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9/21/2016 Latest post:
Welcome to the CaringBridge site for James Moberg. Let us begin by saying that we are glad you have found this site; we, James’ daughters, will continue to share updates on his health and condition as we have them. If you are here, it means you are somehow connected to Dad, and we are grateful for the care, concern, and support you have given and continue to give him.
Allow us to start from the beginning.
In 2013, Dad was diagnosed with prostate cancer. Now, this is often a cancer that does not require treatment, but Dad’s form was a bit more aggressive necessitating surgery. In the preparations for the surgery, doctors found some abnormalities that suggested Dad had a silent heart attack at some point in the past. The effects were minor and Dad was still a good surgical candidate. The surgery went smoothly, but there was a positive margin. In the spring of 2015, doctors recommended radiation because the cancer was spreading.
For months after the radiation, things seemed to be going well and Dad seemed in great health. In February 2016, Dad started experiencing side effects from the radiation. Specifically, he started having unstoppable bleeding in his bladder. The diagnosis was radiation cystitis; the bladder had been radiated because it was in the proximity of the radiated site and it was damaged. Dad spent months getting treatments and blood transfusions, each of which would alleviate the symptoms for a short time. However, the bleeding was persistent and the impact of all these treatments and blood loss was that Dad spent a lot of time over the ensuing 6 months at Mayo, trying to heal but also ultimately losing strength and revealing further damage to his heart. During one of the many hospital stays, Dad was diagnosed with heart failure that requires him to take diuretics to maintain heart function.
By August 2016, the doctors had tried all the treatments and experimental treatments they could and still Dad’s bladder was not healing. At this critical point, Dad made the difficult decision to have major surgery to remove his bladder. Already his system had been weakened by all the procedures, blood loss, blood transfusions, and time in the hospital, but this was the only remaining viable solution.
On August 17th, 2016, Dad had surgery to have his bladder removed. And the surgery was a success. However, complications followed. In the evening after the surgery, Dad had severe internal bleeding. He was moved rapidly to ICU and given several units of blood; they managed to make him stable once again. The bleed clotted itself off and so the doctors did not have to do any further procedures which was a blessing given Dad’s precarious condition.
A week later, Dad was released from the hospital. At home, he was working to recover in the comforts of his own space. He was also well enough to attend Laurie’s wedding and walk her down the aisle.
In the week after the wedding, Dad had an elevated heartbeat and shallow, rapid breathing. When the symptoms didn’t subside, Jennie took him to an impromptu/emergency appointment with his cardiologist at Mayo. The doctor examined Dad and admitted him to the hospital.
Initially, the doctors were concerned about Dad’s heart. His heart failure is a chronic condition that will continue to get worse over time; the collection of fluids on his lungs is also likely to recur and require future hospital stays. There is no way to make his heart healthier. Dad’s doctor was clear about the prognosis: the objective is quality over quantity, to get him out of the hospital to thus have a better quality of life. The doctors gave him medications to remove the fluids accumulating in his lungs and put him on oxygen. He spent one night on a bipab machine to help him get the oxygen he needed. Tests also showed that Dad did not have enough blood circulating in his system. He was given blood. Again.
While they were able to effectively treat the acute conditions, we were concerned about why the fluid had accumulated. The doctors suspected infection. A CT confirmed that the hematoma (collection of blood that had clotted after the surgery) had grown a bit suggesting that dad had bled internally again. While his blood cultures came back clean (no bacteria colonizing), the urology and cardiology teams decided to drain the clot and test the collection of blood in his abdomen.
As if things weren’t already messy and unstable enough, this testing revealed that the clot had bacteria in it, specifically VRE (vancomycin-resistant enterococci), a difficult to treat bacteria that is antibiotic resistant. The doctors had drained as much of the clot as they could without resorting to major surgery and put a drain in place to allow the rest to empty. Dad was put on a particularly aggressive antibiotic to combat the VRE as well. Shortly after, his red blood cell counts and hemoglobin dropped once more. While the cause is a bit uncertain, it is likely a side-effect of medication (one of the known side-effects is that this medication suppresses the production of blood in the bone marrow; since dad had his spleen removed over 35 years ago, it is likely his body just cannot produce enough blood). After consulting with the infectious diseases doctors, Dad was switched to different medication in the hopes that this might help him maintain better blood production.
At this point, we are in a holding pattern of hoping and praying. Currently the bacteria has not spread to his bloodstream; it is contained in the remnants of the hematoma in his abdomen. The doctors put in a larger drain on Monday, September 19th to facilitate the removal of the remaining clot and thus the bacteria. However, if the bacteria manages to spread beyond this clot, Dad will be in a much more severe and precarious position. His doctor framed it this way: we are walking a tightrope and there is every possibility that Dad could decline and decline rather rapidly.
The situation is complicated and uncertain, but we are hopeful that Dad will remain his ever-positive, strong self and see a better quality of life soon. Please keep sending your thoughts, warm wishes, and prayers his way. We will continue to update this page as we learn more about his ongoing condition and prognosis. Thank you again for your love and concern. All of us and especially Dad are grateful for the support and care of friends and family.