Day 10 Tough Day, Longer Stay

This has been a hard day and somewhat tense. When I walked in this morning I could tell right off that things were not right. Louise was feeling pretty bad. She was short of breath and sweating pretty bad from her head but not from a fever. Her heart rate was 120 just sitting in a chair. It didn't take me long to let the nurse know that she had problems and something needs to be done now. The nurse was really proactive and agreed with me that something needed to be done. She called Dr. Perry, the original surgeon and a pulmonary doctor on duty. Before long they were taking more x-rays and doing some other tests. Louise was pretty scared also. She wondered if she was having a heart attack. They gave her anxiety medicine as well as several pain killers.

Dr. Perry recognized what the problem probably was and called in Dr. Standerfer, who is a cardiac thoracic surgeon. He came in and explained to us that Louise had a small leak from her right lung, probably caused by surgery. They had been trying for days to remove the air between her upper lung and the chest cavity and they had been using the chest tubes to suck it out. Every time they did, the air would come back and the doctor said that the air could only come back from the lung. He also said that the chest tubes have only been taking the lower 2/3 of the fluid out and they need to move the chest tubes to the upper lobes of the lungs. So this doctor recommended that she have surgery to put the tubes in the upper chest and (this is laymen terms) he would fix the leak in the lung(s) by scraping the chest wall so that it would adhere to the lungs. Once the lungs adhere to the chest wall, without an airpocket in between, the leak in the lungs will be patched by the adherence to the chest wall. That probably doesn't make any sense to you, but that is how I interpreted his explanation. The procedure is called thoracoscopy and pleurodesis. This surgeon said he had performed this surgery about 300 times and had success in almost every one of them. It is arthroscopic so it is not very invasive. He wanted to do an epidural on her back which would deal with her pain while she wore these new tubes and healed from the scraping of the chest cavity. Both would be very painful. After the surgery she would need to have the tubes in her at least 3-4 days and then they would spend another day making sure the lungs would stay inflated and the problem was solved.

The doctor was planning this 2 1/2 hour surgery for this evening until he found out Louise was on blood thinners. He can't operate if she has no clotting ability. So the next problem was to reverse the blood thinners by giving her a transfusion of plasma and Vitamin K. So when they were about to give her the transfusion they told us in very rare cases she could could have a reaction to the plasma and that if it happened it would probably happen in the first 15 minutes. Well, wouldn't you know, after they had just started the transfusion she got a very sharp pain in her right chest area. It was scary. They stopped the transfusion and called the doctors. They are now doing blood tests and chest x-rays and an EKG to see if the transfusion was the source of the pain or if something else was the source. If they decide that it was not the transfusion, they will start the transfusion again tonight. We will hold our breath if they start it again. If the transfusion works and her blood count is right, they will operate tomorrow evening at 5 pm. If they choose not to try a transfusion again, she will have to wait 7 days until the Coumadin is out of her system before they can operate. They don't feel like she will correct the lung problem without the operation so we are hoping she can have the transfusion tonight and that she won't have the severe pain she did last time. It is 10 pm right now and we have not gotten the lab results yet. Now they have to throw out the first plasma because it has been out too long. So they will have to thaw out the second one which will take at least another hour. This transfusion will be the early hours of the morning at this pace.

So this is the drama of the day. Louise slept from the drugs most of the day. She suffered quite a bit of pain this evening until now. We are sure hoping for success tonight and a successful operation tomorrow evening. I will sign off tonight and maybe update you on the transfusion situation in the morning.

Good-bye for now.
Spence