What was accomplished today?
We have the Oncology people focused on Mary's improperly functioning liver and bloated abdomen. We have the pain specialists working on making Mary pain free and fully awake. It feels like there might be just one or two too many chefs in the kitchen but perhaps this will get us to a resolution sooner.
For the Oncology folks, they have drawn a pile of blood, taken x-rays of Mary's midsection, run a CT scan of Mary's abdomen and juiced her with two units of red blood platelets. We don't have the final results back yet and what we have heard is inconclusive, partly because the analysis is not complete by the specialists, partly because junior ramblers are delivering the info and they are probably not authorized to tell us too much.
The pain folks have taken Mary off the fentanyl dispensing unit that included a push button so Mary could hit it as needed and put her on a 25 microgram fentanyl patch. This was done before the pain folks talked to me because I could tell them what would happen. Mary did this in January and goes immediately into a nausea-vomiting routine even if she had nothing to eat i.e., dry heaves. A few hours later, they adjusted it to a 12 microgram patch and again, I could tell them her need for Roxinol (Morphine Sulfate) would shoot way up. Guess what?
What is different is that she is on ipuprofen (which cancels taking Celebrex), Lyrica and now Cymbalta. These non-narcotics provide pain relief and we were not doing that in Jan-Feb.
Mary's belly is distended and remember, her liver is now located front and center. After the liver resection last May, they left a triangular chuck of liver just above the belly button. When the liver regenerates, it grows the triangle to be a bigger triangle, it does not reshape itself back to a natural configuration. Mary's abdomen is definitely enlarged and appears to have increased just in the past day or two. It is possible that Mary's heavily customized plumbing job--no bile ducts, a Roux-en-Y procedure, regenerated liver and rerouted intestine into the space where a normal liver would be has caused a mechanical blockage and that is the source of the problem.
Mary was visited by a Ramble of Residents today and we educated them as to Reenie and Mary's term for the herd of white smocked medical folks that swam the patient's bed like bees on honey. I think the staff doctor leading the ramble enjoyed the definition.
By the end of the evening, Mary appeared to be comfortable but was not able to carry on conversations. I talked to Tim and Lara and after we hung up, Mary did agree with what I had said so apparently she was engaged.
Hopefully, the pain docs will have her comfortable, awake and engaged tomorrow. We shall see!
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