Appendix 1

This log began with symptoms beginning in Aug/Sept. 1990 and remains active to the present.

 

Chronological Record of Events

 

 

Appendix 1

 

 

Aug/Sept. 90                   Hospitalized with suspected congestive heart failure. With the inability to sleep or lie flat, I had to extract the water build-up.  Lasix was prescribed and I was placed on an intravenous. This may have been congestive heart failure, but of all the physicians overseeing my case, the cardiologist was the only specialist who speculated coronary artery disease

 

These procedural changes caused discomfort since I never knew if

My physicians overseeing my care received the blood test results.  I could no

Longer email blood tests results any longer

.                                      Sight in left eye lost as a result of diabetic retinopathy. First laser treatment to left eye from ophthalmologist.

Oct. 90                            Received second opinion and medication for heart. A comprehensive analysis (including magnetic resistance imaging- MRI) was performed and the conclusion supported the same speculation of the cardiologist at another center.  Received second laser treatment.  Visited Diabetic clinic and was told kidney failing; need to control my glucose and blood pressure levels. Experiencing digestive problems, dizziness and diabetic nephrology; the loss of sensation in the feet.

Dec. 90                           With continued heart failure symptoms, I decided for cardiac bypass surgery, but the X-rays taken in October were unavailable, apparently, in transit from one center to the other.   Coronary bypass surgery will be scheduled when the X-rays are

                                       After attending church, I experienced first diabetic coma due to hypoglycaemia,

                                       revived by paramedics.

Jan. 91                            Quadruple coronary bypass surgery performed.

 

                                       Seen by cardiologist for follow-up and for monitoring of blood pressure

                                       levels. Now prescribed three pills for controlling hypertension. 

Feb. /April 91                  Continued laser treatment at two centers and then visited a

                                       retinal specialist.  Received another treatment for both eyes at with follow-up to    quadruple bypass surgery...

                                       Began investigating disability benefits with the Teachers Retirement System.

Summer 91                     Experienced second diabetic coma; taken to the emergency room and revived.  

August 91                       As my diabetic condition worsened, I researched transplant centers for information on organ transplantation; investigating potential ones for double transplant (pancreas and kidney).

Oct. 91                            Was placed on transplant list at University of Chicago after joining Organ Transport Support group (OTS).  I attended an orientation session at the U of Chicago and decided then, since this was still experimental research that I could at least contribute to the database should this be my last resort to remain alive.  I was provided a beeper so I could be alerted to respond at anytime were an organ donation is made available for transplantation.

92                                   Participated with Department of Rehabilative Services for Braille instruction and went to a clinic for low vision.  I picked up some devices for

sight assistance.  Also contacted and visited the Chicago Lighthouse for the Blind for job assistance.  Joined local chapter for National Federation of the Blind.

April 92                           Received final laser for right eye as suggested.

Visited a nephrologist at the request of the cardiologist for kidney failure and was advised, as creatinine level was high, that I should begin renal dialysis treatment.

Summer 92                     I had informed the school attorney about my need for a kidney/pancreas transplant. 

                                       Nausea and dry vomiting was more frequent which began my treatment of Zantac.

Sept. /Oct. 92                  I was informed that the use of zantac may have contributed to the tumor that was removed from my left breast. Zantac was discontinued. 

I was beginning to experience more diarrhea and nausea symptoms subsequent to kidney failure. 

Jan. 93                            I was in the hospital and started receiving renal dialysis treatment and had a fistula placed in my left arm.  I was also receiving treatment through a shunt placed in the shoulder to draw water from my body.

 

Stayed off of work for a period of time.  Now sought a contract “buy-out” from the local Board of Education (BOE) because of my failing health. I was experiencing a dramatic increased level of stress being caused by some members of board as a result of my absences. The BOE refused my request. I was unable to provide them with an apparent satisfactory proposal.

Feb. 93                            Due to an infection through the shunt, I was placed back in the hospital.

At approximately the same time, a vessel in my right eye ruptured; likely as a result of the treatment I received from dialysis for blood thinning.  I was temporary blind, but regained some vision in the right eye. Later, I became aware that an optic nerve stroke occurred which may have been caused by high blood pressu

March/Apr. 93                 I experienced more frequency with diarrhea and nausea and

                                       was provided medication for both symptoms. 

Began experiencing sores between my toes which were not healing; concerned about potential amputation if gangrene were to take place.

June/July 93                   I was called that a potential donor was available for the double transplant and prepared to go into surgery. Unfortunately, the donor’s pancreas was unsuitable. .

                                       Contacted the Teachers Retirement System about disability filing.

Sept. 93                          A retina specialist performed eye surgery to right eye because of detached retina. The surgery consisted of removing the calcium build-up and then adding a buckle in the right eye.  I told the specialist that I was awaiting a transplant and he said this surgery must be done now should I want to retain what sight I had remaining in my right eye.

                                       Temporarily off work due to call for transplant.

Sept. 26. 93.                    Underwent kidney/pancreas transplant; surgery was a success.  Weekly lab visits were scheduled; I was consuming approximately 53 pills/day for anti-rejection, blood pressure, and heart circulatory conditions.

                                       Remained out of work for another two weeks. 

May, 94                           Received information from the Teachers Retirement System about filing for disability

June 30, 94                     Last work day due to contract non-renewal.  The employer was previously informed that I filed under the American Disability Act.  When the Act became law, the employer was presented information and told that, under the guidelines, their current Chief Executive Officer falls within this classification.

July 94                            Filed for Unemployment Compensation.

Sept. 94                          Filed for disability with TRS and was approved.

Oct. 1, 94                        Taken off Unemployment Compensation due to disability coverage.

Sept. 26, 94                     One year anniversary and medications were reduced to maintenance

                                       level.  Amylase ran consistently at 43 since the transplant and now

                                       has reached 379 at reading on Wed., Nov. 2, 1994. 

Both the urinalysis and Computer Axial Technology (CAT) scan revealed no information to detect cause; Amylase had been steadily climbing since this date and read 73 at the next lab.

Nov. 1, 94                       A biopsy was taken on November 2. The biopsy showed no rejection so an ultra-sound and urine would be taken on Friday, Nov. 4.

Nov. 4, 94                       Took labs, urine test, and ultrasound for bladder.  Urine test confirmed

bacteria and placed on Cipro 750 mg. for ten days.  Results from ultrasound indicated bladder was functioning properly.

Nov. 11, 94                      Called to put in Foley-Catheter.

Nov. 14, 94                      Took second biopsy since lab results showed 1.6 for creatinine, 23 for BUN, and 327 for Amylase (up from the two previous readings).  Added urine test for culture while biopsy showed no rejection.  Culture was negative, thus told I should wear catheter for two weeks.

Nov. 28, 94                      Removed catheter. Amylase down to 117 from 176 last Monday.

Dec. 7, 94                        Amylase down to 77; advised to take labs every other week.

Dec. 21, 94                      Amylase down to 52.

: Feb. 15, 95                    Glucose reading now is 152 and has steadily increased since infection;

readings have gone to 100, 120, and 120 on Monday. Last test for Amylase indicated 40, creatinine levels at 1.0.

3rd biopsy taken, results were negative.

Mar. 13, 95                      Glucose reading was 183 fasting. 

Experiencing increased stress from recent death of father, unemployment, litigation resulting for claim of unlawful termination, concerns over future job opportunities.

Apr. 17, 95                      Glucose read at 171.  Physician wants to take aggressive

                                       approach and check insulin production level, then perhaps pancreas

biopsy.  Apparently, stress not contributing factor, however increased weight due to intake of high levels of steroids may be.

Apr. 23, 95                      Started weight loss program and exercise.  Last 3 days glucose readings

                                       were 116, 111, and today at 110.

Apr. 27, 95                      Weight at 170 and glucose at 96.

                                       Scheduled for removal of skin  cancer on Tuesday, May 2.

Saw endocrinologist, results of tests and exam returned with no negative findings about pancreatic function.

July 24, 95                      Glucose reading at 83 from glucometer.

Aug. 6, 95                       Starting 2nd week of “fat burning” diet.  Lost four lbs. first week, ending at 166.   Glucose read 74 during diet period. 

                                        Experienced more energy, less sleep, greater appetite, and increased positive feelings of general well being.

Aug. 26, 95                     I weighed in at 161 with approximately two good weeks on diet.

Sept. 19, 95                     Saw Ophthalmologist for second opinion; took test to determine if cataract

                                       was cause of blurriness.  Because of risk, decision of physician was to

                                       wait until it becomes absolutely necessary to do cataract surgery due

to remaining sight in right eye.   

Sept. 26, 95                     Second year anniversary of organs transplant.

Nov. 20, 95                      Talked to ophthalmologist assistant who said that the

                                       cataract is in the center of visual field.  I plan to take a vision

                                       exam tomorrow to see if 20/50 has changed since the blurriness

                                       appears to be getting worse.  She again cautioned me, if surgery were

                                       to occur, about the risk involved with blindness due to my past

                                       medical history.

Nov. 21, 95                      Vision test reading showed 20/60 vision in right eye.

Nov. 30, 95                      Met with Ophthalmologist, who provided a more definitive answer to

                                       possible cataract surgery.  He said that he is not concerned about

                                       surgery, but infection may occur some time following. No activity

                                       is prevalent, buckle and laser near mascula under control.  As a

                                       specialist who works on difficult cases, he has scheduled a return

                                       visit for Jan.11 to undergo a PAM test and discuss possible surgery.

Dec. 12, 95                      Experiencing increased tightening sensation in chest that may indicate a reoccurrence of heart problems that has been going on for some time now.  I recall being told that the bypass may only last five years.

Dec. 22, 95                      Last night was a difficult night for sleeping.  Reoccurring chest pain and

heaviness again.  Talked to a nurse and informed her of my symptoms and concern.

Dec. 25, 95                      Admitted to Emergency Room (ER) for chest pains. Transported via ambulance to transplant center; scheduled for cardiac catherization exam on the 27th of December.

Dec. 28, 95                      Cath… exam indicated a 99% block in one of the vein graphs; angioplasty performed and a stint was inserted.  However, during procedure, plaque became dislodged which resulted in a "controlled" heart attack. 

The attempt to clear the graft failed (likelihood of this occurring is approximately 1/1000).

Jan. 2, 96                        Consideration to undergo catherization for irregular heart beat, but cancelled until further observation of condition revealed.

Jan. 7, 96                        Discharged from hospital on Sunday, Jan. 7. Discharged with notices to follow up with cardiology, transplant, and eye clinics.

                                       Noted it is very difficult to see the computer screen; concerned that more damage to right eye may have occurred from heart attack.

                                       Modifications were prescribed for heart condition with a number

                                       of new medications.

Jan. 11, 96                      Saw Ophthalmologist and decision was made to schedule cataract surgery for

                                       Monday, January 29.  Specialist felt that the time is right and PAM test

                                       showed that 20/30 vision can be restored.  Awaiting OK from cardiologist.

                                       As required periodically, provided papers for filing with TRS.

Jan. 17, 96                      Got “go ahead” from cardiologist for cataract surgery.  Also received papers for

                                       cardiac rehabilitation to begin. 

Received papers from a second MD and forwarded to cardiologist for TRS disability.

Jan 26, 96                       After meeting with anaesthesiologist, he voiced concerns about a cardiac

reoccurrence, especially since I recently experienced a heart attack, if cataract surgery is undertaken. He feels comfortable in waiting 6 months before the procedure.  Ophthalmologist called and agrees, but remains open to express aggressiveness depending upon recovery rate.  The cardiologists concur.

Feb. 5, 96                        Started 1st day of Cardiac Rehab.

 

Feb 28, 96                       Follow-up visit to Cardiologist indicated that moderate heart attack caused

                                       little, if any, damage and recovery is going well. 

                                       Cataract surgery can now be performed.

March 18, 96                   Today marked the end of first 6-week period of Cardiac Rehab.

March 25, 96                   Missed complete week of Cardiac Rehab due to sickness.  Taking 500

mg. of Amoxicillin and Robotusin cough medicine.  Must take entire 10- day supply.

April 1, 96                       Cataract surgery performed in morning.

Apr. 9, 06                        Ophthalmologist said that he plans to take out stitches April 3. Sight should be

                                       restored to at least 20/40, without the aid of eyeglasses.

April 21, 96                     Went to optometrist who fitted me for temporary glasses; told

                                       that my periodic blockage in the right eye could result from the packet

                                       that exists where the cataract was removed which may lead to additional

laser surgery.  The risk to this step is potential retinal detachment; other risks could be clotting of blood flow or carotid vessels blockage.  Decision will be left to eye surgeon.

April 22, 96                     The eye surgeon stated that there is a bag but it does not block the central vision area and laser treatment is not necessary.  The eye is clear and looks good. 

                                       Scheduled an ultra sound test for carotid veins in neck which may be causing blockage problems.

April 30, 96                     Took out two stitches from right eye with remaining to be taken out

                                       on May 14th. 

Carotid veins showed 50% block in left artery with right being clear; would not then account for vision blockage.

May 14, 1996                   Ophthalmologist took out all but one stitch. Prescription modification done.  Stigmatism is now at 6, down 3.5 from once we began.  Follow up

                                       tentatively set for two weeks depending on visual correction per glasses.

May 15, 1996                   Met with Cardiologist regarding heaviness in chest area as a precautionary

                                       measure and received written permission to continue cardiac rehabilitation.

June 11, 1996                  Visited Ophthalmologist and took vision field test; revealed a peripheral block in upper

                                       left field which is indicative of an optic nerve stroke which may have

                                       occurred in January 93 while on dialysis.  According to Ophthalmologist, stress

                                       is a contributing factor to this possibility.

Sept. 10, 1996                 Visited Ophthalmologist for a check-up after I had seen optometrist and retina specialist previous.  Ophthalmologist has now agreed to schedule laser surgery of the capsule which may be interfering with visual clarity on Tuesday, Sept. 17 at nine o’clock in morning.  He further stated that due to conditional stress, dialysis, the varying levels in blood pressure may have contributed to the optic nerve stroke that was experienced in January 1993. 

Sept. 17, 1996                 The day after laser surgery has revealed that the cloudiness remains

                                       which now leaves the possibility of either retinal or optic nerve

                                       damage as a permanent condition.

Sept. 24. 1996                 Visitation to Ophthalmologist confirmed that the remaining cloudiness (hazy) is

                                       the result of optic nerve stroke.  This is a permanent situation which

                                       cannot be corrected.

Nov.  5, 1996                   Follow-up visit to Ophthalmologist to determine why it appeared that my sight

                                       has worsened.  Another color vision was given with same results and

                                       display of upper sphere damaged by optic nerve stroke.  The need

                                       to watch blood pressure and check on retinal area is paramount.

Dec. 27, 1996                  Took an echo cardiogram and an ultrasound for abdomen. Ultrasound indicated gall stones. 

                                       Cadiologist placed me again on Lasix and insisted on a visit to

                                       the transplant clinic to see transplant surgeon.  He further has suggested

                                       that a thallium stress test be taken in mid January to check the

                                       heart.

Jan. 16, 1997                   The Thallium stress test is scheduled for Friday, the 31st followed by

                                       visit to cardiology and then a consultation in the Transplant Clinic.   

                                       Recommendation from cardiologist is to undergo gallbladder surgery.

Jan. 31, 1997                   Underwent a treadmill and more profuse stress test due to my heart

                                       rate now climbing to 164; instead it reached only near 100. 

                                       The heart muscle appears strong; however, there is some showing of

                                       significant loss to area where heart attack occurred which could mean

                                       bladder blockage causing lack of blood to that area or damage already

                                       done by previous heart attack.  It is imperative that in order to

                                       discover this condition more clearly; an angiogram must be taken again. An

                                       angiogram will be scheduled and if needed, angioplasty will be

                                       performed given a 50/50 chance with a lesser invasive attempt then

                                       done last December.

                                       Gallbladder surgery is a must so during the week of Feb. 10,

Feb. 13. 1997                  Angiogram performed and results indicated no problem with

Heart. 

 

Transplant surgeon mentioned the possibility of digestive problems due to diabetes which may be affecting digestion and bloated and nausea symptoms.  He will look at ultrasound to determine if any fluid is built up before deciding on gallbladder surgery.

Feb 21, 1997                   Gall Bladder surgery performed. Left hospital; unable to urinate with catheter.

March 4. 1997                 Went to urology for prostate exam and removal of catheter.

March 13, 1997               I visited the Emergency Room to check on water retention in both ankles and legs in order to determine possible blood clots or possible long term effect of

                                       lasix.

March 25, 1997               Prescribed medication to be taken four times a day to help the food

                                       move around for digestive problems that now are prevalent called

                                       Propulsid.

April 2, 1997                   Blood tests indicate glucose level at 95, but creatinine is 1.4 which may

                                       signify water retention occurring even after exercise.   Weight

                                       could contribute as stomach has really ballooned.

April 28, 1997                 Scheduled for an upper gastrointestinal endoscope examination to determine cause of excessive bloating. Results indicated a recommendation to

either wear a patch or take bi-weekly shots to help the movement of food through digestive tract which has been impacted over the years from diabetes

 

Lasix has been increased to 40 mg. when necessary with tapering off as indicated. 

Experiencing continued aches and pains in lower extremities. Circulation to legs is impacted by effects of diabetes and poor circulation results in aches and pains when over exertion occurs.

May 7. 1997                     Legs and body ache continues as does pain in lower back.  Rehab today

                                       was quite difficult.

Aug 31, 1977                   End of Medicare Insurance coverage as primary carrier.

Sept. 9, 1977                   In my visit with gastrointestinal specialists, it was recommended cutting back

                                       on Propulsid as first step which may help current digestive issue.  Eventually,

                                       Miralax was prescribed to facilitate movement in the digestive tract.

Sept. 16, 97                     Assistant recommended that I begin taking Milk of Magnesia.  No other medications are available for this present condition. .

Jan. 28, 98                      Confirming my recent visit to optometrist, Ophthalmologist reinforced the

                                       fact that as an aftermath, which usually he views from much older patients,

is forming due to the surgery. This growth can block the central vision area.  In time this growth will need to be lasered when it is appropriate. 

Oct. 12, 98                          I called my primary physician and informed him that this continual coughing with sinus drainage has not changed much since having taken more than 3 weeks of antibiotics  Still difficulty sleeping at night as this now has lingered on for more than 6 weeks.  He has now prescribed some new drugs which contain an antihistamine and congestion combined in one.

Nov. 11, 98                      Walking remains difficult with pain and stiffness occurring as usual.

                                       The cardiologist noted this may be the result of hardening of the

                                       arteries in my legs.

Feb. 15, 99                      I saw an ear, throat, and nose (ENT) specialist, who scoped the nasal passage and suggested a sinus MRI.  Upon reception of the x-rays, antibiotics and nasal spray was prescribed for a two week period.  Further investigation may result.

March 2, 99                     My visit to ENT presented another final attempt with an increased

                                       dose of antibiotics and another nasal spray.  If this does not help and the

                                       level of discomfort remains, the scrapping (surgery) the nasal area is

                                       a possible next step.

March 11.99                    The ENT went over surgical procedure and then prescribed a different

                                       antibiotic to see if that may make a difference.

March 18, 99                   Conducted a medicated stress test and on March 25, the results were no

                                       different than the one taken two years ago.

June, 99                          Saw optometrist again for yearly check-up and received a new prescription

                                       for eyewear.  More glairiness is taking place and measures are being

                                       employed to reduce the reflection issue and stigmatism through the

                                       selection of plastic versus high index lenses.

August 2, 1999                Informed that the Federal judge rejected the summary judgment of the

                                       defendant and has set a “settlement” meeting for August 26th at

                                       2:00 p.m. before the case goes to jury trial.

September 7, 1999          Visited Ophthalmologist for yearly check-up and asked whether the secondary

                                       cataract ought to be removed to reduce glairiness.  Due to the optic

                                       nerve stroke and delayed receptor reaction, the removal of such

                                       would more than likely make no difference.  He also ruled out

                                       the new laser RK treatment for patients like me since

                                       there has been damage to my retina and the result will

                                       cause more glare.  The use of anti-reflective devices and the

                                       covering of blocked rays by use of Polaroid deflectors are the

                                       best that can be done.

November 12, 1999         Visited 2 nephrologists who will monitor my progress.  An additional test was added for blood results and my Prednisone was reduced from 10mg. to 7.5mg.

March 21, 2000               Nurse from cardiology called and reviewed the lab report

                                       thereby reducing my cyclosporine dosage to 125/100 per day.  I had told

                                       her of the symptoms and the email I sent yesterday and

                                       she was to set the date for the stress test and urologist.  The symptoms

                                       include frequent episodes of nausea and infrequent shortages of breathe

                                       on the treadmill at cardiac rehabilitation.

May 12, 2000                   Saw the nephrologist who has recommended that Propulsid be lowered and

                                       then discontinued due to known side effects. Wants to add fiber by taking

Metamucil nightly.   Ordered some blood exams to recheck the Cyclosporine level.  Previous to this visit, a stress test was completed.

May 15, 2000                   Visited cardiologist who reviewed the stress test and reported that

                                       a build-up is reoccurring in the back of the heart artery which once

                                       was previously clogged.  He wanted an X-ray and Echo done for further

                                       information which may lead to an angiogram and possibly second bypass

                                       operation.  His immediate plan is to continue medication.

 

                                       Visited urologist who completed a digital exam and found an

                                       abnormal prostate (firm or hard) and recommended a biopsy be done. 

                                       He did notice an enlarged prostate and was informed of forced urination

episodes.  A PSA test was done as well.  He did provide sample medications which may help the urination flow and it to be taken nightly.

July 10, 2000                   Reoccurring digestive problems continue with bloating, lack

                                       of bowel movement though the addition of Metamucil without

                                       Propulsid seems to have helped.

Aug 30, 2000                   Last day attending cardiac rehabilitation due to a change in insurance

carriers from Western Illinois School Benefits Association (Wisba) to Blue Cross/Blue Shield of Illinois; BC/BS now becomes the primary

                                       insurance carrier.

                                       Checking into local fitness program; average cost of $77/semester.

Sept 3, 2000                    Started the first activity at the fitness center and

                                       experienced the “squeezing effect” while on the treadmill

                                       at around the 7th minute.  This was done after the cycle was

                                       completed.  Emailed cardiologist on Monday, Sept. 5.

Sept. 7, 2000                   Took blood tests as prescribed and will complete angiogram scheduled for Wednesday, September 13.

Sept. 16, 2000                 Results of angiogram indicated that graft, where angioplasty was

performed, has reclogged; possibly beginning as early as 1997.  The 3 other grafts are functioning while a diminished bump flow is now reported.  Unless

                                       cardiologist feels otherwise, no surgery is needed at this time.

Jan. 14, 2002                   I have continued my attending religiously the physicians monitoring

                                       my care and have modified some of the medications I take.  Lotensin

                                       has been dropped and replaced by Hydrocholorizide via the advice

                                       of the nephrologist. 

 

I am also attending the fitness center fpur times a week for aerobics exercises lasting over 1 hour each visit.

Aug. 12, 2002                  After visiting the endocrinologist, I took a body density scan and spinal scan which determined pockets of arthritis and confirmed a breakdown of bone structure.  As a result, I am taking Oscal (2xday) and Fosamax to help build bone structure.  With the addition of Oscal, the periodic digestive

                                       gastric issue has resolved itself even though Raglan was provided as a possible treatment for modifying the gastric issue.  These tests will be administered each year.

September 20, 2004        Have now included the Multiple Vitamin Daily Supplement into my dietary regimen. The initial reaction seems to be more vigor.  The cramping in the legs has stopped, perhaps due to the herbal ingredients.

February 2, 2005             Basal cell cancer removed from upper eye area on right side of face. 

                                       Additionally, I have been seeing a Dermatology team for nearly 1 year for removal of warts and other skin conditions, primarily caused by sustained use of anti-rejection drugs.

February 3, 2005             Went into ER due to soreness and pain in left foot.  X-rays proved negative; however, an infection was shown between the two smaller toes. Neosporin and antibiotics and pain reliever were prescribed. 

February 13th, 2005             After I made an emergency visit to a vascular surgeon about this continued pain, I called to determine what could be done since the pain that morning required some form of support.  Advil was recommended at 80mg per day and that eliminated most pain, swelling, and redness. 

                                       Doppler and carotid tests are scheduled for Thursday, February 17 in the vascular clinic.

March 2, 2005                 Went to have basal cell removed from face for the second time.  First removal was done in 95.  Since the demand of his skill makes it very difficult to make appointments, I am using a different surgeon this time.

May 16, 2005                   Began taking a chlorestol pill 20mg prescribed by cardiologist

                                       due to elevated readings.  This medication has been working well for

                                       better blood flow with heart transplant patients.

 

                                       An echocardiogram was set to be taken in June and monitoring of more frequent angina which can indicate that grafts may be worse now than

                                       when the last angiogram was done.

June 20, 2005                  With persistent pain in chest area, especially when I sit back in chair

                                       or drive vehicle, cardiologist has set a Nuclear Stress Test for July

                                       To be followed by an angiogram soon thereafter.

                                       I am able to exercise comfortably though I have recently experienced more swelling in left leg. The Doppler test revealed “moderate” circulation in both legs.

Summer 2005                 With the new change in TRS policy, disabled are able to teach up until

                                       “the limit of their pre-determined disability payment”.  I contacted the

                                       the Regional Superintendent of Schools to investigate procedures for

                                       recertification and eligibility to serve as an interim superintendent.

August 5, 2005             Called the cardiologist’s nurse because of near fainting episode at Fitness Center while working out on incline board. She conferred with 

Assistant, and after reviewing recent test results, felt I should come to hospital and be admitted for evaluation.

I was admitted to the Cardiac Care Unit at the hospital about 9:00 PM.

                                       And placed on a heart monitor.

August 6, 2005                Over the weekend, it was determined that I should have an angiogram

                                       to check for blockages in graphs. It was scheduled for Monday the 8th.

August 7, 2005                While being monitored I went into rapid heart beat which I did not feel.

                                       The nurses arrived to check …when I then began to feel a dizzy reaction.

August 9, 2005                Had the angiogram followed by angioplasty in a graft 79% blocked; a

                                       stint was inserted.  The three other grafts were 30% blocked and left alone.

There now appears to have been more visible heart damage than originally suspected from the attack in 95. It was determined by the episode on Friday and then on Sunday that I have an irregular heart rhythm (right atrium and left ventricle) and would be a candidate for insertion of a defibulator.

                                       It is set for Thursday the 11th

August 11, 2005              Went down to the holding area for prep of defib procedure. During the prep,

                                       I went into cardiac arrest.  I was revived in 2-3 minutes.  It was

brought to my attention later in the ICU that the cardiac arrest might have been induced by the administration of a wrong medication. This medication error by the nurse resulted in more hospital time and a reschedule of the implantation, which is now scheduled to be done at the beginning of next week.

 

Following recovery, I was taken to cat lab to check to see if the grafts on Tuesday remained open, they were.

August 15, 2005              Inserted defibulator and pacer in right area of chest and discharged the

                                       following day. No more MRI diagnostic tests can be used.

                                       Both kidney and pancreas levels remaining high.  Kidney was 1.7

August 20, 2005              Possibly restricted blood flow with sensations of “wanting to urinate”

                                       persist as of 8-20-05.  A comprehensive blood draw is scheduled for

                                       August 26th.

Right leg is now swollen and painful with little mobility much like what happened to left leg but no known cause  It is hard to move where joint lies.  Wonder if this could be the result of the additional drugs that have been added to my regiment? As before, I am using a heating pad and ice to see if this will help.

Have experienced much more vigor and energy as of late, probably due to open graf. Have been able to operate on no more than 2 hours of sleep per night.

August 29, 2005              Since the surgeries, I have been unable to put a shoe on left foot and

                                       swelling is taking place in both lower extremities.  The right leg is

                                       gradually easing up though there still remains some tenderness

                                       following the “shin” line.

 

I am able to get more sleep though the lightheadness and dizziness remain, more than likely due to the newly added medications. 

The sensation in the heart appears more prevalent now.  Could this be a mild congestive heart failure or poor pumping from left ventricle?

Sept. 2, 2005                   Took another dobbler for purposes of determining whether any

                                       aneurism(s) exist in legs or groin region which might explain the swelling. 

 

                                       Met with electro-physicist group and surgeon for defibulator.

Sept. 8, 2005                   Visitation with cardiologist resulted in continuous application

                                       of multiple medications to control heart problems.  Grafts appear

to be wide open now.  A new prescription was ordered for acid reflux which may be the cause to the sensation being felt in heart area.  Additional consideration will be given for a different heart medication, pending approval

                                       from nephrologist (for kidney concerns), and the possibility of dropping

                                       the drug that dilates the vessels to assist with muscle contraction function.

Sept 13, 2005                  Due to positional issue for dizziness, an audio test is set for Wednesday,

followed by a visitation an ENT specialist. This action is to determine whether an inner ear infection is causing the dizziness.  Visitation was recommended by nephrologist.

Sept 15, 2005                  After my visitation with ENT, the crystals in the inner ear will

                                       require physical therapy since it appears they are out of line.  Although

                                       there is minor hearing loss (expected of my age group) overall

                                       hearing is fine as indicated by audio test.

Nov 9, 2005                     I attended physical therapy for 3 sessions which helped, but did

                                       not relieve the “vertigo” that still remains. I still experience an imbalance

and spinning when I move to a different position than before; for example, when I lie down on the same side and experience dizziness more when the eyes are closed and I move my head backwards.

                                       On Monday I received treatment for skin condition and will now

                                       have a biopsy in two weeks in approximately 4 areas to determine

                                       whether skin cancer has returned on the arms and face.

Nov 14, 2005                   In my visitation with nephrologist, he suggested that I see another

ENT Specialist and possibly take a cat scan, thinking that the vertigo has nothing to do with the changes in medication.

                                       A meeting is set for January 5, 2006.

Nov. 30, 2005                  With the most recent biopsy report, I underwent surgery on 2 areas, one on the right side of face and one on the left.  The remaining 3 biopsies dictated more treatment, 2 areas for wart-like conditions and a third pre-cancerous.  During the surgery on the right side, I experienced the same dizziness sensation when I turned my head too far to the right. 

Jan 05, 2006                    Saw new ENT specialist for further investigation about reoccurring issues

                                       with faintness.

 

                                       Went to Electrophysics lab for check on the heart pacer and defibulator.  It

                                       was revealed that the upper heart chamber were beating twice the rate

                                       as the lower chambers.  Brought the information to cardiologist at

                                       a routine review and was admitted for cardiac ablation. 

 

During surgery, the surgeon discovered the irregularity in the left upper chamber and corrected 8 areas by burning the irregularities.  This brought the heart rhythm back to normal.

                                       I was released from hospital and now experience pain in my left shoulder

                                       blade.  I have begun to take Advil for temporary relief.  This could be

the result of being positioned for the 6-hour surgery. I remained in the same position for 5 additional hours.

Jan 08, 2006                    Called the surgeon who prescribed Vicotin, a stronger pain relief medica-

tion than Tylenol 3 (which had little effect on me).  I was told that this could be the result of the positioning for the 11 hours of surgery; however, the discomfort should last only two more days.

Jan. 18, 2006                   Urine restriction, breathing difficulty, and swelling in both legs soon

                                       appeared.  Though this was a repeat in October 2005, this time the

                                       bruising and tenderness took place in the upper thighs as well as

                                       the lower leg and foot extremities.  I account this to the amount of

                                       time the procedure took and duration of the catherization.

 

My concern with the kidney function prompted a call into the nephrologists, who ordered a comprehensive blood draw.

Jan. 25, 2006                   I placed calls into two physicians due to the continual problem

                                       with urine reduction.  Labs and ultrasound were taken.

                                       The ultrasound will determine the source of the blockage which may be

focused on the enlarged prostate. There was no obstruction viewed so an appointment was set for urology

Swelling appears to be getting better; however, breathing (fluid build-up) remains an issue as well. 

Feb. 4, 2006                    I am able to put on loafers again and it appears that the swelling is

                                       under control and sensitivity in legs has diminished.  I also am urinating

                                       much better but the urge to do so is more prevalent now. 

 

                                       Thursday, February 2nd was perhaps my best workout by far in the last month.

Feb 13, 2006                   The right ear was laden with wax and hard crusting had to be removed

                                       by ENT. 

The urologist prescribed Flomax as a 2 week trial for the enlarged prostate.  If this does not work, then laser surgery may be required.

March 22, 2006               Started to use ice packs to ease the pain and swelling of both

                                       feet.  The left foot and small toe were quite tender as compared to the

right which is swollen as well.  Without the use of socks, I was able to get a pair of moccasins on.

                                       The following day I visited a podiatrist, who then took 3 x-rays revealing

                                       a possible fractured left toe.  Antibiotics will be administered and a

follow-up visit is set for next week to determine if this is the case for the discomfort rather than an internal blood infection which would require hospitalization and IV fluids.

April 12, 2006                 From the different sections of the leg and foot where swelling and pain is

                                       taking place, this may reveal that I have “gout” (a condition that was prevalent in my father) and a condition that can be precipitated by the use of Cyclosporine. A uric acid test was ordered; the result was 10.7 to confirm “gout” and Colchicine was prescribed.

                                       Today, I will be taking another follow-up x-ray that may reveal some changes

                                       In bone structure and see what the podiatrist recommends if any.  The use

                                       of Tylenol 2 is not responding much to the pain.  .

April 24, 2006                 I was unable to avoid the cold and sinus outbreak this year and began

                                       taking zithromax again and some cough medicine containing codeine. 

The persistent cough and sinus drainage has caused very little if any sleep for the past 3 days with a loss of appetite.  Tomorrow, April 27th, I will use my last antibiotic to complete the 5-day series. 

May 1, 2006                     Was contacted by BC/BS about participating as a selected member in

                                       case management resulting from the variety of health issues I am

                                       involved with.  I will be contacted soon by a case manager.

May 23, 2006                   Follow-up visits with many different specialists were scheduled for

June 28; one being a two hour test to determine the causes of sources of positional balancing that continues to result from moving the head down and moving the head up front which then leads to a temporary loss of consciousness.  

Ear, Nose, and Throat specialist checked the ear and throat again and determined the sinus-cough reoccurrence is due to acid reflux. Prevacid was prescribed for acid reflux at 15 mg to be taken for 30 day.

The nephrologist based on recent experiences and Monday’s blood results, wants an immediate liver scan.  He is also changing Immuran to Cellcept which might reduce the frequent outbreaks of gout and reduce the skin problems as well. 

June 7, 2006                   Second outbreak of gout, this time involved both knees and feet.  The day

                                       previous I had taken 4 Colchicine tablets to alleviate mild pain in left leg and

                                       woke up to experience pain in both legs.  I went to see primary physician who

                                       prescribed a larger quantity of colchicine. 

June 24, 2006                  Gout in left foot; took seven colchicine pills.

June 29, 2006                  Having taken the audio test for inner ear, ENT recommended a

                                       neurological review and physical therapy.  He said the described symptoms

                                       could refer to inner ear, eyes, legs and possibly neurological.  The audio

                                       exam did reveal inner ear problems though there can, over time, be some

                                       dysfunction that has developed.

Nephrologist is changing Immuran to cellcept and blood test will be taken for three consecutive weeks. In three months, cyclosporine will also be changed to prograf. This should help the gout and skin condition. 

July 7, 2006                    I have now attended two sessions of physical therapy, which is limited to the

                                       lower extremities since the therapist is incapable of dealing with the head

                                       movement problems (which she contends is either circulatory or neurological).

                                      

                                       I have now experienced three bladder control episodes at times when I was

                                       unable to get to the bathroom on time.

August 3, 2006                I visited a neurologist and the supervising neurologist about my balance issue and there was some concern, based upon the tests administered, about blood pressure and use of Metopolol.  A cat scan is set for the 16th of August.  Furthermore, the neurologists want a check of the right eye to determine if there is swelling of the retina which then would lead to a

                                       spinal cord check

                                       I contacted the optometrist and emailed the neurologist that there is no

                                       swelling of the retina.

                                       The fourth carotid scan revealed very little change from years previous

August 16, 2006              Met with Ear, Nose, and Throat specialist and once again had my ears cleaned.  His final analysis was that I should remain doing physical therapy for the adaptation will take a long time.  He believes due to problems with inner ear, eyes, and lower extremities (where neuropathy is prevalent), these all contribute to my balance problem. 

                                       I also had the CAT scan completed

August 17, 2006              Today I received a letter from BC/BS about the difference of taking generic

                                       drugs as opposed to non-generic and the differences in cost.  Pravachol

                                       was listed as one.  Steps were taken to review all prescriptions, and if

                                       possible, use generics.

September 1, 2006          I called the neurologist and also nurse in cardiology about progress

                                       and results of CT scan.  Neurologist confirmed that there was no indication

                                       of brain dysfunction and she has emailed cardiologist concerning the syncoptic

symptoms.  She believes this is a case where I will have to be careful when and how I position myself due to the shift in blood pressure. However, a change in medications may have an impact.

                                       With the departure of my nephrologist, some minor adjustments will be made 

relating to blood test results and prescription drug ordering.  These procedural changes caused discomfort since I never knew if my physicians overseeing my care received the blood test results.  I could no longer communicate by email.

I received confirmation that Prograf has been ordered and shipped to replace cyclosporine and blood tests have been set up to measure the levels to assure that the change is positive.  These procedural changes caused discomfort since I never knew if my physicians overseeing my care received the blood test results.  I could no longer email blood tests results any longer

September 8, 2006          Called the Cleveland Institute of Syncope to discuss further investigation of possible syncope. Awaiting cardiologist review of current dosage levels, then will look into an appointment.  Following that discussion, a call to the electrophysiological lab was made about this issue. My condition could be “carotid sinus”.  After further discussion, a meeting was set up for Monday, September 11 to further investigate this Issue.  An additional email was sent to the neurologist, who also recommended referring this to cardiology

                                       Prograf (3mg, 2x/day) was started today.

September 11, 2006        Met with electrophysiology who performed an ICD check, took blood pressure.

                                       Completed Table-Tilt test, results were negative (fine).      Possibly, effects from the medications (Hydralazine and Flomax) may be causing the imbalance problem.   Medications may need adjusting.

 

                                       Question: Why was hydralazine prescribed in place of hydrocholorizide?

September 21, 2006        After sending a two-day reading of blood pressures, a change was

                                       made to reduce Hydralazine from 100 mg to 50 mg daily or 25mg/

                                       2 x days.  Likewise, a prescription refill order was placed which

                                       included 3 additional generic drugs as recommended by BC/BS.

September 25, 2006        I received my second treatment as an attempted relief from the

                                       chiropractor who has indicated an inflamed area of the right

                                       shoulder.  It has filtered down the right arm to the wrist area.

                                       mobility is quite difficult with this ongoing pain.

September 29, 2006        After seeing a physical therapist and receiving no relief from

                                       four consecutive chiropractor treatments, both made referrals to

                                       different physicians. I called both the ER department and

cardiology.  It was agreed upon that I should go to the ER on this day for diagnosis.  I did and the conclusion was once again that gout was now laden in the right shoulder and wrist finger area.  I was given prescriptions for increased Prednisone levels, Vicotin, and Colchicine. 

November 4, 2006           Yesterday I received a drug interactive analysis from a member of the

                                       Primetherapeutics staff about my episodes of pre-syncopy and use of

                                       Prograf.  She said the Hydralazine (80% and an old prescription drug),

                                       Isorbide Monotrate (15%), and Flomax-Lasix (5%) are contributing factors

                                       to my balance issues.  Many other drugs are much better than Hydralazine

                                       and should be considered.

 

                                       One third of patients taking Prograf experience constipation.  She felt this

                                       is a much better drug than Cyclosporine and the need to increase Miralax

                                       might solve that issue.  It was my responsibility to adjust the dosage of

                                       Miralax that worked for me from the time it was prescribed by the gastro

                                       -intestinal specialist I saw years ago.

November 28, 2006         During my six month visitation with the cardiologist, he suggested to drop

                                       Isordil for two weeks and then report to him how the balance issue was.

                                       He also kept Hydralazine at 50mg. 

December 21, 2006         The uric acid test was high even though I have been taking Allopurinal now

                                       for over a month.  As a result, I was told to increase the dosage to 2 times

                                       a day now. 

                                       In the meantime, I started using colchicine due to pain in lower

                                       left toe with redness and pain in right hip.  I also have taken Vicotin for pain

                                       relief.

January 3, 2007              The meeting with the podiatrist revealed a gout deposit build-up in the left foot

                                       which is typical of those persons who have many acute gout attacks.  The

deposit is being sent for analysis with a return visit set up for Monday; the deposit was removed.

January 10, 2007             The analysis confirmed crystallation existed by the specimen typical of

                                       persons with gout.  Another acute attack involving the right ankle, left

                                       side foot, and right wrist was identified and Colchicine was then administered

                                       for relief.

                                       My initial research on gout tophi revealed the possibility of both Lasix and

                                       allopurinal as potential contributors to gout tophi.  I called the pharmacy at

                                       Primetherapeutics who found no information to suggest the relationship

                                       between the two.  However, it raises the possibility of the variety of

                                       medications that I take may contribute, as does Hydralazine to imbalance, to

                                       the most recent activity.  Does Prograf really help with gout or aggravate

It more? 

(After recording two weeks of blood pressure readings, I sent two emails seeking guidance with the medications.  Perhaps a university policy

                                       restricting staff members to communicate to patients via email was instituted

                                       about this time.  I was told on February 22 that no staff member at the

                                       University is allowed to communicate with patients over email.).

February 14, 2007           My scheduled rheumatology appointment was cancelled due to weather

                                       conditions. 

                                       With my last sugar reading of 135 I made a call into and sent

                                       emails to report that.  I have noticed my frequent urge to urinate and a dry

                                       sensation leading to drinking more liquid similar to what I experienced at

the onset of my original diabetic diagnosis.  My urge to eat has lessened as well as weight control.  I’ll be taking a blood draw soon with

                                       upcoming doctor appointments. 

February 20, 2007           In my conversation with the nurse of the primary, she revealed results

                                       of a January chemistry taken which I was unaware of showing glucose at

                                       182. I immediately had the blood tests results faxed and called

                                       a nurse to set up appointment before March 2.

 I am now to take blood tests there and then go to the Nephrology Clinic to review the results and determine the course of action for the pancreas. 

February 21, 2007           My records indicate that Amalyse and Lipase were included in standing orders

ending in July 2006.  Whether records were reviewed with the changing structure of the Nephrology Clinic, the orders for continual blood work did not include Amylase or Lipase, nor a Lipid panel.   Amylase is a predictor of pancreatic function while Lipase reveals liver function.  The lipid panel is primarily needed for cardiology. 

Previously, I would email blood test results to ensure they were received to prospective specialists, since I take my blood draws near my home and have set up procedures for faxing with the local clinic.  However, repeatedly, they were seldom available at the time of my appointments.  Despite repeated attempts, to inquire as to their receipt, no information was forthcoming to validate that they were reviewed and placed in my charts at the respective clinics.  

February 22, 2007           My visitation at the open clinic confirmed what I believed to be the case.  The pancreas is functioning at a poor level; thereby leading me to become insulin-dependent again.  I was instructed to do injections twice a day until I could arrange to see the specialist at the Endocrinology Clinic. 

The history for transplantation as told me usually averages ten years.  The kidney is perhaps the more stronger organ.  The creatinine showed 1.4.  Blood sugar was shown at 486. An additional test confirmed that over the last two months my level was 12.2 as compared the normal level of 6.1, confirming that the pancreas needs assistance.  With the loss of significant pancreatic function, Prednisone can be reduced from 7.5 to 5 mg daily, with monthly draws taken.  It now becomes imperative again to control blood sugar readings in order to protect the kidney.  Logically, the best approach would be the use of an insulin pump.

February 27, 2007           First acute gout attack in 6 weeks.  Once again in shoulder and right

                                       Ankle.  Began Colchicine and Vicotin treatment.

March 2, 2007                 I was aware I was experiencing fluctuations in blood sugar levels, both hyperglycemia and near hypoglycemia; my blood sugar was fluctuating between 95 in the evening, down from 315 this morning.

                                       I look forward to visiting the endocrinologist on Monday to determine a course of action.

March 5, 2007                 Visit with Endocrinologist resulted in change of insulin type through use of

Insulin pens and the need for strict carbohydrate counting.  A record will be kept for 14 days.  Also have 2 meetings with Diabetic Educator/Trainer.

An accurate and complete record of insulin injection levels, blood sugar readings, and strict carbohydrate counting is absolutely critical.  I will do this for 2 weeks in preparation for consideration of an insulin pump. 

March 12, 2007               Checked the ICD functioning and was told the shoulder pain is that of a

                                       muscular/skeleton issue, probably caused by Prednisone.

March 21, 2007               Provided the two week record to the Diabetic Educator/Trainer and to the nutritionist for review.  More data will be generated before

                                       I attend an introduction session to Insulin Pump Therapy.

March 27, 2007               With another gout outbreak, started taking colchicine.

March 29, 2007               Attended session on “Introduction to Insulin Pumps” and made a selection of an insulin pump. 

April 1, 2007                   With Phase 1 near completion, I begin checking websites for information that can be used as I begin to write the book.  Interesting, one site provided information about renal transplant recipient; 20% experience diabetes mellitus using prograf.

April 2, 2007                   Visited the podiatrist who removed a blister between my left toes and calcium deposits in the right foot.  The area where gout tophus was removed has not yet healed.  The blister was caused by pressure between the toes which may require taking out some bone.

April 9, 2007                   Dilated both eyes to monitor any further damage and; No change was observed.  Next dilation is scheuled in three months.

April 14, 2007                 After seeing the podiatrist for the third consecutive week with pain in both

                                       feet, I began taking colchicine and Vicotin for some relief.  Based upon the pain in the right foot and its location, I may be having another gout attack.  The healing process will take some time.

April 21, 2007                 There is no change between the left toes where the blister was taken off, however, the area on the right side of the left foot seems to be healing finally where the gout tophi was removed.

April 26, 2007                 With pain and throbbing in left leg, I began treatment for gout again, though I am unsure if this may be caused by open wound between toes or right side of foot.

April 27, 2007                 I received another letter from BC/BS about the LifeMasters program for those people  with a claims record as I.  This program is a voluntary program that provides assistance, if need be, to those with chronic illness.  Although sceptical about its benefits for my purposes, I will experiment with a supervisor to see if assistance is warranted.  I am quite sensitive to insurance costs and do not support spending money without a benefit even though the attempt by the insurance carrier can be beneficial to others.  The reason for my reluctance to participate is no different than what I shared with a BC/BS representative before when I declined the offer.

May 4, 2007                     After visiting podiatrist, it is recommended that I enter emergency since the wound is nothealing.  There is now redness and the hole is much bigger leading to the bone.  I shall go to the emergency room on Saturday.

May 5, 2007                     After my stay in ER, I was released with no indication that an infection has entered the bone structure.  My creatinine showed 1.0 and the blood sugar was at 85.  I was given a 13 day supply of antibiotics with instructions to visit the podiatrist within the week to monitor the progress.

May 8, 2007                     Began taking colchicine and Vicotin with onset of gout.   Within two weeks, I will visit the rheumatologist.  Thursday I will also follow-up about the foot problem since I started taking an antibiotic.

May 10, 2007                   Due to how deep the hole is in the toe, treatment was changed by the podiatrist with a followup in two weeks.  Another dobbler was ordered to determine if the blood flow to the feet has changed.  The foot xrays revealed plague throughout the foot area which may also be causing this area not to heal well.  An attempt will be made to save the toe and amputation may be very risky as well.

May 11, 2007                   Called to confirm that the fax order for the insulin pump was overlooked.  The manufacturer also called needing two more verifications from the doctor before the company can proceed with the order that has now been faxed.

May 14, 2007                   Today it appears that there may now be an infection in the toe even though antibiotics have been taken three time daily since attending ER. 

May 15, 2007                   The podiatrist reported the culture results and ordered an additional antibiotic to clear the bacteria that is present. 

May 19, 2007                   Swelling, pain, and redness was prevalent in left foot, right ankle, and right wrist resulting in taking colchicine and Vicotin for an acute attack.

May 24, 2007                   Visited podiatrist who thought there is progress taking place and the bacteria is clear, however, the same treatment will be applied.  Met also with rheumatologist who thinks this is trahsplant gout based upon his review and questions raised.  The research is much more clear highlighted both cychosoporin and prograf being factors.  Taking 1 colchisine pill per day should help cut down on acute attacks.

May 29, 2007                   After meeting with cardiologist, hydralazine has been dropped.  Doing a simple lay down then take blood pressure showed a significant drop in readings as shown before with neurologist.  A significant murmur was heard as well light a “skipping beat”. 

                                       After reviewing the blood tests, the rheumatologist changed the administration of colchicine to one tablet every other day.  Feedback will be provided in ten days.

June 7, 2007                   First day with Omnipod insulin pump.  Status report from podiatrist was “cautious optimism” given the hole is smaller, but the expected red inner look is not present.  It could mean that blood flow is very poor.

June 15, 2007                  Dobbler test revealed no change from 05 – moderate flow with plague shown in foot areas since diabetes has damaged the inner linings of the small vessels.  There is good blood flow to the toes.

June 26, 2007                  Due to an infection in toe area, I was advised to soak in iodine for 15 mnutes and then dry and reapply ointment.  Furthermore, the periodic nausea feeling could signal kidney failure.

July 2, 2007                    The infection has entered the bone in the toe which requires amputation to follow next week.  The original xrays did not reveal the bone infection.

July 11, 2007                   Left inner toe was amputated.  PDM was misplaced – left in gown.

July 16, 2007                   Ordered new PDM and encouraged manufacturer to advise new patients about when the Omnipod should be replaced when it has expired.  From those I talked to, most say right away but you can wait an additional 8 hours if need be.

                                       Blood pressure reading was 112/72 leaving one to speculate that the dizziness caused by head shifts may signal “carotid artery blockage”.  The reduction of Metopolol by 25 mg and elimination of hydrazaline did make a substantial change in blood pressure readings and acute dizziness.

July 24, 2007                   Toe amputation area is healing with projection of next week for stitch removal.  50 mg added to allupurinol due to high uric acid level as well.

August 26, 2007              Though a Pressure Blister was created on the left foot, today indicated an infection which resulted in taking antibiotics.  Iodine has been applied daily since the blister was noticed after the wrap on the foot was removed.

August 28, 2007              Today’s diagnosis of the infected area revealed redness and swelling and a change of strategy.  Very little pressure should be applied on left foot and daily soaking with iodine treatment is required.  Continuing taking the prescribed antibiotic until the culture tests and xrays are returned.  The risk to bone will require some removal if necessary 

September 3, 2007          With the reduction of prednisone to 5mg. and the pancreatic failure, the new diabetic management system have all contributed to weight loss.  I now am 164 and blood pressure is steady.  There are still brief short episodes of dizziness when I lower my head and/or raise it up, however, this is much much better than previous reported.

September 21, 2007        Bone Density exam was good while new tests for kidney function will be

                                       Administered on Tuesday, the 25th when I visit the podiatrist concerning the

                                       Ulcer in my left foot.  Weight today was 158 lbs.

                                       Although I have given permission to have a third party representative contact me on a regularly basis for my record with BC/BS, I received another one for people with chronic illness cases like mine again.  I am not in need of counselling or educational matters related to my illness, so much like the one I am interacting with now, there is not, at this stage, that can be offered me via their counsel.

October 22, 2007            Contacted BC/BS about formal appeal regarding denial of table-tilt test of last September concerning pre-syncopy issues and was informed that a number of information have not been received.  Information will be forwarded for an re-adjudgication proceeding.

October 23, 2007            Progress on left foot indicates that healing is taking place but will take more time due to the immunodepressant drugs I am currently taking.

November 18, 2007         I remain daily soaking of left foot with iodine and placing a gauge with medication to avoid infection.  When I wear diabetic shoes, usually I experience pain the following day since the wound has not yet healed.  This is now the fourth month of treatment.

November 22, 2007         Began treatment of antibiotics due to staff infection in open upper wound area in lower left foot.

December 21, 2007         While working at the computer after configuring the UPS, I experienced a near loss of consciousness again since I spent more time with my head struch downwards.  At the last visitation with the cardiologist this month, it was suggested that I may have some malfunction in the autonomic nervous system due to long term diabetes; ruling out any further concern with heart medications.

December 29, 2007         Redness, swelling, and soreness in my left foot indicated another possible infection.  Antibiotics were prescribed again.  In comparison, this has been much more severe than previous infection experiences.  Like before, a smell emanated from wound area.

January 2, 2008              Today I was placed on Zygox which is an expensive antibiotic as the last resort which may help fight this infection.  If not by the 8th, there are no significant signs of improvement, then exploratory surgery will occur on the 10th.  There may be bone infection causing the wound area not to heal and this would need to be removed.

                                       At about this same tme, I received a billing statement from the collection agency seeking payment for upaid bills and asking my cooperation to once again contact the insurance carrier.  (No reimbursement for the lost Personal Diabetic Management device has been received to date.)

January 9, 2008              Due to level one antibiotics that did not fight an infection, Xrays revealed that an area of the left foot has boner infection that will need to be removed with hopes that the toe can be saved.   Until exploratory surgery is performed, there is no certainty to the degree of bone infection.  However, the stronger antibiotics prescribed on January 2 do show promise.

                                       Provided DNA sample for research purposes.

January 15,2008              Surgery was performed removing infected bone underneath the far left toe (joint area) and ulcer was removed before irrigation and wrapping followed.  The foot will be checked on January 21 and new antibiotics were administered.

January 25, 2008             Filed an appeal to the BC/BS Appeal Review Section for unpaid bills dating 9-11-06 after numerous denials.

February 4, 2008             Followup with podiatrist indicated a lack of healing prompting an insertion of a PICC line for intravenaous anti-biotic treatment.  Home Health care nursing will be administered  and follow up visitations will continue.  Inactivity will continue.

March 13, 2008               Contacted BC/BS about progress of appeal hearing case.  Likewise, there is indication that the foot has begun the healing process.  IV antibiotic will terminate on Monday, February 17.

March 14, 2008               Revisited dermatologist who biopsied three areas on face which may be squamous cancer and one area on left hand.  Results were positive.

March 24, 2008               Due to pressure placed on toes from using a stationary bike, blisters formed on three toes on the left foot. 

April 10, 2008                 Moe’s surgery was performed by removing 3 known areas of squamous cell cancer.

April 29, 2008                 Permission was granted to utlilize left foot without major restrictions and disregard the special footwear used to relieve pressure.

May 14, 2008                   While attempting to stop bleeding for a biopsy on finger, the electrical charge triggered the defib/pacer and I experienced my first action from the device.

June 7, 2008                   Was contacted by insurance company regarding 2 blood tests that was scheduled to be drawn.  This has been the first time I have received notice for these scheduled blood tests.

Sept. 17, 2008                 Experienced my first gout attack in right leg since a change was made with my medication.  Use of 11 prednisone tablets solved the issue.

December 3, 2008           Despite the significant change in dizziness with the elimination of hydrocholoride, the dizziness continues depending upon how I position my head.  The followup phone contact with ENT ruled out an “inner ear” issue.

                                       Treatment has resumed for actinic keratosis (precancerous growth.)

February 5, 2009             Beginning to experience similar signs of blockage again.

April 27, 2009                 With the use of the Omnipod, blood sugar levels are well in control.  The past blood level tests indicated overall good levels.  I will now continue visitation with a “mole” surgeon due to suspected squamous activity again.

                                       There was discussion about anti-rejection medication changes but this was done with precaution and more information would need to be obtained.

August 12, 2009              With the advancement of skin lesions, a more aggressive approach is now

                                       Employed to prevent further surgeries.  Three more basal cells have been

                                       Identified.

January 15, 2010             I am more confident stating that the control of blood sugar levels off further

                                       Organ damage throughout the body.  I continue to maintain a 4 day/week

                                       Cardiovascular fitness program and watch my caloric intake to insulin ratio

                                       Using the wireless Omnipod system.

March 10. 2010               Given the economic conditions of the country and the emphasis placed on healthcare costs and price increases, more contact again is being made to participate in monitoring my health care through a third party, even though, I already tried that avenue previously.  For diabetics and transplant individuals, one can certainly feel depersonalized with all the medical needs that are required.

                                       Today I have been diagnosed with “shingles” for the first time and began treatment of voltrex. 

March 15, 2010               More and more episodes of angina are again taking place, in particular, after I have eaten.

June 26, 2010                  With the progression of PAD, I anticipate that I’ll be unable to walk in the future without surgery of aid intervention.  Likewise, my last visitation with the optomalogist may lead to the removal of the growing cataract in the left eye though there will no visual change in that eye.  Bringing in more light may affect the acuity issue in the right eye. 

August 3, 2010                Glare in my eyesight has become more prominent even with a new pair of glasses and a change in astigmatism for better clarity.

                                       Steps have been made to undergo cataract surgery on the left eye within the next two weeks and then the possibility of eyelid uplifting in that same eye to help the perfipheral vision.

                                       Two surgeries were performed to uplift the lid in the left eye. 

March 7, 2011                 The lab results indicate that using the Omnipod insulin pump is quite successful.  Today, the A1C was 5.9 as compared to 5.7 five months ago, and 6.1 a year ago.  Regular exercise, diet, and tight glucose control appear to produce positive results.  However, more episodes of fluttering (afibulation) has been recorded even though ablation was performed five years ago.  The physician has recommended adding Coumadin which can reduce the risks of blood clots and strokes from 6% to 3%.

April 16, 2011                 Both an Echo and Nuclear Stress test were completed.  The results indicate the following:  two valves are now leaking, the left atrium has increased, and the infraction rate is now at 35.7 as compared to 40% five years ago.  It appears that there is not sufficient clogging to date to undertake another angiogram at this time.  Until further analysis of these reslts are made to determine some treatment plan, metropolol was increased to 1.5 tablets twice a day.

May 4, 2011                     An angioplasty was performed and two vein grafs were found blocked.  The vein graf that was done in 1995 was re-opened and an additional stent was inserted.  The othr vein graf was 100% occuluded, however, a collateral developed from the other vein graf to supply the area with needed blood flow and was therefore left alone.

June 6, 2011                   It was determined that I see an ENT for squamouns skin cancer to check for potential node infection and removal.  Likewise, an updated ICD will replace the current ICD when the battery is changed this month.

June 21, 2011                  ENT performs surgery to remove squamous and basal cell.

June 22, 2011          Battery is replaced and an additional wire was attempted in upgrade for ICD but was                                 unsuccessful due to heart damage.

July 27, 2011           The right eyelid was uplifted for more light to the eye.

Nov 18, 2011            Due to rising costs for Flomax under the new health plan, the generic form for Uroxothral                                  started today on a trial run. Tamsulin was never effective in the past.

January 2012            Moh's Surgery scheduled for removal of squamous cell on top of head followed by same                                   procedure on right side face near right eye.

                                  Balance control is again becoming more prevalent.

Jan. 20, 2012             Due to continual AFib episodes since January 2, a cardio procedure to restore rhythm                                    balance was performed as well as a technique to take pictures to determine whether blood                                    clots were present in the heart chambers. Warfarin was started on Wednesday, January                                    18th and today Enoxaparin will be injected twice a day for the next 7 days.

Jan. 25, 2012             Due to excessive bleeding, Enoxaparin was stopped. Test results indicated a high level of                                    thinness and modifications will be taken.