Wednesday isn't better--so far

I arrived about 7:40AM and Mary acknowledged my arrival.  We had a bit of a chat and she said the pain was still low. The pain doctors had reduced the MSContin to 15mg as of the 6AM dose with orders for 15-15-15 on an eight hour cycle compared to the 30-30-45 she had been on at home before things began going bad. Given a 15 mg dose at 6AM and that she has drifted off again is causing the doctors to be concerned about much too much morphine in her system.  


Mary has now signed the consent for the celiac plexus block (CPB) which is now set for tomorrow.  The expectation is the CPB will interrupt the nerve signals allowing Mary to drop much of the pain medication regimen and thus regain clarity of thought again. The pain doctor who had been neutral to the procedure now believes it is necessary because there is not a satisfactory low-high dose of morphine for Mary's condition.  


This first CPB uses anesthetic and provides about 24 hours of relief.  If it does, then they go back in an inject drugs that kill the nerves.  


Mary has not been able to urinate, probably because her abdomen is so enlarged and her mind is so fuzzy that she cannot get the valves to work. As a result, they put a catheter in her this AM.  She has produced more fluid in the first hour than she did all day yesterday so that is good. 


The doctors have definitely ruled out infection which I didn't realize was on the agenda for consideration.  They have also ruled out mechanical blockage based on the images that have been taken.  That leaves inflammation or cancer.  They admitted there is still the very remote possibility that its infection or mechanical blockage.  (What have we done to our medical profession that they all talk like attorneys now?)  The answer may be in the results from the paracentesis done on Monday.  The Oncology team said that it can take up to three days but they would start harassing the pathology folks to get an answer today.  


The paracentesis results are in multiple parts.  The early parts did definitely confirm the fluid was albumin and also ruled out infection. I have asked both Reenie and the doctors where albumin would be coming from.  Apparently it can be generated by many organs in the body if those organs are experiencing some form of distress.  Given they have ruled out infection and mechanical blockage, the distress could be from 1) inflammation such as physical damage like a fall or accident or 2) cancer cells in the peritoneal cavity.  And, the cytology we are waiting for may tell us if cancer cells are present in the fluid which came from the peritoneal cavity.  This is a pretty good link to four pages describing the paracentesis procedure.  The third page discusses results.   We are waiting for the cytology on the sample which is done by centrifuging the fluid to collect the cells and then laboriously looking at the collected cells under a microscope. 


Mary did not eat a bit of her breakfast.  Lunch just arrived and I am going to see if we can get some food into our girl.