Half an Answer

It's been a busy couple of days since Monday's post. Here is a copy of what the plan was, and the results we now know (in italics):

• Today (that was Monday) Dr. Stephan sent us across the street to the Auburn Medical Center lab for some blood work. That will give him another gauge on the gall bladder issue. That lab work turned out nearly normal so at that point the gall bladder was beginning to look like it was not the issue.


• Tomorrow (that was Tuesday), again at Auburn Med, Bettie will have a HIDA scan of the gall bladder which will test its functionality. If this test proves normal, that will pretty much end that organ as a suspect in the pain mystery. If it is not normal, the bladder will be removed, probably within a week. For nearly two agonizing hours, Bettie lay on a hard table, under a camera the size of a Buick, while it took pictures of radio-active stuff trying to make its way into her gall bladder. (Not exactly the same procedure description you'll find in the medical texts.) Anyway, the HIDA scan revealed that the gall bladder is actually NOT working properly. Bettie will probably have gall bladder surgery late next week.


• Wednesday (today, at 7 a.m.) Bettie will go into surgery for a biopsy of the largest of the aforementioned knots in her tummy. This will give us an indication of just how serious an issue we are dealing with in the lymph nodes. Baring complications, she'll be home again that day. The biopsy procedure went as planned with no complications. We arrived at 7 a.m.; she went into the operation room with the "green suits" at 9 a.m.; Dr. Stephan came and gave me an update at 10 a.m.; I got to go sit with her in recovery at 11 a.m. and we left for home about noon.

So now she is back in her own bed, having just had a pretty good lunch (she had not eaten since yesterday dinner due to the procedure). She has pain pills to last the weekend and we settle down to await the results of the biopsy...the other half of the answer.

Doctor does not expect results until Friday or maybe even Monday. I had told him that I have an out-of-town event this week-end but I'll cancel at the drop of a hat if you say so. "Oh no" he says "Go ahead with your plans. If I need to I can reach you by cell phone. We won't be doing anything that soon anyway. You need the break." Since I have lots of live-in help, I sort of reluctantly have decided to go ahead with plans to sing with my chorus in a big "District Chorus Contest" in Whistler B.C. (Hope my cell doesn't ring while were on stage...I'd probably answer it!)

Of course I'll post the biopsy results as soon as I can, but that may not be until Monday. Remember that good things can come from all of this, whatever the outcome. Meanwhile, I'm still whistling.

Hold On With That Scalpel

In last Monday's posts I was sort of celebrating the news that Bettie was going to have surgery. It turns out the party was premature...well...sort of. She is going to have surgery, and soon...Wednesday, the 28th. But it won't be the gall bladder...at least not just yet. There is something more pressing, and possibly more serious.

Here's the story: Dr. Schumer, our primary care guy has referred the results of the most recent gall bladder scan to our old friend Dr. Stephan. (You may remember him from the posts on August 25th and 27th). He is not so sure that the gall bladder is actually the issue after all. That scan was, while not pristine, actually pretty close to normal. Not what you'd expect to see for the level of pain Bettie is suffering.

Meanwhile, a couple of other issues have come to the surface. When comparing images from the last couple of months, there is a noticeable increase in the size of several of her lymph nodes. In addition, a couple of suspicious knots have developed, close to the surface of her lower right abdomen. When I first noticed them about two weeks ago and pointed them out to the doctor, they were almond size. Now they are walnut size. Dr. Stephen does not want to remove the gall bladder, only to later discover that it was actually something else. So Here's the plan:

• Today Dr. Stephan sent us across the street to the Auburn Medical Center lab for some blood work. That will give him another gauge on the gall bladder issue.
• Tomorrow, again at Auburn Med, Bettie will have a HIDA scan of the gall bladder which will test its functionality. If this test proves normal, that will pretty much end that organ as a suspect in the pain mystery. If it is not normal, the bladder will be removed, probably within a week.
• Wednesday Bettie will go into surgery for a biopsy of the largest of the aforementioned knots in her tummy. This will give us an indication of just how serious an issue we are dealing with in the lymph nodes. Baring complications, she'll be home again that day.

While I like to keep this blog as upbeat (sometimes, I'm told, even funny) as possible, we all have to realize what could be going on here...and where it could ultimately end. So for now, it is very day to day. I'll know, and post, more tomorrow. The biopsy results however will probably not be known until Friday at the earliest and maybe not until Monday. In even the worst case however, nothing will be done the rest of this week. That is, the doctor does not foresee any condition that would require emergency action.

So I'll try to continue with the upbeat stuff, but just between you and me, I'm whistling in the dark here.

News! At Last Some News

As previously related, Bettie has been having right side abdominal pain, pretty much from mid-July when they discovered an issue with her gall bladder. In the last couple of weeks it has gotten much worse...to the point where she is only up to move to the bath or down stairs from our bedroom to the wheelchair, where she can be taken to the couch in the family room. Her appetite has deteriorated and she has lost at least four pounds...down now to 98!

Needless to say, this has been a great concern to the family and to her professional treatment staff. Both doctors Schumer (our primary-care guy) and Heide (her "stroke doctor"...actually a neurologist) have provided input. One of their suggestions was a new ultra-sound exam of the gall bladder, which was performed last Friday morning.

Today, Dr. Schumer got the results of that scan and called us with the news: "I'm referring Bettie to Dr. Pettie on Friday...she needs to have her gall bladder removed." I was out when the call came so I didn't speak with Dr. Schumer, but the bottom line is she will have the surgery within the next couple of weeks.

Now it will seem kind of odd to you, for us to be celebrating the need for surgery. This is not the kind of thing one usually looks forward to...kind of in the category of rejoicing over an upcoming root canal...like, who does that? However, if you were here with us, watching her decline these last couple of weeks, you would understand. When Rick told me the news from Dr. Schumer, my heart leaped in relief...almost joy. At last, they have found something. Yes!

Though it is often hard to read Bettie's responses, I think I detected some relief on her part too, when I told her about it.

Being a person of faith, I do not consider the gall bladder a vestigial (look it up) remain from a previous branch of the human tree. Nevertheless, its designed role can be omitted with little effect on one's lifestyle. It this case, I readily accept (for her, as I have durable power of attorney) a life free of both gall bladder and related pain, as opposed to continuing with both.

Modern surgical practice allows this type of surgery to be minimally invasive, which is fortunate, given how weak and frail she is right now. (On that note, I think we have arrested the weight loss and she is eating somewhat better the last couple of days.)

But there is a good thing that will come from this extra trial of pain, coming, as it has, on top of stroke. When Bettie is free of pain, the stroke will seem to me like a relatively minor nuisance in our life together. I predict that she'll walk with little impairment, get better and better at talking, and regain some useful functionality with her right hand. She might even feel like...well who knows. But she'll be back and that is news, at last some news.

Is the Worst Behind Us?

Gee, I hope so.

As you have noted, there have not been many posts to this blog recently. That's because I like to report progress toward recovery...and there has been precious little of it lately. But maybe we are turning a corner just now. By that I mean today...this afternoon!

To recap recent history, since Bettie came home from the hospital on the 30th of July, she has been frequently complaining of pain in the right side of her abdomen. At first we naturally (and probably correctly) attributed it to the drain tube that had been inserted into her gall bladder and which remained with her for another few weeks. When that was removed (see Maybe We'll Glow in the Dark) we thought that would be the end of the pain. It wasn't.

Next we discovered a badly deteriorated right hip joint. We arranged to have an injection of Depo Medrol in the hip to relieve the pain temporarily. It didn't.

Finally, just a week ago today we concluded that she had a bowel blockage. We had just selected a new primary care doctor (Dr. David Schumer) and he had an x-ray made that confirmed her bowel was full, but not necessarily blocked. Four days of Miralax solved that problem...but the pain persisted.

So today I took her back to Dr. Schumer to see if we could determine what we might be missing. Dr. Schumer is just the kind of guy I hoped we would find. (We found him simply by calling a physician referral service in Auburn.) He describes himself as a "former hippie" so you can imagine he is somewhat laid back. He has a wonderful way of making you feel like everything will be OK. He comes in the examining room, sits down, puts his feet up and chats with us as if we are the only important case he has and the rest of his day is ours. We like him.

His take on Bettie's current condition is basically post stroke depression. He says he sees it all the time. He reassures me that it will pass and gives me some tips and adjusts some medication and adds a new one to help with it. "I'll see you early next week...we'll get through this" he assures me. We leave and I feel better...Bettie, not so much.

Reassured that we're doing the right things, it is a little easier to help Bettie through this. For one thing, my son Rick (who I recently hired to be semi-full-time caregiver, partly because he is a former certified nursing assistant) has helped me soften my overall dealings with Bettie. I was getting a little bossy with her, he pointed out, whereas she needs tender right now...lots of TLC. I think it is working. Maybe it's just me, but it seems like she's feeling some better this afternoon. I got her to make some funny faces at me...that's always a good sign.

Meanwhile, the issues that put me in the ER last week seem to be past and I'm following a new regime on doctors orders...weight coming down, neck pain decreasing, and other good stuff. All in all, I'm hopeful that we've left the worst behind us and are ready to make some progress.

Marking Time

It sort of seems like we've been marking time with Bettie's progress this whole month, her first at home from the hospital. It's not that there has been no progress...there has. But it has been greatly restricted by a recurrence of pain in the gall bladder area which has had her spending a great deal of time lying on the couch. This is time she could have been working on walking, right side movement, and speech. The issue has been that *#@ drain tube.

I had thought that as soon as the tube was removed (one week ago) everything would be wonderful. But as noted in the previous post, the rest of that day (Tuesday) she went straight down hill. However, by Wednesday morning there was vast improvement. Even more the next day and the next and the next. Each day there was some discomfort in the (former) drain area but not much and seemingly diminishing.

Then came yesterday (Sunday). She awoke with considerable abdominal pain and her blood pressure was up by 20 to 30 points (I had been monitoring it closely as Dr. Greenman suggested). I was able to contact Dr. Greenman and he suggested I bring her in to see just what was going on.

At Auburn Medical Center, Dr. Greenman did an ultra-sound scan and lab work. Though it is sort of frustrating to find nothing wrong, it is definitely good news. We came home after a mere 4 hours.

My daughter-in-law, Veronica's theory is, Bettie is healing slower than normal as a result of all her body has gone through. This is evidenced by the bruise that still appears on her forehead from her fall two weeks ago. If that still shows, it should not surprise us that her insides would be bruised too from the drain, and that has only been out a week. I think she's right.

Today (Monday) she is better, though there is still some pain in the affected area.

Everyone who sees her after an absence of a week or more sees improvement.

I'll just have to be more patient.

Maybe We'll Glow in the Dark

One can never know what might happen after spending a quarter-hour in a lead suit while X-Ray machines hummed away a few feet from where I sat watching Tuesday morning. Their job was to reveal Bettie's gall bladder on a video screen, just adjacent to where she was lying beneath those probing rays.

And reveal it they did. Well actually they were revealing a dye that had been pumped into the bladder. Bottom line, the bladder is clear and the drain, that has been troubling her for so long, can now be removed.

We were at Auburn Hospital again, two floors below where her home-away-from-home was for the entire month of July. That was a little after 9 O'clock this morning. With the drain issue confirmed, she was moved down the hall where a different imaging device assisted Dr. Gordon Greenman with the actual removal. The internist who we saw last week about having the drain removed (Dr. Donald Stephans) was in attendance too.

Update: A day after yesterday's appointments - on Wednesday morning - within about 30 seconds of each other, both Drs. Greenman and Stephans called me, just to see how Bettie was doing. It sure feels good to be in the hands of such caring professionals.

These things always have risks, and complications are not unknown, so we have to watch Bettie closely for the next few days to see that all is well ... but we're very glad to have that darn tube out of her tummy. That's got to feel better. We always take for granted how good feeling nothing can feel.

The tube out, we had time for just 30 minutes' rest at home before we headed out to Dr. Heide's office for a followup. Both he and his associate confirmed a lot of progress. This is the kind of progress that just sort of sneaks up on those of us here at home, and of which we are largely unaware because we see her every day. Tomorrow we go back to see Dr. Heide's so he can scan the area where she banged her head in last week's fall.

As if all of that were not enough for one day, we next went to the Anti-Coagulation clinic at Valley Hospital where her blood consistency could be checked. It turned out to be still too thick so I am going to have to continue a series of Loxenox injections into her abdomen twice a day, until her Coumadin level improves.

Gee, if it isn't one thing, it's something else.

Well, since she is hopefully headed for brighter days, I won't bore you with the follow up visits and tests she has been through the last few days, but it has been intense. Twelve separate appointments in just the last four business days. Enough already.

She's Got Gall...again

Well, to be more accurate, she's got bile again.

If you read the post from July 14 titled Two Steps Forward, One Step Back you may recall that Bettie had an incident with her gall bladder that required the insertion of a drain. The original prognosis was that the gall bladder was infected and should probably be removed. However, removal in that condition posed a higher risk than the surgeons were willing to take. It was decided that a drain could help clear it up sufficiently to do the surgery later...four to six weeks.

For the past five weeks, since the drain was installed, she has gone without bile. Bile is a digestive juice produced by the liver and stored, when necessary, in the gall bladder. (You don't want to know where or how this is "handled" when a drain is installed...trust me.) The bladder condition, the drain, and the lack of bile to help with digestion, has been somewhat debilitating for Bettie. Today we took what will hopefully be a big step toward solving this issue.

During a visit to the internist, the drain was capped, allowing that nasty collection bag to be removed. The "drain to nowhere" is still in place, but her bile and gall bladder should now function somewhat normally. Next week a couple of tests will confirm that all is well...and if so, the drain comes out and the gall bladder stays in. With that accomplished, we will look for more energy, no more abdominal pain, and an increase in the rate of progress...all good things

A Slow Week

Bettie continues to be troubled by abdominal pain, and it is definitely slowing her progress. We're not sure to what extant the pain is just from her gall bladder drain vs "other issues" she wouldn't want me to mention. Anyway, the net effect is she spends more time than I would like, lying on the family room couch.

When she is up and able, her walking is improving by the day. Many times I walk her to the bathroom, rather that wheeling her, and I can see definite progress. It's frustrating to have her down so much when I can see that with some concentrated work, her walking could improve vastly. Patience is the order here.

When she is down, we work on speech skills, word recognition, and small hand skills as she is able. We see progress there too. During "slow" times like these, it is good to keep in mind that from birth to death, the human body is engaged in a continuous effort to be well. Even while lying down, brain cells are working to restore function, re-make lost connections, etc.

Though the week was slow in terms of progress, she did have visits from all three therapists plus the home nurse. Tram, the nurse, suggested that we try to get the internist doctor visit moved up a week to look into the abdominal issue. We did that and will see that doctor on Wednesday.

Meanwhile, the family continues to refine the routine here at home, adjusting to new duties and requirements. On the three days that I go into my office, I awaken Jordan to come into grandma's bed when I leave. I get home a little before noon to relieve her. When school starts, the schedule will have me, with the blessings of my supervisor at work, working from home most of the time. Two days a week, Veronica will take a long lunch and come home to assist with Bettie while I go into the office for meetings and to maintain a presence with my co-workers. It should work fine.

To the ER...but Home Again

Today we "celebrated" the clot being gone by making a 4-hour visit to the Auburn Medical Center ER, where this whole thing began nearly seven weeks ago.

The gall bladder pain, described in the previous post, got to the point where it hurt her, even when she was lying down. That was the signal that Dr. Spens' nurse said should trigger a trip to the ER. (Of course the issue of pain is complicated by the fact that Bettie cannot accurately relate to us the severity of it.) Better to err on the conservative side, since we can't be sure. That's what we did.

In the ER, Dr. Spens visited us and told us the strategy: "We'll scan the gall bladder and be sure it is OK and the drain is properly in place. If all is OK, we'll assume that the pain is from the drain itself. After all, it is a piece of plastic rubbing on her insides and that is bound to cause some irritation. I'll prescribe a pain killer to help, as the drain needs to stay in for another two weeks."

And that's how it turned out. She's resting comfortably in the family room as I write, looking forward to Friday night pizza. Me too.

The Clot is :-) The Gall Bladder is :-(

Big news today: the clot is gone, I saw the evidence today!

We had our second appointment at Dr. Heide's clinic. First we spent nearly an hour with the dietitian, learning how to feed her to get her weight back up and keep her blood consistency stable. After that, we spent the better part of the next hour having her head examined, quite literally.

In a typical clinic exam room, she lay on the table with a crown-like gadget on her head, to which were attached two ultrasound probes, a left and a right. The technician aimed one probe at the vein where the original clot lodged in her left brain hemisphere, and the other at the corresponding vein in the right hemisphere (for comparison).

When he turned it on, we could watch, on a computer monitor, electronic depictions of the sound waves, picking up the blood flow through each vein. A sound amplifier and speaker completed the information flow.

The device ran for just over half an hour, displaying nearly identical pictures of flow through both veins, side by side. The flow sounded the same on each side, and the digital readout of volume was just very slightly better in the right (non-clot) side than the left. I asked the tech if he could tell how long the clot had been gone, but he could only guess that it was probably breaking up fairly soon after it first lodged there. No way to know. Many clots never break up.

Clear flow of blood, means that whatever cells in the clot area survived, should be able to return to good function. It also means good flow to facilitate retraining of adjacent cells. I may not be describing it in good doctor-talk, but any way you say it, it is good news.

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On the not-so-good side of things is this: For the last couple of days, by afternoon Bettie has been way more comfortable lying down that any other position. So you're thinking: "Well duh, who isn't?" But this is different.

Her gall bladder area seems to be giving her trouble each time she gets up, at least later in the day. I've talked to the nurse at Dr. Spens' (the doctor who is handling Bettie's gall bladder issue) office both yesterday and today. We decided to move Bettie's follow-up visit up by a week. She'll see Dr. Spens on Monday. Until then, she may be down more than she's up.

Comparing the two issues: No Clot vs (maybe) No Gall Bladder ... well, its a no brainer, isn't it?

What's This: Showering Together??

Bettie had another scan of the gall bladder area this morning...nothing unusual found. The scan delayed her breakfast until 10:30, so when I arrived with Jordan at 12:15, she was resting in bed but had not eaten lunch. I let her continue the rest and just brought her lunch in, and fed her in bed. She ate well.

Jordan was with me for some planned "family shower training". Yea...that's what I thought at first too, but it wasn't that. We simply learned how to use a shower bench to get Bettie in and out of a tub shower. She did the bathing, we did the helping. When she was clean and dressed, Jordy and I left her with the speech therapist.

When I returned for dinner, the kitchen was pretty quiet. We are in the midst of sort of a changing of the guard at Acute Rehab Center. Two or three patients were discharged today, and tomorrow Bettie and her roommate Katie, get their parole. Actually, it is kind of a sad thing to break up this gang. There has been a real spirit of camaraderie among both patients and staff. For example, meal times just are not the same without Sandy, a wonderful big-hearted woman who has moved on to an assisted living facility in Seattle. Sandy alwyas kept the conversation going and was a great "straight man" for Katie's humor. Bettie and I will visit Sandy soon to check out her new home and show off whatever considerable new skills Bettie has by then. Looking forward to that, Sandy.

I tucked Bettie in for what is hopefully the last night that we will spend apart for a very long time. Home tomorrow!!

The Countdown Begins

The countdown begins...today we started family training in anticipation of Bettie's return home.

My daughter-in-law Veronica, and my niece and nephew -- her two children (Jordan and Jonny) and I, spent and hour-and-a-half learning about speech therapy; plus, how to assist Bettie with walking and stair climbing. Then we checked out insurance coverage for and availability of home assistance devices at our local medical supply store.

There is still some issue in her tummy, but Dr. Sultana is having a specialist look into it, so I'll trust that they will solve it. At this point, it does not seem like anything that will interfere with her discharge on Wednesday. Hope not.

By dinner she seemed fine. She ate well and we had a nice goodnight with her in bed and me singing "True Love" (our song) to her. Sweet.

Today Was an "Other" Day

Some days are better than others. Today was one of the "others".

Being Sunday, there was no therapy scheduled. I was with her for all three meals, and she ate OK. But she was not very perky, and after lunch she began to have pain in her gall bladder area again. That persisted the rest of the day, and I left her with the nurse changing the dressing on the drain that is installed there, to see if that would help.

For most of the afternoon, our daughter Kim and our good friend: "the other Kim" were there to visit and hold her hand.

By the time dinner came, I fed her in her room as she didn't want to get up. I expect this issue will be resolved tomorrow, one way or the other. I'd rather report more progress than more pain.

Mission Accomplished

The gall bladder drain procedure that was scheduled to take up to an hour this morning at 10 a.m. It actually started at 9:50 and was complete by 10:20. The attending physician took longer to tell me about the risks and possibilities than he did to do the job. These guys are good. No complications, just ... well, drip, drip, drip.

Bettie will be spending the better part of the afternoon in her room, exploring the twilight zone. I'll return to her when she awakens, and report more this evening.

Two Steps Forward, One Step Back

So much for my medical credentials indeed. Yesterday I opined that Bettie's tummy upset was probably due to the fact that she has not been taking HCL with her meals. That may be a contributing factor to the real problem ... or maybe not. But the real issue, confirmed by the scan last evening, is a rather badly infected gall bladder. So much so, that is has to come out...right away.

I arrived at the rehab ward to find Dr. Sultana conferring with an internist, Dr. Spens. As I walked by, he says: "We were just talking about you." I'm thinking: "Gee, do I look that bad?" "Let's go into my office" he says.

For the next 10 to 15 minutes the two doctors outlined the situation: The gall bladder is infected, probably from a stone, stuck in it or the duct. Contributing factors might be not eating enough, not enough physical activity lately, or who knows what. Anyway, antibiotics are not a solution in its present condition. It needs to be removed. They outline the risks (they do that for every procedure) and the rewards. It's a no-brainer, though I asked a lot of smart sounding (naturally :) questions. Because of her atrial fibrillation, they need to stabilize her blood without the thinner they have been using, so the surgery will be at 10 a.m. tomorrow. I'll be there.

When we came out of the office, I found Bettie racing up and down the hall in her wheelchair, physical therapist jogging along side. Actually, she was making pretty good time, doing "sit-walking", with the foot rests removed. I was pleased to see the right leg taking steps almost as big as the left. Her session ended in a few minutes and I took Speed Racer to her room, where she wanted to lie down to rest.

I told her the news and just what to expect. She took it quite well, though I don't know how thoroughly she understood.

Just as I wrote the last paragraph above, the phone rang. It was Dr. Spens, informing me that after further examination of the scans from last evening, she (the doctor) thinks it might be better to hold off on the gall bladder removal surgery and just insert a drain instead, provided that can be done with no complications. Then in four to six weeks, do the surgery. This puts her at less risk overall.

I'll probably have more to report this evening. For now, tomorrow is probably not a good day to plan to visit, while this is being sorted out.