Day of Surgery Lounge again...

We got here at 8:30, so somebody from neurology could glue the feducials (little lifesaver like things) onto dp's head. That turns a regular CT to a 'stealth' CT (they don't look all that stealthy to me, but what do I know?).

Anyway, Katie met us in the CT waiting room, and the CT was finished about 11. From there we went to the fifth floor -pre-surgery and waited there until about 1:30. A stop to meet the gas passer (an RN!), and they wheeled dp off about 2 for what's scheduled to be a two hour and 20 minute surgery. Katie and I went an got some lunch (the burger grill was closed, so we have to settle for salads), and now we're sitting back in the Day of Surgery Lounge.

Diana was in a pretty good mood -- any healthcare worker careless enough to just ask if she had any questions was queried about who would win the Democratic Presidential nomination. Pretty soon, they were just asking if she had any more questions in regards to today's surgery. She also got to tell the nurse anesthetist her 'why woman have no spatial perception' joke.

I think we'll be going back to the sixth floor neurosurgery ward after this, but I'll let you know when I hear more.

The Next Step

Got in to see Dr. R Friday morning. He agrees that the Diamox is not doing the trick, so we're now scheduled for surgery on Tuesday. Spent most of the rest of the day doing all the pre-surgery stuff, so we can go in outpatient on Tuesday morning. They'll do a head CT first, with the lifesavers glued to her head, and then we'll wait for the Dr. R to complete his first surgery of the day.

This will be a peritoneal shunt, which is a tube under the skin from the back of her head to her abdomen. It's two pretty small incisions (and another hole in the head), so the biggest trauma will be the general anesthetic. She'll probably be back on the sixth floor for two or three days after, and then back home again.

All in all, I think it's a good thing -- we've been kind of 'on hold' while we waited to see what the Diamox would do, and so something that offers genuine progress is kind of a relief.

Marie is weathering the winter just fine, and while she shares all our concern for dp, she is otherwise in pretty good spirits. Ambrosya has joined our family/staff/karass, and takes care of Marie in the mornings so Connie can continue her education.

Last Sunday, the tempurature made it into the fifties, so we got in the car, ran some errands, and went to Red Lobster for lunch. It was nice to enjoy the weather before everything froze again.

Stay warm.

Doctors...

Went to see Dr. C yesterday morning, and then Dr. A stopped by for a home visit.

Potassium is a little low, so there's a new pill, and we learned that the standard course of Lovenox is three months -- one more month to go.

Diana isn't getting any worse, but she's not really getting any better, either. I'm wanting to blame spinal fluid, because it's obviously still there, but in her own subtle way, Dr. A reminded us that we still have the kidney thing. Dr. C doesn't want to deal with that until Dr. R resolves the spinal fluid thing. Pushing him would probably bring up the surgical options, and Diana would really rather not do that if she doesn't have to.

The Diamox does seem to have some effect, but it also seems to be a short-term solution -- the right-side neuropathy improves within an hour of taking it, only to return eight to ten hours later. Meanwhile, I don't think the swelling around the incision site is going down. It's more like it's spreading.

Dr. R gets back to town on Monday -- that'll mark the three-week period we were going to try this for, so we'll see what happens then.

I didn't talk about the surgical options, did I? (reads back) Nope.

Basically, it's the age old art of trepanation. They'd drill a small burr hole on the left side of her scalp to relieve pressure there. The next (and I think simultaneous) procedure would be to use an endoscope (or whatever the brain surgery equivalent is) to make a small hole close to where the clogged drain is now (the third ventricle, rather than the fourth). If they can't do that, then there's a shunt that runs under the skin all the way from the skull to the abdomen. As brain surgeries go, it's a lot less invasive than what she's had already, but it's pretty easy to understand why we'd rather not go that route. (The phrase, 'like another hole in the head' comes to mind..)

We had yet another sleet-turned-snow storm last week, followed by single-digit temps. The City Streets division put out a press release that basically said, "It's snow over ice, it's too cold for salt to work, and we really don't have any salt left anyway. We're screwed." I thought that summed up the situation pretty well. We'll come into March with a foot of snow on the ground, but they say it'll be warmer.

The Day After President's Day

Not much new to report -- we're a week into the new drugs, and if they are working, they're working slowly. Some of the right-side numbness seems a little better, particularly for a couple hours after she takes the drugs. The swelling under the incision site (that's where the extra spinal fluid is going, Nancy) seemed like it got smaller early, but I'm not sure that it's stayed that way. I suspect that it's responsible for some of the swelling at the back of her neck, as well.

As Dede mentioned, the swelling at her temples is down, but I think that's because we're down to just 1mg of steroids a day. dp's blood pressure is back to normal, as is her appetite. We've got an appointment with Dr C (he called Sunday morning just to check in) next week, and with the neurosurgeon the week after that.

And yes, the weather still sucks -- we got another couple inches of slush Sunday, which then flash-froze to be covered with another couple inches of snow. Still, we're in the second half of February, so time is on our side...


Notes from dp:
Dennis: Judging from your schedule changes, we're assuming the current trip is off. Fortunately, our schedule is pretty open, so we'll probably be able to fit you in when you're able.

Packages should be on their way to New Mexico and Lacrosse. Let us know when they get there.

Regarding Marie: The plan A to keep her at home is the clear favorite, and we might be close to finding a new person to help out. Failing that, we're pretty sure we'd like to keep her in a nursing home here, rather than in Michigan.

Nancy: Kevin is injecting Lovenox in my thighs -- not my stomach. From the sounds of it, that's a better way to go...

AJ and Robyn's centurytel email addys are bouncing -- got new ones?

A New Read

Okey dokey, we know a lot more today than we knew yesterday...

As you may recall, when the tumor was discovered, one of the concerns was that the swelling was threatening to cut off the ventricle from which the cerebral spinal fluid drains back to the circulatory system. That's not really opened up as it should have, so spinal fluid has been backing up, kind of like a blocked stream -- it looks around for someplace else to go. It's filled the tumor cavity, the area between the brain and the skull, and through the dura at the incision site. That last is really a good thing -- it's given dp a built-in pressure valve.

When Dr. R showed us the post-surgery and recent MRIs of the incision side by side, it was like looking at aerial photos of New Orleans. Here's a dam, and then here's a broken dam with water collecting everywhere. I have no idea what Dr. S was looking at, but it apparently fluid is not his thing.

Anyway, the good news is they're not terribly concerned about it, and it's not all that uncommon with brain surgery. There are a couple levels of surgical fix, but first, we're going to try Diamox, a drug that's generally used to prevent altitude sickness by reducing the amount of spinal fluid the body produces. It's also a diuretic, and that part seems to be working already.

Good News, Revised

The issue in contention is the amount of fluid sitting where the tumor used to be. Dr. S thought there wasn't much, but Dr. C thinks there's enough there to be putting pressure on the brain and causing some of dp's right side weirdness and returning nausea. He called the neurosurgeon, and now we've got an appointment with him tomorrow morning. Dr. C called yesterday morning and said that the neurosurgeon didn't think that more surgery would be necessary. Googling suggests either bumping the steriods back up, or using an 'osmotic diuretic' like mannitol, but that's pretty speculative on my part -- google doesn't really cover post metastatic craniotomy edemas very specifically...

We've also learned we'll need new help for Marie. Connie, who has been Marie's primary caretaker is getting ready to take a new position, probably at the VA. If someone knows someone who can work split shifts and change adult diapers, give us a holler, okay? Failing that, we may need advice on nursing homes.

Here's some of dp's chemo caps (you'll probably have to click on the image to get the real effect.)

Note from dp: Cinda, thanks for the email with the large font.

Good News!

MRI today. We were both pretty nervous, because the right-side weirdness dp has been feeling could be indicative of another brain tumor. The scan shows perfectly clean though -- no sign of the original tumor coming back, nor of any other tumors starting. We'll do another MRI in three months, but Dr S was very happy.

Still, there's the right-side weirdness, and dp's been feeling more nausea for the last week or so. Metaclopromide fixes it pretty quickly, and she's doing more and sleeping less. Dr. S the radiologist wants to go from 2 mg a day to 1 mg, but we'll run that by Dr. C before we do it.

In other news, my Aunt Mary was buried today in Wisconsin. She found out that she had leukemia on Friday and she died of it on Saturday. I didn't know it could work that way.

We got about 10 inches of snow Tuesday/Wednesday. It's getting old, not to mention expensive to keep plowing, but gosh, it was beautiful.

dp asked me to say three things:
Nancy, the gloves got here.
Clan C, the tulips got here.
Mom and Dad, the low-fat divinity got here.