I am online.
I hope you are able to see this reply. This is the link (which you can save in favorite / bookmark);
The above link has a box where you can write the question directly and also tells online / offline status.
Quite a while since we spoke but we have had so many problems, anyway the one that's important is this. Some time ago Andy had a urine test and they called him back and said a bit of blood was in the urine but nothing to worry about and so they did nothing. Tonight the urologist called him and said he would like him to come in for a test because the blood in the urine shows that something may be wrong. We are both so upset. What do you think.
I am now dealing with a broken wrist from a fall then this problem????
Nice to talk to you again. Regards
Hey Stella,I am so sorry about these issues (broken wrist and Andy's blood in urine). Blood in urine may not be necessarily anything serious. Though, it would need further investigations like a urine culture, an ultrasound or a CT scan / MRI.
In Andy's age group the most likely cause is enlarged prostate obstructing the inside of bladder which predisposes for urine stagnation in bladder and secondary infection. This infection may not cause any other symptom and may only be revealed by the routine urine exam. Just called by the doctor for further evaluation is not worrying and it is a routine screening. There is nothing to indicate of anything serious. Believe me, most of the time it is not significant.
The other common cause of blood in urine is a small stone in bladder. Again this may not cause any symptoms except blood in urine on the routine exam. This too can be treated easily as the infection or the prostate enlargement.I am online to answer your all other concerns.When did you fell? How is your wrist now?Dr. Arun
Hello Dr. Arun:
Thanks for your reply. Of course I am a total wreck because had prostate cancer now we are wondering what next. I had to take a tranquilizer. Now for other problems, when you don't hear from me for a while just think Stella maybe having problems.
My fall was a stupid one. Andy and I were standing at the door looking at my daughter in law's new car I turned around to answer the phone and my foot caught into Andy's foot and I fell and pulled Andy down with me. Trying to break my fall I pressed on my right hand when I fell (nothing happened to him - he just laughed at me) so I thought the next day it was just a slight pain from pressing on the hand but the pain was so severe I could not go to the computer or write anything so I used some ice to get the swelling down and heat. The pain continued but I still did not go to the Doctor until a few days ago, he x rayed it and found the wrist was fractured so he had to put it in a cast. NEXT PROBLEM - we went shopping and when I got home Andy said he felt like he could not bear the weight of his own feet he felt so weak he got so pale I immediately took him to the doctor - he checked him over thoroughly and found nothing wrong - he said he must have been dehydrated - Andy don't drink water - he went to the cardiologist and he gave him an echogram and an EKG and found nothing wrong he said the same as the doctor DRINK WATER - but he okay now. I am the one suffering from all these mishaps and now this call from the urologist add to all the problems. Then I hurt my back - I told Andy I need to be blessed (smile). He is having lots of problems with the macular degeneration and the shots he is taking in the eyes - both - so its been quite a trying time - and then the last problem was that my computer was picked up a virus and had to have Dell fix it but it is still giving problems up to today I again had to have it fix.
How is your daughter doing in your new home? Does she like it and is she happy there? Again, thanks for your reply.
Stella & Andy
Thanks Stella for sharing all this. I feel privileged to know you. I understand these are trying time, but this will pass off and both of you would regain good health. You and Andy have been always very strong. I am not sure, if Diagnosis of prostate cancer is confirmed because it needs following investigations;1) A blood test called PSA (prostate specific antigen)2) An ultrasound3) A digital rectal exam (DRE).4) A Prostate biopsy.If these are not done, it would not be cancer and enlargement would be benign (non cancer) which occurs due to aging (as the greying of hair or formation of cataract in eyes). Also an important thing to understand is that prostate cancer has a very good prognosis usually and is easily treatable.Actually the Just Answer TOS prevent me to send you the messages, so I cannot answer you till you send me some type of query.
My daughter is very Happy in San Fransisco. Thanks for asking.Regards,Arun
Andy did have prostate cancer about 6 years ago. I forgot to mention that and he also had colon cancer about 7 years ago. So that's why he is so worried. Thanks again for your help. We do feel that you are such a good friend that we always want to share our problems with you and look to you for help. Again thanks a lot for that opportunity.
I think I did pay you - I can't remember
Good Morning Dr. Arun:
Just to bring you up to date. The urologist called Andy this morning to let him know what he is expecting to do - that is to check his bladder and he has an option of either numbing the area of putting him out - he said numbing - the doctor said it would take about 4 minutes. Now Andy is so worried that they will find something wrong with the bladder or area. He always had such an optimistic view of everything - now he is thinking not optimistic and with that it gets me worried. Anyway we have an appointment for Thursday. Will let you know further.
Thanks Stella for the update. I very much appreciate it. Ask Andy not to worry. Blood in urine does not mean a cancer or serious things. Just an outpouching of bladder (called diverticulum) can cause it. I am very sure, there would not be anything significant.
Thanks for being so concerned, however, Andy is not have it until this Thursday Dec.5 - the doctor had too many appointments so he had to cancel until Thursday. Will definitely let you know what's going on.
Andy just got back from having the procedure - and the results are:
A spot was found on his bladder, the doctor said it happens sometimes after you have had radiation it backs up (what that means I don't know, but he had the radiation 6 years ago) and he will have to go into hospital so that the spot can be removed - 1 day only in the hospital - but his urologist doctor told him before he left that he did not like what he said he saw - so its best for Andy to get it out as soon as possible - the other doctor told him no rush it is not life threatening and he can wait until after the holidays, so what do you think?
Thanks for sharing this with me. This is a good news.The spot is likely to be scarring due to radiation. Though this is unlikely to be worrisome, I would recommend to get it removed, earlier. The reasons are;1) It will play on the mind till is removed.2) The admission for it is quite small, so no reason to wait, I feel.That way you can relax completely.
Please let me know, if you have any further questions.
Andy has a problem. From the time he came home he has been going to the bathroom incessantly he would like to know if that is normal he is wondering if it is going to keep awake tonight.
Also I think he is thinking of not going to get this spot removed - he is so frustrated. Normally he is always very optimistic - one doctor told him he heals himself, and I think he does, but this time he seems doubtful I really don't know why.
I know you are off line now, but will check before I go to bed to see if you replied. Thanks a lot.
You are very welcome, Stella.The increased frequency of urination for couple of days after the procedure is normal. This may subside on its own. Many times a course of antibiotic may be needed (if has not already been prescribed). He can get the spot removed later. The spot forms which we term as radiation cystitis scar (an inflammatory spot). I can understand his frustration. It can be removed later. There is absolutely no hurry.Have a great evening.
Thanks a lot for your prompt reply. Andy says he really appreciates it and he is so sorry that we only know each other by this communication - and I was lucky the day I chose you to answer my first question. We feel so disappointed that we have never met in person. As Andy says we are worlds apart but we feel very close.
Hope you have a good day and again thanks a lot.
Dr. Arun: This is really, really early for me to be up but I had to talk to you before you go off line.
I am having awful pains across my eyes - in the afternoon around four to five o'clock I feel so weak and get so light headed and my nose gets all stuffed the only thing to help me for a while is a hot cup of tea then I take 2 tylenol and a benadryl. I did go to the doctor and he told me to take claridin but the benadryl and tylenol helped better than the claridin. During the day I am okay until afternoon. This morning it woke me the pain across the eyes and I feel just terrible. How much tylenol and benadryl can I take - is there something else that can help. What do you think? Andy says good morning and to apologise to you for me bothering you so early in the morning.
Hope you are having a good day. Andy just got the appointment for his procedure it will be on Dec. 24 (Xmas eve how do you like that??????) at 11:00 a.m. now because the doctor said they are doing a biopsy of his bladder he is all upset again - they may find cancer and keep him in the hospital - but the doctor said it is just a one day in an out procedure. Just thought I'd keep you up to date. Have a nice day.
I am up two hours so that I can get you before you go off line. Andy has a question. He said he noticed that he has been going to the bathroom to urinate quite often - more than usual - since they checked him and his urine burns - now that worries him what should he do? He goes on Tuesday to the hospital.
Don't know if you are in but I sent a message before and not sure if you got it, please let me know. Thanks.
Stella,I am sorry for the delay. I was offline and could not know about the question. I apologize for your wait. His symptoms are likely due to bladder infection. This may come up many days later after the cystoscopy (the procedure he underwent). He may need a course of antibiotics. Usually Cipro or Nitrofurantoin would be recommended, so you may consider contacting your primary care physician. Meanwhile following may help;1) Plenty of fluids.2) Avoid caffeine drinks.3) Pyridium (over the counter) if burning is significant.4) Cranberry juice.
Just saw your email - nice vacation - did your wife enjoy it. Its a beautiful place . Hope you got my e mail about the procedure.
Oh Dear I sent you a long e mail about the procedure where did it go to. Anway here it goes.
Xmas Eve as you know Andy went at 7:30 a.m. for the procedure, everything went well, the doctor came outside and told us he was in the recovery room but it looked at if it was just infection from the radiation backup (as you said) but he will still wait to get the biopsy done. About 2:00 he went home and everything was going fine trying to sleep off the anesthesia but then he suddenly stopped utinating and awful pain and this happened just an hour after the doctor called to see if he was resting. Anyway Xmas Eve the offices are all closed but he will open his office and we should bring Andy down in about half an hour. (I really thought that we so nice of him he could have told us to take him back to the hospital, but he wanted to take care of him in his office) after checking Andy over he inserted a catherer (?) which gave him some relief immediately so he went home and he called about hour after to see how he was doing but he was sleeping off the anesthesia but he was better I had to be up all night to empty that bag he had attached and all yesterday but he wanted to see him this morning he said he was better so he took it out and told him to get back to his office in 6 hours, we wanted to check for infection, which he did and he said so far Andy is doing better now and he will be okay he will see him in two week. But he lost quite a lot of weight and I have to try and give him something to get back his strength and immune system he is very weak and I am a total wreck - no sleep and worry and no XMAS - Anway I would like to wish you and your family a very happy holidays and hope you will have a very happy, healthy, peaceful and prosperous 2014.
Andy sends him best and he said thanks for all your information.
Again happy holidays.
Thanks so very much for your reply. I forgot to mention that the doctor did give him the same antibiotics you mentioned he also gave him a pain killer and a tiny brown pill I think the nake is pyradium which has helped a great deal.
Did your wife buy any silks from Thailand - they have beautiful silks some years ago I got some from there and they were georgeous. But that was a nice vacation you went on, we are planning Alaska - maybe you can come and we will make the trip together that would be fun!!!!!!!!!!!!
Yesterday I was so out of it I could not remember if I paid you - would you let me know if I did.
I am having lots of problems now I just don't feel well, I get very lightheaded at times and the only thing seems to help is tylenol and benadryl or a hot cup of tea what is wrong I don't know - during the day I am find but from about 4-5:00 in the afternoon I take a benadryl. In the morning after my breakfast about 2 hours after I do feel it a bit and I take some tea and about half an hour after I am okay and can get out. But I really don't know what this feeling is - could alergies make you feel this way I don't know?
Have a nice day.
Sorry I am late with this but I have been trying to get over a real HANGOVER - however, a Very Happy, Healthy and Blessed New Year to and your family and the very best to your daughter and her husband.
Hope you had a nice holiday.
I know you are not online now but I am sending this so that you can get it early.
Andy went to the doctor today for the results of the biopsy and we don't have such good news. He has bladder cancer the doctor said it is a tumor and he wants to get it all out so he is going to have surgery again on the 28th. Of course I don't have to tell you how Andy feels, but he wants you to know this and as usual I will keep you updated with everything. He will be happy to hear all of your comments - good and bad.
Thank you so very much for your detailed reply. Now after reading all of that I would like to ask you which you think he should have - acupuncture or therapy? which would give him some quick relief.
Hope you got my message as I have not heard from you, regarding Andy's best treatment acupuncture or therapy. If you did not receive it let me know.
Sorry for taking so long to let you know abou Andy's surgery, but I had quite a busy time and this is the only moment I have free.
He had the surgery on Tuesday, but it was a terrible day, he had lots of pain after the surgery that was because he had to have a catacer (I don't know how to spell it) they gave him Pyridium (?) and an antibiotic and a pain killer in the hospital. When he came home I had to be clearing the attached bag which I am still doing until Monday. Anyway the doctor said the operation went great and last night he called and said he was very pleased with the results of the biopsy. He had to stop the antibiotic because it gave him very, very bad diarrahea (?) but although he stopped the antibiotic on Wednesday evening today he has diarrhea very badly and his still is extremely black I don't know if that is bad or it should be that way or what? everything was okay this morning but this started around 11:00 this morning and he has been going steadily. He also is taking Iron pills but as he said his still is never this black. He has to go back to the doctor on Monday to remove this tube and bag. I will try and get a copy of this biopsy and send it to you later, but as of now he is anxious about this other problem.
Me, I am a wreck and very tired as I have to be up during the night to empty this bag and all day, so I am simply exhausted. This is just to let you know what is going on. Sorry, for the dealy in letting you know but I was waiting to get as much news as I can to let you know. Andy sends his regards XXXXX XXXXX said to tell you he feels like HELL. Regards
Thank you so very much for your nice reply which was accepted. I did give Andy an imodium a few minutes ago, hope that was oaky. He would not take the Pepto and he is miserable when I try to give him something but he took the imodium, lets hope that will work for the night. Dr. Arun I am so tired that I can't walk fortunately I have Philip and his wife they are such a big help but I think what I need is sleep, and with this cold weather we are having its not helping any. Again thanks a lot for your encouraging reply (smile) which I appareciate.
Today was a very bad day so I did not go with Andy to the Doctor to remove that tube, Phil was there and he went home with the biopsy report in his pocket so as soon as I get it from him I will send it to you. However, Andy has to go for some therapy for six weeks (once a week) I think he will have some medication injected into his bladder and he has to try and keep in for at least two hours then he has to drink lots of water to pass it out - I really don't know what it is all about - perhaps you know. Philip did explain it to me but all I know is that he has to have therapy to avoid the caner coming back - is that correct?
Now, I need your advice - Andy is extremely weak what can I give him to strengthen him up - his appetite is very poor he eats half of what I give him and never hungry - he like anything in the fish area - not too fond of meat - cereal he takes every day, he loves milk and ice cream - don't forget the cake - lots of bananas and I give him a vitamin C and D - can you help me what else gives energy and build up his resistance I think - I would appreciate your advice here.
With all of this bad weather we are having hope your daughter is enjoying the warmth of California and you are okay. Regards
1) Omega 3; Fish oil capsule and flaxseed oil capsule.
2) Ginkgo Biloba
3) Zinc 30 mg.
4) Vitamin C.
These are the foods which can be eaten if he has lost some weight. These have high calories but are healthy;
1) Dry fruits; a cup of mixed dried fruits totals up to around 335 calories, while one fourth cup of dried raisins is 108 calories.2) Natural Yoghurt With Honey, Greek Style, one 150g pot has 243kcals.3) Nuts and seeds; they are rich in calories and good fat. These also contain antioxidants. Half a cup of almonds contains about 400 calories, while the same amount of macadamia nuts is closer to 475 calories.4) Bananas5) Mangoes6) Peanut butter: just one Teaspoon/10g carries 62 calories. 7) Avocados are high calorie with good fat, 8) Breakfast Cereal 50 gms can give your around 180 calories and is healthy. 9) Canned coconut milk.10) High calories protein shakes.
Following is a usual meal plan (above all can be added including what he likes);
Breakfast;1 Cup Cooked OatmealOmelet (3 Egg Whites, 1 Slice Cheese, 1 Cup Broccoli)Green teaOrange or appleLunchLight Tuna one canOrange or Apple 3-4 slices of whole wheat breadWater or Diet SodaSnackBrazil nutsDinnerOne cup whole wheat pastaTwo chicken breastsOne cup of cooked cauliflowerHalf Cup Marinara SauceWater
Andy will have bladder instillation therapy to prevent the recurrence. This is very effective and almost all tolerate it well. Though I can understand that going for it to the hospital is tedious.
Please take very good care of yourself.
I remember both of you very frequently. Convey my regards XXXXX XXXXX Phil and your daughter in law.
Wishing you all the very best,
Thank you so very much for your extensive reply. I try to give Andy things to put on weight because he is not heavy he weighs about 150 lbs. so I allow him the ice cream.
He would like you to tell him how this therapy is done and how much pain would he feel and would he get or feel sick from it. He said he has gone through so much pain so he is hopeing this would not be too bad.
Sorry Stella,I forgot to describe the procedure of the bladder instillation therapy. This is an outpatient procedure.Doctors ask not to drink or eat for about 2-4 hours before the procedure so you do not have an early urge to void.
A tube (catheter) is first inserted into the bladder, and a medication is infused through it so that it can coat the inside of the bladder for a short time (usually 2 hours or as much as can if there is an increased sensation of voiding before 2 hours) . The procedure is quick and relatively painless.BCG (Bacillus Calmette-Guérin) is a vaccine used against tuberculosis which is made of a weakened strain of the tuberculosis bacteria. It is shown to be effective in treating bladder cancer, when instilled into the bladder. It is the more commonly used immunotherapy drug for bladder cancer and acts by stimulating the body’s immune system to destroy tumor cells. Some doctors ask the patients to rotate or turn around on the bed, so medication coats the bladder walls all around. Muscle relaxants or bladder relaxants may be given to some patients who are apprehensive or who are unable to hold it for even very short time.
Thank you very much for your reply - hope it relieves Andy's mind a bit. Again thanks so much. Stella
We are having such bad weather I could not get the biopsy report, but will try and do so as early as possible, weather permitting.
Andy is urinating very often and when he goes its only a bit and he is also constipated (which he never was) he is worried about these problems and would like to know if it is normal or should he tell the doctor. Please, your reply will be greatly appreciated.
Hello and welcome, Stella.Constipation and urinary symptoms are not unusual after this surgery. Medications too may play a part in constipation. I would not be worried unless these are too annoying. In any case, these do not point to anything significant. Having said that, for constipation, following measures may help him;
2) Fruits (especially dried fruits)
3) Cereals like whole wheat, bran or oatmeal
5) Grainy breads, such as whole wheat, rye or pumpernickel
6) Legumes, such as chickpeas, baked beans and lima beans
7) Dried plums (prunes), and prune juice
You can try ground flaxseed sprinkled on salads, cooked vegetables, and cereals. Andy may also consider any over the counter laxative which suits him. Small strolls in the house would also help facilitating the bowel movements.
The urinary irritation (frequent small amount of urine) can get better by increased fluids, vitamin C and Cranberry juice. If there is burning and pain associated, he may need Pyridium (over the counter). Any fever or increase in severity of the symptoms would warrant call to the urologist.
Thanks so much for your answer. Now I noticed he goes to urinate like every hour and more and to me I don't think that is much but I have to tell you this. Andy is very vain with his body, he still think he should weigh the same as when we got maried (l35 lbs.) if he think he put on a pound he gets worried he is getting fat, his waist got an inch or two bigger he asked the doctor if something is wrong - if Andy sees a mark on his face he wants to go the dermatologist - so I told him today if his body is not as he wants it something is wrong and he gets worried and worry me too. Everything you say Dr. Arun I have been telling him but he wanted to hear from you - I try to give him all the wheat cereal every day, he eats lots of fruit and nots, chick peas he loves and baked beans so I give it to him, but Andy expect that things should not go wrong with him and only you he believes so thank you so much for sending him all these detailed replies, I greatly appreciate it and for my sake. We have been housed up for about a week, the weather is so very bad and the snow storms are killing us, the plows can't keep up with clearing the snow and another storm is due again over the week end - this keeps us in and we cannot get out and I told him that in no way helps.
Again thanks a lot. So sorry to be such a bother to you. Regards
We have been having such horrible weather that it was difficult to get out and Andy having to go to the doctor and for his therapy it was real difficult, fortunately Phil's car is a Jeep that can handle this kind of weather, at the moment we have about three feet of snow piled up here in front of the house, anyway this is the report:
Bladder, left posterior, transurethral resection:
Ulcerated urothelium with acute and chronic cystitis, focal necrosis and calcification, and reactive urothellal changes, see comment.
No residual carcinoma in situ identified.
Detrusor muscle is present. ( what does this mean???)
Negative for invasive carcinoma.
Comments: Immunoperoxidese stain for CK20 shows patchy urotheial positivity. (not so good?????) CD4< shows diffuse urothelial staining. Multiple levels were examined.
Case reviewed intradepartmentally with agreement on diagnosis.
Preoperative Diagnosis: Carcinoma in situ, bladder
Postoperative Diagnosis. Same
Operative Performed: Systo, TURBT
Received in formalin labeled bladder tumor left posterior are two irregular fragments of tan-red partially cauterized rubbery issue measuring 0.4 and 1.0 cm in greatest dimension. The specimen is entirely submitted in one cassette.
I do hope I have everything correctly, anyway he went for his first therapy treatment yesterday and if went well - no problems and he said very little pain, no after effects and today he is okay. However I had to go to the doctor in that awful weather yesterday, I was feeling real sick - he said I picked up the flu virus, he did not give me antibiotics he said they make you more sick than anything else, just a cough mixture with codene, and he said it will have to run its course - but my body aches so much and I feel so weak, I am taking tylenol for the aches fortunately we have Philip and Vivan they are doing all the run around like the drug store etc. Hope you are well. Regards XXXXX XXXXX of us.
Thanks a lot Dr. Arun:
Andy just wants to know if the bladder is clear of all cancer and he has six treatments to take if that will do for future reoccurence.
Hello Dr. Arun or I should say Good Morning Dr. Arun:
Just like to bring you up to date on Andy. He will be going for his second therapy tomorrow (Thursday) but I don't think he is as tense as he was for the first treatment, because it did not turn out as bad as he thought it would so that is good. He is feeling much better but would be better if he could be not as weak, he seems to tire quickly, but I am giving him vitamins and hope that would help - and lots of ice cream which he loves, his appetite is very poor.
Now I have a question. As I told you before I have been feeling really blah, but the doctor said I had a little virus and did not think he should give me anythig. But I am feeling no better my body still aches as if you are getting a cold - I don't know if it could be the allergies and the asthma, I take a benadryl and feel better but for the last two days I notice I have a little palpitation not for long and don't know if it is a part of all this feeling - what do you think? Would love you get your opinion.
Hope you are well and everything is okay in your area. Regards
Thanks for your reply and compliment and you are the best and we consider you our dearest friend and someone that we feel we can talk to at any time we appreciate this and also your friendship.
I think I paid you not sure please let me know.
I had to take Andy at 3:00 a.m. to the emergency - I just got back home (10:00 a.m.) and would like you to know what is going on.
He could not urinate and when he did it was all blood and very big clots so I called the doctor and he said to get him to the emergency which we did. They took a complete blood test but said they did not know othe cause, however on the report here I see it says something like 'HEMATURIA' they left a cath: in and gave him nothing to take but that he should check with the doctor in two days. In 2 days we expect another foot of snow so we will have to do it in maybe 3 or 4 days. Anyway he is home I gave him his breakfast and now he is sleeping (I took a tranquilizer). They said the blood test was okay. I have it but don't understand it. However, what you can tell me will be a great help you know that. I will try to get some sleep in a while.
Sorry Stella for the delay in answer. I was offline as I had couple of surgeries to do. I apologize for your wait.Hematuria (hem=blood, uria=urine) is blood in urine. This is likely due to bladder infection, or due to delayed bleeding from his previous surgery (which is though rare after so mcuh duration). Bladder instillation therapy occasionally may also cause delayed hematuria.This is unlikely to be anything serious, I am sure. They are likely to remove the catheter in a 3-4 days (when the weather is better there). Occasionally a cystoscopy is required if the blood in urine recurs or urine tests show microscopic blood.
Thank you Dr. Arun:
Since that last question to you we had to take Andy again to the emergency. the cath: was not in properly and it was making a terrible mess. Anyway the doctor wants him to drink a lot of fluids and they flushed out the bladder when he was there because he had too may clots, after they did that he said he felt so much better.
He wants to know if this is anything serious like going through another surgery - he has quite a lot of burning so I gave him a Phenozpy....... which is supposed to help with the burning.
You seem to have had a busy day. Hope I would not have any more problems to disturb you.
Thanks for your reply. I had a long chat with the doctor on the phone about a half hour ago. He explained the same as you did, I called the emergency and they wanted me to bring him back, but I said we live so far from the hospital and when I spoke with the doctor he said that wasn't necessary. He said they could take out the catherer but then he may have other problems and he asked if the hospital gave him any antibiotics but they didn't, they gave him nothing. It is making an awful mess because the catherer was not put in properly, so he told Philip to wrap some gauze around where the cath was inserted that would keep it from spewing it, also if it is going into the bag that is good. But he is still urinating blood, and the burning is awful but let's hope that will gradually go away as the urine clears up. He said he is on his computer trying to get the results of the urine test, I told him the hospital gave me but he said that wasn't wanted he was looking for - he said he will call back later which was very nice of him. Thanks a lot for being there for us in all our problems wonderful having you. I hope I get some rest tonight, I am exhausted but nothing like a big drink to make me feel better. Again thanks a lot for everything.
Here I am again. Andy had a friend come in and put us both in a nervous state, some people don't think - he told Andy and he thinks his colon cancer is back because this bleeding and diarrhea happens when you have colon cancer. He had it in December 2007 is this possible, please let me know what you think. Thanks.
Andy went to his doctor today as he did not see him over the week end. He took out the catherer and he thought it might have been an infection, however, he said they don't give any antibiotics because then you hide up the problem and he is right back where he started. He said see how things go between now and Thursday. So far his urine is the normal color and he drinking lots of water. BUT he is complaining he is very tired he said in all his years he has never been tired but he is so tired now he went to bed. Do you think that could be from all the up and down going to the bathroom? I don't know what to give him really, I thought if he got some sleep that may help and no more water for the night? Please let me know what you think. Thanks a million for your help.
Did you know that this treatment (BCG) that Andy is taking the side effect is this bleeding he had - now I wonder if to expect this every thursday when he goes for therapy.
Thanks a lot and sorry to bother you.
Good Evening Dr. Arun:
Just to keep you up to date - Andy had his treatment today, so far, he has been drinking lots of water and his urination is okay, we are only hoping that there will be no side effects, these things happen on the week end when you can't get the doctor - so let's hope nothing will happen, so far he drank 60 oz. of water and it is now 8:10 p.m. (our time) do you think that's enough water for the night? How was your day - not too busy I hope. Andy sends his regards.
Thanks for your reply. I guess you must be tired - I know its not easy working so many hours in the hospital - my brother and my sister also used to come in so tired they just dropped in a chair. So I can imagine how you feel when you get home, then to be bothered with my questions!!!! and you are still always there to answer them - you are so conscientious and I know dedicated and we both thank you so much. This morning Andy seems much brighter ready to go out but that is difficult unless he has a bathroom in the car so, I think if he stays home another day that would be fine - I told him I can do the shopping without him and it gives me some time to get out. Have a nice day and try not to get too tired. Regards
Hope you are not working too much today - however, I had to send this to you.
My pulmonary doctor - Dr. Mehta is from India - very nice guy and he takes good care of me which is important - (he is always kidding that he would like to take me to India) two weeks ago I tried to get an appointment to see him but he said he was leaving the next day for India. Today when I saw him I asked him why is he going so often to Indian - you know what he said - he goes back to work in the hospital there, they have so much of work that he spends about 10 days working there, I just could not believe it - but he works at the hospital - so if you need a good pulmonary doctor let me know (smile). He goes to the hospital here and his practice is fairly big he just moved into a new office, so I asked him what time he has to do this - he said he needs to help his people - which I think is a great idea. He is very nice and a really good doctor. Anyway I had to let you know this, he was the one i had asked to say hello to you from me, but instead he came back with your telephone number and e mail etc. Don't you think this is wonderful what he is doing?
I heard there was a big earthquake in California, and immediately I thought of your daughter - hope she lives far from these earthquate areas was she okay?
Thank you so very much for your nice reply.
The next time he is leaving I will let you know, and maybe you can expect a call from him - at least he promised me he would try and do that. So you will hear all about his patient. (smile that's just a satisfied patient talking!!!!)
Hope you are okay and not working too hard. I have a problem.
Last week I went to Dr. Mehta (Pulmonary) for a chest congestion. He gave me some prednisone which I have been taking along with Montelukast Sod 1 a day - and a cough mixture with codene. Now I have been having a terrible burning in my mouth as if it is on fire and my tongue and around my lips and throat - for the moment I am sucking on a lot of ice and washing with salt water. Today Dr. Mehta is in hospital and can't get to him until tonight, but I know you will take a moment to help me. What can I do and is it a side effect from the prednisone?
Sorry Stella for the delay in reply. I apologize for your wait. I was in OR. This is the side effect of the prednisone and is causing severe acid reflux and perhaps stomach irritation (gastritis or sotmach sores). The treatment is;1) Tums / Maalox / Mylanta2) Prilosec.
Avoid alcohol and caffeine drinks.Let me know if you have any further questions.
Dr. Arun: I know you are busy and I just hate to bother you but thanks a lot for taking the time to reply. I had an idea it could have been the prednisone and to think I just had one. I am taking lots of ice cubes and washing with salt water. Again thanks so much for all the help.
Dr. Arun: I know I am taking up so much of your time, but I really need some help and advice. Dr. Mehta gave me a second course of this prednisone and I have all the side effects - I feel so weak, nausea, my back aches, now diarrhea and I really now feel so sick. I have this cough is it really necessary that I take all of these prednisone isn't there something else that I can take for a cough on the chest, he gave me cough mixture but that only stop the coughing. I take honey, lemon, a teaspoon of coconut oil and a pinch of salt - warm it and take a teaspoon at a time - I am trying to remember my mother's cures instead of taking all these pills and I find after I eat I get so bloated - this is all so frustrating I have now to take two tylenol because my back and the aches I have are terrible. Please could you tell me what I could do.
My problem is that I had a very bad attach of phneumonia a couple of years ago and from then Dr. Mehta is always careful when I get a chest congestion, but I think this time it is not too bad and he gave me too many pills. Would appreciate your advice. Thank you so very much.
Andy just left to go for his treatment.
Stella,You may also discuss about the following medications with Dr. Mehta for the cough;1) Codeine; this acts as a cough suppressants2) Symbicort. This is again an inhalation medicine thus has far lesser adverse effects.Steam inhalation can also help in decreasing the cough.If you are taking medication for high blood pressure; inquire if it is ACE inhibitor, which are one of the most common medication to cause cough. This will need a shift to another high blood pressure medicine.
Hope your daughter in okay during that earthquake - now they are saying that the worse one is yet to come - so please be sure she is okay.
Hope you are on line now. I have a problem Andy had a tiny little scab at the tip of his nose and he picked it and now he is bleeding. What can I use to stop the bleeding, I gave him some ice to put on the nose would that be enough.
Hello Stella,Ice is good. Ask him to lie down. If you can see the bleeding point, a firm pressure (by mildly pinching between thumb and index finger) for about 2 minutes in all likelihood will stop the bleeding. Avoid nose picking which may dislodge the clot (and can restart oozing). Hope his blood pressure is normal. An high blood pressure may cause continued or prolonged oozing.Let me know how it goes.
Thanks a lot. The ice seems to be helping. He did take his pressure pill I think he just picked at a pimple or something he had at the tip of his nose and like a blood vessel broke or something - he is so stubborn - I told him not to pick on anything - but he never listens to me. Thanks a lot for your help, I will continue the ice.
Hope you are well and everything is ok your way. Andy and I seem to be having a bad allergy season, especially me and it was in the newspaper a few days ago that allergies will be real bad this season. Anyway I have a question.
I have been getting a soreness in my scalp - not a pain - its more like if I comb my hair and the comb scrape my scalp too much, when I touch it I feel so sore sometimes its one spot and then another time its another spot and also I noticed that the extreme tip of my four fingers only on one hand gets a bit numb not bad that I can't feel - I will take a tylenol and maybe a benadryl and I think the tylenol helps - but I would like to know what it is really - I had this afternoon and as I remembered I thought I would ask you because I always forget to mention it.
So far Andy is feeling much better. He said to tell you that they are building a big cricket stadium here but it will be about 30-35 miles from us - they seem to be interested in getting started with cricket here, but we have to wait and see if this fad passes over.
Hope your daughter is enjoying CA.
Following investigations would be required to confirm the diagnosis;
1) X-ray of the neck spine
2) MRI of the neck and wrist
3) Nerve conduction velocity (NCV) study
4) Electromyography (EMG)
5) Blood level of the B12.
The scalp problem is difficult to assess without an examination. But you may do following;
1) Take Vitamin E supplement. (B12 deficiency too can cause it).
2) Use Vitamin E based shampoo.
Allergies may be associated with the scalp issue but numbness may not be related to it.
My daughter was in New York for a week. She was working in Bank of America headquarters in Manhattan. She is back to CA but miss the East coast.
A cricket stadium in USA is heartening for we cricket crazy Indians. Andy, we have a new tournament called IPL cricket which is a 20-20 over format. I do not like it much as it is more for the television.
Thanks a lot for your reply. I will go and take a blood test.
My daughter in law's niece works for Bank of America in downtown Manhattan - she just got married also - she lives in New Jersey, which is quite a trip for her everyday - but she bought a house (with my daughter in law's help - she is a very wealthy girl) and as she said she has to work to pay the mortgage - which today is quite high. I think her husband works for IBM - she also had a very big wedding - its nice to go to big weddings!!!!!!!!!!!!!!
Andy would like to know exactly what is IPL is it a game between teams? He said lately - since his sickness he really don't know what's going on in cricket - he has to get on the computer and get updated with everything. Now we are having new rules on the computer - Microsoft will no longer be supporting the program which I have installed now - after April 30 so I don't know what will happen getting to you. Philip already had his computer updated with the new program but I did not update mine and my computer guy told me not to because the new program is no good. I guess I have to wait and see what happens.
Again thanks a lot.
Hi Dr. Arun:
Andy and I would like to wish you and your family a very happy easter, may you have all the blessings you deserve for all the help you give - I know not only to us but everyone else that you help.
Now, this question is regarding Philip. He had a blood test and the doctor called him and said his blood sugar was high - border line diabetes, but he did not give him any medication.
Can you tell me what is the best diet for him - and what should he do to keep that in control. Any questions you would like to know please let me know.
I thought I would send this now before we go out to dinner and I know that you are not online now. It is so cold here I don't think winter is over and the temperature is awful we had snow last night so it seems as if we will have a very cold easter. Regards
1) Dietary fiber; Soluble fiber is present in foods such as beans, oats, barley, and fruits and vegetables.
2) Phytosterols; Phytosterols are present in small amounts in nuts, seeds, and vegetable oils. There are many products on the market that contain phytosterols for total- and LDL-C lowering. These products are orange juice, yogurt, margarine spreads, salad dressings, breads, cereals, milk, and granola bars. Phytosterols also are available in soft-gel pills.
3) Soy protein is healthy.
Following dietary pattern may be helpful;
1) Red meat in low frequency and amounts
2) Minimally processed seasonally fresh foods
3) Less than five eggs per week
4) An abundance of plant foods; fruits, vegetables, potatoes, breads, grains, beans, nuts, and seeds
5) Olive oil as the principal source of dietary fat
6) Fresh fruits as the typical daily dessert Avoid mango and banana
7) Wine in low to moderate amounts; two glass per day for men.
Also read these authentic resource for the diabetic diet;
I would be happy to assist your further, if you need any more information.
Thanks so much for your reply. Dinner was great we had a few drinks - not much.
I tried to print your reply and send it to Phil's computer but had some problems so I printed it and will give him tomorrow. Of course Philip never listens to his mother and to follow a diet - I would have to cook and send over the diet to him - his wife is not much of a cook especially at this time for Passover she goes to her family and Philip eats with us - anyway thanks again and I will accept and get to bed. Have a nice day.
Hope you had a very nice Easter.
I had a blood test and urine test done and I went back to the doctor today for the results he said everything was very good even my cholestrol was so lay and my blood sugar was a bit high but he said no big deal on that however my CDC Platelets was high 768 should have been 450 but he said the last blood test it was 500 so it fluctuates but he said we would not do anything about that - my urine test he said had a bit of infection and some calcium (I think - I forgot already what he said) but everything on the whole was within range.
Now what could I do to reduce the platelet count and what causes that, my blood sugar was too much of ice cream he said cut down on some sweets - not too high it was 100 it should have been 99.
Hope you had a calm day and not too much at the hospital.
Thank you so very much for your report. I used to take a baby aspirin but for sometime now we both haven't had it so I will start it again. We try to eat lots of fruit - avacado, bananas, strawberries , etc. vegies that's a problem with Andy he only like to have corn on the cob - I love spinach he doesn't so it is difficult.
You may get two ratings I pressed the wrong one then I saw two came up so it was a mistake. Again thanks for your reply and have a nice wee end. Andy sends his regards XXXXX XXXXX would like you to know his urine test was negative.
I got up early to get your before you go offline. I have a little problem. Last week as I mentioned to you I had a blood and urine test and the doctor said I had a bit of an infection BUT he gave me nothing and it is bothering me now. I have some antibiotics Nitrofur-macr 100 mg. 2xa day. I took one yesterday and one a while ago - will that help especially the burning, I also have CEFUROXIME AXETIL 200 mg. Is there anything else I could take. I'm drinking lots of fluid also have some cranberry tabs which I am taking . I don't have going to the bathroom every minute but just a bit of burning. Hope you are not too busy.
Thank you so much for your reply. Andy said he never saw me up so early. I really don't get up until 10:00 a.m. and everyone knows - don't call Stella until after 10:00 - I was making an appointment with the cardiologist for a stress day one day and he said to his receptionist - no appointments until after 10:00 it was so embarrassing, anyway thanks so much for your help.
I know you are not online now and thought this would be the best time to write you.
Andy went today for his cardiology check up - the doctor said he is in good shape - anyway I have a big question.
Since his surgery he lost about 19 lbs. and the doctor said he should put back some of that weight - and maybe he will have more energy. He eats well - was always a small eater but often - must have lots of ice cream and cake but somehow he still cannot put on weight. I don't know what to do.
I don't know if you know about ENSURE and BOOST they are very popular over here don't know what it is about but Philip thought maybe he could try it - what do you think? would he put on weight and get some energy with that - not so much the energy as gaining a few pounds? Some of these drinks you have to be so careful with any reaction from whatever they contain - so Andy thought you were the best person to ask about it - what are your thoughts and whatever help you can give would be appreciated.
Another problem is that he has macular degeneration and he goes every month to get a shot in his eye and driving lately is becoming very difficult. Today I went to check on my eyes and the doctor was explaining to me that before he lost this weight he could see and read much better but now loosing so much it effects the sight because the medication in the shot that he gets really don't have too much in the body to work with and he will find if he puts on weight the sight will improve. I really don't understand these things but I try to explain them to you with the best of my knowledge. After all of that my eyes were okay its just very bad allergies that seem to be bothering me. Regards
Hello Stella,He may take Boost nutrition bars or other drinks of Ensure and Ensure too (any one brand at a time). He may start with the Boost nutrition bars. Loss of so much weight can affect whole of the body systems including vision. Here is a list of healthy but high calorie foods which can used for weight gain;1) Dry fruits; a cup of mixed dried fruits totals up to around 335 calories, while one fourth cup of dried raisins is 108 calories.
2) Natural Yoghurt With Honey, Greek Style, one 150g pot has 243kcals.
3) Nuts and seeds; they are rich in calories and good fat. These also contain antioxidants. Half a cup of almonds contains about 400 calories, while the same amount of macadamia nuts is closer to 475 calories.
6) Peanut butter: just one Teaspoon/10g carries 62 calories.
7) Avocados are high calorie with good fat,
8) Breakfast Cereal 50 gms can give your around 180 calories and is healthy.
9) Canned coconut milk.
10) High calories protein shakes (Ensure and Boost).
These all may help him to regain 1-2 pounds per week or more.Regards XXXXX XXXXX Philip and your daughter in law.It is pleasure assisting you.
Thank you so very much for your prompt reply. Andy take some of those things already - every day he has cereal, bananas, he loves peanut butter, nuts he cannot eat because he coughs incessantly so he tries to keep away from nuts - Cadburys he love - and with all of that still no weight gain. I cook lots of gourmet meals for him - he eats lots of fish very little meat - but he loves sausages - ham and eggs or bacon and eggs he would have like three times a week - I have yogurt every day and I can't get him to eat it but maybe as you mentioned it now perhaps he will try.
Phil, Vivian and I are on a big campaign starting tomorrow - we will get him the dried fruit and go out to shop only for him and see in a week if he puts on even one pound we will be happy. Thanks a lot for your help.
You are welcome, Stella.Apart from his physical problem (which were quite significant), there are secondary psychological issues with any ailment. Both of these may be factors for the weight loss and difficulty in regaining it (we call it a catabolic state). Since now his medical issues are controlled properly, there is a increased chance of positive metabolic responses (anabolic state) by the body. Relaxation, small strolls, eating high calorie healty food (these augment the hormones) are the key for the good health and weight gain. An increase in 500 kcal per day can result in increasing the body weight by 1 pound per week.
Just to summarize (you already know them, Stella!);
1) One may take dietary supplement, but one needs a balanced diet more. Help oneself to nuts and dairy products.
2) Add pistachios to the diet. Make them his evening munchies, as they help lower risk of heart disease. Other snack ideas include whole wheat or multi grain bread/ soy sticks with hummus or peanut butter. Opt for salsa dips as they are high on fibre and very healthy. Increase liquid intake
3) A small glass of wine before evening meal will help appreciate food a whole lot more. Also, avoid drinking water before meals and in between meals,
4) Choose food with nutritional calories and increase intake of starchy foods like potatoes. Avoid junk food.
Eat plenty of healthy fats. Eat egg yolks, chicken, fish, coconut oil, and other healthy fats. Increase caloric. So those bananas count well here. Whole eggs: loaded with protein, vitamins A,D, E and good cholesterol. The vital fatty acids in tuna contain a host of healthy fats, which not only aid in weight gain but also help in maintaining physical well-being. Whole wheat bread: accounts for approximately 69 calories per slice. Peanut butter It gives approximately 192 calories plus it is extra high in protein. Energy bars - It is loaded with good-for-you nuts and oats. One bowl packs around 500 calories. Cheese - One serving of cheddar cheese packs a good 69 calories. Cheese is concentrated milk, so it is high in protein and calcium, fat, cholesterol and cheese calories. Oil - choose olive oil, canola oil, etc. which is good for health and will add those much needed calories too. Banana - One banana contains approximately 100 calories. Bananas are rich in carbs and nutritious. Oats: A bowl of oatmeal is the perfect nutritious breakfast. It is high in fiber, and it also provides the body with vital nutrients. Yogurt: The healthy fruit-flavored, fatless yogurt can give you as much as 118 calories.
Again remember, exercises like brisk walking would help further, apart from diet, as it prevents accumulation of viscera fat.My best,Dr. Arun
Would you please let me know if you were paid -I had some trouble last night and am not sure if it did go through.
Also, Andy went this morning to the urologist for his check up - his urine analysis was okay so in that area everything was good. However, now he gave him a procedure with lots of water to the kidneys because he said he was not pleased one kidney was not putting out enough so he has to go for a RENAL OLTRASOUND of course the thoughts are did the cancer spread to the kidney - our next worry. It seems as if it never ends from one thing to the next Andy is now so depressed and so am I because we were planning a cruise for the summer, I guess that will have to be cancelled. Regards
Stella,The renal ultrasound is just for the caution and bladder cancer are rare to spread to kidneys. So I would not be worried about it. Do not cancel your cruise trip. I am sure you would be able to go ahead with it. The payment did not process. But please do not worry. You always pay.
I am sorry that payment did not go through - I am working on it and as soon as Just Answer get in touch with me everything will be straightened out - really don't know what is the problem. I went as far as submit payment then everything went wrong but I'm working on it and when you do receive it please let me know. Thanks for your reply.
I got through with one payment but I got a message that they are having trouble and I should try again later, so perhaps later tonight I will try again and send the balance of payments. Thanks for your patience.
Thanks Stella. Payment received. I really appreciate it.
Just want to let you know that Andy had his ultrasound and the doctor just called him and said it was OKAY - just a little cyst that is there which everyone would have and it is just something to ignore. Good News????
Have a nice day. I will now!!!!!!!
We will be going away for a few days (11) but before we go I have a question.
I have been on Ambien CR for quite a while and I would like to stop taking it because I have so many side effects I thin they are all due to long term use of the Ambien. What do you think of Melatonin? Any side effects its an over the counter drug so I am not too sure taking it with my other medications? What are your thoughts.
How is your daughter doing? Hope she is okay in CA.
You are up early. Thanks for your reply. Its wonderful that your wife can spend some time in CA. you should have gone also. We are going on a cruise for 11 days.
My other medications are: Avalide, Crestor, Nexium and vitamins (B, C, D and a one a day vit.)
Andy sends is regards XXXXX XXXXX I should tell you that he put on HALF A POUND - I told him that's nothing but he feels better, just a bit unsteady on his feet.
Hello Andy and Stella,Cruise would do definitely some good to you. Keep relaxed and enjoy. I know you have undergone a lot in last few months. Eat a lot of healthy food. Half a Pound!! Andy Please, you have to do better!Leaving practice for so long was not easy, so I could not accompany her. Hopefully next year we may be able to do that, together.None of your medications have drug interactions with Melatonin. So it can be taken.Wishing you all the very best.Let me know, if I can be of any further help.
The goals of the treatment of sleep issues are;
1) To improve related daytime impairments
2) To improve sleep quality.
Cognitive-behavioral therapy (CBT) is also considered the most appropriate treatment for some people with sleep issues. The components of CBT are;
1) Sleep hygiene education
2) Cognitive therapy
3) Relaxation therapy
4) Stimulus-control therapy
5) Sleep-restriction therapy
Phytotherapy (plant based) for the treatment of insomnia is an exciting new therapeutic option, which might benefit patients suffering from different degrees of insomnia. Insomnia or sleeplessness is a disorder characterized by difficulty initiating or maintaining sleep. It affects sleep quality and quantity leading to increased morbidity. Sleep disturbances are thought to be caused by abnormalities of the circadian system as indicated by misalignments of the endogenous circadian cycle and the sleep-wake cycle. Several contributory factors may be involved such as stress, health status, and medicines (e.g. caffeine).
Treating insomnia is a big challenge as the available medications are associated with several side-effects. Herbal medicines are being looked at as an ideal replacement for these medications. Among the ethnobotanicals used for sleep disorders, only Valeriana officinalis and Ziziphus jujuba have been evaluated for pharmacological or clinical efficacy against insomnia. Sedative-hypnotics are the most commonly prescribed drugs for insomnia. Though not usually curative, they can provide symptomatic relief when used alone or adjunctively:
A physical illness is uncommon with the sleep issue. An off and on sleeplessness need to dig the cause for underlying anxiety, depression or other related issue. A thorough evaluation by the history is done to reach to a conclusion. Accordingly the medical treatment is commenced. The precipitating factors can be;
3) sleep-wake schedule changes,
5) other sleep disorders,
6) medical conditions
7) work-related issues
8) family problem,
9) health events.
All these in isolation or in combination play problems in sleep issues. Good sleep cycle, handling the specific problem, counseling, cognitive-behavioral therapy, medications are employed for the treatment.
Following measures are helpful;
1) Avoid if you do;
a) caffeine or alcohol use,
b) environmental noise,
c) inappropriate room temperature,
d) watching TV in bed.
e) avoid large meals in dinner.
2) Relaxation techniques
3) Acupressure and acupuncture.
A study comparing zolpidem with CBT showed continued efficacy for the patients treated with CBT. Please see the reference;
Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. Sep 27 2004;164(17):1888-96. [Medline].
Dietary measures which are useful:
1) Avoid caffeinated beverages in the late afternoon or evening.
2) Avoid alcohol in the evening.
3) Avoid large meals near bedtime.
Acupressure on the Shenmen points of both wrists significantly decreased insomnia, with the benefit persisting for up to 2 weeks afterward. Please see the reference;
Sun JL, Sung MS, Huang MY, Cheng GC, Lin CC. Effectiveness of acupressure for residents of long-term care facilities with insomnia: a randomized controlled trial. Int J Nurs Stud. Jul 2010;47(7):798-805. [Medline].
The following is the guideline when using medications:
1) Try the lowest dose of the medication.
2) Use the medication for not more than 2-4 weeks in a single stretch.
3) Medications with a rapid onset of action, such as zolpidem or zaleplon, are preferable when the problem is falling asleep.
4) If the problem is staying asleep, temazepam, estazolam, flurazepam are more useful.
5) If one is depressed, an antidepressant with sedative properties, such as trazodone, mirtazapine, or amitriptyline, may be preferable.
Hope all is well with you. Andy has a question.
For a few days now he noticed that his going to the bathroom increased - only during the day he urinates incessantly - at night he never gets up until morning.
Now he started the Ensure - also he takes a regular vitamin, C supplement, B12, D3, his iron which he takes since his colon cancer, toviaz and benecar - do you think that with the Ensure that something increased his urination? I can't think of anything else what do you think?
Hello Stella and Andy,Yes, Ensure can be responsible for the increased urination in day time. If there was any other reason like urinary infection; the night time urination too would increase. If this persists, there is no harm in getting a urine test done, just to work on the caution . But this is not likely to be anything serious or significant.How was your cruise trip? Hope you had a great time.
Thanks for your reply. We are leaving on Sunday will be back on the 9th. So really want to leave healthy!!!!!! We will be going as far down as Barbados, so that should be nice.
Anyway, Andy says he feels okay otherwise, no pain or any uncomfortable feeling, so let's hope it is the Ensure when he took the other drink that did not affect him, but I guess the Ensure with all the other vitamins was a bit too much - do you think he is overdoing on vitamins - anything that Andy get do from taking any kind of pills - but maybe the vitamins with the Ensure is too much?
Is your wife back from California? They seem to be having some problems down there - you can't get away from those problems today, its all over.
Again, thanks a lot and have a nice day.