3.30 update (still in surgery)

I called the PA again for an update and the receptionist said she was still under the care of the surgical team (so either in surgery or recovery). She recommend calling back at 6pm based on the time Mum went in. That means I am going to call at 5pm. I will update again just after then.

Update on Mum's progress

I called the PA and Mum went into surgery at 12.10pm. She has not exited the surgical unit so is not on the ward. I was asked to call back in an hour (3.45).

Surgery day update

Mum has been taken into the surgery prep ward. She is expected to be called into surgery at about midday. She is then expected to be out of surgery and recovery (so in the ward) around mid afternoon. When I left I asked her not to bleed out. She said she would do her best.

I will call the hospital around 3 to get an update and I will post her status here.

Ps I have lost my car in the hospital car park so I may just have to wait around here anyway.

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The surgery clinic

Today Mum went to the surgical clinic to speak to four specialists: a surgeon, an anaesthetist, a pharmacist and a Nurse. Daniel and I were there for moral support, to ask questions and because we had nothing better to do at the time :)

Each of the four were considering different aspects of the surgery scheduled for tomorrow and were also there for any questions Mum or the family had. Here is a summary of the consultations:

Nurse- The nurse dealt with the administrative aspects of the surgery, including fasting before, what to wear, what not to wear etc. They also addressed how Mum would cope at home after surgery and said Mum will only be discharged when she can mobilise appropriately (can safely live in her apartment). Although Mum will be in substantially better shape than she is now, there will be recovery time where some domestic tasks which may pose a hurdle to Mum (cooking goes without saying but this is not related to her condition). The nurse was surprised that Mum has not been assessed after her first hospitalisation last month. After this consultation, Mum, Daniel and I decided we would talk to the hospital social worker early about domestic assistance and we would make it clear that Mum will not consent to a discharge without being appropriately assessed with the right level of domestic care in place.

The nurse was very caring and another excellent example of the Qld heath system (for all the flaws reported in the media, there a some amazing people working the system keeping it running for the benefit of the patients).

Anaesthetist: The anaesthetist is in charge of keeping mum under anaesthetic while in surgery as well as managing her pain post-op. He advised that the surgery will be close to her lungs which will necessitate a double barrel chest tube (so each lung can be independently fed oxygen and can independently collapsed to allow the surgeons better access to the site of the surgery). Apart from that, he explained that he will knock Mum out before the surgery and keep her out of it the whole time and that is what we wanted to hear from him.

He also walked through Mum's post-op pain management. Mum will be brought out of general anaesthetic heavily medicated so when she wakes up she will be comfortable. After a surgery like this, the two options that have been considered for Mum's case are an epidural and a Patient Controlled Analgesia morphine drip (PCA). The epidural has been ruled out due to the risk of haemorrhaging around the site of the needle. This leaves Mum with a morphine vending machine with a limitless supply of tokens. She will have a button that she can press to administer morphine when she feels pain. It will deny a dose where it exceeds safe levels but Mum has clearly been told to be aggressive with this. At the slightest hint of pain, Mum is to tap that PCA. If she does not, the pain may take over and it can be hard to bring it under control again.

Mum was not the best at calling for pain relief in her first few weeks of the disease so she is going to need to concentrate on this. If you speak to her over the next week or two, please do ask her how her pain is going (please do) as this reminder really helps. Remember, with the pain medication she is on, there is a level of intoxication that impairs her thinking (her pain meds are very, very strong) so these prompts are very beneficial.

He also considered the risks associated with Mum's blood thinning medication. He was satisfied that the risks were manageable but Mum made it clear her eyesight was very important to her and this was to be taken into account in treating her (i.e. get her back on the blood thinning medication ASAP as this significantly lowers the risk of Mum popping a blood vessel in the eye). They are expect to use frozen platelets during the surgery to reverse the effects of the blood thinning medication. They will conduct a blood test tomorrow morning (the day of the surgery) to work out her blood viscosity (INR) to make a decision on how exactly to treat it during the surgery.

At this point it is worth mentioning Mum's GM. His name is Stuart and when Mum was at an appointment with him on Wednesday, after finding out Mum's INR, he called the PA Surgeon right then to advise of Mum's VERY high INR (meaning low blood viscosity and high bleeding risk). Not only was his action great for Mum's piece of mind, but also was Dr Laherty's response. He said they would counteract this effect with frozen platelets and vitamin K. This quick response was very comforting indicating that he knew what he was taking about and also can think on his feet. Mum has been very lucky in the medical professionals she has been dealing with (with her personal GP being no exception).

Pharmacist: This was a straightforward. She looked at all of the medication that Mum is currently on and considered if it was going to impact the surgery or pose a risk. She found that Mum can keep taking her current medications without a problem (with exception of the blood thinning medication which she ceases on Monday night). This is good news as this consultation is usually about 2 weeks before surgery so this could have posed a risk of postponement as it was only the day before surgery (remember, Mum is being rushed through due to the risk of melanoma and therefore the need to remove the bone legion as quickly as possible).

Surgeon (neurologist): This was the money consultation. Although we had received a substantial amount of information at the consultations so far, this one was with the team who were in the drivers seat. He was a confident man with a sense of humour and it really worked well to provide us with confidence and also put us at ease (it was not the inappropriate humour that one would expect if he was a Young- which is a little disappointing).

He reinforced the information provided by the anaesthetist about Mum's blood thinning medication which is good. Neither are concerned about the risks because they are manageable. This was something I was worried about before but I really believe it is not a risk of concern after these consultations.

The operation will take a few hours but in total, Mum will be in pre-op, the operation and post op for about half a day. After this, she will be in recovery. If it does not go as planned, she may be in intensive care but this is a very low risk. So tomorrow Mum checks in at admissions at 10am and they take her to surgical care in prep for the operation. They also take blood to test her INR (blood viscosity) so they have the most up to date information to decide on how to deal with her higher bleeding risks.

So we can expect Mum to be out of surgical care and on the ward in the late afternoon or evening on Friday. From there, the focus will be on pain management (and Mum was advised that the aim is for her to wake up in a state of comfort through effective pain medication, basically a chemically induced Saturday night in the Valley). The next day (Saturday) Mum is expected to be out of bed and walking (although I cannot see this being a problem as Mum will be fighting for a nicotine fix well before this point). She will also have a fluid drain in her side for 24-48 hours.

Overall, the day was long but very comforting. We are under no illusion that this is not a significant surgery but from the consultations, it would seem that all parties have the risks mapped out and planned and Mum is in good hands. We are now at the point of crossing everything to bolster the medical team in any way possible- every bit counts.

We have some action

Mum had her spinal consultation today with Dr Laherty. His recommendation was that Mum have surgery on the fractured vertebrae to remove it and replace it with a combination of a cage (to replace the bone) and a plate to hold it in place. The plate will be screwed into the vertebrae above and below the cage.

The surgery is called a vertebrectomy and the purpose is to:

1. Relieve a significant portion of Mum's pain which is caused by the collapsed vertebrae and restore her spine's function allowing her to regain most of her movement (there will be some loss of flexibility from before the fracture but it will be largely restored).

2. Remove a significant portion of the suspected cancer that is in her bone.

3. Provide a viable sample of tissue to test so her disease can be diagnosed. This will allow treatment to be determined for the cause of the disease that is impacting her bone.

Here is an animation of a similar surgery that I found interesting. It is not a video of a person, it is computer generated images ==> http://www.youtube.com/watch?v=SYwPyoDIEfM

There is a chance the disease has impacted the pointy out bits on the vertebrae (they are called the pedicles) and if so, there may be a need to perform a follow up surgery to remove the pedicles. This needs to be done from the back rather than this side so cannot be done at the same time. It is hoped they are intact so this is not necessary. After the removed bone is tested, follow up treatment will be determined which is likely to be radiotherapy.

The expected diagnosis possibilities for the cause of the bone degradation are:

- Melanoma (suspected due to Mum's history)

- Myeloma (due to Mum being diagnosed with the pre-condition to this cancer)

- Osteoporosis (which is considered unlikely as the full body CT has shown no signs of other osteoporosis symptoms)

There is of course a chance it is something else so it is all guess work until the removed bone is removed and tested.

The risks of the surgery are:

- Bleeding due to Mum being on a blood thinning medication and also that melanoma is a tumour which has a large number of blood vessels (and this is one of the possible causes of the bone fracture). Mum has been taken off the blood thinning medication so this risk is going to be controlled as best can be.

- Spinal cord / nerve damage. There is a very low risk of paralysis and a small risk of nerve damage that may lead to numbness or tingling in the legs.

- Cord fluid leakage that can lead to increased recovery times.

- Other standard risks of surgery (the above are specific to this type of surgery).

The doctor described it as being a big surgery but not uncommon (and one they have the requisite skill to perform well). He also recommended that it is performed as soon as possible as if the cancer is aggressive, the earlier the better (this is a precaution in the event it is melanoma).

So the benefits of this surgery are it will fix Mum's pain (largely) and restore her back function. This will get Mum off the pain medications (at least significantly reduced) which will reduce the grogginess she suffers. Also, they will have a real sample of tissue to test for cancer so we will get a firm diagnosis. Overall, we think it is the right thing to do. Mum is scared and that is very natural going into something like this.

The details:

- We are going to the pre-admission clinic on Thursday at Midday. We will speak to a nurse, doctor, surgeon and anaesthetist. This is a chance to ask any questions we have before the surgery.

- The surgery is scheduled for Friday with the time to be determined at 4pm on Thursday (that is when the following day's surgery schedule is finalised).

If you have any questions at all, please post them to this blog or email them to me (myprivateradio@gmail.com) or Mum. We have our chance to ask them on Thursday so everyone's input would really be appreciated. This is happening really fast and we may not think of all of the important questions in advance of the clinic. I have update the blog settings so anyone can comment. Any well wishes you would like to offer would also be appreciated!!!

I will update the blog Thursday evening after the clinic.

EDIT: The recovery time for the surgery is hospitalisation for 1-2 weeks

Tuesday consult

We have been advised the spinal clinic consultation today at 2.30 will also talk through the results of the CT. I will update everyone on the outcome of this later today.

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No news is . . . . no news

Just a quick update to say there is not much to update. We are waiting on the appointment time on Tuesday for the spinal clinic and we are also waiting on the results on the full body CT.