A bright and sunny Sunday

I arrived just before 8AM and missed an oncology internist.  The nurse told me that was probably the "scout" assessing patients before the main ramble shows up.  Who knew they needed a scout to find the patients and probably draw a map so the ramble can find them too?  When the pain resident showed up, I was here and we had a good discussion about Mary's pain killer history.  


The objective for the pain doctors is to find a regimen that Mary can use at home.  That is why they took her off the IV so soon.  And, as a result of the conversation and the fact that Mary was in pain all night with yesterday's fentanyl patch + Roxycodone, they are now willing to listen to us. I explained again Mary's successful history switching from the fentanyl patch to MSContin plus liquid morphine sulfate (Roxinol) in Feb and how that worked well.  


So as I finished the above paragraph, the pain ramblers arrived. Guess what?  They have discovered that MSContin plus liquid morphine sulfate (Roxinol) is the best solution for her!  And I am very sure they think it was their idea.  

In the middle of all of this, they brought Mary a breakfast consisting of cornflakes with non-fat milk, banana, OJ and coffee and tea.  Mary ate a few small bites of the cornflakes--something she never eats so I am not surprised--and a small bit of the banana.  Given that she had not had any solid food since Thursday, that is probably a good thing.  


The Oncology ramblers arrived and I was able to ask them a couple of key questions. First question addressed the diuretics.  Mary had been on diuretics ordered by the surgeon from post surgery until she went off of them in late Feb. Is this fluid retention something that going back on the diuretics would possibly alleviate?  I showed them the list of medications she had been taking and got a nod of approval for the diuretics. I just checked with the nurse and they are ordering her back on the diuretic originally prescribed by Dr. Visser. Imagine that! 


The second question addressed the results of the CT Scan.  The answer is that the final answer isn't going to be forthcoming until the A team looks at the images tomorrow.  The weekend team doesn't see any obvious blockage.  Then again, I don't know how many liver trisegmentectomy images they look at so we'll just wait for the A team interpretations on Monday. In addition, we got clarification on the nature of the obstruction: the obstruction is inferred from the blood test data and there is no other confirmation yet.  OK, gang, I understand that. Now can we concentrate on Mary's distended belly.  She looks like she is about 7 months pregnant and her belly button is just about inverted.  


They are ordering an ultrasound of the distended belly in an attempt to establish how the fluid is being retained. There is a small pocket of fluid on the CT scan but that would not explain Mary's distended belly.  


The pain folks have also put her on the schedule for some form of a spinal nerve block procedure.  They will come back to discuss the procedure later today and the risks.  Decision to proceed will be after that.  


This morning, I talked with Daniel so we have had in depth conversations with Mary's three offspring.  


More later...