Update from Megan, 18 Oct

All, Today at the hospital I received some informal updates from Dr. Seeram. The cytology report is still pending. However, the pathologists and physicians are studying the work in progress and continue to believe that this is lung cancer. I saw today's chest x-ray and can see the fluid has continued to build in the right lung. It looks cloudlike and obscures the ribs. You can see how abnormal this is when compared to her left lung. Grandma's breathing is becoming more labored as a result. Dr. Seeram has ordered a pigtail catheter to be inserted tomorrow. This will drain the fluid into a bag that the nursing staff can empty. The insertion of the catheter is facilitated by use of a CT scanner, so I'm sure you realize that this is not a simple intervention. The typical treatment would be another chest tube, but Grandma is not strong enough for it. Dad has described Grandma as being alert, but I feel that further explanation is required for those of you who have not been present to witness her decline. Grandma is very rarely in a state of wakefulness. She only responds when spoken to both loudly and insistently. Her communication at that time is usually limited to slight head motions to answer yes or no questions. Sometimes she cannot even do that. Occasionally she makes repetitive grunting/moaning sounds that we believe are meant to be complaints. When she is asked what is wrong she just continues to grunt. Her eyes are hardly ever open. This is why the fact that she was able to speak briefly to the newly arrived visitors very surprising and made Dad characterize it as "very alert and talkative". In the sense that this is atypical, Dad is correct. But you should not mistake this for Grandma being at all herself. Grandma has also been refusing nearly all food. There are a few medications that are in pill form that are broken up and mixed into applesauce for her to take. It has been a struggle to get her to swallow the three or four spoonfuls of applesauce that are necessary for her to get her daily Synthroid, aspirin, and Nexium. Dr. Seeram suggested that we try Ensure, which would provide 250 kcal per can. However, Grandma was not able to suck it up through a straw, so Dad and Uncle Keeng were given wide syringes as I was leaving tonight that they were going to use to squirt the food into her mouth so that the only work she needs to do is swallow. There are some health notes to mention that I'm not sure have been covered in recent emails. One, the echocardiogram revealed Grandma's aortic valve to be narrow and therefore less efficient at pumping blood. Two, her blood pressure, while stable, is still low. The aortic valve is probably a major factor in that. Megan