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!

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.

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.

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.

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.

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'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.

2012 Medical Expenses

I finally got all our receipts and EOB's (Explanation of Benefits)

 compiled into the "2012 Medical Expenses" binder.  

It's a 3 1/2 inch heavy duty binder. 

 I held it down in the first picture, and it was 6 inches tall.  

That's just crazy!  

(How cute is that boy that photo bombed the picture though?)

I had to hold my hand on the side of the binder in the second picture or it kept sliding open.  

It was that full!  

Anyways, it measured about 8 inches tall.

And in case you're wondering how that calculated for our pocketbooks ...

Let's just put it this way ...

We paid more in out-of-pocket medical expenses in 2012 

than I made my entire first year working as a Juvenile Probation Officer.

A Wise 3 Year Old

Last night I was really missing E. and the tears were trickling down my cheeks.  Peanut asked me what was wrong and I told him, "I'm just missing your daddy."

He crawled up in my lap and wrapped his arms around me.  He told me, "It's okay.  Daddy still loves you."  And then he added, "And I do too."

He told me to close my eyes and he took my hand and put it over my heart.  He then asked, "Do you feel him?"

Not only did I feel him, but I also felt the love of a pretty incredible 3 year old.

Oma's Appt with the Gynecological Oncologist

Today Oma met with the Gynecological Oncologist.  He had reviewed all of Oma's scans to date and still wasn't sure exactly what the mass was on her ovary.  He indicated that it was a cyst about the size of a golf ball.  Cysts of this size on women Oma's age have a less than 5% chance of being cancerous.  It admitted that the cyst was not normal and most likely benign, but the only way to know for sure was to remove it and send it to pathology.

The Gynecological Oncologist explained that Oma had two options:

        Option #1 ... The "watch and see" approach.  Oma would be monitored with ultrasounds every six weeks for a period of time, then every three months, then every six months to eventually once a year (so long as the cyst did not change).  When asked if the cyst could transform into the cancer, the doctor stated that the answer was unknown.  He did state that most cases of ovarian cancer are already at a Stage 3 by the time they are found.

        Option #2 ... Surgery.  Oma would have a laparoscopic surgery to remove both ovaries and the mass.  Like any surgery, there are risks of complications.  The mass would go through a freezing process and several sections of it would be examined under the microscope.  If everything is benign, Oma may stay in the hospital overnight and could expect a couple weeks of recovery.  If anything was malignant, a more invasive surgery would be completed and the lining and lymph nodes would be removed.  This would require a hospital stay of 7 to 10 days and recovery could be expected to take 6 to 8 weeks.

The cyst could have been there a long time.  There is no way of knowing.  In post-menopausal women like Oma, the cyst is unlikely to shrink.  Although Oma's tumor marker test (the CA-125) came back normal, the doctor didn't give that a lot of weight.  He indicated that of all Stage 1 ovarian cancer diagnoses, 50% of them had a normal CA-125.  Furthermore, 25% of Stage 3 ovarian cancer patients also had a normal CA-125.

Oma didn't hesitate to say that she preferred to have the surgery.  She doesn't want to take any chances.  I don't blame her.  I think I would have done the same thing.  There is still a chance that the pancreatic surgeon will want to "check out the pancreas" while the Gynecological Oncologist is in there doing his thing.

Oma has an appointment with the pancreatic surgeon on January 15th.  The day before that, she'll get another CT scan of the abdomen and pelvis, which will provide current information and give the doctor something to compare.  Then, finally, surgery will be scheduled.

Oma's Doctor Appts

Oma had two doctor appointments today.

The first one was with the GI who had performed the endoscopic ultrasound.  He reviewed the results with us once again.  The biopsy had come back benign, as did the final pathology report.  All good news!  There are a few things that the mass could be, but the doctor kept talking like it was more like a cyst than anything.  According to the GI, Oma still needs to be monitored closely.  He'd like another CT on January 16th to compare to the original CT.  The hope is that the mass is shrinking.  If that's the case, it sounds like she'll continue to be monitored and it will eventually just shrink and go away.  If instead the mass is getting bigger, then in all probability, another endoscopic ultrasound will be performed with another biopsy collected.

The next appointment was with the oncologist.  He didn't have much to add.  He was thrilled that all the pathology reports were showing that the mass was NOT cancerous, since it certainly wasn't looking that way in the beginning.  He shared with us that the two tumor marker tests (the CA 19-9 for pancreatic cancer and the CA 125 for ovarian cancer) were both within the normal range.  He obviously had nothing but respect for the OB/GYN oncologist that we're meeting with next week.  We won't know more about the mass on Oma's ovaries until she actually has surgery.  If that mass does turn out to be cancerous, the OB/GYN oncologist would oversee any and all treatment.  Therefore, unless the pancreas turns up something cancerous, the oncologist is stepping off the team at this point.

The next appointment is on January 9th with the OB/GYN oncologist, followed by an appointment on the 15th with the pancreatic surgeon.  The oncologist did tell us that he's seen both these doctors work well together and often coordinate surgeries together, so that was good news.  We'll see how it pans out.

Daddy is Always with Us

Peanut misses his dad like crazy, but doesn't understand where his dad is.  While we've had many conversations about heaven and God, he just can't grasp those abstract concepts.

Dad's in heaven.  Where's heaven?
Heaven is a wonderful place in the sky.  Can we go visit?
God is taking care of daddy now.  Who is God?
God takes cares of us.  No, my daddy takes care of us.
Dad is not sick anymore.  He's all better in heaven.  Can we go pick him up then?

Yes, I realize I don't have a strong religious background, but I try my best.

After having a variety of discussions with Peanut, none of which seemed to satisfy his mind or his heart, I think we finally came up with one that worked (at least for now).

Dad is always with us.  Close your eyes.  Can you see him?  Peanut scrunched his eyes up tight and his whole face squished in concentration.  Suddenly he broke into a big smile, "I can see him!"

Dad is always in your heart.  Think about him.  Can you feel him?  Peanut put his hands over his heart and sighed, "I can feel him."

So now when Peanut gets to missing daddy, he closes his eyes and puts his hands over his heart and he reminds me, "Daddy is always with us."

S.

Delays for Oma

Remember all those folks saying mom (Oma) would hopefully be having surgery in the days following Christmas?  And how I was skeptical and thinking that the days following New Year's might be more realistic?  Well, looks like it may be A LOT of days following New Year's.

The oncologist is still out of town.  We've scheduled an appointment to see him for January 3rd.  It seems as if no one will give us the final pathology results until we see him.

My brother called the OB/GYN oncologist on Wednesday morning like instructed, hoping to get a quick surgery date.  Instead, we got an office appointment for January 9th.  In speaking with him, it sounds like he is delaying things because he is still holding out hope of combining the two surgeries (the ovarian surgery and the pancreatic surgery).

The pancreatic surgeon wanted to see Oma on January 8th, but we then learned that he was the second choice for a surgeon as the first choice was originally out of the country.  My brother called the first choice surgeon and made an appointment for January 15th, but she's on the cancellation list if something comes up sooner.

At this point, we'll be lucky if Oma gets into surgery the third week of January.  Of course, I'm a little jaded, but figure I'd rather set my expectations low and be pleasantly surprised if things happen sooner, than if I set my expectations high and be disappointed if we run into delay after delay.  At least there are appointments made.  We're making progress, slow progress but progress.

Missing him

Snuggled up in bed last night, Peanut's eyes welled up with tears.  "I miss Daddy."

Me too, Nut.  Me too.

Mom/Oma is Home

Mom/Oma got discharged today and we got her settled in nicely back at home.  We are to call a few different doctor offices come Wednesday and hopefully come up with a plan from there.

In the meantime, I hear there's a big holiday coming up.  (Thanks to the kindness of others, there are actually presents under the tree.  Heck, thanks to the kindness of others, there's actually a tree!)

S.

Oma's Preliminary Biopsy is Benign!

Mom went for her endoscopic ultrasound today.  The preliminary biopsy is benign!  They took tissue samples from two spots on her pancreas and pathology folks looked at them right then and there.  From what they saw, they were NOT cancerous!  Now, those samples have to grow in the petri dishes or whatever for a few days, and final results won't be back for 3 or 4 days, but this is some pretty great news.  (We actually aren't expecting to hear the final results until after Tuesday, with Christmas and all.)

So, what happens now?  We have no idea.  Obviously, she has this 4 cm THING in her pancreas that shouldn't be there.  Does it come out?  Do they just watch it?  We're not sure.

And then there is still the issue of the mass on her ovary.  We still haven't seen that last doctor, the OB/GYN.  We've begun to question if he is real.  Haha.  We've joked that he's just an imaginary doctor.  They keep telling us that he'll be in to see us.  He's pretty much the only reason mom is still in the hospital.  She'll get released tomorrow no matter what I think and the nurse just said that if we don't see the OB/GYN before she gets released, we can make an appointment to see him in his office.  Uhg.  I'm really hoping he makes an appearance.  That was the whole point of getting admitted ... to get as much of this stuff done as quick as possible and not have to make appointments two months out.

Things are looking a little more manageable than they were two days ago.  We still have things that need to be addressed, but as we tentatively cross the big looming pancreatic cancer off the top of the list, the rest seems like smaller workable chunks.  Right now though, Queen Mom is demanding coffee and pie.  Unless I head to the cafeteria and make a delivery immediately, there will be hell to pay.  Her wish is my command.  At least for the moment.

S.

Edited to add:  The elusive OB/GYN came by at about 7:30 p.m.  Now, to his credit, he's not just a run of the mill OB/GYN, he's an OB/GYN oncologist, and a very busy one at that.  He's not really sure what the mass is on mom's ovary, but it doesn't matter, it needs to come out.  He'd like to take out both ovaries and the mass all at the same time via a laparoscopic procedure.  Then, as part of the procedure, the mass would go through some sort of freezing process and then be examined through a microscope.  They would be able to tell right then and there if it was malignant or benign.  Based on what they found, that would determine if the surgery was over or not.  If it was benign, mom would be all done.  She'd stay in the hospital one or two days and have about a week long recovery period.  If they found cancerous cells though, they would slice her abdomen open and remove lining, lymph nodes and whatever else they needed to.  She'd be in the hospital a week to ten days and her recovery time would be MUCH longer.  There would also be a discussion of potential chemotherapy and/or radiation post-surgery.  He wouldn't know until he got in there though.  The OB/GYN would like to schedule surgery as early as next week.  He also mentioned that he'd like to coordinate with the thoracic/abdominal surgeon to possibly do both surgeries (the ovarian surgery as well as the pancreatic surgery) within the same time period although he and I both realized this is a remote possibility.  We are to call his office on Wednesday to see where things stand.  (I'm guessing that realistically, things won't happen next week, but probably the week after.)  In the meantime, Mom is all set to be released tomorrow.

Scans, Scans and More Scans

Last night's CT scan with contrast showed a "possible pancreatic neoplasm" and a "possible ovarian  tumor."  It stated that the 4 cm structure in the pancreas could also represent a "pseudocyst" rather than a mass.    The structure on the ovary measured 3 X 5 X 3 cm.

The oncologist visited with mom bright and early this morning and my brother was present to ask questions and take notes.  The plan to biopsy the pancreas via a fine needle aspiration was scrapped as I guess removing the needle runs the risk of potentially spreading the disease.  Instead, an endoscopic ultrasound will be performed and a biopsy will be collected that way.  A GI doctor would be in to discuss the procedure, which would hopefully take place today or tomorrow.  A thoracic/abdominal surgeon would also be in to discuss potential pancreatic surgery.  And finally, an OB/GYN would be in to discuss the mass on the ovary and how we would go about addressing that issue.  More lab work would be collected, specifically to look at two cancer markers, but that would take several days to get back.  Mom's case could potentially be turned over to the surgeon, depending on how test results come back.  In some cases radiation and chemotherapy are needed before surgery, or sometimes after, or sometimes not at all.  The oncologist is going out of town for two weeks, but has updated his partner about mom's case and so we can move forward if need be before he returns.

The hospitalist also came in and informed us that mom's case had the team of doctors perplexed.  Mom isn't presenting the typical symptoms of someone with pancreatic cancer.  But she isn't presenting the typical symptoms of someone with a "pseudocyst" either.  Mom isn't presenting the typical symptoms of someone with ovarian cancer.  But she isn't presenting the typical symptoms of someone with a cyst on her ovary either.  Her medical history isn't consistent with these diagnoses either.  So, they're all scratching their heads.  There are a lot of potential scenarios and they are going down the list to eliminate things one by one.  It is hard to answer questions about what is going to happen when we are not even sure what we are dealing with.  Because the pancreas seems to be the most serious issue, I think that is why that is where all the attention is focusing on first.  The endoscopic ultrasound was scheduled for today, but because of some miscommunication, mom had already eaten lunch (oops).  Therefore, the procedure will now be conducted tomorrow.

Mom had to do yet another CT scan.  This was a more detailed and localized CT (with and without contrast) specifically of the pancreas.    It indicates that the "hypodense sharply marginated mass of the body of the pancreas" is 4 cm in diameter and does not obstruct the pancreatic duct.  It states it could be a "cystic neoplasm or other cystic lesion."  I'm not really sure how much more information that gave anybody.

The GI doctor came in and reviewed the endoscopic ultrasound procedure.  The information he collects during his procedure will give the surgeon additional information to make necessary surgical decisions.  He will also collect tissue samples for immediate preliminary biopsy review.  The samples will then be sent to pathology, where we will have final pathology results in 3 or 4 days (or probably a bit longer with the Christmas holiday around the corner).

The thoracic/abdominal surgeon also visited with us.  Because there is so little information available about what we are dealing with, we spoke in a lot of hypothetical terms.  In all likelihood, this mass will need to be removed.  It appears to be in a "good" location for removal, being in the middle of the pancreas, although if it's a little more to the right or to the left, that could change things.  The pancreas is a very intense organ with lots of nerves and blood vessels and so surgery is a complicated matter.  Sometimes, chemotherapy and radiation are required pre or post surgery.  He would not be able to make any decisions until he was able to review the endoscopic ultrasound and see the biopsy results.  If mom did in fact require surgery, he didn't anticipate that it would take place until after the first of the year.

Mom is comfortable.  She complains of a burning in her upper stomach, right below where the ribs meet.  She receives pain medication as needed and that seems to control things superbly.  She is definitely not a fan of hospital food and has not missed an opportunity to let people know that.  Other than that, things are good.  Her spirits are good, her attitude is feisty and she's taking things as they come.

Seriously?

Today my mom called me complaining of abdominal pain.  Bad abdominal pain.  I suggested she go to the Emergency Room, but she came up with every excuse in the book.  What is it with people who don't want to get help?  Gosh darn stubborn people in my life!  I made a quick trip to her house and after a little bit of tough love, we were in the car and on our way.

Would you believe me if I told you we got the exact same room in the Emergency Room that E. was last in?  What are the odds of THAT???  Oh yes, same nurse and everything.  Blood work, a urine sample, a CT scan.  My brother arrived and we settled in for what we figured would be a long wait.  It wasn't long at all when the doctor returned and announced that the CT showed a 3.5 cm mass in her pancreas.  Are you frickin' kidding me?  If this wasn't happening right in front of me, I'm not sure I'd believe it.

Long story, short ... she was admitted to the hospital to get a jump start on things.  A CT with contrast was completed tonight of the chest and abdomen.  A biopsy will be done in the morning.  A call was put in to the oncologist.  With the holidays and vacations undoubtedly on the books, I'm sure we'll be running into delays after delays.  I'm crossing my fingers we can get some sort of plan in place sooner rather than later.  I function better with a plan.  It makes me a little less crazy.

(Yes, she's on the oncology floor.  Yes, I requested that she not be placed in E's same room.  Yes, we saw lots of familiar nurses.  Yes, it was very difficult.  Yes, we continue on.)

S.

Obituary

Earl Horton, Jr., 54, died peacefully at home on December 11, 2012 with his family by his side.  Earl was diagnosed with Stage IV Esophageal Cancer in 2009, but gave that beast a run for its money, beating it back, not once but twice even after it has spread to his brain.  Earl’s body gave out way before his spirit.

Earl was born on October 24, 1958 in Winnemucca, Nevada, where he spent his childhood and graduated from high school.  He attended the University of Nevada, Reno graduating with a Bachelor’s Degree in Psychology in 1991 and a Master’s in Social Work in 1994.  During his college years and even after, Earl was very involved in the ATO fraternity, and established meaningful and long-lasting friendships with his fraternity brothers.  

Earl worked for Washoe County Juvenile Services for thirty years in a variety of capacities, from work crew to detention to a probation officer.  He influenced and made a difference to many youth and families.  Earl enjoyed camping, fishing and a cold beer.  He was a loud and spirited fan of the Nevada Wolfpack, the Los Angeles Dodgers and the Minnesota Vikings.  

Earl’s biggest joys and proudest accomplishments were his children, Morgan Horton (age 19), Katie Horton (age 17) and Earl Horton, III, “Peanut” (age 3) who will carry on his legacy.  He is also survived by his proud father, Earl Horton Sr., his beloved sister, Joan Horton, and his three nephews, Jeffrey Horton, Joseph Horton and Julius Horton.  

He will be forever cherished and missed by his wife Sandy Tedsen Hellman-Horton as well as his step-children, Keegan Hellman (17), Luke Hellman (16), Chase Hellman (14), Gage Hellman (13), T.J. Hellman (12), Seth Hellman (12) and Ty Hellman (12).  Additionally, he is survived by his aunts Margaret Horton-Davis and Barbara Mills, numerous cousins, and his in-law families, the Scrivens and the Tedsens.  He was preceded in death by his uncle Richard Horton, his cousin John Harris and his mother Hilda George.

As per Earl’s wishes, there will be no formal services.  There will be an informal gathering of family and friends at his home on Saturday, December 15th from 1:00 p.m. to 5:00 p.m. to enjoy drinks and food, and share memories and stories.  

In lieu of flowers, Earl’s ATO brothers have set up an account to assist the family at Wells Fargo.  The Earl Horton Donation Fund, C/O Wells Fargo Bank, 1200 Disc Drive, Sparks, Nevada 89436 (Account #1016982298)

Goodbye E.

A man of great honor, integrity and courage left this Earth this afternoon.  While his family and friends will all miss him immensely, I think I can speak for all of us when I say we are all relieved that he is now pain-free and enjoying a beer with his fishing pole in hand.

As per E.'s wishes, there will be no formal services.  We will be gathering at our home for an informal open house on Saturday, December 15th from 1:00 p.m. to 5:00 p.m.  Please join us for food and drinks, and to share memories and stories of this man we all loved so much.