Update from Megan, 16 Oct

All, Dr. Vu met with Dad, Ruth, Lang, Keeng and me late this afternoon. Because it was his first time meeting three of us, he began explaining Grandma's health situation chronologically. The problem that brought her to the ER -- fluid in the lungs -- made the doctors curious about getting a closer look at that area. A CT scan revealed several nodules. These sorts of nodules are usually indicative of metastatic cancer. The fact that the drained fluid was bloody ("malignant effusion") usually also indicates cancer. The fluid that was removed from Grandma's lungs is being studied to determine if cancerous cells are present. Dr. Vu did warn that sometimes the cytology is negative and further testing (biopsy) is the only way to really rule out cancer. For a patient of Grandma's age, physicians usually don't try to find the primary site; such information is helpful in determining a treatment plan, and the aggressive treatment that is necessary to attempt to eradicate cancer is not appropriate for someone who is already frail because of advanced age. Over the past day the amount of IV fluids that have been administered to Grandma has been reduced; the concern was that it was more fluid that could later make its way to the lungs. The potential consequence was lowering of blood pressure, but Grandma's BP has been ok today. Dr. Vu said that Grandma's heart is "pretty good for her age". He had theorized that a weak heart could contribute to some of the fluid buildup (not processing efficiently) but that does not appear to be the case. One of the symptoms that Dr. Vu is monitoring closely is Grandma's mental status. When she was first admitted she was very alert, but has declined. He explained that is a result of the lowered BP... the brain isn't getting the profusion that is required. It explains why she is sleeping almost all the time. He recapped yesterday's conversation with Dad in which they decided against medication that can raise BP, since it can result in problems with the extremities. The medical staff have been developing cultures from samples of Grandma's blood, sputum and urine. So far no infections have emerged, though Dr. Vu said it takes five days for the cultures to develop fully. But at this time it doesn't appear that Grandma is suffering from infection. Keeng asked about pneumonia and Dr. Vu said she definitely does not have pneumonia... the fluid that came out of the lungs would have been milky and they would have seen infection in the lab very soon. Right now Dr. Vu describes his approach as "conservative management". He is giving her breathing treatments, antibiotics on a prophylactic basis to prevent infection, and fluids to keep up blood pressure. Megan