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Wednesday 04 Nov 1998
10:00am - Paige was extubated about an hour or so ago, which is a fancy way of saying "the damn tube is out." She'd had the respirator tube in overnight and hated every minute of it.
She's smiling a bunch now, and looks a lot better. Dr. Perez came by and changed her dressing (abdominal). There is still small bowel output in there, but she looks good overall. The drainage is a bit less dark, and reduced in volume.
The actual respirator tube removal was very smooth. It came right out and she didn't even seem to notice. She coughed a bunch right afterwards, which she did after her first 2 surgeries that required intubation. Her cough right now is one of those small little coughs, like a young child might do. She's been through a lot. Despite how well the surgery went, it was still a procedure that used a general anesthesia, so she is doing all the same recoveries as before.
They did her left lung cavity yesterday and will do the right on Friday.
Sunday 07 Nov 1998
Paige is doing very well right now. She looks like her old self again and it fidgety as hell and wants outta this CCU NOW!!! or so she keeps telling me :-)
her 2 surgeries last week went exceptionally well. They are technically surgeries but only used scopes, so the incisions were only a centimeter or two for each. They did 'thoraciscopies', which involve draining the lung cavities of fluid (they drain the cavity surrounding the lung. there was no fluid in the lung itself). On tuesday (11/03) they did the left lung cavity and on friday (11/06) the right. her physiology turned around after those. and sure, why not - they only drained a combined total of 6 liters from her lung cavities!! yikes. she ain't that big to start with, nevermind a gallon and a half of infectious fluid in her. even at her worst, she got up and did laps around the nurse's station, with her little walker in hand and all that fluid in her lung cavities. she won't quit. then on saturday (11/07) they drained the 2 largest collections of fluid in her abdominal cavity via needles (non -surgical, used local anesth. only). under a CT scan. so now that she's rid of all that stuff, she's rapidly improving once again.
we hope that there are no more surgeries and maybe she can move down the hall to a normal room soon, maybe within a week. (ihopeihopeihope). she is still fighting a bit of an infection (white cell count still up) so we're not quite there yet. however, some good milestones have been passed in the past couple days:
(i) all medicine to control her heart rate have been removed, so she's on her own and doing great. (for you med. info. junkies she's off the brevibloc). to let you know how dramatic her improvement has been, at her worst 10 days ago, her heart rate was 130-140, and that was with the medicine to keep it low. after the massive fluid draining 'scopies, etc. she is now in the 70-90 range, unmedicated. that's huge progress. yay!
(ii) she's hungry and thirsty again. this is good progress too, since it means her metabolic processes are re-establishing themselves with her brain and other stuff. when she was really infected, those went masked or unnoticed. now that the vast majority of the fluid & infection are gone, her natural body processes are coming back. yay!
(iii) all chest tubes from the thoracic operations have been removed. these were big tubes that went in after the drainage to make sure nothing came back. the last of those came out last night (ouch!) and paige is road mobile again. she did some more laps around the nurses's station again today, this time with ease. we also took her on a bootleg mission to the side hospital door and let her dog Sunshine in so she could see her! yay again!
(iv) the cardio doctor said from his perspective she can leave the CCU. there are another half dozen doc's that must also be ready (well, ok, there are about 3 more). I'm not sure what all the criteria are so I'm not too sure when she can move, but we're ready for it. anyway, one down! hooray!
What's Next:
once all traces of the infection are gone, gone and doublegone then we can begin the chemo. paige is anxious to get that started since she is aware that if we wait too long stuff can begin to grow back (recall the initial surgery took out all cancer down to under 1cm in diameter, but some little 'dots' remain, and we need chemo to fix those). if everything goes really well, we hope to see paige at home for thanksgiving, maybe even eating regular food then too. we're still not sure if we will keep Sunshine around or send her back to Ellen for the duration of the chemo. We're grilling the doc's about that now.
the other thing Paige has to beat is called a 'fistula'. her bowel has another small leak in it, and it has been persisting for about 10 days now. her body was unable to heal while all the organs that are instrumental for healing were working overtime to fight the infection. now that all that fluid was removed, her organs, such as her liver, can get back to the task of rebuilding and healing. The specific example Dr. Katske (the thoracic surgeon) gave was of her liver. Her liver was busy full time trying to detoxify all that fluid so it had no bandwidth to make protein to rebuild. now that the fluids (toxins) are out, her liver can go back to making protein that can be used to heal things (like fistulas, incisions, etc). Today her progress is very good, with signs of fistula healing beginning to show.
[News Flash]
Just spoke to Dr. Spirtos about Paige's condition. He was very optimistic. He said everything is going our way right now, in particular he thinks the fistula will heal itself without additional surgery. He is very adamantly holding his position that she needs no further surgery. We like him a lot for that. (some of the other physicians think that more abdominal surgery would be required for all the abdominal infections/abcesses to clear up). However, that kind of surgery would reset the clock back 2 weeks and further delay chemo. He's on our side with this one, finding every way to fix her non-surgically. We really like him for that. (his bio, and the cancer center he started are on www.wccenter.com). Also, (drumrole please), as Dr. Spirtos told us after her 2nd surgery (10/23) that infections that blanket cancerous regions sometimes infect the cancerous cells right along with the non-cancerous, and the body's white blood cells wipe out the lot, cancer included. We asked if any evidence of this type of clearing occured. He said that when he was in Paige's abdomen for the emergency surgery on 10/23, that many of the residual cancer (the 'dots') had disappeared!!!!!! now that does not mean that her residual cancer was eradicated, but it was reduced!!! double hooray!
He also said it's ok for Sunshine to stay. he said the best thing she can do for her spirits is to keep her dog around. He wasn't as kind to my cat, but I can keep him :-)