Correction -- Septic Shock

Sorry, I meant septic shock, not toxic shock.

In ICU - Long Version

Short version is here.

Ma has lots of problems

Colitis - The colonoscopy showed that Ma has mild colitis due to the chemo.

Leg pain - No DVT. Pain is due to edema. Both arms and legs are swollen and painful. Treatment is to eat protein.

Low blood sugar - Ma hadn't eaten since the night before, and she wasn't given dextrose. By late afternoon, her blood sugar had dropped down to 39. She was given a big shot of dextrose and put on a dextrose drip, bringing her blood sugar up to 158. But a few hours later, it dropped down to 23. Again, she was given the same treatment.

Stomach cramps - Ma was in extreme pain yesterday. At first, the morphine wasn't helping at all. But the dose she got at 5pm finally provided relief, and she fell asleep.

Low blood pressure - Ma's blood pressure had been low throughout the day, below 100/40.

Infection - Ma's right leg got worse and started oozing. The doctor started her on antibiotics.

Low white blood cell count - Ma's WBC is very low, and she was put on protected isolation. No flowers, limited visitors.

Low platelets - She needs another superpack of platelets.

Because of the low blood sugar and the morphine and the way Ma's breathing reminded me of how she sounded when she overdosed yesterday morning, I asked the nurse to wake her up. She wouldn't wake up. The Rapid Response Team was called. They tried two doses of Narcan (1 mg total), and she still wouldn't wake up. The doctor ordered her sent to ICU.

Soon after arriving in the ICU, it looked like Ma was about to go into cardiac arrest, and a Code Blue was called. The crash cart wasn't needed after all. Her heartbeat is fine. It's the breathing that's the problem. She was put on a ventilator. She has acidosis. The most worrisome is that the infection in Ma's leg is due to septic shock. She's on two antibiotics for it. For now she's stable.

Another thing is that the doctor wants a CT scan done on Ma's head to check for bleeding in the brain caused by her low platelet count.

In ICU - Short Version

Ma is in the ICU with septic shock. She was on morphine yesterday for pain. She had very low blood sugar twice (39 and 23). When the nurse couldn't wake her up, the doctor sent her to ICU. Soon after she got there, she went into Code Blue. Her heart is actually okay, so they didn't need to use the crash cart, but her breathing is irregular, and she's on a ventilator.

Overdose

Ma has been having pain in her legs, especially her right leg. Last night she was in a lot of pain. The Norco (Vicodin) was taking too long to take effect, so the nurse gave her 2 mg of Dilaudid at around 3:30am after consulting with the on-call doctor. Apparently this was too much, and the day shift nurse could not wake up Ma. Her respiration was 8, and her blood pressure was low. The nurse had to give Ma two doses of Narcan to wake her up. Even then she was still groggy. Don't know if this is considered a hospital error.

The pain in Ma's leg is possibly due to DVT. She's having an ultrasound done this morning.

In addition, she's having a colonoscopy done this morning to see what's causing her bad diarrrhea. To prep her, she was given a water enema last night and this morning.

Still in Hospital

Ma's still in the hospital. On Tuesday she was given platelets and another unit of blood. Yesterday 2.5 liters of fluid was drained from her abdomen. Despite the platelets, the incision bled a bit last night. Ma started solid food yesterday. She still gets diarrhea. Dr. Irwin said she'll be discharged when her diarrhea is under control and she's seen by a physical therapist. I don't even  know how much she can walk at this point. I doubt she'll go home today but maybe tomorrow.

In the Hospital

Ma's in the hospital. She's been having severe pain in her abdomen and diarrhea and vomiting. Turns out she's anemic. Probably a side effect of the chemo. She was given two units of blood. They did a CT scan of her abdomen today. No results yet. Don't know if she'll be released tomorrow. But her symptoms are under control. She's a bit bummed that she's not allowed to eat.

Ma's Home

Chemo #4 Day 8

Ma was sent home today. I'm not clear on why she was even admitted to the hospital. The gynecologist never did show up. Ma will see a different gynecologist on an outpatient basis.

Pa slept in Ma's room last night. I didn't think he'd be able to because Ma had a roommate, but the nurses managed to squeeze in a recliner for him.

Ma is still feeling weak. She didn't do any walking around the house today, and she spent most of the day sleeping. Her appetite is still good though, and she's eating a lot.

Bleeding

Chemo #4 Day 7

Pa took Ma to the emergency room this morning because she had vaginal bleeding. Her hemorrhoids have also been bleeding. Blood tests show a low platelet count, but they're holding off on giving her platelets till she really needs it.

More troublesome is the ultrasound. They found something in her vaginal canal. The hospital doesn't have a resident gynecologist, so someone has been called in to see Ma. The doctor didn't come today though.

In the meantime, Ma was admitted to the hospital. The hospital is full, and Ma has to share a room. Bummer.

Oh, and I found out today that Ma hasn't had a gynecological exam since she lived in Michigan. She left MI in 1982.

Back Home

Chemo #3 Day 14

Ma was released this morning. I was bad and didn't get to the hospital early enough. Pa had to leave the office to take Ma home. It took over two hours for her to get discharged.

Ma's leg muscles are too weak, and she can't get up by herself from her rocking chair. She can get up from the dining room chair though. And she can walk to the bathroom with her walker. I didn't make her walk through the living room for exercise. Ma said the hospital will arrange for in-home physical therapy for her.

She Does Have an Infection

Chemo #3 Day 12

Ma's still in the hospital. No word on whether she can go home tomorrow. Pa said she has a urinary infection, but the nurse said it's not a UTI, so I'm not sure what she has. She's on Zosyn and Vancomycin.

Ma got annoyed with me because I keep telling her to go for a walk. She finally went, after many excuses, but the walk lasted less than 3 minutes. She decided she was tired after going barely halfway down the short hall.

Ma still has mouth sores, but they don't hurt anymore when she eats. She can't taste her food though and didn't eat much for dinner.

Back in the Hospital

Chemo #3 Day 11

Ma has been feeling weak and had been asking Pa since yesterday to take her to the emergency room. She insisted again this morning, and Pa finally took her. Her white blood cell count (WBC) was 33.2. Normal range is 10.8 max. The doctor thinks Ma has a bad infection and decided to admit her.

It took several hours to get Ma to a room. She was still in the emergency room when I arrived even though I took my time getting to the hospital. She ended up in her old room on the telemetry floor. That's the floor where the patients are put on a wireless device that monitors their heart.

Dr. Reis, one of the pulmunologists, stopped by soon after Ma arrived in her room. He thinks there's nothing wrong with her. The weakness she feels is a side effect of the chemo. The high WBC could be due to the Neulasta shot she got on August 7, nine days ago. Also, she has no fever. She'll continue her antibiotic (Zosyn), and if she does well tomorrow, she can go home on Monday.

At the emergency room, Ma's nurse knew how to access her port, so he didn't have to use her arm to give her IV. They still used her arm to draw blood though. When I arrived in the emergency room, her antibiotic drip was done, but she was not given Heparin to ensure her port stays clear, nor was she on a saline drip to keep her line open (TKO). I insisted that Pa ask her nurse to put her on saline TKO, and the nurse had no problem doing so.

Kuya Jess, Helen, and their youngest son Jerel drove up from LA to visit Ma. That was really nice of them. Of course they expected to visit her at the house, not at the hospital. They arrived in the late afternoon with Kuya Richard and brought a box of mamons. Yum! I forgot to take photos, darn it. By the way, Monday is Kuya Jess' birthday. He turns 30 x 2. Happy birthday!

Ma had other visitors. One of the nurses upstairs was expecting Ma on her floor before they decided to change her room. She came down anyway to see how Ma's doing. The security guard downstairs, who's a patient of Pa's, also stopped by to say hello.

I left the hospital around 8:30pm after Pa came back from the house. He is staying overnight in Ma's room. There's a second bed in the room that he can use.

Home on the 4th of July

Ma went home yesterday. Her catheter had to be drained twice. Although I believe she produces 2L of fluid a day, only 650 ml came out the first time she was drained and 500 ml the second time. Draining is a painful process for her despite the Darvocet. The pain is supposed to subside in a few days.

Kuya Richard and Ryan stopped by with pancit malabon. Ma couldn't resist eating some right away. She really should eat more protein though. Ensure & Boost & Glucerna drinks give her diarrhea. I got her some Glucerna bars, and those she can tolerate.

Some stats:

33 days in the hospital
2 hospital admissions
8 hospital rooms occupied
3 pleurodeses (none of them worked)
2 surgeries
7 chest incisions
11 days in ICU
5 days on ventilator
1 bed sore
12 lbs. lost

This will be my last post for a while. Thanks for reading.

Second Chest Tube Out

The Pleurx was installed yesterday. We asked the nurse to make sure Ma doesn't feel any pain from the procedure, and she didn't. Afterwards, the PA removed Ma's second chest tube. She felt some pain despite the morphine, but Darvocet took care of it.

This morning the nurses showed Pa how to drain Ma's catheter. They did it too early, before I arrived at the hospital, but I have a DVD and instruction manual on how to do it.

Ma is going home today. We've started packing and are just waiting for the discharge papers.

Pleurx Pleural Catheter

As I mentioned the previous night, Ma's fluid output wasn't as bad as last week's. However, that changed overnight. In the 12-hour period from 8pm-8am, 1100 ml of fluid was drained from her. She must have put out 2L yesterday.

Today she will have a Pleurx catheter installed in her so that she can go home. A nurse or PA (physician's assistant) will teach us how to drain the catheter. At the rate she's going, we may have to drain it twice a day. No official word yet on when she can go home, but maybe in a day or two.

One Month Anniversary

Ma was first admitted to the hospital on June 1st. Today is her one month anniversary. It's not a happy milestone, but the end is in sight. One of her chest tubes was taken out today. Good thing, too, because I had accidentally knocked over the canister that the tube drains into. Oops! The nurses reassured me they had all done the same thing at one time or another.

I had misgivings about the PA (physician's assistant) removing the tube instead of the surgeon, but she did it quickly and painlessly. I had asked her to give Ma morphine before the procedure, and she agreed to it. With just one tube left in her, Ma's pain should lessen.

With the other tube gone, the remaining tube has started draining more than usual. It's nothing compared to last week though. If the second tube is removed tomorrow, Ma could be discharged by Thursday. But don't listen to me. I had also predicted that Ma would be home before Kit arrived.

Ma's friend and hairdresser Auring and her husband visited two days in a row. Yesterday they brought lots of fresh fruits -- plums and apricots from their trees and two mangoes. Today they brought more plums plus some food they promised Ma - sinigang bangus, rice and eggplant. I told Auring I prefer my bangus fried, and she cooked that, too. :) Tonight Ma asked Pa to get her some fried quail from the Thai restaurant. All this food is interfering with my weight loss plans. And the nurses are probably wondering why Ma's blood sugar is so high.

Slowing Down

Not much happened yesterday. Ma had nausea in the morning, but Zofran and a nap took care of it. She managed to walk just once around the unit. In the afternoon she had more pain and took a long nap.

No surgeon stopped by to check on her. But the fluids draining out of her chest are definitely diminishing. After her first surgery, the fluids coming out of one chest tube slowed down, but the other just kept going and going. This time it looks like both chest tubes are slowing down.

The pulmonologist stopped by. He didn't really have much to say. I thought we'd be seeing a liver specialist while in the hospital, but it looks like that can wait till Ma is discharged.

In the meantime, a hospital bed for Ma has been delivered to the house. We just need to find some extra long bed sheets for it. Isa's cat has been checking out the bed and has approved it.

Private Room

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.

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?

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

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.