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.
Thursday, February 28, 2013
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.
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.
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.
Subscribe to:
Posts (Atom)
