Ma was transferred to a regular room yesterday. The nurses had set aside a private room for her. All her previous rooms had been private (or semi-private but no roommate), but her new room is the biggest room in the unit. The bathroom is large enough for wheelchair users. It's nice to have connections. Did I mention I'm glad Dorothy's back? :)
Ma's pain is under control. Around breakfast time she had bad pain despite both the Toradol and Dilaudid, but Darvocet brought it under control. The rest of the day, Toradol kept her comfortable enough that she hardly used the Dilaudid (on PCA). I don't know why her doctor didn't do this kind of pain control for her after her first surgery. It would have kept her more comfortable.
Some friends visited with Ma early in the afternoon. Then Ate Vicky & Ate Beth arrived with Tita Belen and Tito Pepe. They brought dim sum. Yum! I mean, Ma said they were delicious. I wouldn't know.
Monday, June 30, 2008
Sunday, June 29, 2008
Cirrhosis
Ma was in surgery from 7:50-9:30 Saturday morning. That's twice as long as her first surgery. The surgeon, Dr. Stanten, said that Ma's CT scan showed she has liver cirrhosis, and that's probably what's causing the fluid build-up. The fluid is pushing through her diaphram and into the lung area.
For now, Ma is in the CPU (Cardio-Pulmonary Unit), similar to the ICU. She has two tubes coming out of her chest again. This time she has a PCA (Patient-Controlled Analgesia), a device that lets Ma self-administer her own pain medication with a push of a button. She is getting Dilaudid through the PCA. She was given Zofran for nausea just once, so I told her to tell the nurse immediately if she starts feeling nausea after the Zofran wears off. In addition, she gets shots of another painkiller called Toradol every few hours. Between the PCA and Toradol, maybe she'll have better pain control this time.
Ate Eva & Raymond stopped by with some food -- lugaw, okoy and pancit palabok. Ma is on a liquid diet though and was really disappointed she couldn't eat the food.
Kit flew home yesterday. Since we knew Ma would spend most of the time sleeping right after surgery, Pa & I took went ahead and took Kit to the airport ourselves and kept her company till it was time to go through security. The food at the International Terminal is actually pretty good. We had lunch over there -- noodle soup with BBQ duck, unagi bowl, and sushi (soft-shell crab, unagi rolls and salmon skin rolls).
I failed to mention before that Ma's previous CT scans and PET scans showed cirrhosis. No one ever suggested doing anything about it, maybe because her breast cancer is more important. Ma has tested negative for hepatitis, so I don't know how she ended up with cirrhosis. Hmm, is Ma a closet drinker??? The only symptom she seems to have is edema. Maybe she can see a liver specialist on Monday.
Here's where I get confused. Ma's breast cancer did not cause the cirrhosis. The cirrhosis caused the pleural effusion. Her pleural effusion is probably not malignant then, just as her tests always indicate. Does this mean all these problems she's been having have nothing to do with breast cancer?
For now, Ma is in the CPU (Cardio-Pulmonary Unit), similar to the ICU. She has two tubes coming out of her chest again. This time she has a PCA (Patient-Controlled Analgesia), a device that lets Ma self-administer her own pain medication with a push of a button. She is getting Dilaudid through the PCA. She was given Zofran for nausea just once, so I told her to tell the nurse immediately if she starts feeling nausea after the Zofran wears off. In addition, she gets shots of another painkiller called Toradol every few hours. Between the PCA and Toradol, maybe she'll have better pain control this time.
Ate Eva & Raymond stopped by with some food -- lugaw, okoy and pancit palabok. Ma is on a liquid diet though and was really disappointed she couldn't eat the food.
Kit flew home yesterday. Since we knew Ma would spend most of the time sleeping right after surgery, Pa & I took went ahead and took Kit to the airport ourselves and kept her company till it was time to go through security. The food at the International Terminal is actually pretty good. We had lunch over there -- noodle soup with BBQ duck, unagi bowl, and sushi (soft-shell crab, unagi rolls and salmon skin rolls).
I failed to mention before that Ma's previous CT scans and PET scans showed cirrhosis. No one ever suggested doing anything about it, maybe because her breast cancer is more important. Ma has tested negative for hepatitis, so I don't know how she ended up with cirrhosis. Hmm, is Ma a closet drinker??? The only symptom she seems to have is edema. Maybe she can see a liver specialist on Monday.
Here's where I get confused. Ma's breast cancer did not cause the cirrhosis. The cirrhosis caused the pleural effusion. Her pleural effusion is probably not malignant then, just as her tests always indicate. Does this mean all these problems she's been having have nothing to do with breast cancer?
Saturday, June 28, 2008
Photos 6/27/08
Ma & Kit. You can see the Pleur-evac (the canister connected to Ma's chest tube) in the left foreground.
Ma & Pa
(Clockwise) Isa, Kit, Ma & Lou
Friday, June 27, 2008
Repeat Surgery Tomorrow
Ma is scheduled for surgery at 7:30am tomorrow. She had a CT scan of her chest this afternoon. The ultrasound yesterday didn't show anything abnormal. The surgeon was concerned that Ma might have ascites due to the amount of fluid she's producing, but the ultrasound was negative.
The fluid has been draining into a canister that holds 2.5L. It took 4.5 days to fill the first canister, 29 hours to fill the second canister, and 27 hours to fill the third. She's on her fourth canister. The surgeon said he's never seen anyone with so much fluid. I hope tomorrow's surgery works because I don't think the surgeon knows what else to do. There is something called a Pleurx Pleural Catheter that allows you to drain the fluids from home, but the amount of fluid Ma produces would overwhelm the system.
The fluid has been draining into a canister that holds 2.5L. It took 4.5 days to fill the first canister, 29 hours to fill the second canister, and 27 hours to fill the third. She's on her fourth canister. The surgeon said he's never seen anyone with so much fluid. I hope tomorrow's surgery works because I don't think the surgeon knows what else to do. There is something called a Pleurx Pleural Catheter that allows you to drain the fluids from home, but the amount of fluid Ma produces would overwhelm the system.
Thursday, June 26, 2008
Possibly More Surgery
One of the thoracic surgeons stopped by. He said if Ma's fluids don't clear up by tomorrow, she will need surgery again. It's going to be the same procedures as before -- VATS and pleurodesis. This afternoon she had an ultrasound done on her abdomen. I don't know what the doctor expects to find.
I don't like Ma's new day shift nurse. Maybe she was just too busy today, but she seems easily flustered. This morning, it took her almost two hours to give Ma her pain medication. Then she gave Ma the antibiotic IV for another patient. As Ma pointed out to her, she should have checked the name on the IV bag against Ma's ID bracelet. I know she was busy, but isn't that why they have these cross-checking procedures -- so that they don't make mistakes like this especially when they're busy? Fortunately, the other patient's medicine is the same as Ma's. Nevertheless, if they assign her to Ma again tomorrow, I will ask for another nurse.
There was a little excitement today. As I was walking down the hall, the fire alarms started ringing, and the intercom announced, "Code Red, Code Red!" Doors everywhere started closing automatically. I thought I was trapped in the hallway, but the doors were actually unlocked, and I managed to get back to Ma's room. Ten to fifteen minutes later, the All Clear was given. It turned out the alarm was triggered by someone smoking on the first floor.
I don't like Ma's new day shift nurse. Maybe she was just too busy today, but she seems easily flustered. This morning, it took her almost two hours to give Ma her pain medication. Then she gave Ma the antibiotic IV for another patient. As Ma pointed out to her, she should have checked the name on the IV bag against Ma's ID bracelet. I know she was busy, but isn't that why they have these cross-checking procedures -- so that they don't make mistakes like this especially when they're busy? Fortunately, the other patient's medicine is the same as Ma's. Nevertheless, if they assign her to Ma again tomorrow, I will ask for another nurse.
There was a little excitement today. As I was walking down the hall, the fire alarms started ringing, and the intercom announced, "Code Red, Code Red!" Doors everywhere started closing automatically. I thought I was trapped in the hallway, but the doors were actually unlocked, and I managed to get back to Ma's room. Ten to fifteen minutes later, the All Clear was given. It turned out the alarm was triggered by someone smoking on the first floor.
Wednesday, June 25, 2008
Breathing Exercises
I just found out that wi-fi is available at the hospital. Woohoo! The other hospital didn't have it, and neither did the other hospitals I've visited in the area, so I assumed Summit would be the same way. I'm happy to find out otherwise.
The physical therapist made Ma walk without a walker. She was able to do it with a little help. Hopefully she'll be able to walk unassisted by the time she goes home.
The amount of fluid draining from Ma's lung is worrisome. Her surgeon is on vacation. Maybe we can catch his backup tomorrow and ask him about it.
Her nurse ordered an incentive spirometer so that Ma can exercise her lungs. I thought they usually give you one right after surgery. I don't know why it took so long to get one. Ma is having trouble getting the hang of it. I run out of breath myself just watching her try to use it. She breathes too fast and seems unable to hold her breath. Kit told her to pinch her nostrils when inhaling, and that seems to help.
The physical therapist made Ma walk without a walker. She was able to do it with a little help. Hopefully she'll be able to walk unassisted by the time she goes home.
The amount of fluid draining from Ma's lung is worrisome. Her surgeon is on vacation. Maybe we can catch his backup tomorrow and ask him about it.
Her nurse ordered an incentive spirometer so that Ma can exercise her lungs. I thought they usually give you one right after surgery. I don't know why it took so long to get one. Ma is having trouble getting the hang of it. I run out of breath myself just watching her try to use it. She breathes too fast and seems unable to hold her breath. Kit told her to pinch her nostrils when inhaling, and that seems to help.
Tuesday, June 24, 2008
Still Draining
Ma's remaining chest tube is still draining her lung. Unfortunately, it shows no signs of letting up. There has been no further estimate on when Ma can go home. I'm afraid her doctor is going to say that the pleurodesis failed again, and she'll need more surgery.
Other than the fluid, Ma is doing well. They're making her walk around the cardio unit 4x a day. She's able to use the toilet instead of the commode, and she brushes her teeth at the sink. And her appetite is good. Kit sneaked in some fried quail and boiled peanuts for her today.
Other than the fluid, Ma is doing well. They're making her walk around the cardio unit 4x a day. She's able to use the toilet instead of the commode, and she brushes her teeth at the sink. And her appetite is good. Kit sneaked in some fried quail and boiled peanuts for her today.
Down To One Chest Tube
Ma is still in the hospital. One chest tube had stopped draining, but the other one is still draining fluid. The doctor stopped by and removed the first chest tube. She turned off suction on the other one to see if it will stop draining. If it does, it can be removed today. The nurse removed Ma's catheter in the afternoon. She's now down to just one tube coming out of her. That should make walking easier.
The surgeon gave Ma a shot of morphine before removing the tube. I was afraid morphine would give her nausea, but it didn't. Maybe because it was only 1 mg. She also had Darvocet in the morning, and that didn't make her sick either. With Fentanyl, that makes three drugs that don't make her throw up.
Dorothy & Kuya George are back. They stopped by along with Anjelica. I don't know what it was I wanted Dorothy to help us with. I can't really complain much about the standard of care. The only thing that bugs me is the different protocols that each nurse follows when using the Port-a-Cath. I have to ask them each time if they used Heparin when disconnecting her IV. But I'm glad Dorothy's back.
Anyway, Dorothy, Kuya George & Angelica brought a big pot of hydrangeas. Dorothy also brought parking passes and lunch passes. The cafeteria prices are actually reasonable, but parking is $18/day. We've been buying 3-day passes for $20. At Doctors, parking was free. Dorothy stayed with Ma while the rest of us had lunch. She said she'll be back to work on Wednesday.
It's amazing how many people Pa knows at the hospital. He knows Ma's surgeon, Dr. Khan, because he used to work at Doctors. He knows the dietitian because she works at both hospitals. Someone at the lab stopped by. She also works at both hospitals and had seen Ma at both ICUs. Her mother is a patient of Pa. Ma's swing shift nurse yesterday also knows both Ma & Pa. She's a neighbor in Hercules, and her in-laws are also patients of Pa.
The surgeon gave Ma a shot of morphine before removing the tube. I was afraid morphine would give her nausea, but it didn't. Maybe because it was only 1 mg. She also had Darvocet in the morning, and that didn't make her sick either. With Fentanyl, that makes three drugs that don't make her throw up.
Dorothy & Kuya George are back. They stopped by along with Anjelica. I don't know what it was I wanted Dorothy to help us with. I can't really complain much about the standard of care. The only thing that bugs me is the different protocols that each nurse follows when using the Port-a-Cath. I have to ask them each time if they used Heparin when disconnecting her IV. But I'm glad Dorothy's back.
Anyway, Dorothy, Kuya George & Angelica brought a big pot of hydrangeas. Dorothy also brought parking passes and lunch passes. The cafeteria prices are actually reasonable, but parking is $18/day. We've been buying 3-day passes for $20. At Doctors, parking was free. Dorothy stayed with Ma while the rest of us had lunch. She said she'll be back to work on Wednesday.
It's amazing how many people Pa knows at the hospital. He knows Ma's surgeon, Dr. Khan, because he used to work at Doctors. He knows the dietitian because she works at both hospitals. Someone at the lab stopped by. She also works at both hospitals and had seen Ma at both ICUs. Her mother is a patient of Pa. Ma's swing shift nurse yesterday also knows both Ma & Pa. She's a neighbor in Hercules, and her in-laws are also patients of Pa.
Monday, June 23, 2008
Tita Belen Visits
Ma was transferred out of the ICU around noon yesterday. She still has her chest tubes and catheter. They're supposed to be removed today. She walked twice yesterday, about 100 feet each time, and was out of breath at the end. But her doctor said she may be able to go home this afternoon.
Ate Vicky finally told Tita Belen about Ma, and they came for a visit along with Tito Pepe, Dennis & Ate Beth. Tita Belen had been crying but was okay during the visit. At least Ma is looking much better compared to last week. They brought pad thai, watermelon, a pot of cyclamen, and a get well balloon. After the visit, Ma ate some of the pad thai. It was good. I had to do a taste test to make sure there was nothing wrong with it. :) Ma's blood sugar was 347. I hope it gets under control once she's home and is more mobile.
Ate Vicky finally told Tita Belen about Ma, and they came for a visit along with Tito Pepe, Dennis & Ate Beth. Tita Belen had been crying but was okay during the visit. At least Ma is looking much better compared to last week. They brought pad thai, watermelon, a pot of cyclamen, and a get well balloon. After the visit, Ma ate some of the pad thai. It was good. I had to do a taste test to make sure there was nothing wrong with it. :) Ma's blood sugar was 347. I hope it gets under control once she's home and is more mobile.
Saturday, June 21, 2008
Clogged PORT-A-CATH
Ma's PORT-A-CATH got clogged last Wednesday while she was still at Doctors Medical Center. The nurses had been flushing her port with 3 ml saline after every use. It turns out that was not nearly enough. A nurse from the Cancer Center came over and injected TPA into the port to clear it. TPA is supposedly stronger than Heparin for dissolving blood clots. It took 2 hours to unclog the port. This is the procedure the oncology nurse recommends each time the port is used:
1. Flush with 20-30 ml saline.
2. Follow-up with 5 ml (100 units) Heparin
I wrote down the instructions for the nurses at Summit. They have a better protocol that they follow compared to Doctors Medical, but I nag them anyway, just in case. I also remind every new nurse not to use Ma's left arm and that she has a port. I don't know if they do it at Summit, but at Doctors they rotate the nurses. Ma would always end up with a new nurse who's not familiar with her requirements. Even though there's a sheet in the room saying not to use her left arm, the nurse doesn't always notice the sign. I've had to stop more than one person from using her left arm.
Update 07/20/08: I added clarification that 5ml Heparin = 100 units. Also, if the patient is on a saline drip, the Heparin can be skipped till the saline is discontinued. The saline drip should be at 30 ml/hr.
1. Flush with 20-30 ml saline.
2. Follow-up with 5 ml (100 units) Heparin
I wrote down the instructions for the nurses at Summit. They have a better protocol that they follow compared to Doctors Medical, but I nag them anyway, just in case. I also remind every new nurse not to use Ma's left arm and that she has a port. I don't know if they do it at Summit, but at Doctors they rotate the nurses. Ma would always end up with a new nurse who's not familiar with her requirements. Even though there's a sheet in the room saying not to use her left arm, the nurse doesn't always notice the sign. I've had to stop more than one person from using her left arm.
Update 07/20/08: I added clarification that 5ml Heparin = 100 units. Also, if the patient is on a saline drip, the Heparin can be skipped till the saline is discontinued. The saline drip should be at 30 ml/hr.
Pain
Well, I was right to worry. Ma woke up with really bad pain last night. She pressed the button to call the nurse but didn't press hard enough. It took an hour for the nurse to get to her. And when she got her painkiller, it took a while for it to take effect. Also, she needed the max dose of 50 mcg. We'll see if she fares better tonight. I asked about staying overnight at the ICU, but they don't allow it. Too bad Dorothy isn't around to pull strings.
Other than that, Ma seems to be doing well. Her appetite is good, and she went for a very short walk today complete with a walker, two chest tubes and the containers they drain into, a catheter, an oxygen tank, and a portable monitor for her vital signs. It took way longer to prepare her for her walk than to do the actual walk.
Other than that, Ma seems to be doing well. Her appetite is good, and she went for a very short walk today complete with a walker, two chest tubes and the containers they drain into, a catheter, an oxygen tank, and a portable monitor for her vital signs. It took way longer to prepare her for her walk than to do the actual walk.
Friday, June 20, 2008
No Ventilator
The surgeon, Dr. Khan, was running late. Ma wasn't wheeled into surgery till around 17:20. By 18:20, she was done. The surgeon said it took him only 5 minutes to do the procedure instead of the 30 minutes he estimated. I assume he did a VATS or he wouldn't have been done so quickly.
Ma was in the recovery room for a long time before being transferred to the ICU. We didn't see her till almost 21:00. She has two new chest tubes coming out of her; the old one was removed. The good news is she's not on a ventilator! She was alert and talking when we saw her. She also didn't have any nausea from the anesthesia.
Originally the surgeon prescribed morphine for the pain. But we pointed out that Ma gets nausea from morphine and asked if she can have Fentanyl instead. The nurse got approval for up to 50 mcg. But it will be given to her as needed. She's not on a continuous drip. I'm worried that they won't be able to control her pain as well if they have to wait for Ma to complain about pain before giving her more Fentanyl. But at least she can communicate since she's not on a ventilator. I told her to make sure to tell her nurse as soon as she feels any pain.
Pa didn't stay overnight today. We didn't bother asking if he could. And Ma didn't complain about Pa going home. Maybe she really is getting better.
Ma was in the recovery room for a long time before being transferred to the ICU. We didn't see her till almost 21:00. She has two new chest tubes coming out of her; the old one was removed. The good news is she's not on a ventilator! She was alert and talking when we saw her. She also didn't have any nausea from the anesthesia.
Originally the surgeon prescribed morphine for the pain. But we pointed out that Ma gets nausea from morphine and asked if she can have Fentanyl instead. The nurse got approval for up to 50 mcg. But it will be given to her as needed. She's not on a continuous drip. I'm worried that they won't be able to control her pain as well if they have to wait for Ma to complain about pain before giving her more Fentanyl. But at least she can communicate since she's not on a ventilator. I told her to make sure to tell her nurse as soon as she feels any pain.
Pa didn't stay overnight today. We didn't bother asking if he could. And Ma didn't complain about Pa going home. Maybe she really is getting better.
Thursday, June 19, 2008
Thoracotomy
Ma is having a video-assisted thoracoscopic surgery (VATS) and another pleurodesis done tomorrow. If there is too much scar tissue from her first chest tube, the surgeon will have to do a thoracotomy. He will also scrape her lung and pleural lining. The surgery is supposed to take only 30 minutes. Ma will end up with 2-4 chest tubes. She will have to be put back on a ventilator again. She will be in the ICU for 3-5 days. That's if everything goes well. Nothing has gone well for her so far. Pa approved the surgery. I think if Ma could remember how much she suffered the last time, she wouldn't agree to it. She thinks the surgery will make her better.
Transfer to Summit Medical Center
I just got home. Ma got transferred to Summit Medical Center. We will meet with a thoracic surgeon tomorrow. She is supposed to have surgery on Friday -- something called VATS. It's supposedly "minimally invasive," but it sounds too risky to me. I'll know more tomorrow and will ask about other options, but there doesn't seem to be many.
Summit is where Dorothy, Kuya George's wife, works as a nurse. Unfortunately, she's on vacation in Europe, so we can't call on her for help.
Summit is where Dorothy, Kuya George's wife, works as a nurse. Unfortunately, she's on vacation in Europe, so we can't call on her for help.
Tuesday, June 17, 2008
Chemo #1 Day 21 - Good Appetite
Ma got half a dose of Ativan last night. She slept well overnight and also slept quite a bit during the day, but nowhere as much as yesterday, thank goodness. She ate a lot today. For lunch, Kit brought Filipino food that Tito Lum cooked. In the evening we had Thai food -- fried quail, pad thai and fried rice. Ma also had boiled saba banana and corn on the cob. The physical therapist made her walk down to the nurses' station using a walker. She had to rest on a chair twice along the way but was able to walk back without stopping. She still has loose stools, possibly due to her antibiotics, and is taking Imodium for it.
The hallucinations seem to be gone. Ma seemed clearer yesterday, but I wasn't sure because she was asleep most of the day. But today her mind is totally clear, although she still sometimes speaks to me in Kapampangan.
Dr. Majid, the first pulmonologist who treated Ma, stopped by today. He ordered suction (aka negative pressure) added back to the canister that her pleural fluid drains into. This will suck all the remaining fluid out of her chest. If her x-ray looks good tomorrow, he will remove her chest drain. Then maybe she'll be able to go home soon after. This is the first time that going home has been mentioned. Unlike Dr. Raees, the other pulmonologist who treated Ma, he doesn't recommend another pleurodesis. If the pleural effusion comes back, he recommends that a tap (drain) be implanted in Ma's chest. I'll have to find out the proper name for it.
A couple of days ago, Ma's pleural fluid was tested again. For the third time, it came out negative for cancer. But as I mentioned before, Dr. Majid thinks either her pleural lining or her lung is malignant. All the signs point to one of them being malignant.
The hallucinations seem to be gone. Ma seemed clearer yesterday, but I wasn't sure because she was asleep most of the day. But today her mind is totally clear, although she still sometimes speaks to me in Kapampangan.
Dr. Majid, the first pulmonologist who treated Ma, stopped by today. He ordered suction (aka negative pressure) added back to the canister that her pleural fluid drains into. This will suck all the remaining fluid out of her chest. If her x-ray looks good tomorrow, he will remove her chest drain. Then maybe she'll be able to go home soon after. This is the first time that going home has been mentioned. Unlike Dr. Raees, the other pulmonologist who treated Ma, he doesn't recommend another pleurodesis. If the pleural effusion comes back, he recommends that a tap (drain) be implanted in Ma's chest. I'll have to find out the proper name for it.
A couple of days ago, Ma's pleural fluid was tested again. For the third time, it came out negative for cancer. But as I mentioned before, Dr. Majid thinks either her pleural lining or her lung is malignant. All the signs point to one of them being malignant.
Chemo #1 Day 20 - Zzzzzzzzzz
Not much happened today. Ma was given Ativan last night. It was too strong for her, and she spent most of the day sleeping. Her voice is hoarse. Must be due to all the talking she'd been doing the last few days.
Ma's hairdresser and friend Auring came to visit along with her husband. They brought a flowering plant and a big bag of sweet cherries. The lady across the hall from Ma & Pa's office sent a large and beautiful flower arrangement.
Ma's hairdresser and friend Auring came to visit along with her husband. They brought a flowering plant and a big bag of sweet cherries. The lady across the hall from Ma & Pa's office sent a large and beautiful flower arrangement.
Sunday, June 15, 2008
Chemo #1 Day 19 - Lots of Visitors
Pa left the hospital before I arrived. When I got to Ma's room about 20 minutes after he left, Ma was sitting up on the edge of her bed. She was able to sit up by herself. I'm glad she didn't try to actually stand up by herself or she would have fallen. Now we know for sure she shouldn't be left alone at all.
She said she was in pain, rating it a 5/10. But I told the nurse to try Tylenol first instead of something much stronger, and that did the trick.
Pa didn't get much sleep again. Ma had a panic attack last night. She was crying and kept saying she was going to die. Tonight she'll be given Ativan to calm her anxiety and maybe help her sleep. I don't think she's been sleeping well at all. When she tries to nap during the day, she's really restless. I don't think she's fully asleep at all.
Ma's been getting Colace (a stool softener) the last few days. They had to stop it though because it worked too well. Now she has to take Imodium. I wonder though if it's the Boost protein drink (similar to Ensure) that's been giving her problems. It contains milk, and Ma is lactose-intolerant.
Ma was able to sit up most of the afternoon. She seems to be a little stronger in that she can get up with minimal help. We haven't tried to make her walk yet though. There's no word on when she can go home because her chest tube is still draining fluid.
There were lots of visitors today. Ate Eva & Raymond arrived with tons of Filipino food -- buro, chicharon bituka, talong, ampalaya, puting keso, rice, ginatan and puto. Ma ate a lot of food. She was really happy. Buro is one of her favorites. Later Isa arrived with BBQ & arroz caldo for Ma. She was followed soon after by Pa (who got some much-needed sleep and brought corn requested by Ma), Tito Lum, Kuya Richard and daughter Marianne. After they left, Ma & Pa's friends Tito Bien & Tita Litz came for a visit.
It was a long day for Ma. I hope she sleeps well tonight.
She said she was in pain, rating it a 5/10. But I told the nurse to try Tylenol first instead of something much stronger, and that did the trick.
Pa didn't get much sleep again. Ma had a panic attack last night. She was crying and kept saying she was going to die. Tonight she'll be given Ativan to calm her anxiety and maybe help her sleep. I don't think she's been sleeping well at all. When she tries to nap during the day, she's really restless. I don't think she's fully asleep at all.
Ma's been getting Colace (a stool softener) the last few days. They had to stop it though because it worked too well. Now she has to take Imodium. I wonder though if it's the Boost protein drink (similar to Ensure) that's been giving her problems. It contains milk, and Ma is lactose-intolerant.
Ma was able to sit up most of the afternoon. She seems to be a little stronger in that she can get up with minimal help. We haven't tried to make her walk yet though. There's no word on when she can go home because her chest tube is still draining fluid.
There were lots of visitors today. Ate Eva & Raymond arrived with tons of Filipino food -- buro, chicharon bituka, talong, ampalaya, puting keso, rice, ginatan and puto. Ma ate a lot of food. She was really happy. Buro is one of her favorites. Later Isa arrived with BBQ & arroz caldo for Ma. She was followed soon after by Pa (who got some much-needed sleep and brought corn requested by Ma), Tito Lum, Kuya Richard and daughter Marianne. After they left, Ma & Pa's friends Tito Bien & Tita Litz came for a visit.
It was a long day for Ma. I hope she sleeps well tonight.
Chemo #1 Day 18 - Catheter Out
I arrived this morning to find Pa was still in the room with Ma. He usually leaves early for daily Mass, and Ma is alone when I arrive in the morning. But today he decided to skip Mass because Ma had been hallucinating all night. She kept Pa up till 5am. I sent him home to get some sleep. The hallucinations continued throughout the day. The worst one was when she suddenly yelled out. When I asked her what was wrong, she said she was falling. I told her no, she was safe in bed. Later she started crying because she heard some people say she was crazy for having all these hallucinations. I told her it was just a dream. Most of her hallucinations are pretty harmless though, and we just humor her.
There were no celebrity sightings today. I don't know if she still thinks her Tiger Woods hallucination was real.
Kit joined me most of the day at the hospital. I made her do most of the things I usually do. Might as well put her to work. She brought pancit for Ma, and Ma ate it instead of her hospital food. In the evening, our family friends Tita Josie & Tito Ben stopped by with egg drop soup. Ma had a bowl of it.
The port saga isn't over. Someone drew blood from Ma's arm instead of her port. Pa was in the room but wasn't paying attention.
The doctor stopped by and is concerned that Ma's chest hasn't stopped draining. Her pleural area keeps filling with new fluid daily. He ordered the catheter removed, and it was done tonight after I left. That leaves just one tube sticking out of her, the chest tube.
Ma sat up in a chair a couple of times today. With the catheter out, she'll be forced to get up and walk to the commode. But it's one less tube to deal with. There's only one tube left to deal with -- the chest tube. It drains into a container that looks like this. The fluid has also started clearing up and is no longer bloody. We'll have to talk to the doctor about alternatives to doing another pleurodesis. I don't want Ma to experience that kind of pain again. She does remember some things that happened before she went into the ICU, and the pleurodesis is one of them. She remembers how painful it was.
There were no celebrity sightings today. I don't know if she still thinks her Tiger Woods hallucination was real.
Kit joined me most of the day at the hospital. I made her do most of the things I usually do. Might as well put her to work. She brought pancit for Ma, and Ma ate it instead of her hospital food. In the evening, our family friends Tita Josie & Tito Ben stopped by with egg drop soup. Ma had a bowl of it.
The port saga isn't over. Someone drew blood from Ma's arm instead of her port. Pa was in the room but wasn't paying attention.
The doctor stopped by and is concerned that Ma's chest hasn't stopped draining. Her pleural area keeps filling with new fluid daily. He ordered the catheter removed, and it was done tonight after I left. That leaves just one tube sticking out of her, the chest tube.
Ma sat up in a chair a couple of times today. With the catheter out, she'll be forced to get up and walk to the commode. But it's one less tube to deal with. There's only one tube left to deal with -- the chest tube. It drains into a container that looks like this. The fluid has also started clearing up and is no longer bloody. We'll have to talk to the doctor about alternatives to doing another pleurodesis. I don't want Ma to experience that kind of pain again. She does remember some things that happened before she went into the ICU, and the pleurodesis is one of them. She remembers how painful it was.
Saturday, June 14, 2008
Chemo #1 Day 17 - Out of ICU
Ma was finally transferred out of ICU to a regular room late this afternoon. That's the good news. The bad news is that she'll have to undergo pleurodesis again. So the big chest tube in her side that was removed a few days ago will have to be reinserted. Both procedures were very painful before, during and after.
My friend and former high school classmate Joji stopped by at lunch time and brought lots of food from her restaurant in Vallejo -- nilagang baka, pancit, BBQ pork, monggo, a cantaloupe drink, and champorrado. Ma had an appetite and was able to eat quite a bit. We forgot to feed her monggo though, one of her favorites. Maybe tomorrow.
The physical therapist arrived and made Ma walk a few steps. She was able to do so with a lot of help. She then spent the rest of the afternoon sitting up in a chair. But her chest started hurting again, so her nurse gave her Dilaudid. The nurse refused to give her Zofran though until Ma either got nauseated or vomited. A couple of hours later, she did vomit. By that time she was out of the ICU and in a regular room. Her new nurse is more sympathetic, gave her Zofran, and will give her more, as needed. She also said she will make a note in Ma's chart that she should always get Zofran with Dilaudid. Ma's doctor also stopped by and said he will make a note in her chart. I don't understand why the ICU nurse refused to treat her for nausea before she showed any symptoms, especially when Ma just went through this experience yesterday and couldn't eat all day. Now she'll have to be miserable all over again and unable to eat. I just spoke to Pa tonight, and Ma vomited again after I left.
On a lighter note, Tiger Woods came to visit. It's true, it's true! Ma said so! She even woke up Pa at 2am to tell him, but he was too sleepy to get up and look. Tiger couldn't enter the room, but he waved to Ma from the window, and she waved back.
Oh, and Kit arrived tonight.
My friend and former high school classmate Joji stopped by at lunch time and brought lots of food from her restaurant in Vallejo -- nilagang baka, pancit, BBQ pork, monggo, a cantaloupe drink, and champorrado. Ma had an appetite and was able to eat quite a bit. We forgot to feed her monggo though, one of her favorites. Maybe tomorrow.
The physical therapist arrived and made Ma walk a few steps. She was able to do so with a lot of help. She then spent the rest of the afternoon sitting up in a chair. But her chest started hurting again, so her nurse gave her Dilaudid. The nurse refused to give her Zofran though until Ma either got nauseated or vomited. A couple of hours later, she did vomit. By that time she was out of the ICU and in a regular room. Her new nurse is more sympathetic, gave her Zofran, and will give her more, as needed. She also said she will make a note in Ma's chart that she should always get Zofran with Dilaudid. Ma's doctor also stopped by and said he will make a note in her chart. I don't understand why the ICU nurse refused to treat her for nausea before she showed any symptoms, especially when Ma just went through this experience yesterday and couldn't eat all day. Now she'll have to be miserable all over again and unable to eat. I just spoke to Pa tonight, and Ma vomited again after I left.
On a lighter note, Tiger Woods came to visit. It's true, it's true! Ma said so! She even woke up Pa at 2am to tell him, but he was too sleepy to get up and look. Tiger couldn't enter the room, but he waved to Ma from the window, and she waved back.
Oh, and Kit arrived tonight.
Thursday, June 12, 2008
Chemo #1 Day 16 - Hallucinations
Ma had pain in her lung last night and was given Dilaudid. Her lung hurt because it was draining more fluid, close to two liters as of this morning. But the Dilaudid made her nauseated, so she's being given Zofran every 4 hours. She still had nausea though and barely ate all day.
Fr. Rene drove up from LA last night and showed up this morning with Tito Lum. He anointed Ma and said some prayers. I'm sure that made Ma feel a lot better.
An occupational therapist stopped by and made Ma sit up in a chair. She sat for an hour. Yay!
The nurses love Isa when she stops by because she brings freshly-baked goods. Today it was oatmeal raisin cookies with walnuts. The other day it was coffee cake.
Ma had lots of hallucinations today, among them:
Fr. Rene drove up from LA last night and showed up this morning with Tito Lum. He anointed Ma and said some prayers. I'm sure that made Ma feel a lot better.
An occupational therapist stopped by and made Ma sit up in a chair. She sat for an hour. Yay!
The nurses love Isa when she stops by because she brings freshly-baked goods. Today it was oatmeal raisin cookies with walnuts. The other day it was coffee cake.
Ma had lots of hallucinations today, among them:
- There are lots of paper on the wall, and a bunch of them have fallen on the floor. She kept asking me to pick them up.
- She wanted me to give an invisible envelope to Fr. Rene. I pretended to take it from her hand and gave it to Fr. I didn't ask if there was invisible cash in the invisible envelope.
- Pa threw a large party outside her room (although she doesn't realize she's in the hospital), but there were too many guests, and we ran out of food.
- We're on a cruise ship or a bus or something, and Ma wants to know why some passengers are getting off at the current stop instead of wherever it is that we're headed.
- She stared fascinatedly at the ceiling. When I asked her what she was looking at, she said there were black spots on the ceiling.
Wednesday, June 11, 2008
Chemo #1 Day 15 - More Pleural Fluid
I failed to mention that Ma's chest tube did not completely drain all the pleural fluid. Her x-ray this morning showed that the fluid has increased since yesterday. This is not good because it means the painful pleurodesis treatment did not work. Ma has a second tube in her chest that creates negative pressure to inflate the lung. It's a thin tube that's inserted into the top of her lung area. It also drains some of the fluid. Ever since the chest tube was removed yesterday, the second tube has been draining fluid like mad, about 2 liters. The doctor decided to tap Ma's lung today to get rid of the rest of the fluid. But the ultrasound revealed that the talc used in the pleurodesis caused some, but not all, of the lung to adhere to the pleural lining, created compartments of fluid in the pleural space. Therefore, the doctor couldn't tap the fluid from a single location. He wants to let the second chest tube keep draining. Whatever doesn't get drained will hopefully get absorbed by the chest wall.
Ma has cold sores on her lips and thrush in her mouth. They don't seem to bothering her much, and she's getting treatment for them. But she isn't eating much. She said food doesn't have much flavor. Maybe it's time to start tempting her with forbidden foods.
I haven't questioned her too closely, but Ma doesn't remember yesterday's events at all. She doesn't remember the pain when her chest tube was removed. That's a relief. I'll have to ask her if she even remembers being on a ventilator.
Ma has cold sores on her lips and thrush in her mouth. They don't seem to bothering her much, and she's getting treatment for them. But she isn't eating much. She said food doesn't have much flavor. Maybe it's time to start tempting her with forbidden foods.
I haven't questioned her too closely, but Ma doesn't remember yesterday's events at all. She doesn't remember the pain when her chest tube was removed. That's a relief. I'll have to ask her if she even remembers being on a ventilator.
Tuesday, June 10, 2008
Chemo #1 Day 14 - Off the Ventilator!
Ma was successfully weaned off the ventilator today. Yey! There was a different respiratory therapist today, and she said Ma didn't have to be in agony during the weaning off process. Her nurse gave her enough Fentanyl to make the pain tolerable. That means Ma suffered needlessly yesterday.
The sedation was turned off because Ma has to stay alert. When the doctor came over, her pain med was also turned off. First, the doctor removed her chest tube, the thing that was bothering her the most. I heard Ma cry out in pain when it was pulled out. But the pain didn't last long (at least I hope not). Then the respiratory therapist and nurse took out her breathing tube. She looked so much better but a bit shocked that it's almost over. Her voice is very hoarse. One of the first things she said to me was did I have lunch yet. Typical. She's coughing up thick mucus from her lung. A couple of hours later, the nurse removed her feeding tube. That's three down, two to go. There's another chest tube that's supposed to be removed tomorrow. Maybe the catheter can also be removed.
Ma was in pain after the tubes were removed, but it must have faded because she stopped complaining about it. When I left in the evening, she was still off the Fentanyl. I'm sure her throat is raw though. She has scabs on her lips and nose where the tubes rubbed against them, and it looks like she has sores on her tongue. But she was able to drink some soup and ate most of a popsicle. The nurse gave her something for her constipation yesterday. Today it worked too well, if you know what I mean.
The meds made Ma confused. She asked me several weird questions. Then there's the hallucination. She wanted me to move her bed because there's something in the ceiling that's loose and likely to fall on her. But she decided after a while that it's bolted firmly to the ceiling, whatever it is. Oh, and she kept talking to me in Kapangpangan. I think I understood everything she said, but I answered in Tagalog.
One notable thing is that her hair started falling out today. It's been two weeks since her first chemo. The hair loss is right on schedule. I'd better warn Ma tomorrow. I left three hats in her room but still hoped this wouldn't happen.
When Ma was still on the ventilator, of course she couldn't talk. She could nod and shake her head, but I had to guess from her hand gestures what it was that she wanted. I tried having her write it down, but her writing was unreadable even when I helped her hold the pen. Throughout it all, she didn't express any frustration. And with all that pain, she never cried.
Ma looks ten times better today than yesterday. At this rate, she could be home by the time Kit arrives.
The sedation was turned off because Ma has to stay alert. When the doctor came over, her pain med was also turned off. First, the doctor removed her chest tube, the thing that was bothering her the most. I heard Ma cry out in pain when it was pulled out. But the pain didn't last long (at least I hope not). Then the respiratory therapist and nurse took out her breathing tube. She looked so much better but a bit shocked that it's almost over. Her voice is very hoarse. One of the first things she said to me was did I have lunch yet. Typical. She's coughing up thick mucus from her lung. A couple of hours later, the nurse removed her feeding tube. That's three down, two to go. There's another chest tube that's supposed to be removed tomorrow. Maybe the catheter can also be removed.
Ma was in pain after the tubes were removed, but it must have faded because she stopped complaining about it. When I left in the evening, she was still off the Fentanyl. I'm sure her throat is raw though. She has scabs on her lips and nose where the tubes rubbed against them, and it looks like she has sores on her tongue. But she was able to drink some soup and ate most of a popsicle. The nurse gave her something for her constipation yesterday. Today it worked too well, if you know what I mean.
The meds made Ma confused. She asked me several weird questions. Then there's the hallucination. She wanted me to move her bed because there's something in the ceiling that's loose and likely to fall on her. But she decided after a while that it's bolted firmly to the ceiling, whatever it is. Oh, and she kept talking to me in Kapangpangan. I think I understood everything she said, but I answered in Tagalog.
One notable thing is that her hair started falling out today. It's been two weeks since her first chemo. The hair loss is right on schedule. I'd better warn Ma tomorrow. I left three hats in her room but still hoped this wouldn't happen.
When Ma was still on the ventilator, of course she couldn't talk. She could nod and shake her head, but I had to guess from her hand gestures what it was that she wanted. I tried having her write it down, but her writing was unreadable even when I helped her hold the pen. Throughout it all, she didn't express any frustration. And with all that pain, she never cried.
Ma looks ten times better today than yesterday. At this rate, she could be home by the time Kit arrives.
Monday, June 9, 2008
Chemo #1 Day 13 - In Pain and on Ventilator
In order to wean Ma off the ventilator, it was necessary to withhold her sedative and painkiller. The ventilator was set to CPAP (the same CPAP that's used for sleep apnea). If I understand it correctly, Ma was breathing on her own with a little assist from the CPAP. She was in a lot of pain though. And today she had a lot of thick secretions from her lung. The doctor thought it best to wait another day. But he didn't give her enough painkillers, only 12.5 mcg/hr of Fentanyl when she was on 35 mcg/hr the day before. After watching Ma suffer for several hours, I got the nurse to call the doctor and get approval for a bigger dosage. The doctor okayed 25 mcg, but it still wasn't enough. Ma indicated the pain was 10 out of 10. The doctor finally okayed up to 50 mcg, and the nurse set the IV to 35 mcg. She also put Ma back on the sedative. Ma was finally able to sleep around 7pm.
Tomorrow she'll have to go through this all over again.
Tomorrow she'll have to go through this all over again.
Sunday, June 8, 2008
Chemo #1 Day 12 - Pain Under Control
Ma was much more comfortable today. Even though her sedation was decreased, she wasn't waking up as often. More importantly, she wasn't waking up in pain. Well, except once this evening. Her throat is really bothering her because of the breathing tube. I told her to go back to sleep so she won't feel the pain, and she did.
Ma's white blood cell count is abnormally high, and she has a 99° fever. She's now on antibiotics.
Two of Ma's friends stopped by in the afternoon to visit. I don't know if she heard them though.
Ma's white blood cell count is abnormally high, and she has a 99° fever. She's now on antibiotics.
Two of Ma's friends stopped by in the afternoon to visit. I don't know if she heard them though.
Saturday, June 7, 2008
Chemo #1 Day 11 - Too Much Pain
Last night, Ma's Fentanyl dosage was at the max, 25 mcg/hr. For some reason, it was turned down to 5 mcg/hr this morning. That was way too low. No wonder Ma was awake and grimacing in pain and restless. When I asked her if she was in pain, she was able to nod her head. (She can't talk because of her breathing tube). The nurse doubled the dosage, but it still wasn't enough. She finally turned it up to 25 mcg/hr, and Ma was able to go back to sleep. But she awoke in pain again two hours later. This time the pain was from the breathing tube down her throat. The nurse got authorization to increase Ma's Fentanyl to as much as 50 mcg. She set it to 35 mcg and also increased Ma's sedation so that she doesn't wake up so easily. She seems more comfortable now.
The doctor wants to wait till Monday to wean Ma off the ventilator to give her lung more time to adhere to the pleural lining. There's still a chance though that her lung will collapse again. He said Ma's case is unusual. Pa is optimistic and thinks Ma will be able to go home soon.
There were several visitors today -- Dr. & Dra. Ibabao, old friends of Pa; Ate Vicky, Ate Beth & Kuya Richard. Isa & Tito Lum arrived at almost the same time as Ate Vicky et. al. I don't know if Ma was aware of their visit.
I do have some good news. Kit is arriving on Friday and will be staying for two weeks. Yey! I told Ma the news but don't know if she heard me.
The doctor wants to wait till Monday to wean Ma off the ventilator to give her lung more time to adhere to the pleural lining. There's still a chance though that her lung will collapse again. He said Ma's case is unusual. Pa is optimistic and thinks Ma will be able to go home soon.
There were several visitors today -- Dr. & Dra. Ibabao, old friends of Pa; Ate Vicky, Ate Beth & Kuya Richard. Isa & Tito Lum arrived at almost the same time as Ate Vicky et. al. I don't know if Ma was aware of their visit.
I do have some good news. Kit is arriving on Friday and will be staying for two weeks. Yey! I told Ma the news but don't know if she heard me.
Chemo #1 Day 10 - Possible Malignancy
The pulmonologist suspects that Ma has a malignant pleural effusion. He said there might be tumors in the pleural lining. But he has no proof. The cytology report for the pleural fluid doesn't confirm a malignancy. Ma's oncologist sounded doubtful that it's malignant even though he himself used to think the same thing. But the possibility does exist. After all, why did Ma get a pleural effusion in the first place?
Ma is still on the ventilator and sedated. The plan is to x-ray Ma's lungs tomorrow. If they look good, she'll be weaned off the ventilator. I hope the process isn't painful. She's already on the max dosage of Fentanyl.
Ma is still on the ventilator and sedated. The plan is to x-ray Ma's lungs tomorrow. If they look good, she'll be weaned off the ventilator. I hope the process isn't painful. She's already on the max dosage of Fentanyl.
Thursday, June 5, 2008
Chemo #1 Day 9 - Collapsed Lung
I arrived this morning to find Ma back on the full oxygen mask. In the early morning, Pa said she had a panic attack and said she couldn't breath. Turns out her lung had collapsed, a complication caused by her chest tube (the tube that was draining the pleural fluid). The doctor put another tube in Ma's chest that created negative pressure, thereby sucking the air out of her chest and reinflating the lung. But she was transferred to the ICU so that she can be monitored closely. She was also put on a ventilator and will stay sedated the rest of the night. We're hoping she can be taken off the ventilator tomorrow and that her lung won't collapse again. The doctor doesn't know if this means the pleurodesis didn't work. I hope he doesn't have to do it again as it put Ma in extreme pain.
Wednesday, June 4, 2008
Chemo #1 Day 8 - Pleurodesis is Painful
The lung doctor did the pleurodesis at 11:30. He used some kind of talc. The nurse gave Ma Dilaudid (supposedly stronger than morphine) as the procedure began. Pa says it takes about 5 minutes for Dilaudid to take effect. Well, they didn't wait 5 minutes. The procedure hurt Ma. She was crying out in pain. The doctor said the Dilaudid will not take away all the pain, and she'll be in pain for 4-6 hours. The nurse gave her two Vicodin. I doubt that they helped much, but they made her sleep. She woke up several times though, and she threw up once. When she woke up about two hours later, she was in agony. She rated the pain as 10 out of 10. It seemed to take forever for the nurse to come back with the painkiller. She gave Ma another shot of Dilaudid. Ma finally fell asleep again after 10 minutes. It look longer for me to calm down. The pain is apparently a good sign because it means the linings in the pleural space are adhering together and will thereby prevent further effusions.
Ma's oncologist stopped by around 6pm. The blood counts look better. He wants Ma on antibiotics for a few days while her white cell count is still low. The cytology for the pleural fluid shows it's negative for cancer. As the pathologist had told Pa before, the fluid is transudative, not exudative. Don't you love all these medical terms?
Ma woke up round 7:30pm after about 6 hours of sleep. She didn't have any lunch and was starving. But she had some nausea from the painkillers and was given Zofran. I fed her ice chips. Then she took a sip of apple juice. And fell asleep again. She vomited a few times. When I left at 9pm, Pa was trying to feed her gelatin and hoping she won't throw up again.
The chest tube is still in Ma, and it's still draining. It will be removed tomorrow, then maybe Ma can go home.
Ma's oncologist stopped by around 6pm. The blood counts look better. He wants Ma on antibiotics for a few days while her white cell count is still low. The cytology for the pleural fluid shows it's negative for cancer. As the pathologist had told Pa before, the fluid is transudative, not exudative. Don't you love all these medical terms?
Ma woke up round 7:30pm after about 6 hours of sleep. She didn't have any lunch and was starving. But she had some nausea from the painkillers and was given Zofran. I fed her ice chips. Then she took a sip of apple juice. And fell asleep again. She vomited a few times. When I left at 9pm, Pa was trying to feed her gelatin and hoping she won't throw up again.
The chest tube is still in Ma, and it's still draining. It will be removed tomorrow, then maybe Ma can go home.
Chemo #1 Day 7 - The Port Saga
Ma has diarrhea again. But it may be due to lactose intolerance. She had milk with her cereal. Why she used the milk when she knows she's lactose intolerant, I don't know. Other than that, she's able to eat solids now -- breakfast, lunch, and dinner. She gets gas pains though from not moving around enough. She can't walk to the bathroom yet but can use the bedside potty and is able to stand up briefly. She was also able to sit up in a chair for over an hour. Her breathing is much better although she's still on oxygen.
Ma's blood counts are all low. She was given two bags of blood (6-packs?) and a jumbo pack (10 units?) of plasma. Her chest tube is still in. Only 100 ml of fluid has drained out since the night before.
As I mentioned before, Ma has a port. When I arrived at the emergency room the other day, she already had an IV line in her arm. She said she had mentioned she had a port, but the nurse didn't use it. Every time a tech came over to draw blood, I would ask why she can't use Ma's port but couldn't get a straight answer. Poor Ma kept getting poked with needles over and over again. Her arm is all bruised because of her low platelets. When I first arrived this morning, the house doctor was making his rounds. I asked him why they can't use his port. He said it's because the nurses aren't trained to access it, it's too close to her heart, and there's a risk of infection. I asked if a nurse from the Cancer Center can come over to access the port. He said it's too much trouble for them to come over.
Later in the day when Ma was receiving her first unit of blood, it was flowing too slowly into her vein. The charge nurse came over to start a new IV line, but she couldn't find a vein in Ma's arm. Despite the doctor's discouraging words, I asked again why she can't use Ma's port. The nurse didn't even know Ma had one and said sure, they can use the port. In no time at all, a couple of nurses from the Cancer Center were in Ma's room and stuck a needle in her port. Her IV was transferred to the port, and we were in business. No more needles in Ma's arm. Yey! I love that charge nurse!
Ma's blood counts are all low. She was given two bags of blood (6-packs?) and a jumbo pack (10 units?) of plasma. Her chest tube is still in. Only 100 ml of fluid has drained out since the night before.
As I mentioned before, Ma has a port. When I arrived at the emergency room the other day, she already had an IV line in her arm. She said she had mentioned she had a port, but the nurse didn't use it. Every time a tech came over to draw blood, I would ask why she can't use Ma's port but couldn't get a straight answer. Poor Ma kept getting poked with needles over and over again. Her arm is all bruised because of her low platelets. When I first arrived this morning, the house doctor was making his rounds. I asked him why they can't use his port. He said it's because the nurses aren't trained to access it, it's too close to her heart, and there's a risk of infection. I asked if a nurse from the Cancer Center can come over to access the port. He said it's too much trouble for them to come over.
Later in the day when Ma was receiving her first unit of blood, it was flowing too slowly into her vein. The charge nurse came over to start a new IV line, but she couldn't find a vein in Ma's arm. Despite the doctor's discouraging words, I asked again why she can't use Ma's port. The nurse didn't even know Ma had one and said sure, they can use the port. In no time at all, a couple of nurses from the Cancer Center were in Ma's room and stuck a needle in her port. Her IV was transferred to the port, and we were in business. No more needles in Ma's arm. Yey! I love that charge nurse!
A Room with a View
Doctor's Medical Center is in San Pablo, about 15-20 minutes south of Hercules and an hour north of Sunnyvale (1.5 hours during morning rush hour). Ma's room is large and has two beds, but the staff is making sure Ma doesn't get a roommate. It's on the 6th floor. If you look to the far right, you can see the Bay Bridge, San Francisco Bay, and the high-rise buildings of downtown San Francisco.
Pa has been sleeping in Ma's room since the first night (Sunday). He was able to sleep on the second bed the first night, but the bed was taken away the next day. The second night, he slept in the chair. Last night he slept in the chair again, but a recliner was rolled in around 4am for him to use. I offered to stay over last night last night so he can sleep at home, but he wouldn't hear of it. I'll ask him again tomorrow.
Pa has been sleeping in Ma's room since the first night (Sunday). He was able to sleep on the second bed the first night, but the bed was taken away the next day. The second night, he slept in the chair. Last night he slept in the chair again, but a recliner was rolled in around 4am for him to use. I offered to stay over last night last night so he can sleep at home, but he wouldn't hear of it. I'll ask him again tomorrow.
Tuesday, June 3, 2008
Chemo #1 Day 6 - Thoracentesis
Ma's xray showed that her pleural cavity was 2/3 full with fluid. She had even more trouble breathing in the morning and was given a full oxygen mask. That's the kind that covers both your nose and your mouth. She had been using just the nose piece kind prior to that. However, she also developed asthma due to the lung problem and was given respiration treatment twice in the morning.
The breathing problem made her really weak. Just moving around in bed made her out of breath. Forget standing. Lying flat on her back also made breathing difficult, so her bed had to be raised.
The lung doctor showed up rather late, after 4pm, for the thoracentesis. The first time she had this procedure done, she was sitting up and the fluid was tapped through her back. She only needed a local. This time it was through her side and she was lying down. Initially she was given just a local but eventually was given morphine. I don't know if this was before or after she yelled out in pain. The good news is the morphine didn't make her sick. I would have liked to watch the procedure, but they closed the curtain on me, darn it. A tube was inserted in her side. Initially, the fluid coming out was straw-colored, just like the last time. But it soon turned bloody. The problem with having a low platelet count is it makes you bleed. Over 2 liters of fluid came out. I don't know how much of it was due to her bleeding problem. The tube is still in Ma and will be removed today. She's breathing much better but is still on oxygen.
Ma's platelet count in the morning was only 24K. Normal is 150-250K. She was given 1-1/2 units of platelets, raising her count to 62K. But after the thoracentesis, her count dropped to 43K. When I left last night, she was supposed to receive a jumbo pack of platelets.
The breathing problem made her really weak. Just moving around in bed made her out of breath. Forget standing. Lying flat on her back also made breathing difficult, so her bed had to be raised.
The lung doctor showed up rather late, after 4pm, for the thoracentesis. The first time she had this procedure done, she was sitting up and the fluid was tapped through her back. She only needed a local. This time it was through her side and she was lying down. Initially she was given just a local but eventually was given morphine. I don't know if this was before or after she yelled out in pain. The good news is the morphine didn't make her sick. I would have liked to watch the procedure, but they closed the curtain on me, darn it. A tube was inserted in her side. Initially, the fluid coming out was straw-colored, just like the last time. But it soon turned bloody. The problem with having a low platelet count is it makes you bleed. Over 2 liters of fluid came out. I don't know how much of it was due to her bleeding problem. The tube is still in Ma and will be removed today. She's breathing much better but is still on oxygen.
Ma's platelet count in the morning was only 24K. Normal is 150-250K. She was given 1-1/2 units of platelets, raising her count to 62K. But after the thoracentesis, her count dropped to 43K. When I left last night, she was supposed to receive a jumbo pack of platelets.
Sunday, June 1, 2008
Chemo #1 Day 5 - Hospital
Ma had been complaining of difficulty breathing the last couple of days. It got worse today, so Pa finally took her to the emergency room. The x-ray showed Ma's pleural effusion is back. She was admitted to the hospital and will have a thoracentesis done tomorrow. The tube will be left in her lung. When the fluid being drained is down to 100ml, the doctor will do a pleurodesis on her lung to stop the pleural effusion from coming back. So Ma will be in the hospital till at least Tuesday.
Ma's platelets have been low since last year. Before starting chemo, her platelet count was only 100K. Today it was down to 28K due to the chemo. She will be given platelets tomorrow. Ma's white blood cell count was normal (the Neulasta worked!), so I don't know why she had a fever. The fever's gone though. Her red blood cell count is below normal. Don't know if they plan to do anything about that.
Ma hadn't been eating or drinking much the last couple of days, so she's dehydrated. The ER forgot to give her fluids though. When I left her hospital room at 9pm (she'd been in the hospital since maybe 1:30pm), she was still waiting for her IV. Also, the nurse thought Ma wasn't allowed to eat or drink. Turns out she's allowed food & drink till midnight. When I left, she was working on a ham sandwich. Ma's diarrhea stopped, but I don't know if it's simply because she hadn't been eating.
Pa is staying overnight with Ma. The rest of us (Isa, Tito Lum & me) will be back in the morning.
Ma's platelets have been low since last year. Before starting chemo, her platelet count was only 100K. Today it was down to 28K due to the chemo. She will be given platelets tomorrow. Ma's white blood cell count was normal (the Neulasta worked!), so I don't know why she had a fever. The fever's gone though. Her red blood cell count is below normal. Don't know if they plan to do anything about that.
Ma hadn't been eating or drinking much the last couple of days, so she's dehydrated. The ER forgot to give her fluids though. When I left her hospital room at 9pm (she'd been in the hospital since maybe 1:30pm), she was still waiting for her IV. Also, the nurse thought Ma wasn't allowed to eat or drink. Turns out she's allowed food & drink till midnight. When I left, she was working on a ham sandwich. Ma's diarrhea stopped, but I don't know if it's simply because she hadn't been eating.
Pa is staying overnight with Ma. The rest of us (Isa, Tito Lum & me) will be back in the morning.
Chemo #1 Day 4 - Fever
Ma still had leg pain. It was worse when lying down, so she spent most of the day sitting up. She didn't bother taking Vicodin till evening to help her sleep. She still complained of difficulty breathing, though she said she could relieve it by taking deep breaths. In the afternoon she developed a slight fever (99° F). Pa started her on antibiotics (Cipro) as a precaution. Ma also had hyperacidity.
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