Friday, February 7, 2014

Identified, diagnosed, treated Pt. 1

My oldest son rushed to me with the news the early afternoon on January 1, 2014 that mom was crawling on the floor in what appeared to be severe pain.  When I arrived in the house I found her crawling & crying in my direction mumbling unintelligible words. I first assumed that she was experiencing flu symptoms but soon found that the source of her pain was fear. Fear derived by the sensation of a lump that she felt in her abdomen releasing itself in the form of nausea.  Once calm I guided her to the car and away we went to the hospital emergency room.  As we traveled down the highway my wife continued to probe the area where she first felt the lump.  She appeared to become more calm as she moved her hand back and forth and side to side.  I was told to stop, turnaround and go home because the lump could no longer be found.  Rather than go home I made a deal with her in which we would bypass the ER & make a stop at the medical aid unit instead.  She agreed.
Exam #1 Medical Aid Unit
The exam at the medical aid unit would be the first of many each with their own unique diagnosis.  I found out quickly that the professionals staffed at a medical aid unit are not equipped with the tools, experience or knowledge to appropriately diagnose this type of condition.   It was confirmed that her stomach was distended which could a product of a blockage in an intestine or one of a million other reasons.  In order to rule out a blockage an X-ray of the abdomen was ordered but it did not reveal a blockage or abnormality. The consensus amongst the medical staff was that the distention of her stomach could be the result of constipation so we were sent home with instructions for her to take a laxative & wait.  As the day slowly progressed there were no results prompting my wife to make an appointment with her primary care physician for the following day. 
Exam #2 Primary Care Physician
Upon examination the tending physician showed some concern about what he felt so he ordered her to undergo an immediate CT scan & blood testing. There was no diagnosis at this time leaving me a bit shocked & bewildered that this particular medical professional allowed her to leave with the message that I’ve never seen anything like this before. 
Exam #3 OBGYN
The results of the blood test and CT scan were sent to her OBGYN and reviewed with my wife at appointment #3.  A preliminary diagnosis as a result of a physical examination & the diagnostic tests revealed the mass as uterine fibroids.  An ultrasound was ordered to confirm the diagnosis as well as to confirm the exact location of the structure.  A day later when the results of this test were returned we received a phone call from her OBGYN informing us of an inconsistent report delivered from the ultrasound as opposed to what was identified by the CT scan.  The conflict was significant in that the ultrasound indicated a mass on the ovary while the CT scan identified the mass as a uterine fibroid.  I’d been on the Internet long enough to know that a cancerous fibroid was less likely than a cancerous mass on the ovary.  After a night of worry we received another phone call from her OBGYN on the 8th of January confirming that the mass was indeed situated on the ovary.  The news that the mass could very well be cancer almost brought me to my knees.  In the coming days, when not in my wife’s presence there would be moments of sadness, times of fear & tears galore.  While my wife put on the strong front in my presence there were enough signs to indicate that she was experiencing the same emotional breakdowns.  I remember one night specifically when our eyes met & our thoughts became as one that I could no longer refrain from crying in her presence.  As the first tear dripped down my face my wife joined me in the longest, saddest cry that I’ve ever had in my life. 
Exam #4 Oncologist
Since visit #3 with the OBGYN an OVA test indicted the presence of cancer so an appointment was scheduled with an Oncologist to discuss his role in the surgery to remove the mass. The examination by the Oncologist as well as a review of the diagnostic tests & OVA blood test results produced a differing view point.  The doctor confidently informed my wife that there were more indicators identifying the mass as benign vs. the indicators that identified it as malignant.  The doctor was so sure of himself that he made the comment that he believed that his role in surgery would be less than ten minutes allowing him time to have his second cup of coffee before her surgery ended.  The news of this report was obviously received with open arms. Understanding that the mass could still be malignant I now had hope that the extent of the remedy would a full hysterectomy & the removal of the mass.
Much planning had taken place leading up to the day of surgery including the travel plans of my wife’s parents from Eerie, Pa to Bear, De.  Funny thing happened the day before the scheduled surgery is that an unplanned snowstorm hit the area virtually shutting down the state of Delaware including the hospital.  I was stunned that a hospital would shut down amidst what I consider to be a nuisance and even more stunned that an administrator would be the one to make the decision to cancel forty plus surgeries without so much as consulting with a medical professional.  There were many emotions experience by me on this day including amazement that my 70+ year old in-laws traveled 400+ miles right through the meat of the storm to be by their daughter’s side but a basically every school, business & agency, including hospitals felt it necessary to shut down.  Anger aside I finally realized it was out of my control so I began to work hard to ensure that someone was working diligently to reschedule her surgery. As the in-laws packed to return to Eerie we badgered the scheduler until we were told that the new date would be eight days later on January 31. 
The mass had grown to such a size that my wife was feeling significant pressure from bloating.  While I could not feel her pain I was stressed & distressed knowing that she was uncomfortable and that there was nothing that I could do.  It was a grit your teeth & hold on situation for eight days but she made it.
When the day of surgery arrived my wife appeared to be relieved but I was stressed.  She was admitted into the hospital and almost immediately transitioned into the OR processing area where she would wait two hours before the start of the procedure.  My mother & I were joined for periods of time by my cousin and her husband as well as my brother for while surgery took place.  The scheduled 10 a.m. surgery started at 11:43 a.m. and ended three hours and thirty eight minutes later at 3:21 p.m.  I stared at the surgery status board, which had the characteristics of an airport flight status board, to make myself aware of when surgery was complete.  I fidgeted in my seat waiting for the news of my wife’s condition hoping & praying that cancer would not be found.  Finally the surgeon tapped me on the shoulder and walked me back to the consultation room where she reported that my wife was stable but cancer was found.  The Oncologist, who apparently did not get that second cup of coffee, was called in to remove the tissue & stage the cancer.  I can not even begin the describe the emotions running through my body at this time.  I cried, I was angry & I was sad for my wife.  I finally settled and made the phone calls to family & friends before being allowed to stand by my wife’s side in the recovery room. After thirty minutes or so in a semi-lucid condition the doctor, in my presence, reported the news to my wife.  Every inch of my body, mind & spirit wanted to hover over my wife to deflect, protect & buffer this pain from her but there was nothing I could do.  Amazingly enough Angela took this news in stride, barely batting & eyelash impressing the living daylights out of me. 
In the coming days I would watch Angela suffer in pain & overcome adversity while recovering from major surgery.  In my mind I could not help but compare her to my one and only hero who once traveled this world ignoring pain & anguish to function better than any other human & that would be my grandfather.  I’ve documented the six day ling struggle here
Angela had a difficult night last night.  Remnants of anesthesia are still impacting the functionality of her bowels & kidneys  & she is not getting enough oxygen into her blood without the use of a machine.  The nurse antipated  quicker progress so the breathing air tube  & catheter were removed during the daylight hours yesterday.  Monitoring throughout the night revealed fluid being produced  (a good sign) but not being released & insufficient O2 in her blood. As a result both the catheter & the air tube had to be reinserted early this morning to stabilize her condition.  Though her attitude remains positive I do sense that she is becoming frustrated because her body is not bouncing back like she expected.  I'm expecting a visit from the doctor this morning at which time I will ask her to set some clear expectations so Angela has a more accurate gauge for which to monitor her
progress.  Just as an FYI the anesthetic still has her feeling very groggy so if you call and she doesn't answer or get back right away try not to be too upset.  I know this is a long disertation but by doing this I get relief and I feel I'm helping everyone stay in tune. If you have any questions feel free to ask at any time.

Angela had another rough night last night. She sent me a text at 4:30 a.m.describing the pain she was experiencing.  I called her right back to get more info & to make sure that the staff was responding to her needs. Here main issues were nausea & headache. The nausea was remedied by a dose of Zofran & but the headache persisted despite a dose of Advil that she took from her own stash. When I got here at 8 I immediately noticed that Angela's mood had drastically changed from frustration the night before to pure anger now.  Insted of getting an update from her I spoke to the day nurse. She was surprised to hear that Angela had such a rough night because there were no documented events listed on the night notes nor was there a verbal given during face to face turnover. My discussion with the nurse prompted her to immediately observe Angela's condition to ensure that there were no abnormal
signs.  The observations that were made were 100% positive.  Her body temperature was back to normal, blood oxygen level @ 95% (normal) and obvious bowel activity wad heard. Oh and the biggest news of all is that she urinated on her own only two hours after the catheter was removed!  A gold star is in order. Emotionally she is angry, moody & frustrated but physically she has made dramatic improvement since last night.

I received a text from Angela this morning saying that she experienced another bad night. Pain, elevated temperature & bright red bleeding from  the vaginal area. What I was told by her  is that the doctors were meeting to discuss the possible cause(s) of her symptoms.  I was very stressed by the time I arrived this morning.  The ride in here was hard but I convinced myself not  to jump to conclusions without first talking to a nurse or a doctor. Luckily Dr. Glover's assistant was reviewing Angela's charts  when I arrived so I had a good source to answer my questions. Just as it was the case the last  3 days the report that I received from Angela was not consistent with the views of the medical staff.  The elevated temperature  is of some concern because it is an indicator that infection could exist however her white blood cell count is normal  so while not ruled out it is doubtful that
there is an infection. Also the staff did proactively pull blood & urine  samples last night for further analysis just to be sure that there is not an infection. It was explained to us that  the source of the bleeding is most likely the result of residual blood that still remains in the body cavity as  a result of the surgery. If it the bleeding persists Dr. Glover will check to ensure that there is no internal  bleeding but again there are no other signs indicating that this is a problem. It has been four long, hard nights  for Angela but every medical professional that I've spoken to ensures me that she is progressing however slow it may be and that we need to be patient. Angela is still frustrated but she is less moody today than yesterday. Still taking Dilodin & Zofran through IV and mostly sleeping this morning.
Angela is 100% better today. The fever broke late last night after a 2nd  dose of the antibiotic Rocephin & the introduction of a second antibiotic Azithromycin. It has become obvious that the source of the fever was a lower lung infection just as was suspected. The other big news of the night is that her bowels decided that it was time to wake up. It was because of this that she was treated with solid food this morning for the first time since being admitted. I'm hopeful yet doubtful that she will be discharged today.  Her pain medication was downgraded from an IV dose of Dilaudid to Percoset in pill form which she has accepted well. That being said she is still receiving IV fluids & the same  IV port is being used to introduce the antibiotics & the anti-nausea medicine.  I haven't been told formally but I would assume that she will remain in the hospital until enough antibiotic is
intrduced into her system to clear the infection. Obviously the turn of events has left her excited, bubbly & generally back to her norm'al self. On the docket for today is lots of walking, using the spirometer & thanking the nurses for their support.

I received my daily panic text from Angela around 3:45 this morning.  Apparently she had been denying herself the pain medication for fear that it might cause her to be constipated.  As a result she woke up around 1 a.m. in "horrific" pain.  She also suffered with bouts of nausea & severe gas pains. Coming to the realization that sleep was not in her future she became angry and started to rip off her clothes to be prepared to leave as soon as the discharge papers could be processed.  As Angela was in the act of changing her clothes the nurse asked her jokingly if she had planned to take a walk through the park.  Angela's anger became more intense when she found out that the clothes she intended to change into did not fit due to bloating.  The emotional outburst must of stimulated her bowels as it was not long after that she began passing gas "like crazy".   Once her body relieved itself she began to think more logically and found that the clothes that were given to her by Gary as a gift fit perfectly.  Now happy & content she layed in bed and rested until I arrived around 6:30.  The good news out of all of this activity is that every sign still pointed to a late morning, early afternoon discharge.  A visit was paid to her by the resident physician & also her primary doctor's assistant who both confirmed that Angela's condition was stable so release was in her near future.  As I write this note the discharge papers are being processed and we hope to be home by noon at the latest.

It was a good night &  day with Angela actively sleeping more than half the time. Keeping track of the different medications and how often they should be taken was a challenge however there were bigger obstacles to overcome on this day.  First & foremost I found it difficult to convince the now refreshed Angela that it was important to moderate her activity.  My understanding of her condition was that she should do no more than walk from room to room refraining from any activity that might result in undo stress to her body.  Apparently her understanding is that it is okay to bend down to scratch the dog’s belly & to do some light cleaning of the kitchen.
Though rested and energetic I still sensed frustration on her part.  Frustrated that her bowels were not as active as she thought they should be, frustrated because her temperature once again became elevated & frustrated because she was forced to take a dozen medications.  Regardless of her position she was making obvious progress toward a full recovery.  Her appetite is slowly recovering, her breathing is returning to normal & the swelling is her legs is significantly reduced allowing her to walk in less pain.  All & all this was a good day.

A long night’s sleep , the prospect of a good meal (more on this later) and the knowledge that her staples would be removed on this day left Angela in a good mood most of today.  Today’s challenges once again included reminding her that she needed to restrain from activity that could jeopardize her recovery (cleaning the house) & reminding her that her body will become more regular each & every day. (Continued frustration at the slow movement of her bowels)  Highlights of the day were the removal of her staples, a visit paid to us by my brother & his wife & finally a bowel movement.  The most gracious act on this day was delivered by my brother & his wife.  Platters full of excellent homemade food were given to us by them.  This will go a long way in helping us to bring some normalcy back to our lives when the kids return over the weekend.  Thank you Joe & Lucy!  All & all this was a good day.

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