Monday, January 31, 2011. The weekend was Long. I was looking forward to Monday, don't know why, but Monday seemed like it would be simpler then the weekend. Less noise, activity, etc.
Insurance lady called Monday. [I am reviewing this post on 4-22-2011. I called her a lady. Now I am changing that word to machine. She is not a lady, and I don't even think she is a human.] Now that is stress. She wants permission to be the case manger for Carl. Her husband died of cancer, so she knows what I am going through. Really? I don't know what I am going through, but talking to her, God my stomach gets in such a knot, I feel like I really want to barf. Her questions, comments, insinuations of 'help', they made me feel like I was talking to Satan. I DO NOT TRUST ANY INSURANCE COMPANY. I THINK THEY WOULD PREFER MY HUSBAND DEAD SO THE CASH OUTLAY WOULD STOP. If an insurance company could get away with it, I think that there are people in the top echelons of insurance that would like to send a hit man to finish the capital outlay so they can 'make more money'. [I am reviewing this post on 4-22-2011. Today, I calmly and skeptically wonder if the insurance's machines' husband really existed, or had cancer, or if it was all a line to establish 'report'.]
The principles of good honest business are that you make a contract, initially believed to be good for both parties, and you honor it. If your business involves you taking a risk, you accept it. Trying to renege on a contract for profit is Evil perverting business.
Any F-ing individuals who think that what is good for business is good for the country, who think Fraud will self regulate, who think greed is good, who think consumer rights are anti-business, who think tangled contracts with loop holes are a good thing - they are EVIL, and sure sign that Satan is winning. How the HELL does the conservative party in any way equate with Christianity - caring for ones fellows man, that has to be the LIE OF THE CENTURY. And Satan is the prince of lies.
So now you might think I am a religious freak. (But then I'd be a very conservative Republican?) I am not, really, at least I don't think I am.
Carl took his first shower / bath today post chemo. It makes me want to cry. I think they put his head back on wrong. I think a first year resident stitched him up. And yet this totally conflicts with my also Genuine feelings - I am so damn glad he had the surgery and much of the tumor was gutted.
[4-22-2011 addition: I added the photos above on 4-22-2011. These photos were taken Jan 23, 2011, the night before the neck surgery; Jan 25, 2011, the day after surgery; on Jan 31, 2011 right after his shower; and Jan 31, 2011 with the Aspen collar neck brace Carl wears 24 hours a day except when in the shower.
Carl is not holding his neck that way to be funny. That is the only position his neck can be in.]
You might think I am in a crisis . Yes, I think I probably am. It's weird that a crisis can be helped by punching keys.
I don't know why, but I feel better after writing this. I am not sure I should ever publish this, but writing from the heart is supposed to make your writing powerful. Raw, yet real. I want to let this rip out there - maybe it will touch someone for a good purpose. Waiting, rewriting, would make this more objective, but is all writing supposed to be objective? Perhaps we should not be afraid of raw emotion now and then.
I pray that this post will go out and do God's will - that this writing will touch someone in some way for Good. I pray that God only allows those people that should see this see this. I am not against any political party, of any person employed in any job anywhere. Many businesses do good, some do evil (drug dealers, for example). Many people are employed to do good, some to do evil, many work just to have a paycheck to take home to their family and don't think about their job in terms of good OR evil. I hope you always try to do what is right, which to me is what is Christian. But the 10 commandments span more religions then just Christianity, and include the basis for many business rules - contracts are formed from thou shall not lie, thou shall not steal, thou shall not bear false witness, thou shall not covet... Thou shall not put false Gods (profit, money, gain) before the real God.
God Bless.
[NOTE: I could try to edit this into something better, but I don't want to spend the time and effort. Here are some real feelings, raw and unedited. If they make no sense, then let it be. I'll be honest, my notes above are, shall we say... conflicted...; to me now as I read them, they just remind me of a frustration I tried to bury on Monday, the last day of January.
I do feel the need to say this though: There is good and evil. It is mixed into our lives. The internet can be used for good or evil. Books can contain good or evil. People can do good or evil. Policies can be good or evil. Businesses can do good or evil. Politics can be good or evil.
I in no way feel that any political party is good or evil. I think all political parties have a little good and evil. Anything a reader reads into the rant above about politics should know that I consider myself fortunate to have friends who want good for this country in both political parties, and I have voted for people in both political parties.
[I finally posted this Saturday Feb 12, 2011.]
Carl came home from the hospital yesterday, Wednesday, January 26, 2010 at around 8:30 PM at night. My son Anthony and I went to pick him up and then I drove Carl home over the bumpy roads which caused pain at each bump. After Carl was tucked into bed at home, I went to fill prescriptions for him - the total bill for the prescriptions before insurance exceeded $1000. (It's a good thing I had the new prescription card with me. Insurance plans changed on January 1, and... lets just say I still had to pay WAY over $100.)
Carl was released about 48 hours after his neck surgery, and I personally think that was too early. He had barely eaten anything solid since the surgery, and the nurses had been giving him lots of drugs in the hospital. It throws a lot of responsibility on me be able to recognize problems.
Here is an example. On January 1, 2010 (one year ago) Carl went in to get chemotherapy. The night before he had been sick, it was the 4th day of a 5 day chemotherapy string, and I didn't know what to expect. All that I remember thinking was he was like a walking zombie. Carl never got chemotherapy that day, because pre-chemo blood work revealed his potassium level had crashed and so the nurses gave him IV fluids and potassium, etc., and sent him home. I now know (from this sample of 1) that "walking zombie" possibly means potassium is low. I have no idea what hi or low blood sugar, sodium, any of the other 30 things they check in a blood test would result in, so I happily only worry about potassium.
So yesterday I had the nurse check his blood test results before we left the hospital. Carl had his blood tested on Wednesday morning, Jan 26, 2011, and his potassium levels were only 'a little low'. How will I recognize (much less fix) a problem like this at home? Problems like this can only get worse then it probably would in the hospital, and then we would have to run back to the hospital to get it fixed.
That being said, if it were me in the hospital, I'd want to get out ASAP. (And Carl is the same way). In the hospital, people are always monitoring the patient, morning, noon, and night. Blood pressure, temperature, heart rate, blood oxygenation are checked often, 4x a day. They wake you up to check these things - day and night, they take blood tests, and more. You don't go to a hospital to get rest. And you don't get it either.
The fear of infection, usually highest at a hospital, is one of the main reasons medical personnel send post surgery patients like Carl home so quickly after a surgery. That, and Carl moaning "I just want to go home".
So, home he is. And since things seem to be going well, I am very glad. Today I don't have to race over to the hospital, and that is a really nice relief. WHAT A TREAT. Carl slept well, he has had some food, and is getting lots of rest. I will keep you posted.
Thank you for your prayers. Keep them coming. What I am praying for now is that the neck tumor does not grow back, a very real possibility.
Tuesday, Jan 25, 2010 Carl was at Froedtert Hospital all day recovering from yesterday's surgery. Carl is exhausted, and it hurts him to move, even with the pain medications he is taking. Talking is 'draining'. Carl lies really still in bed after finding a "comfortable" position. Carl "graduated" from PT (Physical Therapy) this morning after he walked, climbed stairs, and got in and out of bed a couple of times for the physical therapist. Carl's neurological surgeon (spine surgeon) came in a talked to him for a few minutes, and reiterated that the surgery was very successful. Carl didn't want any phone calls or visits, although he did get to talk to his dad for a few minutes on the phone. He didn't watch TV, and mostly slept. Recover Carl!
A friend who has also had neck surgery told me that she remembers being given the benchmark that for each hour a person is out under a general anesthetic, it takes 1 week to recover, and that it is preferable to separate general anesthetic procedures by a week. I think avoiding a surgeon is probably preferable. I do not want to try and calculate how long Carl was out under general anesthetic.
On Monday, Jan 24, 2010 Carl had a surgery at Froedtert Hospital to de-bulk the tumor in his neck. The surgery goals were to remove as much of the tumor as is safely possible, stabilize the neck, and relieve the pain that Carl has been experiencing recently. The surgery and procedures went well, started about 7:30 AM, and ended about 3:30 PM. Carl went to the recovery room, and at about 6:00 PM he was wheeled into his hospital room on the 5th floor of Froedtert, where I first got to see him since 7:20 AM in the morning. He was groggy, in pain, and very still, but otherwise doing well. By 8:30 PM he had walked half the length of a hall, taken some steps and was back resting in his bed for the night.
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| Carl recovering |
Below are the bloody details only for people interested. Don't read below if you are the sqeamish type, the summary above should tell you enough.
Carl was scheduled to show up at 5:30AM for a 7:15AM surgery. Carl was in the hospital already, recovering inpatient from Friday's angiogram with embolization procedure, so 'early arrival' was somewhat easy (for Carl). The surgery was scheduled to start at about 7:15AM, I left him at about 7:20 AM as they wheeled him in to surgery. Carl was out under general anesthetic at about 7:30AM.
First the surgery team "installed" multiple IV's (including one called an arterial line), a breathing tube and a foley catheter. At some point after the IV's and breathing tube and catheter were in, Carl had to be carefully lifted off the portable hospital bed (where he was laying on his back) and turned over and placed lying on his stomach on the surgery table, with his neck position immobilized the entire time. This procedure alone takes a fair amount of time (and coordinated teamwork between many people), because head can't be rotated independently from the body. (The operating team does this type of positioning roll with people with broken necks from accidents, so they are used to the procedure, but that doesn't mean it is easy.) The length and positioning of IV lines are carefully thought out in advance so that lines don't get crossed, pinched, or end up getting in the way of the surgery personnel or equipment. Carl hasn't been able to lay on his stomach for about a year because of his port, which sticks out from his chest. Padding and positioning of sponge like O-rings takes care of this, but again, it all has to be thought out in advance.
It is my understanding that the skull was locked into place with screws through Carl's skin into the bone of the skull, and X-ray imaging photos (and MRI?) were made so the surgeon could "see" precisely where the tumor lay before the first cut. I am guessing that these steps were done after Carl was rolled onto his stomach. Throughout the operation neurological functions where checked with monitoring impulse signals being sent and received from the head to the limbs, this functioning being entirely monitored by a neurological Doctor and his team. At points throughout the operation progress was checked with more X-rays.
This preparation, monitoring, imaging and other setup steps took until about 9:53 PM, when the first cut was made and the "surgery" officially began. The surgeon made an incision into the back of Carl's neck, 4 to 6 inches long, (I haven't seen it yet) and started the process of carefully removing the tumor through the back of Carl's neck. The surgeon did not try to remove all of the tumor, particularly the tumor that lay along Carl's main vertebral artery. Accidentally harming this artery could be fatal. The tumor that lay next to the spine seemed to neatly "peel away from the dura", which was a nice turn of events. It is my understanding that the surgeon cauterized the edges of the blood vessels that fed the tumor, hoping to prevent them from regrowing and resupplying tumor growth.
The tumor in Carl's neck had invaded and eaten away some bone in Carl's neck. There are 7 neck bones, called vertebrae, labeled C1 to C7 from top to bottom. The neck vertebrae C2 and C3 had lost bone material to the tumor, mostly the spiny pointed part on the the back of the neck bone. (The 'ring' portion of the vertebrae was still intact, but weakened). The tumor was removed here, along with some bone, and the neck was then fused with titanium metal hardware from the skull, through C1 to the intact C4 vertebrae. The fusing will stabilize the spine, but will result in some loss of movement in the neck. However, in the proceeding weeks, Carl has been in so much pain that he already stopped turning his head much. It is possible that he will have more movement (in several days) then he did immediately proceeding the surgery.
Carl received two units of blood, about 1000 ml, as blood transfusions throughout the surgery. (Thank you to all who have ever donated blood. Its not fun, but it is important.) The surgeon indicated that five years ago he would have expected Carl to lose about 5000 ml of blood in a surgery of this type, and he was surprised at how little blood was used. This was the reason that they did the angiogram with embolization procedure on Friday, and it was very successful in minimizing the blood loss. I expect it helps lower the surgeon's stress level as well - I looked at my pyrex measuring cup and thought of 500 ml of blood spilling all over my floor. Then I thought of 5000ml (more then a gallon of blood) spilling out of someone's neck as you are trying to do a careful job of identifying healthy cells from tumor cells, removing the tumor cells, and then building a superstructure of titanium in a living person's neck, and I was grateful for Friday's procedure.
They were closing Carl's surgery from about 2:00PM on until the surgery ended about 3:20PM. Carl was then taken to the recovery room. I met with two anesthesiologists at around 3:40PM, after they had stopped the anesthetic and removed the breathing tube and left Carl in the recovery room, (where visitors are not allowed). At about 3:45 PM I talked to the neck surgeon on the phone briefly before he went in to his next surgery. The neck surgeon indicated the surgery went well and he was pleased with the results.
Carl was in the recovery room until about 5:45 PM, and before 6:00 PM he was wheeled into his hospital room on the 5th floor of Froedtert, 5 South East room 25, where I first got to see him since 7:20 AM in the morning. It felt great to see Carl after all that time. My brother Tom stopped by within 10 minutes of Carl arriving at 5 SE room 25, which is in the 'Spinal Injury' Center.
Carl was groggy, thirsty and in pain, able to talk but only in a pained whisper, and was occasionally quietly agitated and anxious. His eyelids were very puffy (from having been laying on his face for hours), and he used his fingers to open his eyelids now and then, but mostly kept his eyes closed. He was very thirsty. As soon as the nurse 'read his orders' (instructions from the doctors), I was allowed to feed him ice chips. Carl was mumbling about water rights, and how people should not steal water. (This may be funny in the future, but at the time it just told me he was still pretty out of it.) My brother Tom kept saying "what?" every time Carl made some remark, and I kept making weird eyes at Tom effectively saying "I have no idea". It was nice to have Tom there at that time. Tom recently helped my brother Paul after a spine surgery, and he saw some of the similarities of the situations.
The neck surgeon stopped in to 5 SE room 25, and answered a few questions before leaving to arrange for more pain medication for Carl. Eventually pain medications were given and Carl settled down into a barely alert dozing state, waking to try to turn and find a more comfortable position. Tom left around 8:00. Carl had a neck draining blood from his neck (ok, yuck...) and woke up at around 8:30 PM when they emptied it. He wanted tubes out. The catheter could come out after he walked, and this motivated Carl. At around 8:40 PM he had walked half the length of a hall flanked by 2 nurses, with me pushing his IV 'tree' behind him. The nurses had to keep telling Carl to open his eyes. As soon as he was back in bed, he was asking them to take out things. The catheter came out, and arterial IV was removed, and the pain medicines were kicking in, and Carl fell asleep by about 9:15 PM, (after numerous times of shifting around his position, and Carl having me and the nurse change the incline of the bed, and location of pillows, etc.) He fell asleep, and his pulse below 60, which tells me that he wasn't in pain. (Of course, I had to first go and checked with the nurse to make sure the pulse rate that low was OK.) Carl didn't stir at all after about 9:20, and I left a little after 10:00 PM to drive home to my sleeping children, who had been fed and cared for by a team of friends that day on Monday alone. Thank you all.
Please pray that Carl recovers quickly and well, and that the tumor is mortally damaged and unable to grow back.
Carl's Angiogram procedure was successful and ended about 8:10 PM, on Friday, Jan 21, 2011. This is the first time that Carl has been knocked out with a general anesthetic, unless maybe when he was a baby. All other procedures (2 biopsies, and the port placement, etc.) have always been done with local anesthetic. Carl came off the anesthetic and had a breathing tube removed around 8:30 PM. The procedure went very well according to the Doc.
More later.
(Please keep Carl in your prayers.)
Today Friday, Jan 20, 2011, is the day that Carl is having his Angiogram and procedure. And what a rough day the day has been already.
The children have no school today, just because -- I guess the reason given is that it is the end of the semester. (And Monday was a "holiday" as well.) So, ... I have to make arrangements for the children. This shouldn't be hard, but the children want to lounge around and play, not get up, shower, eat, etc. on any sort of (highly delayed) time schedule. I guess I thought that my children kind of understood that today, with their dad having a medical procedure, they might have some responsibilities beyond self gratification. The children kind of thought today would be "Saturday like" with the added bonus that there would be zero adult supervision. So, today I had children breaking all sorts of rules, well before the 'adults' (parents) even left. (The children don't consider that they have rules, they consider them "guidelines".) One rule/guideline - once you get up: Shower, get dressed, possibly eat breakfast, and if the Dog is barking for attention, put him outside. One "rule": Practise the piano before playing computer or "screen" games.
I think my children have only absolutes:
- If any sibling is breaking any sort of rule, then you should also.
- If the dog is barking to go outside, then someone else should put him outside.
- If the phone rings, (even if you are expecting a call) someone else should answer it.
- If mom starts to yell at ALL FOUR children to take a shower, you can gain bonus points by pushing others out of the way once you belatedly (1/2 hour later) decide it is time for you to comply with her request.
- If mom starts to "yell", then children should pre-emptively yell.
- If mom is yelling at any sibling, then other siblings should pre-emptively yell if she looks at them.
- When mom lowers her voice and says "Do it now", then mom is yelling. Pre-emptively yell. If you are feeling teen-like, swear as well.
- If an event is going to happen more then an hour in the future, you don't need to start getting ready.
I think I am probably being passive-aggressive here, but I hope that someday my children read this and think "That is SO UNFAIR". My Mom is not supposed to have any feelings other then a desire to make me ridiculously happy. My mom is not supposed to have any negative feelings at all. (Well, maybe at my siblings when they interfere with the world wide goal of me being ridiculously happy.) My mom is not supposed to require me to participate in any work required for the upkeep of the family, house, dog. (GOSH, isn't that what she is supposed to do? I mean, LIKE, isn't that her bleeping JOB?)
I also hope that someday my children read this and think "That is SO UNFAIR". That is so unfair of my mom to use writing skills to vent her feelings. (We want writing to become obsolete, not used to remind our short term memories of negative things.) Writing is supposed to become obsolete, like hand-writing. Even the curriculum people know that. We keep telling mom that. OMG, DO I HAVE TO make MOM a power point? I'd TEXT her, but she won't even buy me a cell phone.) I know that the teachers have accepted that hand-writing is obsolete. The teachers don't even want to see our handwriting, because they can't read it. And neither can we. SO THERE.)
Well, I admit to my general audience here that I was stressed this morning, and my children did not come to my aid, but instead aggravated the situation. I know from personal experience that pre-emptive strikes do not work, and I know from personal experience that escalating hostilities are a natural human condition.
Where was I. Oh yeah. Carl has a medical procedure today; children weren't cooperating; no-one wanted to walk the dog in the cold; dog poohed in the house; someone stepped in the pooh, no child wanted to find ground zero (Ground Zero here refers to the initial spot the dog poohed in.) Car stalled a couple of times; Car needed gas...
Oh, let's just fast forward to the hospital.
The schedule we had been given was all geared for Monday's surgery. Not Friday's procedure. Where Friday's procedure is being done was not clear. Actually, since everything is computerized now, the computer printout had a column that says "Center". It has the Acronym "Radfec" Let's not spend any time helping the customer (patient) getting anything beyond a poor acronym. In fact, even the people filling out the computer form don't understand the acronym. And since the column heading 'center' doesn't really scream "Location", anyway, the data entry people will use the column 'Provider'. Perhaps that is the only field where they can type an entry. So, Provider will have "Ir 5 - FWC 2nd Fl". Yep, that will help our customer. No matter that it directly conflicts with Radfec.
You see, I have a four year engineering degree. (Not that I usually admit to it). I can speak (some) Acronym. So I know that ...
"Radfec" is probably Radiation or Radiology (two vastly different departments and locations) and fec is probably Froedtert East Clinic. (I know you readers recognized that right away.)
But everyone knows that Radiation wouldn't be located in Froedtert, it's in the connected building - the Cancer Center, so Rad can only be Radiology. Oh yeah, but not the X-Ray kind either, that is a TOTALLY different department, that's not really radiation anymore, that's, Oh never mind.
This then conflicts with "Ir 5 - FWC 2nd Fl" I believe Ir is Interventional Radiology. Well there, the customer (patient) should know right where that is. FWC (why the caps? Oh, punctuation, capitalization, all that stuff is obsolete or else it has a secret meaning that we won't bother you with...) FWC would (of course) be Froedtert West Clinic. And 2nd Fl - well second floor.
Well, F (Froedtert, for those not thinking acronym) is a big place, so the big people (administrators) labeled all the parts with East Clinics and West Clinics, even though it is a hospital, and an overnight hospital at that, so that there are a lot more then just clinics, but that's just... never mind. Anyway, (I think) Clinics are where you meet and greet your Dr, and Procedures are done elsewhere, (keep them doctors walking, it's part of our health care plan for them) but whatever....
I'm not conversant enough in acronym to know what the 5 means. I don't have advanced degrees. (Although I suspect it is the Ir room Carl is scheduled to have the procedure done in.)
Really, I should scan in our schedule. Oh well. We got lost, parked in the wrong area, walked back and forth, a lot, etc. Got Carl to where he should be. That's when we figured out that Friday's "procedure" is probably and almost bigger than Monday's surgery. Actually, an angiogram with an embolization procedure in the neck will require possibly more time than the surgery will. And Carl will need a general anesthetic, and ... But that can be for another post. Tah! (One of my friends uses Tah! instead of saying good bye...)
I hope all is going well with Carl's thing (angiogram with an embolization). They are hopefully about 2 hours into a four hour procedure.
Signed, Jeanne (Mistress of Laundry, Evil Mom).
The people at Froedtert are scheduling Carl's surgery and pre-op appointments and procedures. They were trying to get insurance approval, and sent in for the approvals on Thursday, January 13, 2011. The approvals should come back by the next day. I called the Dr.'s office late Friday afternoon, there was no answer from the Insurance company. I called the Dr.'s office later in the day on Monday, Jan 17, 2011. Because of Martin Luther King Day, most insurance companies are closed, and the Dr.'s office has not yet gotten approval. Perhaps this is one way of keeping insurance costs down. The earliest the insurance company will approve this procedure will be on Tuesday, January 18, 2011, when the approvals were requested Thursday, January 13, 2011.
In any case, it looks like Carl's surgery will be Monday, January 24, 2011. Please keep him in your prayers, and add him into the prayer chains at your church.
Happy New Year, 2011!
Carl and I and the children ended 2010 as we have been ending the Year for over a decade now - welcoming in the new year with some college friends and our eight assorted children, all born within 5 years of each other. (I think Carl and I visited each child in the hospital when they were born.)
It was a good way to close out the decade - We have been getting together for New Years Eve with these friends every year since before the turn of the millenium. (Photo above from Dec 31, 2000.)
January ushered in cold weather and more pain in Carl's neck. Multiple Doctors reviewed Carl's case, and are now recommending that Carl has a surgery to de-bulk the tumor in his neck. They considered this surgery before (in April 2010), and decided not to operate, (and at the time we were glad!). Now that the neck is giving him more trouble, the plan is that Carl will have surgery on his neck near the end of January 2011. [Update: The Surgery was on January 24, 2011] (Keep Carl in your prayers, PLEASE!)
First a special Doctor will do a procedure called an angiogram a day or two before the surgery. They will do an angiogram with embolization. Embolization is kind of the opposite of an angioplasty - the Doctors will attempt to kill and destroy the blood vessels that are supplying the tumor. [Update: The angiogram with embolization was on January 21, 2011]
On surgery day a neck surgeon will carefully remove as much of the tumor in Carl's neck as he safely can, approximately 90-95%. The surgeon will not try to remove it all, there are important nerves, blood vessels and spine stuff he doesn't want to get too close to. (The neck is a pretty important part of the body.) The surgeon will also try to cauterize (kind of burn to a crisp?) the blood vessels that are looking like they might want to supply the tumor area. A downside of removing the tumor is that the surgeon will then have to fuse several of Carl's neck vertebrae (C1 to C4, for those curious). An upside of this fusing procedure is that Carl may (with luck) actually have more neck mobility then he currently has now. Carl is in enough pain that he really turns his head very little at the moment. Carl will hopefully stay in the hospital for only a couple of days, stabilize, and then go home to recover. He will not be able to drive for 6 weeks.
I was glad the doctors didn't recommend this procedure in April of 2010, but now I really want the days to pass quickly until the surgery is over and done with. Carl has not bounced back from the last chemotherapy (which ended Dec 30, 2010) like he has from previous chemotherapies. Carl's pain is barely controlled by the medication he is taking - daily Oxicodone, with Oxicontin and Tylenol for 'break through' pain, of which there is a lot. The pain drains him of a lot of energy. It's hard to watch someone in pain and be unable to help in any meaningful way. Carl has lost weight for the first time in a year. Through this month he has been dragging himself to and from work as well, and I don't know whether to encourage or discourage this. (He probably wouldn't take my suggestions, anyway.) He basically comes home and collapses, sleeping an incredible amount, leaving me to wonder if I should wake him up to encourage him to eat, or let him sleep. I don't know the answer. When you get married they don't give you a book that tells you what do do in situations like this. I actually pray that I am not messing it up too badly.
I'm glad we made it to this weekend, (Jan 15 and 16), where Carl can rest, eat, and rest more. Next week the children have off Monday and Friday, and the two in high school have "exam week", and then we will tackle the medical procedures. Hopefully all will go well.
May your 2011 be healthy.
