Another One of Those

Karen is back to her nights of broken sleep. The pain is, as you'd expect, worse than before the surgery. But she has a PCA again, so she can push a button to get morphine when the pain picks up. The downside is waking up after a short time in a lot of pain because you haven't been getting the morphine. Her heart rate is also more elevated than usual, but they say it's from the surgery.

Also, because she got the blood transfusions, she is even more immunodeficient than before, so even when she's out of intermediate care, they're asking for no visitors who are coughing or sneezing.

Out of Recovery

Karen's now out of recovery and in the intermediate care unit. She seems to be doing alright on pain. Her vitals are certainly better this time around. She also says she's able to breath better now; so maybe the air leaking into her abdomen was pushing up against her diaphragm before this?

Surgery Complete

The doctor says Karen's surgery went well. They found the source of the leak. It turned out to be her colon after all. It was in a section where they had removed a large tumor, and with the chemo from the HIPEC, it was unable to heal completely and had reopened. Her body was doing an amazing job keeping it in check, but the doctor said leaving it to see if it healed on it's own was added risk - and pain - Karen didn't need. They performed a colostomy an ileostomy, and she will need to have the stoma for 3 months. After which, they can reattach all the plumbing and things should work as they originally did.

Once More Into Surgery

She finished her second unit of blood less than an hour before wheeling her out of pre-op and into surgery. The operation is an exploratory laparotomy, and due to the nature of the surgery - exploration - they've not given us a time estimate.

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.