Saturday, March 16, 2013

Finally an Oma Update

I'm overdue for an Oma update.  And today is her birthday, so first things first ... Happy Birthday Oma!

Oma got transferred to the Rehab Hospital, which is right next door to the hospital, on March 6th or somewhere close to there.  She's been complaining of pain and doesn't think the pain medication is adequate, but is making it work.  She doesn't much care for the food, but I think that is standard in places like this.  The staff all seem to be nice, so that helps.  She goes to therapy three times a day, and that wears her outs, but at the same time, hopefully makes her stronger.

Oma did have a small setback when her incisions started leaking and were infected.  Thankfully, they were able to give her antibiotics and get things under control without having to transfer her back to the hospital.  They will able to wean her off the oxygen too.  They are watching her closely for blood clots and pneumonia because she is spending so much time in bed.  They are also adjusting her medications as needed.

Her appetite has been poor, but she really liked the goodies I brought from the German store today ... brotchen, fleisch salad and schincken.  It was a big hit.

If everything goes according to plan, Oma should be released to go home this week.  The doctors are saying she should go home on the 19th on the 20th, so that is great news!

Monday, March 4, 2013

No Cancer for Oma!

The best news of the day is that Oma does NOT have cancer.  At all.  Anywhere.  All of the masses were benign.  Anything suspicious at all was benign.  It can't get better than that.

Oma had some chest x-rays taken.  While she has a bit of fluid in one of her lungs, I guess that is normal after surgeries such as these because they fill the patients up with so much fluid.  She does not have a pneumonia, so that is good.  She is still receiving 3 liters of oxygen to maintain her oxygen saturation levels though.  She is supposed to begin a new "respiratory protocol," so a respiratory therapist will visit her, evaluate her and do what needs to be done to get things working right in the respiratory area.

The drain tube has been removed and Oma managed to get by without a leak from the pancreas.  Her blood sugars have been running anywhere from the 120's into the 200's, so she's been getting periodic insulin.  The nurse didn't think this was any indication of future numbers though as these could still be a reflection of the surgery and the resulting stress.  It is still too early to tell if diabetes is here to stay.

Oma's on a morphine pump for pain, and able to get a couple of other pain medications orally for breakthrough pain.  While she's not totally miserable, she's certainly not comfortable either.  The short walk from the bed to the restroom tires her out.  Her catheter is out now, so frequent trips to the restroom are definitely happening.

Oma has been referred to a rehab center.  A rehab person will now come and assess her to see if she qualifies for the rehab facility.  In order to qualify for rehab, she has to be able to tolerate three hours of therapy during the course of a day (not necessarily three hours back to back, but three different hours in one day).  If she does not qualify, she will be instead referred to a "nursing home," which has the ability to do various levels of care.  She was not thrilled with the mention of a nursing home until she was reminded that she was in a nursing home (that she chose!) after her hip replacement surgery last year.  If she does in fact qualify for rehab, she would probably be transferred within a few days.

She's having trouble eating as she still has no appetite.  She's thrown up a few times, but generally nothing sounds good.  Even her beloved coffee doesn't entice her.  She's drinking plenty of liquids, but not eating much but little bits of fruit.

We'll work through the little stuff.  Just breathing a sigh of relief about the big stuff.

Saturday, March 2, 2013

Oma's in a Regular Room

Oma made it into a regular room yesterday afternoon.  She has a roommate and would probably be much happier in a private room, but she seems comfortable enough.  She's still receiving oxygen through a nasal cannula at the rate of 4 liters.    They removed her epidural and she's now receiving pain medication (morphine) through an IV pump.  She got her catheter taken out, but couldn't urinate on her own, so the catheter is back in for now.  She was cleared to eat regular food (more than clear liquids), but claims to have no appetite yet.  The pancreatic surgeon was by to see her and seemed pleased with her progress.  While there was once mention of a possible Sunday release, there was no mention of that today.  Still awaiting those pathology results, which should be back on Monday.

Thursday, February 28, 2013

Oma's Still in ICU

Oma's hanging out in the Intensive Care Unit.

Her pain is pretty intense.  Her Dilaudid is flowing at the maximum dose in her epidural.  She's also getting Norco for breakthrough pain.  She's still on 7 liters of oxygen, but we're told that is normal for patients with this kind of abdominal surgery ... they take shallow breaths because of the pain and the pain medication also further relaxes them.  She did get out of bed today and walk to the nurses' station (probably only about 20 feet, but a good start anyways).

She's had some clear liquids so far ... chicken broth, Sprite, apple juice and jello.  Her blood sugars have been running high and she's been getting insulin regularly.  There's no telling yet what the permanent situation will be.  She's running a low fever, but we're told that's expected after this kind of surgery.  She's already draining less fluid from her abdomen than she was yesterday.

She's complaining of the noise in the ICU and that she can't get any rest.  I don't think most of the patients in the ICU are as coherent as she is.  She's been okayed to be moved to a regular room, but a bed wasn't yet available as of this evening.  They were hoping one would open up so she might get a good night's sleep, but no one was really sure.  She should be moved by tomorrow at least.

The nurses have been re-positioning her every two hours to prevent bed sores and Oma doesn't much care for that.  Any movement at all really hurts.

Considering it's only been a day since surgery, she seems to be doing quite well.

Wednesday, February 27, 2013

Oma's Surgery

Oma checked in at 7:00 this morning for surgery.  They called her back quickly to the pre-op room, where she changed into her fancy gown and began the pre-op rituals.  Surgery was supposed to start at 9:00, but they got a late start, taking her back fully coherent at 9:15 a.m.  She still needed to have the epidural from the anesthesiologist before surgery could get underway, so I'm not exactly sure what time surgery got started.  The surgeon anticipated that surgery would take approximately three to four hours.

The pancreatic surgeon finally emerged at 2:00 p.m.  He said that all went well, but that surgery took longer than expected because of all the inflammation (possibly because of the pancreatitis?).  He indicated that the mass didn't look cancerous.  It looked odd though.  It looked like a cyst with material inside of it (I guess cysts don't usually have anything inside of them).  It was also in an awkward spot.  The pancreatic surgeon removed the mass, the back half of the pancreas, many lymph nodes and the spleen.

He informed me that the Gynecological Oncologist removed both ovaries (Oma will be pleased to hear that).  That looked good as well and that mass looked like a big fibrous cyst.  Pathology on both masses (and the lymph nodes) may be back on Friday, but most likely on Monday.

Oma was in recovery for a bit before being transferred to the Intensive Care Unit.  Removing a big chunk of her pancreas can cause her blood sugars to go crazy and they need to be monitored closely.  (Hopefully the remaining pancreas will be able to efficiently process the blood sugars, but if not, Oma will become insulin dependent.)  Her breathing also needs to be closely watched after such a big surgery, and they need make sure her pain is under control.  If everything goes well, she may possibly be moved to a regular room tomorrow.

Oma is in significant amounts of pain.  She is on oxygen.  She is receiving pain medication (Dilaudid) via an epidural.  They are concerned about fluid building up in her lungs and so she is supposed to use the spirometer (that plastic contraption that you suck the tube and make the ball go up) hourly.  It does not go over well.  I guess after having major abdominal surgery, it doesn't feel so good.  Imagine that.

My shift is over and I'm heading home.  My brother and sister-in-law are on shift now.  Next update will be from them.

Tuesday, February 26, 2013

Another Appt for Oma with Pancreatic Surgeon

Oma STILL has not had surgery.  Apparently, the Gynecological Oncologist wanted to hold off until she had another CT and met with the pancreatic surgeon yet again.  We thought we were moving forward with at least the ovarian surgery, so we were a bit frustrated as we felt we could at least get one out of the way.  But it is what it is.

Oma had another CT of her abdomen yesterday, both with and without contrast.

We met with the pancreatic surgeon today.  According to the CT scan, the mass on the pancreas is still there.  Not only is it still there, but it is perhaps a little larger.  Not exactly what we were hoping for.

Additionally, both tumor markers came back elevated.  The CA 19-9 (a tumor marker test for pancreatic cancer) was 151, when anything above 37 is considered elevated.  An elevated score can also be caused by gallstones (which we know she has), pancreatitis (which we suspect she has), or liver disease (which she has had in the past from her auto-immune hepatitis).  The doctor indicated her Chromogranin A (a tumor marker test for a neuro-endocrine tumor) was elevated with a score of 7, but according to what I read online, anything below 15 was considered in the normal range.  Perhaps I misheard the score or perhaps I misunderstood what I read.  In any event, because the tumor markers are elevated and because the mass has grown, things are again very concerning.  Surgery is back on the table.  For tomorrow.

During surgery, they are going to remove the end portion of the pancreas (where the mass is located), lymph nodes in the area, and the spleen.  The mass is intimately associated with the vein and artery by the pancreas which goes to the spleen, which is why they have to remove both.

A big portion of the pancreas will be left behind which is usually sufficient to process sugars, but there is typically a risk of an increase in diabetes.  Since Oma is already pre-diabetic, this may push her over the edge to a full-blown diabetic.

After surgery is complete, there is a risk a leak can develop from the pancreas.  The leak rate is 20 to 25% of all cases.  She'll have a drain tube after surgery.  If she develops a leak, the drain tube will stay in longer until the leak stops (it won't require more surgery).  Surgery will take anywhere from 3 to 4 hours.  The Gynecological Oncologist will come in for the last 1/2 hour to remove the ovarian mass and ovaries.  (There is some confusion as to whether he is just going to remove the left ovary where the mass is or if he is going to remove both ovaries.  Oma wants both ovaries removed.)

Without a spleen, you can develop certain infections.  Oma will need a variety of vaccinations to help protect against those infections.  Anesthesia during surgery can also flare up her hepatitis.  Of course, there are all the additional risks that generally come with surgery as well.

Oma could be in the hospital about a week, although some patients have been discharged after 3 or 4 days.

The mass could be a neuro-endocrine tumor.  It could still be a benign cyst.  Or it could be adenocarcinoma (cancer).  Final pathology will take 2 or 3 days to come back.  If it comes back as cancerous, Oma will be referred back to the Oncologist for further treatment.  There are genetic links between ovarian cancer and pancreatic cancer, so if these come back as cancerous, we will all be referred to a geneticist.

Oma has to check-in at 7:00 a.m. tomorrow morning for surgery.  Wish her well.

Tuesday, January 15, 2013

Oma's Appt with the Pancreatic Surgeon

Oma had another CT scan of her abdomen and pelvis yesterday, both with and without contrast.

Oma finally had her appointment with the pancreatic surgeon today.  According to him, it appears that the mass on her pancreas (On top of her pancreas? Near her pancreas? Behind her pancreas?  The location isn't exactly clear.) is a cyst.  There aren't too many things that can cause the cyst.  Auto-immune hepatitis (which Oma has) can cause auto-immune pancreatitis, which in turn, could have caused the cyst.  It was discovered that Oma also has gall stones and a rogue gall stone could have caused pancreatitis as well.  Many of Oma's symptoms are consistent with those of pancreatitis.

If it is a "pseudo-cyst," it will most likely resolve within twelve weeks.  As of right now, there has been no change in the cyst.  The CT scan taken yesterday looked the same as the CT scan taken six weeks ago.

There are a few cysts of the pancreas that are cystic tumors and can be cancerous.  One cystic tumor is called a mucinous tumor, but none of Oma's pathology reports saw any mucine.  There is a 25% chance of malignancy with these tumors.  Another cystic tumor is called a serous tumor.  Typically, these have a honeycombed appearance, which again did not show up on Oma's pathology.  There is a 1% chance of malignancy with these tumors.

It is the recommendation of the pancreatic surgeon that Oma undergo another CT scan in 6 weeks (to see if maybe it was a "pseudo-cyst" and has resolved itself, as it will have been 12 weeks from the time it was first noticed).  It was further recommended that she be re-imaged approximately six months from now to look for any growth, spider webbing, or nodules (none of which was seen at this point).  They want to make sure that the mass is not growing into something dangerous.  There is no need to do anything surgically unless the mass grows or changes.  Because Oma is going to undergo surgery for the ovarian mass already, if the pancreatic surgeon is available, he indicated that he may want to take a "peek" at the pancreas during the surgery.

Oma has to have some more labwork done tomorrow.  Although we were previously told that the the CA 19-9 (a tumor marker test for the pancreas) was normal, the pancreatic surgeon could find no record of it in Oma's file.  Therefore, he is ordering another CA 19-9.  He is also ordering another tumor marker test for neuroendocrine tumors called the Chromogranin A.  If those labs are elevated, there would be more imaging in store.

That's it for now.  Oma is still waiting on a date for her ovarian surgery.