Chest Tube is out

Chest Tube is out, actually more like side tube. The hospital folks remove the chest tube early this evening about 7pm Thursday 6/28/07.

This means also the nurse are getting Heidi ready for discharge by decelerating the pain management via the epidural. Just like one of those long jet plane ride, the pilot slowly lowers the plane from high altitude to lower altitude so the passenger can get use to the pressure [ear]. In Heidi's case however, the nurse are slowy lowering the doses of pain medication from 14 cc (thats metric folks) down to zero (i guess) by 0.5 cc every hour. I forgot to ask the nurse what the unit time for 14 cc (per minute or per hour).

What i dont understand is that every time the nurse lowers down the medicine, Heidi uses her clicker to get more intake of the pain killer - she basically overrides the automatic fluid flow.

For a while early this evening, she had this bad hiccup and she couldn't talk becuase it hurts her so much.

I went for a walk with Heidi around the hall corridor. She even lapp some other fellow, and he had a helper carrying his oxygen; while Heidi had hers on wheels. At one point Heidi got mad at me for slowing her down because i keep on stopping reading the factoid on the walls. One factoid say: the blood vessel is 60,000 miles long enough to go arround the equator two times. Another say the blood circulate around the body in 20 seconds. Now i wonder if that means the blood circulates 60,000 miles within 20 seconds.

I heard that people around the world come to UCSF for treatment, and this must be true because when Heidi and I were going to her pre-surgery appointment they kept on asking us if our hotel is nearby. And Heidi would politely say something like "Oh no we leave accross the bridge, and didn't have take a plane or something, we just have to ride the traffic."

So with that in mind, I expected Heidi's roomate to be someone from a very far place. Nope. Her roomate lives on on West Avenue which is a few blocks from our home in Hayward, California.

I ask if the result of the biopsy was available, they said it will probably be ready by early next week.

Heidi told me that since the chest tube is out, visitors are now welcome.

Thank for your continued prayers. Please keep on praying for Heidi. Some say that Heidi's surgery is sometimes more painful than an open hearth surgery. Thats probably becuase Heidi's was "open surgery".

Folks, that's all for tonigh'ts report,
Lawrence

Heidi is out of the ICU

This afternoon (Wednesday 6/27/07) Heidi was transfered from the ICU to the regular hospital. Most of the tubes that were dangling around her body were removed, but not all. She stilll have the chest tube coming out of her left side as a drainage tube; and she still have the catheter, epidural and other tubes and monitoring devices hook up her still.

Via the epidural, she's taking Dilaudid with her thumb self-click. The ICU nurse explain to me that Dilaudid is 10 times more powerful than morphine. She is also taking Thoradol; which was approved override by Dr. Kukreja because the other pain doctors would not approve more than one dose. I am told that Thoradol is like 100 times more powerfull than Ibuprofen.

Yesterday, Tuesday morning, the doctors were concern that they may have nick into the esophagus because Heidi's pee were not at the level that it should be. So they did some "live" xray for which she had to drink some bitter medicine and some bromide. The xray ruled out the possibility of cut on her esophagus because it was not leaking.

Heidi and I meet Dr. Jasleen Kukreja a couple of weeks ago for the pre-surgery meeting. My impression of her was that she really knows her trade like a good car mechanic knows the problem of a car by the sound even without opening the hood. She answered all our questions and not just the way she spoke with confidence but the way she answered it made me feel she really knows her stuff. On the way home that day, I even mention to Heidi that that doctor knows her stuff. Something about her not throwing in big words and instead use layman terms. And when she did use some not so common word, she immediately followed it up with an explaination. Or, she'd say "i am not explaining this well", and she explains it differently. She was not cocky.

I just google her name, and she is some "rising star" in her field.
http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/02/11/CMGDVNKA3H1.DTL

And for those who want to see the "puppy" (warning: do not click if you don't want to see blood)
click here (if you can't see the puppy, send me an email):
http://cache.pando.com/soapservices/Package/package.pando?id=8E7A810A82D89EB4DB9B67E08CB9D2D11416A796&key=12A9BD88D524A9FCF30B26B05525A73B4181785BF1F64BAAF121DC62C3971EF5&tt=S2W&embedId=1F087B7096DC1C7AF99E25401CF628A7

2nd blog for Heidi,
Lawrence

Surgery Day

The Thoracic Surgeon abandons thoracoscopy procedure after a couple of hours of maneuvering her tiny cameras and hers tools of trade within the 3 to 4 inch incision. Dr. Jasleen Kukreja goes for the full open surgery at below Heidi's left arm pit and between the ribs so she can remove this one large "puppy" the size of tennis ball and golf ball combine.

I asked Dr. Kukreja how big the cut was and she motion with her fingers (pointing to her pinky and her thumb) the approximate length which i guesstimate to be about 9 to 10 inch. She said she tried really hard to get that puppy out using thoracoscopy but the mass was hard-firm to touch and difficult to maneuver her camera. Her original plan was to go in there, bag it with plastic bag and squeese it out of a small hole incision . Due to difficulties, she went with the second option by way of open surgery. This way she did not break any ribs nor cut any ribs.

Heidi checked in 6am Monday 6/25/07; and, at 7:30am she rolled into the surgery room. By 1:35 pm the surgeon handed me a picture of the "puppy" that she got out. Earlier when Heidi (and Caleb) requested a piece of the mass to take home to look under our microscope, the doctor look at her funny becuase nobody else has ever asked for sample. Heidi thought its kinda like when you take your car to the mechanic, you can always or at least the customer have the right to ask for the old parts. But because of some bio-hazard health code regulation, the next best thing was a colored picture.

At the previous office appointment, Dr. Kukreja said there was 20% chance that she may have to call in a Neuro Surgeon if the mass is wraped into the spinal chord areas. Dr. Kukreja did not have to call in the Neuro Surgeon. And she got it out.

However, the surgeon said because of the open surgery, the location and how big the incision was, Heidi will have some [BIG] pain. Later Heidi ask the surgeon about recovery if these was the 5 to 7 day hospital stay recovery as oppose to the 4 to 5 day hospital stay recovery for thorascospy - the surgeon responded by saying " we'll see..." . I think the surgeon did not want to answer becuase i think the surgeon did not want to plant in Heidi's mind that the hospital stay could be longer than 7 days (plus the weeks and weeks of home recovery) because its an open surgery.

The hospital finally let me see Heidi at the post-op room at 4:30pm. She had tears in her eye because the pain management doctors could not figure out how to relieve the pain in her shoulder. Heidi have epidural in her spine and a clicker on her right hand so she can self-click to control the pain from her chest area down to her odomen areas, but not the upper shoulder. The doctor tried one dose on Toradol and that did not relieve the pain. Maximum of one dose of toradal was allowed because possible side effect was bleeding - and doctors don't want bleeding.

Heidi is allergic to morphine, so that option is not available.

At about 9:45pm they move Heidi to the ICU (10th floor for cardiac, lung and vascular). I came in to the ICU about 11pm and they were changing her bed sheets. Heidi had to roll as much as she can to one side and she was in BIG pain while she rolled over.

Some of the side effect on the pain medication or whatever the anesthesiologist (i think that was the nurse said) gave her causes constipation. So, the ICU nurse give her some drugs to counter act the constipation.

Even though Heidi had not drink liquid since the night before, she has IV for fluid intake and the ICU nurse were a bit concern that Heidi's output (pee) level were not as expected. They then took some blood sample for testing on why her pee is not at the level they expected. They also flush her catheter.

As i left to go home at about 12:30am, i could see Heidi's skin below her throat areas shaking (vibrating) from pain in her shoulder.

And for the folks, friends and families reading this blog: Please pray for Heidi for relieve from pain or at least manageable pain at her left shoulder; and, a quicker than typical recovery from an open surgery. And for the other pain management to continue to work. And for the nurses and doctors to be always at their peek performance skill level and be able to make the right call/decision at the right time. And for the nurses and doctors to be attentive to Heidi's needs.

writing in for Heidi's blog,
Lawrence

Thank you in advance

“The LORD will keep you from all harm— he will watch over your life; the LORD will watch over your coming and going both now and forevermore.”- Psalm 121:7-8

Thank you for puting my mind at ease and helping take care of my children, feed them, play with them. I can work on my job of taking mind altering drugs and healing:)

All set for surgery! And away we go!

After raw few hours of being overwhelmed yesterday with three demands, everything is coming together. Many of you have signed up to help with childcare, and bringing meals. Knowing my family will be fed is a big load off, and knowing Lawrence will not be on 24/7 is big too.

The pulminary function test is on Wed at 2p. Pre-op appt is on Friday at 830a and surgery is at 6a Monday 25June.


UCSF Medical Center at Parnassus
505 Parnassus Ave.San Francisco, CA 94122(for mail use zip code 94143-0296)
(415) 476-1000


If you are available to bring a meal or be on call for childcare, please email me. Therese is coordinating and will call to arrange dates.

You are welcome to visit me in the hospital un-announced or announced, as I will likely be just hangin' around by an IV:) If you want to do more than sit with me, we can take a walk, yes that's encouraged! If you're a touchy feely type you could rub my feet, my hands, massage my scalp, or just talk with me. I only mention things to do since I usually have no idea what to do or say to someone in the hospital who's gone through surgery. Sitting and talking is a wonderful gift. Reading the funnies from Readers Digest, or other, is a fun way to spend time also.

If you want to bring me a meal, I'd welcome that too. Homemade, restaraunt... Hospital food has some deficiencies, though it is great to be fed and not have to lift a finger to prepare it! I like Thai food, spicy food, vietnamese food, mexican food, middle eastern food. I especially love veggies and fruit and salad, romaine lettuce my fav. I'm pretty open palated.

I have had my eyes open to many things. I have a pretty deadpan sense of humor, and this is just fuel for my humor. No need to feel pitty, or feel you have to put on a somber face. I am very comfortable with what is happening to me, not that I won't be in pain and on drugs:)

This whole experience has been a catalist for fast personal growth and I truely see it as a good thing in my life. This is an 'information package' that I no longer need, so good ridence, and thank you for what I have learned. The Lord has sustained me through your prayers. Where 1 or more are gathered together in my name(Jesus) I am there. So many of you have lifted me to the Lord in prayer and without that, I could not have the peace I have.

I am so thankful for the health I and my family have. This type of experience really puts that in your face. (Being pregnant does too, at least for me:)no I'm not pregnant, I'm just saying)

THings to pray:

• For Silas to adjust, be busy, have fun with life, not tramatic
• For all of my family to grow from this in charicter, deepen their faiths now or in future because of this experience.
• Peace between all of them, support eachother, get along, resolve conflicts on own
• Breakfast and lunch every day
• health

For me:

• IV's to be done skillfully and not hurt
• For doctor/s: health, focus, simplicity, attention to detail
• no long term damage, nerve and all else

I can't think of anything else. I'm sure you can. God sent his holy spirit to interpret our prayers, in groanings and utterings too profound for us to understand. So just pray anything. God knows better than I/we what needs to be done.

Above all else, I want Gods glory to be reflected and seen through this experience. He is truely worthy of my praise and worship. Every good thing comes from him.

Surgery date set :-o

Now it's getting real! My pre-op appointment is Friday, 22June @ 8:30a. For those of you, who, like me think that is next month, that's this Friday! Surgery is scheduled for 6a Monday 25June.

Of course this experience wouldn't be complete if there wasn't some kind of wrench in the works. I have to take a pulminary function test before this date. There are no appointments, available, so surgery will be cancelled if I cannot get one before surgery! I have a pretty high tolerence for stress right now with all of your prayers, but this makes it stressful for me.

Please pray for a quick cancellation or not needing pulm. function test or ????? Please and thank you for bringing me before the Lord in prayer. We are really going to need to be carried by your support through these next 3-4 weeks.

After the Pre-surgery appointment

Ok, first things first. I just read the Pet-scan report. The biggest thing I was hoping for was for the mass to have shrunk.The measurments of the tumor can vary based on how it is measured, but...... new measurments are: 6.3 x 5!!! Origional measurements were 6.6 x 4.6 x 9cm in the MRI from March 21. similar measurements from March 12, 8.4 x 4.1 x 5.4 Variation based on exactly where is measured, who is measuring. The most recent report says not significant change, but I'll tell you, to me this is significant. There has been much work, prayer and more in my life that I attribute this change to.

On to what you're wondering about, the Thoracic surgeon consultation today. This was a pre-surgery meeting. She answered 90% of my questions before I even asked. I did ask for the tumor, or if I could at least see it. She said that was a first for her:) She said she'd try to take a picture, if the equipment was working, if the wind blew from the west at 50 knots and it rained at 10a. So I doubt I will get to see my companion. So long little guy. Thanks for what you taught me, glad you're out of my life.

We're looking at the next 2 weeks or so. THis is very soon! The goal and expectation is that this will be thoroscopic surgery, like laporoscopic, but in the chest cavity. There would be 3-4 incisions, a bit larger than with laporoscopic due to bones and the torque of the instruments. There is a chance of numbness in those areas, we'll pray not permanent. Other misc. info, not for the fainthearted:) Main surgery will be from my side. The largest incision will be on the back, and is expected to be the removal site.

Hospital stay will be 3-5 days if all goes according to plan above, and if neurosurgeon is called in, will require more things not for the faint hearted. I love all this biology stuff, so if you are interested, feel free to ask and I'll be happy to share all the future gore with you:)

If thoroscopic doesn't work out, hospital stay would be 5-7 days. Healing time at home for either way will be approx 2 weeks on pain meds.

At this point, the Lord has been so good to me. He has given me so much grace. I pray the grace my children need to not just survive while I'm gone, but to thrive will be given to them as well.

I plan to 'read' lots of books on tape/cd. So if you have some cd's, books, music you'd like to share with me for my enrichment at the hospital stay, I would be very blessed by them. Be sure to put you name on them so you will get them back afterward. My mind will be drugged out a bit to remember what came from whom. If you have a tape/Cd player walkman/ earphones I can borrow please let me know. This will make the hospital stay a better time. Almost a trip to Calistoga, ok not even close:) But much better.

Lawrence, Caleb, Malachi and Silas are going to have the toughest time with this experience I think, so please remember them in prayer, and if your local, and so inclined, drop them a meal with-out cheese:) My biggest challenge with the surgery is leaving my family without me. A blessing and a challenge. I have been going out on my own much more lately, so I'm not completly without practice as you may think.

As soon as I have a date for surgery, I will post it. This will be at UCSF. I will post all info, address, phone number, etc... I welcome unannounced visitors, calls, meals etc... while I'm in the hospital. I doubt I'll be too busy in the middle of my gimping around:)

Radioactive milk

In the interest of keeping Silas from getting Radiation poisoning, I had to watch him sadly fall asleep without nursing. After what seemed like hours of inconsolable screaming in the middle of the night, I decided to rewire his brain and turn the T.V. on so I could get some sleep. It worked for a while. Once my back was stuck in a sideways position, I picked him up to bring him to bed upstairs.......screams..... It was a hard night. This was pretty close to the age when I night weaned both Caleb and Malachi, but I don't have the motivation of an impending baby to give me the willingness to go through this more than 1 night!

I went to my moms to pump to releave myself. I had no idea I had enough milk to be this uncomfortable, I hadn't nursed since Tuesday morning. There's nothing to make you feel contaminated with radiation, like having to throw the containers away as well as the milk.

Training Complete!

I've now had several cat scans, MRI, X-Rays, and now a Pet cat scan. I've completed training on all scans:)

After filling out my paperwork, I received a beautiful bracelet for my stay. I went into a small room with a big blue throne. Even had a pillow for my arm. After looking over my veins for several minutes, the very personable Tech hooked up the IV. Have to say, this was the best IV I've had. Least pain of other sticks, and no bruising even now. I wish I could remember what it said on his nametag. Radioactive something. Very cool title. First, saline injected via IV, then after a try at drawing my blood from the IV, he had to stick me:( Checking glucose level. If level is too high, as with diabetics, the scan will not work. Then he injected the radioactive isotope florine 18 with glucose. This radioactive isatope was brought into the room after all the prep was done. It was in this metal container marked radioactive and injected from there into my IV.

After this I waited in another room for 45 minutes so the glucose can begin to metabolize in the tissues. Info on the bottom of this entry about pet scan and more info. Next I was brought into the room with the cat scan equipment. The Tech, Michael, very kind, enjoyable even, got me set up on the bed, if you can call the long plank a bed. 1st there were x-rays, then cat scans and lastly the pet scan which lasted 35 minutes. Lawrence was able to be in the room for the petscan portion.

After the pet scan they gave me water, and a granola bar! Who ever heard of such a thing! How nice. All around, best customer service in a medical situation I've encountered.

I can't nurse for 24 hours, so that takes me to 2p tomorrow. Poor Silas. He was so sad tonight when he couldn't nurse to sleep. He laid under the piano bench gently crying face-down on the carpet. So sad. He didn't cry and scream, but morned.

Positron Emission Tomography (PET) which is a more precise and sophisticated technique using isotopes produced in a cyclotron. A positron-emitting radionuclide is introduced, usually by injection, and accumulates in the target tissue. As it decays it emits a positron, which promptly combines with a nearby electron resulting in the simultaneous emission of two identifiable gamma rays in opposite directions. These are detected by a PET camera and give very precise indication of their origin. PET's most important clinical role is in oncology, with fluorine-18 as the tracer, since it has proven to be the most accurate non-invasive method of detecting and evaluating most cancers.

Pet scan rescheduled

My insurance denied the pre-authorization for the pet cat-scan. I was in the middle of another busy project, and had to add dealing with calling. I finally found a wonderful, helpful person, Aurelia(please pray for her to be blessed and to know Christ). Unfortunately, after an appeals proccess yesterday, I was denied again.

Had to cancel my appointment 6p last night. At least I didn't have to get up for a 7a appointment. I did get a call today around 12n that after my doctor called this morning, that I am now approved! SO, the pet-cat-scan is now scheduled for June 12, at 2p. Then on Friday, June 15 @ 12n I meet with the Thoracic surgeon to go over everything.

Will keep you posted as I find out any new news.

We put a bid on a cool house in Castro Valley, there was another offer, without the contingencies we had, so they are making a counter offer to the other people. Bummer, but that free's up some brain cells for other life. The timing wasn't great, but it was a great house, one that doesn't come up too often. Since we didn't get this one, I'm sure God's plan for us is amazingly better. It would have been good, but we wait on the Lord, his plans are immeasurably better than any eye has seen, mind conceived...