Post- Op Note

Well, Leenie was finally released from the OR and is awake and progressing in stages to where all tubes and oxygen devices can be removed.
She complains of pain at the mediport insertion site - which is perfectly normal. She has received pain meds and has a prescription for oral medication at home. Her Heart Rate, Blood Pressure and oxygen saturation are good. She has no recollection of the OR so she must have responded very well to the general anesthesia.
Dr. McGraph came in to speak with Tim, Leenie and me. He was very kind but straightforward. The frozen section revealed what is called "Non small cell" carcinoma of the lung. He was able to retrieve large chunks of several of the affected lymph nodes and the cells from each were included in the frozen section. Now it will be placed in Dr. Cross' capable hands. First, the biopsies will go to the lab for a variety of staining procedures geared toward narrowing the diagnosis from non small cell to a specific type of non small cell carcinoma. Once that determination is made - probably by Friday b/c there is a temporal element to each testing procedure - Dr. Cross reviews the data.
When Dr. Cross is satisfied that he knows precisely what type of lung cancer Leenie has, he will select the chemotherapeutic agent that is specific to only that cell type and implement a regimen of treatment which includes, dosage, frequency, duration of treatment; additional follow-up testing to determine the efficacy of therapy; adjunctive medication predicated on the findings of the follow-up testing and, perhaps most importantly, in what way(s) has her clinical picture changed, ie, is she becoming weaker, showing signs of improvement and if so, in what areas; the status of her nutrition based on blood work and THE CLINICAL PICTURE. You can have great, textbook lab results but clinically demonstrate an obvious need for something to increase strength, comfort, mental clarity and the presence/absence of a developing secondary infection, ie, urinary tract, sinusitis, etc from a compromised immune system.
It will be a minute by minute, hour by hour (you get the picture) progression with signs and symptoms that require investigation/treatment or, just a slow, uneventful course of very gradual improvement. Needless to say she will be closely monitored. But she must also be evaluated mentally & spiritually by those who know and love her best such that we can provide appropriate support and advise the medical team of changes that, were they to know her as we do, they would address.
For now, the next few hours are going to be rough re: physical comfort/healing from an invasive surgical insult AND digesting the words spoken by Dr. McGrath. There was no element of surprise but the reality of hearing out loud from the man who has just experienced with all of his professional senses/experience the reality of Leenie's illness and announced it with great dignity, respect and care that one could possibly have hoped for, is sobering, frightening, yes, but, with time, will echo in her mind and give her the strength and fight that we all know she has to address this announcement head-on - and with the help of God and her God-given abilities, STRIKE BACK, NOT OUT.
Knowledge, the biggest hurdle, is behind us. We know the enemy - a disease to be cured, not a state of fear, confusion and impotence.
Let's move on with confidence and love - and, yes, a few toasts to the future.
Till tomorrow,
Lorane & Tim
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We're Off. . .

OK guys,
Mom just went up to the OR. The OR next to the valve case became available and they will be getting her ready for Dr. McGrath in there. So the timetable has changed:
When valve case over, Mom's mediastinoscopy will begin.
It will probably take from 12-2 hours.
Dr. McGrath said that if, in phase I, checking all reachable branches of her airways, he finds a node, he will take it for study.
Then he puts the scope with the "pac man" biter into the mediastinal space and retrieves 1 lg, entire node & several chunks from surrounding nodes.
Finally, he places the mediport under the skin around the R clavicle. It will be filled with heparin (blood thinner) as the body reacts to anything foreign/plastic by clotting.
Once that's stitched into place, she will go to recovery where he anticipates 1-3 hrs. to have her wake up, remove breathing tube and reach a point of alertness/stability such that he can tell her what he found & discharge her. Tim will be here with me to take her home.
She's still scared but wants to get it over. By now, they've given her some "feel good" meds IV in preparation for anesthesia so she's a happy camper.
It's OUR turn to work - PRAY!
Lorane
,

Tuesday at the Heart Hospital

Arrived & met with Dr. McGrath. Leenie extremely frightened and nervous. Unfortunately, a young man who needs a new valve stat will be first. Leenie has had blood work and an EKG and will now rest until she is called for surgery at 2PM. Dr. McGrath says if an adjacent OR opens up while he is closing the young man, they will bring Leenie in and get her medicated & ready.
ISSUES:
'To answer some questions/clear up misunderstandings, Leenie has around 10 ENLARGED lymph nodes. Lymph nodes are the body's sewer system and should not be enlarged. As the doctor said, when you hear the sound of running hooves, think horses, not zebras. So the enlargement tells us that the lymph nodes have been invaded by a disease. When he gets his large samples today, they will do a frozen section and be able to tell us that she has a particular kind of cancer - based on the shape of the cells.
' Then the path lab people will begin their studies involving the reaction of these cells to various stains and media, the end result, hopefully, identifying the source of the cells or the primary site of the cancer.
' Finally, Dr. Cross will take this information and select a chemo drug and protocol that will kill these particular cells beginning Monday.

As for today, Dr. McGrath expects that his surgery will take approximately 2 hrs. and that she will be able to go home this evening. I think the hardest part for her is from now until 2 PM. We can only hope that she will fall asleep in a "quiet room" with a warm blanket & no cares.
Philip will get Tim from the airport and bring him here so he can see Mom when she wakes up.
Till later. . .
Lorane
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