Rescheduled

Karen's surgery has been rescheduled to 3:30 "or" 4:00. Seems someone else out there always has it worse. The first unit of blood is done and they've started on the second. So far that looks good, no reactions. An ostomy nurse has been in to mark a location for a possible (but unlikely) colostomy. Her pain level is still somewhat reasonable and she's been sleeping a lot.

Sleep and Surgery

Karen got a good night's sleep for the first time since the surgery. Her pain level is down to a 3 out of 10, also near to the best it's been. They did an x-ray of her abdomen and noticed more air than last time. More air tends to mean the hole is getting bigger instead of smaller. Since the fluid was sterile the leak is probably higher up in the intestine, or may even be a perforation in the stomach. This could potentially be very bad; so the doctor who did the majority of the surgery last time, wants to do an exploratory surgery to look for the leak. Karen said while she is feeling better, something still feels wrong, and agreed to the procedure. This means she will need the blood transfusions after all, since she will lose more during the operation. The surgery is scheduled to start at noon, and she will be getting the transfusion as soon as possible.

No Blood Given

The doctor who performed the larger part of the surgery on the 9th came back in from a conference. He was the one everyone else was waiting on. He says since the fluid they removed is sterile, there's nothing urgent happening there. The bigger concern is the air. He said the pain seems to be in the same areas as the air. To have that much air a week after surgery, there is most likely a small leak in the intestines, but too small they can't see it on the CT scan. He says the only way to know for sure is to open her up to see, which is overkill at this point; the body will close small holes just fine on it's own.

He also canceled the blood transfusions. He said the risks and negative effects on the immune system outweigh the benefits, especially for cancer patients.

Lab Results

It doesn't appear the fluid is from a leak in the colon or intestine because it was steril. This means a surgery is unlikely after all, although more doctors are reviewing the results. We should know by tonight what they will do. Until then she's still NPO, so, no liquids.

They've decided to upgrade the blood transfusion to two units.

Back From Ultrasound

They took Karen to a steryl ultrasound room where they extracted roughly 60 cc's from one of two pockets of fluid they found. Lab results will take roughly 1 to 2 hours. It's looking more like a surgery will be necessary. During the ultrasound they also found she's retaining urine, so she's getting a catheter yet again. Third time's a charm?

Blood work they ordered this morning just came back. Her hemoglobin is low and they've decided to give her one unit of blood (450 ml).

Peritonitis

The CT results are in and it looks like she has fluid in her abdominem. They called it peritonitis, and is most likely the cause of the fevers. They will remove some of the fluid with a needle, guided by ultrasound. It will be analyzed to find the content and source. No ETA on when they will do this or when they'll get the results, but it should be fast. Best case scenario is it's just leftover water from the surgery, but that's pretty much unheard of after 7 days. It could also be an abscess or a leak in the colon or intestines. If it's the later, she will need surgery again.

Trouble

What started out as a good night for Karen took a turn for the worse. It seemed like she was finally able to sleep well, but it didn't last. First there was some stiffness and (more) soreness. That was followed by chills and sweats, and then a fever of 103 °F. She seems to have some kind of infection. They're worried it's related to the operation, but they took out the catheter just in case it's a bladder or urinary tract infection. She's able to void without it, so that's good. They took her off fluids again, but she does get to drink a bottle of disgusting contrast for a CT scan.