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.
Sunday, February 14, 2016
Follow Up
They got Karen back on the PCA pump around 5 or 6pm, and with a higher dosage than before. She's been able to bring her pain back to around a 4 or 5, and seems at least somewhat comfortable. Her heart rate has been somewhat elevated since the surgery, but it's in the mid 120s now. Her temperature was 99.8°F when they tested it last. And lastly, she's has an NPO order for after midnight - which means no food or water.
I guess when they said a doctor would be coming around later they just meant sometime later in the day. A pair of them came in about 10pm. They say what Karen has is a hematoma - a collection of blood within the tissue. They says it's actually pretty common and not something we should worry too much about. They also said her blood counts have gone up slightly since she received the platelets, so that could mean whatever internal bleeding she had has stopped. It could also mean she isn't getting enough liquids and her blood is simply thicker. So they want to make sure she's getting enough fluids. They will reevaluate in the morning, and one thing they may decide at that time is to give her more blood product to help things clot. They also said the NPO after midnight is in case they decide they have to go in surgically to resolve the situation. We asked if they could just drain it with a needle and they said that's one thing they will be discussing with our surgeon, but they want to watch the situation till morning, and want her ready in case surgery turns out to be the best option. They may also do an ultrasound to look at the hematoma before making a decision, but that would also be in the morning. Often times the body will simply reabsorb the blood without intervention. We asked about the increased temperature and were told it's common with hematoma and not a concern yet. The heart rate is probably also related to the hematoma, but other things such as pain or dehydration can cause an increased heart rate.
They're giving her 500ml of Albumin, which is the primary protein found in the blood. If she is dehydrated this should also help pull some fluid back into her blood. Now we wait until morning.
I guess when they said a doctor would be coming around later they just meant sometime later in the day. A pair of them came in about 10pm. They say what Karen has is a hematoma - a collection of blood within the tissue. They says it's actually pretty common and not something we should worry too much about. They also said her blood counts have gone up slightly since she received the platelets, so that could mean whatever internal bleeding she had has stopped. It could also mean she isn't getting enough liquids and her blood is simply thicker. So they want to make sure she's getting enough fluids. They will reevaluate in the morning, and one thing they may decide at that time is to give her more blood product to help things clot. They also said the NPO after midnight is in case they decide they have to go in surgically to resolve the situation. We asked if they could just drain it with a needle and they said that's one thing they will be discussing with our surgeon, but they want to watch the situation till morning, and want her ready in case surgery turns out to be the best option. They may also do an ultrasound to look at the hematoma before making a decision, but that would also be in the morning. Often times the body will simply reabsorb the blood without intervention. We asked about the increased temperature and were told it's common with hematoma and not a concern yet. The heart rate is probably also related to the hematoma, but other things such as pain or dehydration can cause an increased heart rate.
They're giving her 500ml of Albumin, which is the primary protein found in the blood. If she is dehydrated this should also help pull some fluid back into her blood. Now we wait until morning.
Something's Wrong
Karen slept alright last night, but not as well as the night before. She woke up this morning with a small fever of 99.2°F. Looking over her labs I can see her blood counts have been dropping since yesterday. The doctors think there must be some internal bleeding and one called it hemorrhaging. They have put a stop to her heparin shots. It's a blood thinner that's given to you when they don't think you'll be moving around much so you don't get blood clots. They're painful, burning, "horrible" shots and her primary motivation in getting up and walking around has been being able to refuse them.
She's been walking around a decent amount since they took her off bed rest, but now I wonder if she came off it too soon. Her abdomen has continued to swell throughout the day and her pain level has continued to rise as well. This morning she thought she could do without the PCA pump, just taking oxycodone orally. This, however, turned out to be some bad timing. The unexpected swelling/hemorrhaging has increased her pain level at the same time she agreed to start backing off the pain meds. She can still get something through the IV once an hour, but her pain level jumps up to about 8 out of 10 between doses now.
They took her off food and fluids about an hour ago and gave her an infusion of platelets. They wouldn't do this unless they were also thinking surgery might be required. They said depending on how her blood work turns out after the infusion, she might be able allowed to eat and drink again. And... that was pretty fast, they've lifted the food and water restrictions. That seems almost too fast for them to know anything. The nurse tells us someone should be coming around to talk to us. I'll update again when we know more.
She's been walking around a decent amount since they took her off bed rest, but now I wonder if she came off it too soon. Her abdomen has continued to swell throughout the day and her pain level has continued to rise as well. This morning she thought she could do without the PCA pump, just taking oxycodone orally. This, however, turned out to be some bad timing. The unexpected swelling/hemorrhaging has increased her pain level at the same time she agreed to start backing off the pain meds. She can still get something through the IV once an hour, but her pain level jumps up to about 8 out of 10 between doses now.
They took her off food and fluids about an hour ago and gave her an infusion of platelets. They wouldn't do this unless they were also thinking surgery might be required. They said depending on how her blood work turns out after the infusion, she might be able allowed to eat and drink again. And... that was pretty fast, they've lifted the food and water restrictions. That seems almost too fast for them to know anything. The nurse tells us someone should be coming around to talk to us. I'll update again when we know more.
Saturday, February 13, 2016
Slowly But Surely
Yesterday's lunch stayed down fine, and her nausea is now under control. She started taking olanzapine when on chemotherapy to help control the nausea, and it seems to be working great in this situation as well. They've OKed a solid food diet for Karen today, but she had already eaten breakfast by this time. So far the solid food seems to be staying down and not causing any problems.
Everything else has been progressing nicely as well. She was able to get a decent amount of sleep at night again so I'm sure that helps. Her pain level is still at a 3 out of 10 but she's using a lot less hydromorphone. She has been taking some of her medications orally, which they like to do before they send you home. She still has the PCA pump because they expect the pain level to increase as she begins to move around. Her "bed rest" order has been removed and they are now encouraging her to walk around bit. Everything related to her digestion seems to be working again, but this also means they expect her to be using the bathroom "8 to 10 times a day." So she'll get some moving around from that.
Those first 24 hours of nausea and vomiting weren't conducive to healing and was part of the reason she was confined to bed for that time. We're still happy with the progression, but it looks like it might end up being closer to 5 days than the 2 or 3 the doctors had hoped would be possible. Everyone always says how healthy she looks, even when she's often not feeling well at the time. While at first we were surprised, it's happened so often that we now find it funny when we meet a doctor for the first time and they say, "you look so much better than you sound on paper." And it's not just doctors, it's the nurses, friends, and family. So it's easy to overestimate her recovery speed. We aren't disappointed with the recovery speed.
Everything else has been progressing nicely as well. She was able to get a decent amount of sleep at night again so I'm sure that helps. Her pain level is still at a 3 out of 10 but she's using a lot less hydromorphone. She has been taking some of her medications orally, which they like to do before they send you home. She still has the PCA pump because they expect the pain level to increase as she begins to move around. Her "bed rest" order has been removed and they are now encouraging her to walk around bit. Everything related to her digestion seems to be working again, but this also means they expect her to be using the bathroom "8 to 10 times a day." So she'll get some moving around from that.
Those first 24 hours of nausea and vomiting weren't conducive to healing and was part of the reason she was confined to bed for that time. We're still happy with the progression, but it looks like it might end up being closer to 5 days than the 2 or 3 the doctors had hoped would be possible. Everyone always says how healthy she looks, even when she's often not feeling well at the time. While at first we were surprised, it's happened so often that we now find it funny when we meet a doctor for the first time and they say, "you look so much better than you sound on paper." And it's not just doctors, it's the nurses, friends, and family. So it's easy to overestimate her recovery speed. We aren't disappointed with the recovery speed.
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