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Letter from Dr. H 10/21

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Nitsana and Kathy,

I need you to read this carefully, let me know if there need to be any

changes in these plans, try and answer Mrs. 's questions and help her

schedule this procedure within your schedules. Though I expect it to be done

by

then, I shall be away from 11/4 to 11/13 so it should not be scheduled during

that time.

Madeleine

Mrs. ,

Dr. Spigland is on board to do this as a 2 stage procedure, J now and Nissen

and Gtube repair later.

I have here copied my previous email which included plans that still stands.

Please read it carefully.

I assume that her TPN has been spread out and her BS is stabilizing.

This first surgery will be short and not difficult according to Dr.

Spigland. When we get her back to J-tube feeding, her BS will stabilize making

her

metabolic management much easier during the longer more complicated second

surgery. Dr. Spigland and Dr. Chen will be better able to estimate how long it

will be before we can start to USE the new J tube and how long it would

normally take to advance to full feeds into a new J-tube. I expect that it

will

take me 36 to 48 hrs to transition her from TPN to full continuous J tube

feeding if her gut responds normally to the feeding.

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