We spent a stressful morning at Norris and Keck Hospital. Selby's office put our pre-op tests into the computer, and we were supposed to complete the tests at either Norris or Keck. We chose Norris, but soon found out that there were no tests in the computer. A call to Selby's office revealed that they know of "occasional" glitches where the Norris and Keck computers don't exchange information.
So, we went to Keck. They had the tests in their computer, but no "account" had been set up. The admitting office set up an account, but accidentally made it a one-day account for Feb 25. The error was overlooked by radiology, and Barbara had her chest X-ray. Next, at the cardiology department, they didn't like the account. One of their techs ran down to admitting and obtained a new account, and brought back the new account stickers. He gave us the unused stickers for the blood-draw lab. Unfortunately, we didn't apply one of the new stickers to Barbara's wrist band, and they noticed that the new sticker on the order form didn't match the wristband! After much "hand wringing", they went ahead with the blood test. This completes the pre-op stuff, but Barbara paid dearly in added stress.
The afternoon went much better. We met with Dr. Chang, the pulmonologist. She reviewed the scans and compared them with past scans. Most of the lung imperfections appear reduced, and the rest look calcified, which means that they will be there forever. She said that there is no reason for Barbara to take the lung meds anymore, or to schedule any more appointments. Barbara should only see her again if symptoms appear, like sputum or pneumonia symptoms.
The next two weeks look quiet, with no appointments scheduled. Then it's time for surgery!
Surgery is scheduled later this week. We are making final preparations. The hospital bed has been borrowed from Convalescent Aid Society. They also supplied a bedside commode, and a transfer bench to help Barbara get into the shower. Barbara bought an over-the-bed table on line, and I assembled it yesterday. We each have our worries: Barbara is most worried about the IV line that they will no doubt place into her neck. I worry about caring for her after she comes home. We both worry about the risks of the surgery itself, and whether we will have the same problems getting her adequate pain care. Luckily, we have Norris Pain Management on our sides, and I won't hesitate to call Pamela and Dr. Ryan to insure proper care.
I will attempt to post timely updates here as Barbara comes out of surgery and recuperates in the ICU and the surgical unit of the hospital.
Meanwhile, life goes on. Michelle is coming over with Kanan and our great granddaughter, Eva. She is Lexi's daughter (Lexi is Sandi's daughter). We've only seen Eva once, at a restaurant, and we hope that she feels comfortable with us. I'm sure that she will find the trampoline a fun experience, walking on the spongy surface.
Barbara is out of surgery. She is expected to be in recovery for 2 hours, and then we can see her in the ICU.
Dr. Selby explained that the surgery was much harder than he expected. Barbara's liver had grown since the last surgery, and it expanded into the area where the new tumor lies. The expanding liver dragged blood vessels along with it, and these vessels were dangerously near the tumor. Selby called in a radiologist to help map the mislocated vessels, and then he used a microscope to avoid damaging the arteries or veins. He had to advance very slowly and carefully, and the procedure lasted 4 1/2 hours. He also found that her colon had been pushed out of place by the liver, and part of the colon was up near her diaphragm. This is probably why she has had pain shortly after eating. Selby moved the colon back where it belongs. Ultrasound confirmed that there are no additional tumors.
Pain management is already actively involved. They plan to install an epidural catheter for pain medicine, but they must wait until tomorrow morning since Barbara didn't stop her Xarelto blood thinner until Tuesday evening. If we had known, she could have stopped it a day earlier. So, for the rest of today, the pain meds will be limited to the IV drip, which will keep Barbara drowsy. The epidural lets Barbara remain alert.
Looking forward to seeing her in a couple of hours.
Barbara says, "Tell them that I'm dancing in the streets."
She is indeed doing much better. When I first saw her after surgery (at 3 pm) she was in a lot of pain and the pain meds were making her confused. It was difficult to give her enough pain meds without increasing the disorientation. They increased the meds, at which point she fell asleep. Boyd, Yvonne, and I left at 6 pm, figuring that she would be asleep for the night.
It was not meant to be. I was awakened at midnight by a phone call from the nurse saying that Barbara wanted me and wanted her glasses. So, I came back to the hospital. Barbara was in better shape, with the pain under control. She was still pretty confused. Good things started happening quickly. They removed her IV line in her neck and the arterial line in her right hand. Then they took out the gastric tube which ran into her nose and down to her stomach. Next went the oxygen cannula. She felt much better with all of these tubes gone. Now she has only an IV in her left arm, the Foley catheter for urination, and a JP drain sucking fluid from the incision site.
The whole pain issue was solved this morning when they installed an epidural catheter, which infuses the pain medicine directly into the spinal column. This gives pain relief without dulling the brain.
At 3 pm, they moved her out of the ICU into a regular room. Finally, she is away from the infernal beeping machines.
At 4 pm we were visited by Dr Sher, one of Selby's associates. She said that Barbara is improving very quickly. She was impressed that Barbara was already out of ICU. Barbara commented that she had walked 5 miles on Tuesday before the surgery, and Dr Sher said, "Well, that explains your rapid improvement."
A few minutes later, Dr Lee came by. He had assisted in the surgery. He too is very pleased with Barbara's progress. He will come again tomorrow morning.
Michelle and Sherri have been doing yeoman duty. Michelle has been here frequently, allowing me to grab a little sleep. And Sherri has been at the house preparing easy food like smoothies for Barbara to enjoy after coming home.
Barbara is making dramatic improvement. Although she had some pain in her right shoulder this morning, it subsided. She has not complained about the pain since then. The epidural is great - she is no longer confused, and seems her normal self.
She insisted on walking, and I took her down the hallway and back. By the end of the day, she was doing laps around the floor. At one point, she passed gas. That is a big deal, because it now allows her to switch from a clear liquid diet to soft foods. She's been eagerly awaiting this change, since her last meal was Wednesday breakfast. She had a chicken sandwich for lunch. She is looking forward to her morning coffee (with cream).
Meanwhile, Michelle came by this afternoon. I went home to rest. The rain was coming down hard - five inches in the last two days. After two hours, I got up to return to the hospital. I noticed that the furnace was not operating. Looking into the basement I found two inches of water. Just great! So, I spent the next two hours pumping out the water and drying the floor. Miraculously, when I turned the power back on, the furnace operated properly - what a blessing!
Returning to the hospital, the room was empty. Barbara was out alone doing laps around the floor. They told her that it is 16 laps to the mile. I wonder how many miles she will log before they kick her out of here.
Barbara suffered a setback. At 11:45 pm last night her heart went into atrial fibrillation. After an XRAY and EKG, they started a big dose of Amiodarone, a standard antiarrhythmic drug. She had taken the drug once before when she experienced atrial fibrillation after her VATS surgery in 2010. But this time she had an allergic reaction. After administering only 35 mg of the planned 150 mg, she went into the shakes, much like the allergic reaction to the contrast dye used during cat scans. They cut off the Amiodarone, and gave her Benadryl to tame the allergic reaction. With the afib, her heart rate was very fast, up to the 170's. Next they gave her Cardizem, to lower the heart rate. I know from my afib experiences that if the rhythm can't be restored, they focus on lowering the heart rate.
She was moved from the surgical floor to the "step down" unit, where the care is more than a regular floor but less than the ICU. After two hours she began to return to normal, and the shakes stopped. But the atrial fibrillation is still present. After the VATS procedure, she was in afib for about 36 hours, and that was with the Amiodarone. So, we'll see what happens. They won't let her walk until the heart rate becomes more stable - it's fluctuating between 70 and 120 now. She's understandably disappointed at this development.
Barbara made steady improvement yesterday (Sunday). She took a walk and was feeling better until, at shift change time, the new nurse asked her to sit up. She pressed with her arm against the bed, and pulled at her surgery. The pain came on very strong. She asked for a bolus of the pain med, but the nurse had trouble finding the doctor's orders in the computer. The delay made Barbara's pain ever more intense. Finally, the orders were found and the extra med was infused into the epidermal catheter. After 15 minutes, Barbara was better. A little more training on the computer would help.
Sunday night we had a good night's sleep - good for a hospital - perhaps three hours of solid sleep. Today, Barbara had her epidural catheter removed. It needed to be taken out before she could have the urinary catheter removed. Also, she cannot start the blood thinner for her fibrillation until the epidural is out. With the epidural out, the regular pain meds need to be increased rapidly. The nurses weren't fast enough, and Barbara went into pain again. This time it took an hour before she began to feel relief.
In the afternoon, Sherri stayed with Barbara. Christina Gardner came by for a visit; her husband was Barbara's chemo buddy for several years. Then we had a special visit by Dr. Sher, one of Selby's fellow surgeons. She is delightfully entertaining, and we thoroughly enjoyed chatting with her for almost an hour. We originally met her after Barbara's 2006 surgery, but we never knew that she was so fun.
After another long walk, Barbara happily climbed into bed. She is watching TV, and dozing off.
This morning at 5am Barbara had to urinate. I was asleep, and she had the nurse help her. She had sweat during the night and her gown was wet. The nurse took the gown off, and then spent 15 minutes fussing around trying to figure out how to put the new gown on. Meanwhile, standing in the nude and damp, Barbara was getting thoroughly chilled. Back in bed she couldn't come out of the chill. She asked for a warm blanket, but they have no warm blankets on this floor. Eventually, the charge nurse arrived - he went to another floor and obtained a warm blanket. Finally she started to warm up.
Later in the morning a tech arrived to take an echo cardiogram. A cardiologist is on board to make a decision about the atrial fibrillation. They want to rule out any more serious cardiac problems. The echo cardiogram took over an hour, and it included pressing the probe on the surgical area, causing lots of pain. Luckily, Barbara has a pain pump, and was able to give herself doses of the pain medicine. Again, it took a while for the pain to subside.
The doctors are talking about letting Barbara go home tomorrow. The issues are the fibrillation and the pain medicine. The fibrillation is now under control to keep the rate down, and hopefully the heart will return to normal rhythm by itself. For the pain medicine, she must be off of all IVs, and transitioned to oral meds which she can continue at home. This evening, they removed the pain pump and started the long acting pain medicine. I hope that we don't go through pain battles as she switches to the oral meds.
De Selby came by and chatted for most of an hour. He is delightful. He gave more details about the surgery, and then he and Barbara chatted about children, bike riding, and anything else that came up. Leave it to Barbara to find the personal side of the doctor.
Barbara is home! They released her this afternoon after giving her one last dose of pain med. Upon arriving, she had a Moussaka dinner prepared by Sherri. What a joy to have good food again. We have a hospital bed, and Barbara is resting comfortable. We see Dr. Heger, our cardiologist, tomorrow morning to talk about the atrial fibrillation, which is still happening. We're about to launch into slumber land - minus the beeps from machines, the noise in the halls, and the incessant interruptions "to get vital signs."
Yesterday we saw Dr. Heger, our cardiologist. He is not overly concerned about Barbara's atrial fibrillation. He increased the dose of Xarelto to make sure that she doesn't form blood clots in the heart - clots are the primary danger from afib since they can travel to the brain and cause a stroke. His primary thrust is to control the heart rate, and he chose to switch her from a beta blocker to a calcium channel blocker. In a few weeks, if she is still fibrillating, he will consider cardioversion, the well known electrical shock to the chest. If it fails, then we will just accept the fibrillation, and keep her on the blood thinner. People lead normal lives with continuous fibrillation.
Michelle came over, letting me get a nice rest. She brought lots of food from Sharky's, and we are enjoying it - Barbara had some tortilla soup for a late morning snack. Michelle helped bathe Barbara. It was a delight after a week with only two bed baths in the hospital.
Barbara talked at length with Pamela in Pain Management. We now have a clear plan on the pain meds. Everything was confused in the discharge instructions from the hospital.
Our neighbor, Cara, has been extremely nice. Her child, Spencer (about 5), created a card with a rainbow drawing and his name in block letters. Cara is constantly passing gift packages over the fence. There is a wonderful bond between Cara and Barbara.
Barbara is curled up with her stuffed dog, a gift from Christina Gardner. The dog was a favorite of Christina's husband Bob; he had outfitted it with a specially made sweater saying "Cancer Sucks".
Barbara is doing well. She is able to get around the ground floor of our home - we're holding off on trying to get upstairs.
Michelle has been wonderful. She came by yesterday with food for both of us. Then today she did some grocery shopping and again brought us specialty sandwiches. She helped Barbara bathe yesterday, and they went on a walk today up to the corner.
Barbara's heart has been racing. We called the cardiologist, and he changed the cardiac meds, switching her back to the Lopressor instead of the Cardizem, which didn't seem to be doing the job.
We're getting back to normal. We played Sudoku both days, and she beat me both times - "and I wouldn't have it any other way!"
Barbara's heart rate is still too high some of the time. The Lopressor controls it for about 12 hours, and then the rate goes high. We called the cardiologist, and as we expected, he said to take the med twice a day. Hopefully, that will keep it under control. I find it surprising that she hasn't returned to regular sinus rhythm. It's different from my afib, which stops after several hours.
We took a walk to the corner - much farther than her last walk. She was in great spirits, noticing the colors in the trees contrasting with the sky. We have a nice walker with a seat, and she can stop and rest whenever she gets tired. The cardiologist thinks that her tiredness is either from the meds or from the rapid heart rate.
Michelle and Brent brought dinner last night, and we all ate together. Kanan and his friend Matthew were also here. It was a nice, relaxing family time together. Michelle has really come through in this time of need.
Barbara just walked around the block. Yesterday, she was able to climb upstairs to use her computer. So she is getting stronger.
The atrial fibrillation stopped Monday evening. She is now tapering off the cardiac drugs.
Sherri came by yesterday, and brought us dinner from one of our favorite Mexican restaurants, La Cabaņita. Barbara is in good spirits.
We saw Dr Sher today. She is another liver surgeon on Dr Selby's team. She was concerned about the pain in the incision area, and tentatively diagnosed it as rib pain from the retractors used during the surgery. But, to be safe, she sent Barbara for an ultrasound and determined that there was no problem like fluid buildup. It was a long day, waiting an hour for blood draw, 30 minutes for Dr. Sher, and 2 hours for the ultrasound. But we're relieved that Dr Sher was thorough.
We saw Dr. Heger, our cardiologist. Barbara had converted to normal sinus rhythm last week, but he did an in-depth analysis of the condition. He reviewed the echo cardiogram which was taken at the hospital. He said that both atria (upper chambers of the heart) are enlarged; the right atrium can be explained by the many months that Barbara had a Groschong catheter. But the left atrium is probably caused by back pressure in the blood flow. This may also leave her predisposed to atrial fibrillation. Since she has only had two episodes of afib, and both episodes were directly after major surgery, he felt that it is best to "watch and wait", rather than take an aggressive tack with antiarrhythmic drugs. I read to him his statement from 2010. "Let's let the Celestial Design Committee do their job."
Barbara is rapidly getting back to normal. She had been on the treadmill several times. She still has pain in her right abdomen. It could be from the surgery, when they used a retractor to pull her ribs out of the way. Or it could be adhesions forming already. Barbara had done a lot of research on adhesions, and she found that they form right away after almost all surgeries.
Today, Barbara is baking a lemon pound cake (from scratch, naturally) to take to Dr. Selby and his team tomorrow.
We've had a flurry of doctor appointments: Dr. Selby (surgeon), Dr. Liebmen (hematologist), Pain Management, and Dr Lenz. Everything is progressing normally, and the doctors are surprised at how fast Barbara is recovering. Her surgery looks like it was a long time ago (a good sign). Dr. Lenz discussed the possibility of chemo - he thinks that we should wait until we get the first PET scan next month. He also mentioned radiation, but that is best when all of the sites of tumors are next each other. Barbara's tumors were on both sides of the abdomen. Radiation also causes adhesions, and Barbara has had plenty of trouble with adhesions in the past.
We attended the 40th running of the JPL Arroyo Seco Freako, a wacky running race put on by the JPL running club. Being the 40th anniversary, all of the "old timers" were invited. It was fun seeing some of our running buddies from long ago. Barbara walked the 5K with Ed Rinderle, who was the president of the running club years ago. He and his wife helped keep Barbara from getting lost, and aided her through a stream crossing. Wonderful people.
We watched Kanan participate in a track meet. He ran the 800 yard run, the one-mile, and the 4-man relay. I've posted photos and movies at http://www.boothhartley.org/2014_03_30_Kanan_track/ Beware: the movies are huge (12 MB to 27 MB).
Michelle's friends, Preetha and Sunil, brought Barbara a multi-course Indian dinner. Preetha is a gourmet cook, and she uses only the best ingredients, and she modified her recipes to make sure that the dishes weren't too spicy for Barbara. Barbara first heard of the couple a few years ago when their son died of cancer. Barbara sent them a Compassion book, especially written to help parents through the grief of losing a child. They wanted to do something caring for Barbara when they heard that she had yet another surgery. They are sensitive, caring people. Michelle has some very nice friends.
Last updated on Saturday, 4/05/2014 at 3:00 PM
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