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.

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.

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!

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.

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.

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.

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.