I just talked to the surgeon. He said it was worse than he expected. He says Karen's mesh had torn free of the muscle and they had to redo the whole thing. He said add to that the fact that she has so few platelets to cause clotting, and it was a difficult surgery for her. She'll probably be groggy for the rest of the evening as she recovers from the surgery. They put a much larger mesh in this time, so there will be more give. So if she heaves or vomits now it will stand a much better chance of staying in place. The downside to a larger mesh is one side of her abdomen will have a bit of a bulge. The doctor says it's something she'll just have to get use to, and that it's still an improvement over an ostomy.
I remember Karen saying she felt something pop that first day after surgery when she was heaving. There wasn't any pain involved so the nurse wrote it off as the constricting band slipping or popping open, as it's held together with velcro. In hindsight I guess we should have insisted we talk to a doctor about it. There still would have been another surgery, but there wouldn't have been so much pain in between. As far as the surgery goes there's really nothing the surgeon could have done differently, they don't usually use a larger mesh for cosmetic reasons. If they had given her more platelets from the start and she had clotted right away, the mesh would have just healed out of place and she still would have required another surgery to fix it.
Monday, February 15, 2016
Into Surgery
They've just taken her into surgery but it took a long time to clean her up for surgery and as soon as she was ready they were ready for her in the operating room, so I didn't get a chance to go back to preop and talk to the nurses and doctors like I usually do. I don't know how long the operation is expected to take. I'll post again when she's done.
Pre-Op
They've taken her back to pre-op. So it's happening soon. They've only had time to give her 2 units of red blood cells and 1 unit of platelets, but they're comfortable with that. It's typically an hour until they take you from pre-op into surgery. I'll post again once they take her back for surgery.
Going Back In
Karen managed to get a good 5 hours of unbroken sleep last night, which is fairly good for a hospital stay, but as her condition becomes more "interesting" we have more and more people that want to talk to her. So she was barely able to sleep after that and is very tired. Her pain level is still slowly climbing, she's a 5 or 6 out of 10, even with the PCA pump. She's also more nauseous than before, which she thinks might be due to her pain level. No one's offered any other suggestions as to why that might be. Her blood counts are still dropping and her hematoma is still enlarging. This indicates she still has some internal bleeding.
The surgeon says even if the bleeding were to stop now, there's so much blood trapped in the tissue that it would become very hard and take a long time to recover. Having such a large hematoma also presents a chance of infection. He wants to reopen the surgical site, flush all the blood out, and see if they can pinpoint the leak and fix it. If nothing else they would have washed out everything that's built up so far, greatly reducing recovery time. She's being given 2 units of red blood cells to replace what she's lost. After that they will give 2 units of platelets, not only to try and stop the bleeding, but in preparation for surgery. She's still NPO - no food or water. It takes some time to receive all those transfusions and then we're expected to go into surgery sometime early afternoon. Although I wouldn't be surprised if it didn't happen until later in the day.
The palliative team was also here and they are going to up her PCA pump dosage more. There are a couple antiemetics we like that help with the naesua and don't have many side effects, but Karen's been needing something more and they have been giving her Compazine. It knocks her out for hours at a time and she has trouble answering questions or holding a conversation after it's been given, an effect neither Karen nor the doctors like. The palliative team wants to try something called Haldol. The hope is that it won't be as sedating as the compazine.
The surgeon says even if the bleeding were to stop now, there's so much blood trapped in the tissue that it would become very hard and take a long time to recover. Having such a large hematoma also presents a chance of infection. He wants to reopen the surgical site, flush all the blood out, and see if they can pinpoint the leak and fix it. If nothing else they would have washed out everything that's built up so far, greatly reducing recovery time. She's being given 2 units of red blood cells to replace what she's lost. After that they will give 2 units of platelets, not only to try and stop the bleeding, but in preparation for surgery. She's still NPO - no food or water. It takes some time to receive all those transfusions and then we're expected to go into surgery sometime early afternoon. Although I wouldn't be surprised if it didn't happen until later in the day.
The palliative team was also here and they are going to up her PCA pump dosage more. There are a couple antiemetics we like that help with the naesua and don't have many side effects, but Karen's been needing something more and they have been giving her Compazine. It knocks her out for hours at a time and she has trouble answering questions or holding a conversation after it's been given, an effect neither Karen nor the doctors like. The palliative team wants to try something called Haldol. The hope is that it won't be as sedating as the compazine.
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