Mom at Shands, 17 Oct

Hello all, Dr. Seeram came in at 1:45 to talk to Jonah, Ruth, Keeng, Lang, Peter, Sanford, Cara and me. She said the cytology reports are not back yet; they are expected tonight or early tomorrow. When the results are received the pulmonologist, Dr. Curry, will be by to examine Grandma and come up with a treatment plan. If the results are negative or inconclusive for cancer, it might be tricky figuring out what to do next. For a healthier patient a bronchoscopy would be recommended. However, sedation is required for such a procedure and the thought is that Grandma is too weak to tolerate it. The chest x-ray this morning was worse. Fluid is definitely reaccumulating. Because the way to drain the fluid is through use of a chest tube, and because the chest tube is an invasive procedure that caused Grandma pain the first time, we are holding off on doing anything about the fluid for now. Grandma is still breathing, though she is laboring more. At some point it may be necessary to drain the fluid, either for therapeutic purposes and/or to have more fluid to examine. Dr. Seeram mentioned possibly using a needle to do this rather than the chest tube. One of the concerns that had been raised earlier was whether Grandma's earlier fall could have punctured something, causing the bleeding in the lung. Dr. Vu showed us chest x-rays from earlier in the week, when the fluid was largely cleared out, revealing a good shot of the ribs. There doesn't appear to be a fracture. Had it been a trauma that caused the bleeding, Dr. Seeram would have expected it to have clotted. The reaccumulation of the fluid supports the theory that the nodules in the lungs are causing the fluid accumulation. Dr. Vu showed Cara, Keeng and I the CT images and we can see how the nodules are mostly on the right lung, which is where the fluid is building up. Grandma's electrolyte levels have improved with the addition of that treatment. Her levels upon admission were 111. Normal is 135-145. Dr. Seeram explained that a level of 111 achieved suddenly would put an otherwise healthy person in a coma. That Grandma was able to function with such low levels suggest that this decrease happened slowly, over time, by excreting sodium through the urine. She explained this is characteristic of cancer. Grandma is still groggy. Dr. Vu said that it could be the low blood pressure, or it could be that she is really tired. The breathing is requiring a lot of work, even with breathing treatments administered every 4 hours to clear out the brochial passageways. The doctors are having a hard time assessing mental status since Grandma does not speak English. I've mentioned Dr. Vu a few times here. He stopped by at 2:30 to follow up. At that time, Keeng, Lang, Cara, Sanford and I were the ones in the room. He repeated some of what Dr. Seeram had told us (though he said that the cytology expected tonight, pulmonologist will examine Grandma afterwards) but also showed us Grandma's radiology images, which I referenced earlier in this message. Love, Megan