Karen got a good solid 4 hour block of sleep last night, which is hard to do in a hospital. But she woke up pretty confused. She eventually went back to sleep for a couple more hours and woke up a little confused again. But the third time's a charm, and woke up pretty alert come this morning.
I don't think I've described it here before, but her stomach had really gotten swollen. One of the friendlier doctors had joked that she looked pregnant, and honestly, that's what it looked like. That said, the swelling in her stomach has finally started to go down. She's still not allowed food or drink, but her rectal tube has come out and her vitals have improved. Her heart rate is back in the low 100s and her blood pressure is a healthy 117/91.
It's been a little frustrating lately. It seemed like everything that could go wrong, did. We finally feel like we're heading in the right direction again.
Thursday, February 18, 2016
Wednesday, February 17, 2016
Long Day
It was a long day. They had to adjust Karen's NG tube twice, and her nose was already sensitive and in a lot of pain because the nurse who put it in first was way too rough about it. Her heart rate has been climbing the whole day. It's been in the 120s all night, but has jumped into the 130s on occasion. Her blood pressure has been rising throughout the day as well. It's currently at 140/91, when her normal is in the low 100s. Her blood counts are pretty steady for yet another day, so I think we're past the previous problem. They did finally move us out of the ICU and into a regular room this afternoon.
They've been doing a good of job of keeping her pain level lower, but I think the amount she's taking is knocking her out. She slept, on and off, for most of the day. She probably needed some sleep, but I'm not sure how helpful it is in small quantities. Everyone wants to see you during the day when you're as interesting as Karen is. And because she's been so tired and moving so little, she's getting some atelectasis; essentially, her lungs are closing up. It's not as bad as it sounds, but it's one more thing.
We were under the impression that this was a mechanical blockage like before, but when the surgeon came around tonight he said there is an obstruction, but it's due to an ileus. This is when your intestines go to sleep, and is usually caused by surgery but can be triggered by drugs. But the whole diagnosis is strange to because she's having bowl movements, one this morning and one this evening. And that's usually a sign you're not obstructed. They believe there's a build up of gas causing the obstruction, and placed a rectal tube several hours ago to try and resolve the problem. They think the NG tube may be too small, but it doesn't seem they are going to do anything about it tonight. Still no food or drink for her though.
They've been doing a good of job of keeping her pain level lower, but I think the amount she's taking is knocking her out. She slept, on and off, for most of the day. She probably needed some sleep, but I'm not sure how helpful it is in small quantities. Everyone wants to see you during the day when you're as interesting as Karen is. And because she's been so tired and moving so little, she's getting some atelectasis; essentially, her lungs are closing up. It's not as bad as it sounds, but it's one more thing.
We were under the impression that this was a mechanical blockage like before, but when the surgeon came around tonight he said there is an obstruction, but it's due to an ileus. This is when your intestines go to sleep, and is usually caused by surgery but can be triggered by drugs. But the whole diagnosis is strange to because she's having bowl movements, one this morning and one this evening. And that's usually a sign you're not obstructed. They believe there's a build up of gas causing the obstruction, and placed a rectal tube several hours ago to try and resolve the problem. They think the NG tube may be too small, but it doesn't seem they are going to do anything about it tonight. Still no food or drink for her though.
Long Night
Karen got a sharp pain in her abdomen in the middle of the night. Her pain level quickly jumped to a 9 out of 10, and it took most of the night and into the morning to get her pain level back down. Needless to say, she didn't sleep very much. Her heart rate also jumped back into the 100s; so that's got to be pain related. They brought in a portable X-Ray machine and took an image of her abdomen. They tell us we're dealing with an obstruction of the intestines.
They inserted an NG tube to drain the contents of her stomach. She really hates those, and this one was particularly painful as it went in. It hasn't actually suctioned anything out yet, so maybe that means things are still moving forward at this point? It's also worth noting that she hasn't been nauseous through any of this, which is almost always the case with a blockage. It may have been caught early due to her abdomen already being sensitive from all it's been through lately. However, this does mean she's been taken off solid food again, and with the NG tube in, she won't be able to drink anything either.
Two steps forward, one step back. But at least we're moving forward.
They inserted an NG tube to drain the contents of her stomach. She really hates those, and this one was particularly painful as it went in. It hasn't actually suctioned anything out yet, so maybe that means things are still moving forward at this point? It's also worth noting that she hasn't been nauseous through any of this, which is almost always the case with a blockage. It may have been caught early due to her abdomen already being sensitive from all it's been through lately. However, this does mean she's been taken off solid food again, and with the NG tube in, she won't be able to drink anything either.
Two steps forward, one step back. But at least we're moving forward.
Tuesday, February 16, 2016
Slight Improvement
Karen's heart rate has come down since yesterday, before the surgery. It's in the mid 90s now. Her temperature is normal again as well. The surgical team had put in a JP drain to help her abdomin drain after the surgery. A lot of blood has been coming out, but it seems a lot of air is filling the JP drain as well.
The diuretics they've been giving her seem to be working very well - she has had a lot of urine output. It seems the swelling in her body is going down, but maybe not in her abdomen. It's hard to say but swelling may still be increasing there. They did end up changing her pain medication to be more consistent. Half the dosage is administered automatically and the other half when she activates the PCA pump. This seems to be enough to let her sleep without needing to wake up to activate the PCA pump. They're also giving her the antinausea medication as she is able to take it instead of as needed, which seems to be staying ahead of any nausea. She's back on regular food again and eating quite well. Her stomach muscles maybe still be a mess, but her intestines must be working as she has defecated several times today.
She was very happy with the adjustments to the pain medication, but it seems her pain level is still slowly climbing. I can't help but wonder if it's related to the swelling in her abdomen. I'm not sure what will come of it, but she's had a good day so far, all things considered.
The diuretics they've been giving her seem to be working very well - she has had a lot of urine output. It seems the swelling in her body is going down, but maybe not in her abdomen. It's hard to say but swelling may still be increasing there. They did end up changing her pain medication to be more consistent. Half the dosage is administered automatically and the other half when she activates the PCA pump. This seems to be enough to let her sleep without needing to wake up to activate the PCA pump. They're also giving her the antinausea medication as she is able to take it instead of as needed, which seems to be staying ahead of any nausea. She's back on regular food again and eating quite well. Her stomach muscles maybe still be a mess, but her intestines must be working as she has defecated several times today.
She was very happy with the adjustments to the pain medication, but it seems her pain level is still slowly climbing. I can't help but wonder if it's related to the swelling in her abdomen. I'm not sure what will come of it, but she's had a good day so far, all things considered.
Recovery
When they said it was a tough surgery for Karen they meant it. They wanted her in the ICU overnight to monitor her. Luckily the night was uneventful, and so far they haven't had to give her more blood. She's still quite groggy and falling in and out of consciousness when people are talking with her. She didn't sleep very well and says she's afraid to go asleep for too long because she doesn't want to wake up to a high level of pain because she wasn't activating the PCA pump.
The surgical team has put an order in to move her to a regular room, and they are allowing her to eat a regular diet again. They said they're concerned with how much swelling her she's having in her body as a whole, and are putting her on a diuretic to get some of that fluid out of her body. The palliative team has also been around and said they want to address the issue Karen's having with sleep and the use of the PCA pump. They said they might be able to get the hydromorphone on a drip, but if that isn't an option they'll come up with something else. We also saw a social worker today. Sometimes I feel social workers are more interested in being social, than in helping, but I didn't get that impression this time. I don't think there's anything she can help us with, but she kept steering the conversation towards our needs and didn't overstay her welcome as I've often felt social workers have done.
The surgical team has put an order in to move her to a regular room, and they are allowing her to eat a regular diet again. They said they're concerned with how much swelling her she's having in her body as a whole, and are putting her on a diuretic to get some of that fluid out of her body. The palliative team has also been around and said they want to address the issue Karen's having with sleep and the use of the PCA pump. They said they might be able to get the hydromorphone on a drip, but if that isn't an option they'll come up with something else. We also saw a social worker today. Sometimes I feel social workers are more interested in being social, than in helping, but I didn't get that impression this time. I don't think there's anything she can help us with, but she kept steering the conversation towards our needs and didn't overstay her welcome as I've often felt social workers have done.
Monday, February 15, 2016
Surgery Complete
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.
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.
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.
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