The report is in

We managed to get to Stanford by the appointed hour for Mary's blood test--but just barely. We saw Dr. Visser pretty much on time at 8:30AM. The result? Overall, good. Maybe even great. Remembering we are commenting on Step 2 (getting the liver to regenerate) progress. Step 3 (all cancer is gone) comes later.

First, he said that our call to the on-duty doctor last night had him alerted to the fluid retention problem. In fact, when Mary checked in today she was 20 lbs (8.5kg) heavier than on the same scale for the pre-surgery appointment at the end of April. That is retaining a lot of fluid considering she didn't eat for two weeks of those four weeks because of surgery and hospitalization. Mary now has an appointment request with the nefrologists (kidney) for next week to look at her entire electrolyte spectrum. Today, at least, she is off the salt tablets and the recommendation is a potassium rich diet because her potassium level was on the low side. She was dancing about the termination of the salt tablets. Ok, not dancing, making motions of excitement.

Second, the incision is looking good. Reenie and I estimated it the other night. It runs about 8 inches (200mm) from the sternum to the belly button and then turns and runs about 12 inches (300mm) from the belly button along her waist to her right side. These dimensions will shrink as the fluid bloat disappers, her abdomen looks like a balloon right now. (However, not nearly as much bloat as when she was in ICU a few weeks ago.) In the incision, there were two areas of infection when we left the hospital and Reenie has been cleaning and packing those two areas three times a day diligently for the past week. Dr. Visser said it looked great and now we can switch to a once a day and a 'shallow' packing to allow the tissue to heal together in the deepest part of the wound.

Third, they called in nursing specialist with a cart of medical goodies to work on Mary's ostomy bag. Dr. Visser said that the fluid being collected in the ostomy bag is a result of a salt rich environment so as the salt goes away, the fluid volume will drop and the stoma (hole in the abdomen) will seal up. And he is happy with that scenario. In the meantime, we wanted more supplies to make sure we didn't have a catastrophy on our hands. So they called for the ostomy bag nurse (who knew?), she came in, redid the bag, gave us enough supplies as if this thing would leak for the next four months and generally was very mothodical and careful to help us understand how and what was happening. Very nice.

Fourth, we did get a refill on Mary's pain pills but the doc extracted a promise she would wean herself of off the pills.

Fifth, I did ask one of the surgical residents about Mary's path report after surgery. I wanted to know if the cancerous material was intrahepatic or extrahepatic. The answer was both but predominantly intrahepatic.

Sixth, Dr. Visser made Mary get up out of the chair and on to the examination table to see how she moved. He was very pleased with her progress and mobility. He then proceeded to remove almost but not quite all the staples along the incision. He left the staples on either side of the two infectious locations to minimize tearing.

Finally, we asked about radiation. His response was that Mary needs to heal from the surgery and given that she appears to be healing very well, it will likely be about four weeks before radiation begins.

That's all for now. I had great difficulty sleeping last night and given that Mary is taking her nap now, I am going to do the same.