to a surgeon, Dr. Berson, to explore options. He expresses concern that surgery and anesthesia would be risky, given Ren’s heart and kidney condition.
 
January 20, 2011 Ren is in great pain in the night because of the hernia – worst pain he had ever experienced. His general doctor, Dr. Reeves, immediately identifies it as a strangulated hernia, which means that some of the intestines have pushed out through the muscle/tissue and gotten blocked off from the rest of the intestines. Dr. Reeves said surgery would have to be done immediately because the intestines are blocked and there could be dying tissues. We go to Memorial Hospital and meet with Dr. Berson who examines the hernia and agrees with Dr. Reeves. However, this is especially risky surgery because Ren is on Plavix (blood thinners) for his heart. After talking with Dr. Metz, Berson proposes to attempt physically repositioning the hernia and then waiting 10 days before doing the surgery; this time will allow the Plavix to get out of the blood. Ren and I say our goodbyes with special care, given all the warnings about the risks. Berson is unable to do the physical manipulation so he does the surgery. Because there is necrotic material (dying material), he is unable to use the preferred method for fixing the hernia. Instead, he has to cut out the dead material and sew the intestines back together. Ren makes it through the surgery fine.
 
January 20-21 Ren spends two nights in intensive care, but he is never in any danger (at least as far as he or I knew). This is mainly precautionary, since the surgery was high risk.
 
January 22-30 Ren is on the surgical ward, 6th floor, Memorial Hospital, recovering from the hernia surgery. At first, he is doing well – up and walking “around the block” on the floor. They give him nothing by mouth to allow his intestines to recover. When he finally starts drinking small amounts, he throws it all up. X-rays reveal a blockage. The doctors hope it is just swelling near the surgical site. They hope it will reduce over time. This begins a waiting period that becomes a downward spiral. From Jan 20 – Jan 26 Ren gets nothing but IV glucose water for nutrition. This is reflected in his steadily decreasing strength and ability to walk. On the 26 or 27th they put in a “pic” line to provide nutrition. But he continues to get weaker and weaker and to become slightly disoriented. The blockage remains.
 
February 1, 2011 Each day this week Ren sees the following doctors: Reeves (GP), Traxenburg (nephrologist), Berson (surgeon), Metz (cardiologist), and Leininger (intensive care).
 
February 2, 2011 The fluid isn’t getting his blood pressure up. They try giving him medication which could threaten his heart (dopamine). This seems to help somewhat. But then his kidney numbers are not good. Dr. Traxenburg, neurologist, recommends dialysis. He receives a 2.5 -hour dialysis treatment. One of the doctors says, “Things are not going in the right direction.”
 
February 3, 2011 Now there is something wrong with the liver and gallbladder – bile is backing up in his blood. Is this a discrete problem or is it caused by congestive heart failure swelling? Ultrasounds are done. Another dialysis treatment – 4 hours this time from 9-1. At 10:10 the blood is found to be way too thin; they give him plasma.

In the early afternoon, Dr. Metz speaks to me – Dr. Leininger is going to talk to me about the situation. It is clear that this is not good. Dr. Leininger talks to me and suggests that we now only give palliative care – the body systems are in too much stress to recover. I agree. I ask to leave the breathing tube in until Jeannine arrives in the morning. In the evening, Ren’s pupils are not responding to light normally, and I worry that he is going but he continues to live through the night. I am by his side all night and very happy for this.
 
February 4, 2011 Around 5:20 am Ren’s heart stops responding to the pacemaker. Kathy is at his side, supported by daughter Kelly who arrived the night before. Ren passes away.