Another eventful couple of weeks.

31 August 2020

CW: Stuff about medicine, post-surgical care, and cancer.  Feel free to close the tab if you need to.

It's been a couple of weeks since my last update.  I was working on a different post in my spare time but I'm not entirely pleased with how it's turning out, plus I think it needs a lot more work, so I thought it'd be easier to write about the last week and change.  By "easier," I mean "easier to write," not "easier to handle."

A little over a week ago, on the 21st of August, I was killing time with mom rewatching Twin Peaks (she didn't know there was a third season so of course we had to rewatch the first two beforehand).  Nothing fancy, just the television and me hacking around a bit on a project.  Partway through the episode, around 2230 local time, she said in that quiet voice that in my family means that something is terribly wrong, that she was having trouble breathing and that I needed to call 911.  I'm sorry to say that I was expecting that something like this would occur so I kept my phone within arm's reach and had a go-bag packed and standing by, so it was the work of a few seconds to dial emergency services, give a situation report, request an ambulance, and get my stuff together.  There isn't much to say about the process of paramedics showing up, gathering data, loading my mom onto a stretcher, and heading to the hospital.  There wasn't any room in the ambulance, unfortunately, so I had to call in a favor from a neighbor to follow.

To make a long story short, rather than fluid accumulating in her abdomen (as has happened a number of times before) it started accumulating around her left lung.  Looking at her chest x-ray and comparing it to the pre-op one, her lung had been compressed to around half its normal volume by the fluid.  Thankfully, this isn't a strange or even un-predicted situation for a cancer patient so the solution is about as straightforward as it gets.  Thoracostomy - poke a hole in the chest and slide a tube into the space between the lung and chest wall, and then start pumping.  The procedure was scheduled for the next day, and while running on a fraction of a lung sucks by any stretch of the imagination (doubly so late at night) at least she was in the right place at the right time.

I tried to stick it out all night, I really did.  For some reason, the room they had my mom in was freezing cold, and between that and the coffee I'd had in the emergency room there was no way I was going to get any sleep.  I'm not as young as I used to be, I don't handle sleep deprivation very well anymore, and if I needed to do something the next day I did't want to be running on wiring only.  Unfortunately, rideshare options in outer Pittsburgh are pretty thin on the ground in the middle of the night, so I had to call in another favor to get home.  I didn't get to sleep until around 0500 local time, and what sleep I did get wasn't particularly restful.

They had to drain fluid from mom's chest a couple of times in the last week or so.  At one point they installed a semi-permanent chest drain and hooked it to suction to pull out a couple of liters.  The day before I brought her home (a day ago, as I write this) the surgeons installed a permanent chest drain that the in-home nurse is supposed to take care of.  On the same day they implanted the infusaport that they're going to use for chemotherapy once she gets stronger.  Fun fact: It's radiopaque and shows the international symbol for a radiopaque implant when x-rayed.  (image source: Patient manual for the Bard Peripheral Vascular PowerPort, used without permission though I did try to find an image online.)  I've been told (and suspected) that chemotherapy would help with the edema problem because ovarian cancer throws the body out of whack just enough to cause fluid to build up wherever it can.  It's also worth noting that the oncology lab found the protein markers for ovarian cancer in the fluid from both her abdomen and chest cavity, which pretty much confirms that mom's cancer and bouts of edema are related.  Take care of the cancer, take care of the edema, too.

In other news, the water blisters on mom's legs have almost completely healed.  She's been on some pretty hardcore diuretics for the last few weeks, and I think the time in the hospital (NOT on four IVs running at KVO, mind you) have done her a lot of good.  The skin's almost completely regenerated and now the dead skin is coming off.  The infection of her surgical incision has fully cleared up and the tissue is almost completely knit.  Mom's also a lot stronger now.  Her voice is much more clear, her appetite appears to have come back, and she's walking much more steadily (albeit she still needs a walker for balance).  Understandably she's not too pleased with the placement of the chest drain (on her back, left side) so there probably isn't any really comfortable way for her to sit or lie down.  The implantation surgery was also rather painful, regardless of local anesthetic.  Whenever a surgeon says that you're going to feel some discomfort, it's going to hurt like a son of a bitch.

I seemed to visit mom in the hospital every time her oncologist paid her a visit.  He was very amenable to discussing mom's cancer diagnosis, and is also very confident that treatment will be successful.  Ovarian cancer, he says, is very well understood these days and treatments for it have come a long, long way in the last 30 years.  He mentioned that he was planning a two-drug cocktail for mom's chemotherapy; doing a little digging it's probably going to be a combination of carboplatin and a taxane of some kind.  Mom also has an ongoing prescription for a fairly high dose of the corticosteroid decadron, which she's supposed to take the night before and prior to a chemo run.  I happened to be talking with a colleague who was successfully treated for a particularly nasty form of cancer some time ago and learned something interesting.  Decadron has the interesting side effect of hastening cellular division, which doesn't make a whole lot of sense in the context of cancer treatment.  However, carboplatin works by damaging cells' DNA as they replicate, which means that the already overly ambitious cancer cells will be damaged and possibly non-viable while they're dividing.  Taxanes function by interfering with cellular replication in a different way, vis a vis, by interfering with the process of chromosomes splitting and pulling into the two new cells during cellular division.  tl;dr - it's like fixing an engine while driving in fourth gear.