From Barbara:
Thank you all for your good thoughts for Greg during his Whipple procedure, which lasted for 9 hours yesterday.
The surgeon (Dr. Tara Kent) reports that all went well and that they did not find anything unexpected. After they removed the tumor and harvested a bunch of adjacent lymph nodes, they paused while an on-the-spot pathologist examined the margins of the specimen to check that the margins were free of cancerous cells. Apparently his passed the test, so they were able to move on to the second and more challenging aspect of the procedure--reconnecting the now diminished parts.
Good news - the pancreas looks normal, which gives Greg a leg up in the recovery process and ultimate resumption of more normal function. Bad news - the consistency of a healthy pancreas makes it a bit more difficult to work with (I find this aspect of things quite unimaginable), which may have contributed to the length of the operation.
Bad news - the bile duct is still very distended from the obstruction. Good news - this actually made it easier to work with.
Today was Day 1 of what is projected to be an 8 day hospital stay. He is still affected by the anesthesia and obviously is in pain, but for someone who has just undergone such major surgery, I think he is doing appropriately. He is equipped with a pain button he can push as frequently as every 6 minutes, which delivers a dose of nirvana, or at least something that removes the edge somewhat.
The nurse announced mid day that he needed to get up and make it into a recliner type chair, where he was to remain sitting upright for an hour. This helps clear his lungs and get the blood circulating. They gave him an hour's warning so he could gear up, both in terms of loading up on the pain med, and just getting psyched. When the time came, he accomplished the task with less pain than he expected, and was able to attend to a couple rounds of two-handed bridge before declaring exhaustion and the need to return to bed and sleep. Not bad for day one.
Currently he has tubes draining secretions from all organs involved in the digestive process that were affected by the surgery. He will not be able to take anything in orally for several days, and they are only providing electrolytes intravenously....no nutrition, as these organs need to heal before being asked to do any work. He will lose a lot of weight. Unfortunately, I will no doubt pack on those pounds, as I do my duty, eating for two.
I've requested a private room for him should one become available, as currently he is sharing a very small room. There was barely space for me, given all the equipment he is attached to. It will be best to postpone visits for several days....probably until at least Monday, though if he rallies sooner, I'll let you all know.
The big danger now is clots. They are walking a fine line, as usually they do not start blood thinners immediately after surgery: obviously the organs need to heal. But with his history and such a long operation, they have already begun administering anticoagulants.
The other unknown is the full pathology report on the specimen they removed. This we will not have for a week. Meanwhile, we very sincerely thank you all for your love and concern. I'll try to keep you up to date, but Greg usually posts the blog from his computer, which is in Stow. I continue to stay at Brian/Bridget's house in Jamaica Plain. I am counting on Brian's wizardry at the computer to get this out somehow!
Barbara
Day of the surgery, recovering in the PACU
I'm unable to hack into Greg's account to post this, as I no longer have access to his phone, and he has 2-factor authentication. So, here's the latest update from Barbara from ~2pm today (Saturday). Presumably there will be an actual update posted tomorrow.
ReplyDelete-Brian
This is Day 3 following Greg's Whipple procedure. Gradually the number of tubes supplanting or providing support for various life-sustaining systems are being removed, as Greg begins the slow transition to his newly structured body. Gone is the oxygen tube, the dreaded catheter, and various other lines into vacant spaces remaining on his arms.
He is very tired and sleeps a lot. By far the most uncomfortable aspect -- other than the surgical site itself-- is the NG tube, which snakes through his nose, down the back of his throat and into the stomach. The purpose is to remove any secretions that are naturally generated by the stomach, even in the total absence of any food or liquid. The tube irritates the back of his throat and vocal cords, making it painful and difficult to speak. Normally the tube is scheduled for removal on Day 4, but it depends on when the production of secretions slows sufficiently that the body can deal with absorbing them naturally. Once the tube is removed, he can begin with small sips of clear liquids, increasing the quantity and variety of clear liquids slowly each day. Needless to say, we are hoping the tube can come out on schedule, tomorrow.
We are waiting for someone from the anesthesiology team to come by to evaluate whether this is "normal" discomfort or something more. Last night, Greg was running a bit of a fever, always a concern for immuno-compromised bodies, so they are watching that, as well as redness which has shown up around one side of the sutures. Blood tests do not seem to indicate the presence of any infection, thank heavens.
Keeping his lungs clear is difficult, as coughing is painful. He is supposed to use the spirometer 10 breaths every hour, but he is not keeping up with this, since it is painful to do. Needless to say, my nagging is ineffective.
What he is doing well is walking. Yesterday he managed two corridors, today he totaled four. He is supposed to "ambulate" twice today, so perhaps he can do this when He receives his first real visitors (other than myself, one from Brian and one from sister Margo). Andrew and family are arriving from Vermont later this afternoon. I will entertain kids outside somehow while they get to see Dad. Even Bridget has yet to visit the post-surgical patient. Since he rests/sleeps so much of the day, and talking is painful and difficult, it is still best to keep visits to family only. Once that tube is removed, I hope he begins to rally and feel a bit better.
This is not the start of the week we had planned...everyone took this next week as vacation so we could all spend time together on Cow Island. Brian arranged to have his house scraped and painted during his time away...I believe the boys, their families and dogs are going to go to the island after tomorrow morning's visit, to salvage some family time. I will stay in Boston with Greg.
I will definitely let you know when he can speak comfortably on the phone, and when it is appropriate to have visitors. Meanwhile, thanks again for all your good thoughts. I hope I do not go into too many gory details (believe me, I am leaving some out), but I do find many aspects of this complicated medical venture very interesting.
Shall we say how grateful we are that we have medical insurance? Especially as this is not the result of bad behavior or poor life style choices?
As we were warned, this will be a long recovery.
Barbara