Hallelujah!! The horrible NG tube was removed from Caryn's nose/throat/stomach around noon today. Her nose and throat are still very raw and sore but getting better every hour. She started a clear liquid diet and has been instructed to go very slowly as they monitor her ability to take in liquids and watch for any bloating. So far so good.
She's looking forward to restarting the long road to recovery and leave the bowel problems behind. Thank you so much for your love and support.
Wednesday, November 20, 2013
Monday, November 18, 2013
Most likely not obstruction
Met with her surgeon around noon. He feels strongly that this is an Ileus (sleeping bowel) rather than an obstruction. He says its common after this type of surgery. Her family doctor also came in at the same time and concurred. He also explained that the doctors at OHSU probably felt they saw enough positive signs that the bowel had awoken that they released her. In fact they were not woken enough causing this backup in her stomach. The surgeon felt confident this condition would resolve itself. It just takes time. Plus walking would help too. I liked the surgeon and liked what I heard.
Unfortunately resolving itself means keeping the tube in her nose/throat/stomach which has been very painful to Caryn. If it doesn't resolve itself and is indeed an obstruction, then surgery to clear the blockage would be the next step. And not for another couple of weeks due to the fact that she just underwent surgery. But as I said above, he's leaning towards it being an Ileus. If so, lets hope it resolves in the next few days so she can come home and get better. Thanks for hanging in there with us.
http://medicine.med.nyu.edu/conditions-we-treat/conditions/ileus
Peter
Unfortunately resolving itself means keeping the tube in her nose/throat/stomach which has been very painful to Caryn. If it doesn't resolve itself and is indeed an obstruction, then surgery to clear the blockage would be the next step. And not for another couple of weeks due to the fact that she just underwent surgery. But as I said above, he's leaning towards it being an Ileus. If so, lets hope it resolves in the next few days so she can come home and get better. Thanks for hanging in there with us.
http://medicine.med.nyu.edu/conditions-we-treat/conditions/ileus
Peter
Update - Monday 11/18
The recovery got progressively harder last week as she valiantly tried to have a bowel movement. Despite laxatives, suppositories and enemas, her bowel was slow to wake up. Her spirits were still high, especially on Thursday in anticipation of going home. They tried pumping her with all of the above to get her bowels moving so she could be released Friday. She had a few very small BM's but nothing substantial since the surgery. She developed a lot of bloating and gas pain in her abdomen area while unsuccessful with having a BM. Nevertheless, they felt she was ready to go home on Friday despite her not having a substantial BM. The car ride home was very uncomfortable due to the gas pains and bloating.
Saturday and Sunday got progressively worse as she was still unable to have a BM. Her pain got worse, she was unable to eat or drink much. Although she had a fairly substantial BM early Sunday morning (5:00 am) with the help of an enema, she got progressively worse rather than better as we hoped. Finally at approximately 7:00 pm Sunday , we brought her to Virginia Mason Hospital emergency. She was given a CT scan to ascertain if she had a bowel instruction. It was found that she does have a small obstruction, probably due to scarring or inflammation from the surgery but they are not completely sure. She had to have a procedure called a NG tube where a clear plastic tube was inserted through her nose, past her throat and down into her stomach so that her stomach could be drained. It is extremely painful and uncomfortable for her. The worst part being we don't know how long it stays in. Could be today or a couple of days. It just depends on when the obstruction clears. Please pray that it is removed soon and her bowels resume ther natural function. She will remain at Virginia Mason until the situation is resolved. We are hoping it resolves with the NG tube rather than surgery.
Thank you all for your thoughts and prayers. We're hoping and praying for a quick resolution to this small but painful complication so that she can resume the path to good health and a high quality of life.
Peter
Saturday and Sunday got progressively worse as she was still unable to have a BM. Her pain got worse, she was unable to eat or drink much. Although she had a fairly substantial BM early Sunday morning (5:00 am) with the help of an enema, she got progressively worse rather than better as we hoped. Finally at approximately 7:00 pm Sunday , we brought her to Virginia Mason Hospital emergency. She was given a CT scan to ascertain if she had a bowel instruction. It was found that she does have a small obstruction, probably due to scarring or inflammation from the surgery but they are not completely sure. She had to have a procedure called a NG tube where a clear plastic tube was inserted through her nose, past her throat and down into her stomach so that her stomach could be drained. It is extremely painful and uncomfortable for her. The worst part being we don't know how long it stays in. Could be today or a couple of days. It just depends on when the obstruction clears. Please pray that it is removed soon and her bowels resume ther natural function. She will remain at Virginia Mason until the situation is resolved. We are hoping it resolves with the NG tube rather than surgery.
Thank you all for your thoughts and prayers. We're hoping and praying for a quick resolution to this small but painful complication so that she can resume the path to good health and a high quality of life.
Peter
Monday, November 11, 2013
2nd Surgery - updates
Peter here.
As you all know Caryn had her second surgery, the goal to remove the primary tumor in her pancreas, meaning parts of her pancreas and the entire spleen would be removed. The medical team led by her surgeon Dr. Rodney Pommier took extreme precautions to avoid any repeat of the complications Caryn had during her first surgery. He had a team of anesthesiologists at the ready in anticipation of any difficulties.
I am happy to report that her surgery went very smoothly and was deemed a success. Her blood pressure only had one small dip which they were able to control and the only unplanned action they needed to take was the removal of a one inch section of her colon, which is not considered serious. Plus the surgery took a minimal amount of time, probably 2-1/2 hours. Dr. Pommier was quite pleased and ebullient when he reported the results of the surgery to myself and to Caryn's parents Shirley and Ed Swan.
Recovery
Caryn was assigned to a regular hospital room after surgery, not ICU as in the first surgery. That was a surprise to us. It turns out this was indicative of the success of the surgery that no complications arose that would have necessitated recovery in the ICU. She was pretty sedated Friday night. On Saturday there wasn't major pain or discomfort like there was during the first surgery. Her disposition and mood was great and her skin color was rosy and eyes bright. She did experience rough patches as expected during the first two days after surgery but as you all know, she's a trooper. Sunday night and Monday morning were rough for her as she experienced nausea and flushing. By this afternoon (Monday), she finally experienced a breakthrough in that she had her first bowel movement. Since then she has been feeling much better and has been able to sleep comfortably the last few hours, a good indication of her feeling better and worry-free. The doctors told her if she continues to progress, she may be able to leave by Wednesday. We'll see
In any case, this surgery and recovery has been a little easier than the first surgery and recovery. But I don't mean to mislead by thinking it's been pain and worry-free. She's still having her challenges as recovery is a very slow process. But relatively speaking, it has been a little better than the first surgery so far. I'm hoping the trend continues and we will be home safe and sound later this week. Thanks to all of you for you words of love and support throughout this ordeal. I want to send a special thanks to Shirley and Ed for their unconditional love and support during this challenging time.
The next report will either be done by me or better yet by Caryn upon her return home.
As you all know Caryn had her second surgery, the goal to remove the primary tumor in her pancreas, meaning parts of her pancreas and the entire spleen would be removed. The medical team led by her surgeon Dr. Rodney Pommier took extreme precautions to avoid any repeat of the complications Caryn had during her first surgery. He had a team of anesthesiologists at the ready in anticipation of any difficulties.
I am happy to report that her surgery went very smoothly and was deemed a success. Her blood pressure only had one small dip which they were able to control and the only unplanned action they needed to take was the removal of a one inch section of her colon, which is not considered serious. Plus the surgery took a minimal amount of time, probably 2-1/2 hours. Dr. Pommier was quite pleased and ebullient when he reported the results of the surgery to myself and to Caryn's parents Shirley and Ed Swan.
Recovery
Caryn was assigned to a regular hospital room after surgery, not ICU as in the first surgery. That was a surprise to us. It turns out this was indicative of the success of the surgery that no complications arose that would have necessitated recovery in the ICU. She was pretty sedated Friday night. On Saturday there wasn't major pain or discomfort like there was during the first surgery. Her disposition and mood was great and her skin color was rosy and eyes bright. She did experience rough patches as expected during the first two days after surgery but as you all know, she's a trooper. Sunday night and Monday morning were rough for her as she experienced nausea and flushing. By this afternoon (Monday), she finally experienced a breakthrough in that she had her first bowel movement. Since then she has been feeling much better and has been able to sleep comfortably the last few hours, a good indication of her feeling better and worry-free. The doctors told her if she continues to progress, she may be able to leave by Wednesday. We'll see
In any case, this surgery and recovery has been a little easier than the first surgery and recovery. But I don't mean to mislead by thinking it's been pain and worry-free. She's still having her challenges as recovery is a very slow process. But relatively speaking, it has been a little better than the first surgery so far. I'm hoping the trend continues and we will be home safe and sound later this week. Thanks to all of you for you words of love and support throughout this ordeal. I want to send a special thanks to Shirley and Ed for their unconditional love and support during this challenging time.
The next report will either be done by me or better yet by Caryn upon her return home.
Thursday, November 7, 2013
To Portland for surgery 11/8/13
We will soon be leaving for Portland. I'm ready and packed. The kids and many friends have spent time with me over the last few days in preparation for this. I imagine I've gathered up all the love sent my way in a blanket and wrapped myself in it. I feel so forcefully surrounded by prayers and well wishes. It is true that I believe in prayer and that many people want me to do well. I've never been more aware of how others think of me. I treasure all my relationships.
"We are most alive in those moments, when our hearts are conscious of our treasures." Thornton Wilder
"Love this moment, and the energy of the moment will spread beyond all boundaries." Corita Kent
"Life, even in the hardest times, is full of moments to savor. They will not come this way again, not in this way." Paula Rinehart
The CT Scan showed some tumor growth in the left lung and a new nodule in the lung. It commented on bone metastases in the hip, pelvis and back. It showed that the Octreotide has not completely kept all tumors from growing, which is disappointing. On the other hand the tumors continue to be very slow growing and very small. The lung nodules were 3 and 5 mm. There is some evidence that removal of the primary (which is what we are doing in tomorrows surgery) slows the growth of tumors.
Even with this somewhat disappointing news I fell joyful for life and grateful for all that I have. Illness can make you take stock of what you have and what you would loose if you transitioned out of this life now. I am amazed at what I have discovered since taking stock of all that I have and how absolutely wonderful my life has been and is right now. I have had a very good life. I have loved and been loved. I am secure in this moment with the knowing that I will be all right, what ever happens.
"Joy is what happens to us when we allow ourselves to recognize how good things really are". Marianne Williamson
"Abundance is something we acquire. It is something we tune into." Wayne Dyer
"If the world is to be healed through human effort, I am convinced it will be by ordinary people, people whose love for this life is greater than their fear. People who can open to the web of life that called us into being, and who can rest in the vitality of that larger body". Joanna Macy
"The Universe Funds me with Strength
In times of adversity, I remember I am equal to every situation, a match for every difficulty. Sourced in the power of the Universe, I allow that power to work through me. I meet calamity with strength. I have stamina. Rather than draw on limited resources, I draw on the infinite power within me that moves me to accomplish its good. I am fueled by all the love, all the strength there is. Loving strength melts mountains. I am ever partnered and supplied by Universal flow. Knowing this, I do not doubt my strength. I am strong and secure". Julia Cameron
Thank you for all the support. I will ask Peter to post how I'm doing following the surgery.
Happily grateful,
Caryn
"We are most alive in those moments, when our hearts are conscious of our treasures." Thornton Wilder
"Love this moment, and the energy of the moment will spread beyond all boundaries." Corita Kent
"Life, even in the hardest times, is full of moments to savor. They will not come this way again, not in this way." Paula Rinehart
The CT Scan showed some tumor growth in the left lung and a new nodule in the lung. It commented on bone metastases in the hip, pelvis and back. It showed that the Octreotide has not completely kept all tumors from growing, which is disappointing. On the other hand the tumors continue to be very slow growing and very small. The lung nodules were 3 and 5 mm. There is some evidence that removal of the primary (which is what we are doing in tomorrows surgery) slows the growth of tumors.
Even with this somewhat disappointing news I fell joyful for life and grateful for all that I have. Illness can make you take stock of what you have and what you would loose if you transitioned out of this life now. I am amazed at what I have discovered since taking stock of all that I have and how absolutely wonderful my life has been and is right now. I have had a very good life. I have loved and been loved. I am secure in this moment with the knowing that I will be all right, what ever happens.
"Joy is what happens to us when we allow ourselves to recognize how good things really are". Marianne Williamson
"Abundance is something we acquire. It is something we tune into." Wayne Dyer
"If the world is to be healed through human effort, I am convinced it will be by ordinary people, people whose love for this life is greater than their fear. People who can open to the web of life that called us into being, and who can rest in the vitality of that larger body". Joanna Macy
"The Universe Funds me with Strength
In times of adversity, I remember I am equal to every situation, a match for every difficulty. Sourced in the power of the Universe, I allow that power to work through me. I meet calamity with strength. I have stamina. Rather than draw on limited resources, I draw on the infinite power within me that moves me to accomplish its good. I am fueled by all the love, all the strength there is. Loving strength melts mountains. I am ever partnered and supplied by Universal flow. Knowing this, I do not doubt my strength. I am strong and secure". Julia Cameron
Thank you for all the support. I will ask Peter to post how I'm doing following the surgery.
Happily grateful,
Caryn
CT Scan result
CT SCAN chest, abdomen and pelvis - Details
Narrative
[HST]: neuroendocrine tumor of pancreas
[SAS]: restaging
Exam: CT chest, abdomen and pelvis with contrast
History: Restaging neuroendocrine tumor of pancreas
Comparison: CT Chest, 10/17/2012. MR Liver, 3/22/2013. CT Abdomen,
4/17/2013.
Technique: CT scan chest, abdomen and pelvis with 100 cc Optiray 320
IV and oral contrast, without event in both arterial and venous
phases. Coronal and sagittal reconstruction images were viewed on
the viewing station. However, due to small PIV used 22 G restricted
injection speed and venous phase is in more delayed phase.
Findings:
Chest:
There is minimal right basilar atelectasis.
Previous pulmonary nodule in the right posterior lung base (image 58,
series 6) has increased in size measuring 5 mm (previously measured 4
mm) when compared to 10/17/2012. New subtle 3 mm ground glass nodule
in the left apex (image 8, series 6).
Subtle 3 mm groundglass opacity in the left pulmonary fissure (image
30, series 6) and right minor fissure (image 33) may represent
intrafissural lymph nodes.
Left node located in the anterior upper thorax just below the
clavicle (image 10, series 5) has slightly increased in size
measuring 11 x 10 mm (previously measured 10 x 5 mm). Similar
appearance of subcentimeter axillary lymph nodes. No new mediastinal
or hilar lymphadenopathy.
Heart size is stable. No pericardial effusion.
Abdomen:
Patient has undergone resection of the left hepatic lobe. Previous
metastases in the right anterior inferior and right hepatic lobe are
similar considering differences in technique when compared to
4/17/2013, but are better appreciated on the prior MR abdomen from
3/22/2013. No definite new hepatic lesions, but limited due to timing
bolus. Small calcified granulomas again noted in the liver.
No hypervascular enhancing lesions within the pancreas or new ductal
dilatation. As before, patient is status post cholecystectomy. The
spleen, adrenal glands and kidneys are unremarkable in appearance. No
hydronephrosis.
The aorta is normal in size and caliber. No new retroperitoneal
lymphadenopathy.
Bowel loops are unremarkable in appearance. No small bowel
obstruction.
Pelvis:
Bladder is normal in appearance. The uterus is unremarkable. Adnexa
are not well visualized. No free pelvic fluid. No pelvic or inguinal
lymphadenopathy.
Again noted is severe disc height loss at L2-L3 and minimal Grade I
anterolisthesis of L4 on L5 with moderate disc height loss. Stable
sclerotic lesions within the bilateral iliac wings, sacrum, pelvis,
right acetabulum, T12, L1, L2 and L4 vertebral bodies when compared
to 4/17/2013. No pathologic fractures.
[SAS]: restaging
Exam: CT chest, abdomen and pelvis with contrast
History: Restaging neuroendocrine tumor of pancreas
Comparison: CT Chest, 10/17/2012. MR Liver, 3/22/2013. CT Abdomen,
4/17/2013.
Technique: CT scan chest, abdomen and pelvis with 100 cc Optiray 320
IV and oral contrast, without event in both arterial and venous
phases. Coronal and sagittal reconstruction images were viewed on
the viewing station. However, due to small PIV used 22 G restricted
injection speed and venous phase is in more delayed phase.
Findings:
Chest:
There is minimal right basilar atelectasis.
Previous pulmonary nodule in the right posterior lung base (image 58,
series 6) has increased in size measuring 5 mm (previously measured 4
mm) when compared to 10/17/2012. New subtle 3 mm ground glass nodule
in the left apex (image 8, series 6).
Subtle 3 mm groundglass opacity in the left pulmonary fissure (image
30, series 6) and right minor fissure (image 33) may represent
intrafissural lymph nodes.
Left node located in the anterior upper thorax just below the
clavicle (image 10, series 5) has slightly increased in size
measuring 11 x 10 mm (previously measured 10 x 5 mm). Similar
appearance of subcentimeter axillary lymph nodes. No new mediastinal
or hilar lymphadenopathy.
Heart size is stable. No pericardial effusion.
Abdomen:
Patient has undergone resection of the left hepatic lobe. Previous
metastases in the right anterior inferior and right hepatic lobe are
similar considering differences in technique when compared to
4/17/2013, but are better appreciated on the prior MR abdomen from
3/22/2013. No definite new hepatic lesions, but limited due to timing
bolus. Small calcified granulomas again noted in the liver.
No hypervascular enhancing lesions within the pancreas or new ductal
dilatation. As before, patient is status post cholecystectomy. The
spleen, adrenal glands and kidneys are unremarkable in appearance. No
hydronephrosis.
The aorta is normal in size and caliber. No new retroperitoneal
lymphadenopathy.
Bowel loops are unremarkable in appearance. No small bowel
obstruction.
Pelvis:
Bladder is normal in appearance. The uterus is unremarkable. Adnexa
are not well visualized. No free pelvic fluid. No pelvic or inguinal
lymphadenopathy.
Again noted is severe disc height loss at L2-L3 and minimal Grade I
anterolisthesis of L4 on L5 with moderate disc height loss. Stable
sclerotic lesions within the bilateral iliac wings, sacrum, pelvis,
right acetabulum, T12, L1, L2 and L4 vertebral bodies when compared
to 4/17/2013. No pathologic fractures.
Impression
Impression:
1. Previous right posterior lung base nodule now measures 5 mm
(previously measured 4 mm) with new 3 mm nodule in the left apex. Two
new 3 mm subtle nodular opacities in the left pulmonary fissure and
right minor fissure may represent intrafissural lymph nodes.
2. Lymph node in the left upper anterior thorax just below the
clavicle has slightly increased in size measuring 11 x 10 mm
(previously measured 10 x 5 mm) when compared to 10/17/2012.
3. S/P resection of the left hepatic lobe with multiple hepatic
metastases in the right hepatic lobe similar compared to 4/17/2013,
but better appreciated on the prior MR abdomen from 3/22/2013.
4. No new hypervascular enhancing masses within the pancreas or
ductal dilatation.
5. No new retroperitoneal or intraperitoneal lymphadenopathy.
6. Multiple sclerotic osseous lesions within the spine, pelvis,
bilateral iliac wings, sacrum and right acetabulum are similar
compared to 4/17/2013 and some of which are likely due to metastatic
disease.
______________________________________
Electronically signed by:SUNG E LOGERFO, MD
Date: 10/30/2013
Time:11:49
1. Previous right posterior lung base nodule now measures 5 mm
(previously measured 4 mm) with new 3 mm nodule in the left apex. Two
new 3 mm subtle nodular opacities in the left pulmonary fissure and
right minor fissure may represent intrafissural lymph nodes.
2. Lymph node in the left upper anterior thorax just below the
clavicle has slightly increased in size measuring 11 x 10 mm
(previously measured 10 x 5 mm) when compared to 10/17/2012.
3. S/P resection of the left hepatic lobe with multiple hepatic
metastases in the right hepatic lobe similar compared to 4/17/2013,
but better appreciated on the prior MR abdomen from 3/22/2013.
4. No new hypervascular enhancing masses within the pancreas or
ductal dilatation.
5. No new retroperitoneal or intraperitoneal lymphadenopathy.
6. Multiple sclerotic osseous lesions within the spine, pelvis,
bilateral iliac wings, sacrum and right acetabulum are similar
compared to 4/17/2013 and some of which are likely due to metastatic
disease.
______________________________________
Electronically signed by:SUNG E LOGERFO, MD
Date: 10/30/2013
Time:11:49
Component Results
There is no component information for this result.
General Information
Collected:10/30/2013 10:34 AM
Resulted:10/30/2013 11:49 AM
Ordered By:Eric Martin Feldman, MD
Result Status:Final result
Resulted:10/30/2013 11:49 AM
Ordered By:Eric Martin Feldman, MD
Result Status:Final result
Saturday, November 2, 2013
Pictures
Jerome, Lauren, Caryn, Peter
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