Sunday, June 17, 2007
Autoimmune Cirrhosis?
Dr. Barnes brought up with me the topic of autoimmune cirrhosis with respect to possible genetic instances--since I don't have the usual symptoms, but I have very little info on my ancestors' health problems--as in the case with Dad's and my generation. most people died before the health issues we have had a chance to show themselves. Barnes obviously is an expert on PBC, but he didn't pinpoint that with me. He's waiting to find out more from tests, and apparently doesn't see a rapid change coming or he wouldn't have scheduled my next MRI and consultation with him until the middle of September. If things change though I get in touch with him. I've noticed on some sites that techology is superceding bipsy--a needle poked into the abdomen--and more reliable--like the blood tests, MRI, etc. He did say however that I'm not near liver failure at the moment. I'm seeing D. Hoynes tomorrow and we'll talk about this--I've been lax about getting the regular things done--an order for a mamogram is on my bulletin board for last December, and I didn't go back to the opthamologist for more tests like I was supposed to.
Thursday, June 14, 2007
Which is Better? The World-Class Hospital Near You--or Your Modest Local Hospital?
Something to think about when contemplating surgery or any other hospital procedure is whether a so-called "world-class" hospital is really better than your local hometown facility or the general medical center in a nearby city--like Akron for us. We live only 45 minutes from Cleveland Clinic, world famous for its state of the art medical treatment. World leaders and millionaires as well as ordinary people from all corners of the globe fly to Cleveland for treatment. It's also the go-to place for many locals and when Paul needed treatment for lung disease followed by lung cancer, the Clinic was first choice. The surgeon was top of the line and the operation a success--and yet the after care failed to impress us. Doubled with another patient in a small room after a day in the ICU, Paul was constantly exposed to people coming and going--professional and housekeeping staff attending both patients, plus friends and relatives visiting both. Who knows how many germs were walking right into the room as well.
A couple weeks later I had to rush Paul back to the Clinic where he was treated for pneumonia and kept there for several days. Hardly had we got him home than breathing difficulties, a temp of 102, and general weakness, recurred necessitating a trip in the Granger rescue unit to Medina Hospital where they eventually decided that what he had was C-Difficile, an infection contracted in hospitals! A disease specialist called in from Southwest General Hospital in South Cleveland identified the C-Diff--an infection that is virulent and often very hard to quell. Now, after a couple of weeks, Paul appears to be winning the battle and his strength is returning.
Cleveland Clinic didn't identify C-Diff. The Medina doctors did. Perhaps, because they were so focused on his lung, the Clinic did not look elsewhere to solve the problem. And Paul says the food at Medina Hospital is much better than the dreck they serve in Cleveland. Thank you Medina General Hospital!
A couple weeks later I had to rush Paul back to the Clinic where he was treated for pneumonia and kept there for several days. Hardly had we got him home than breathing difficulties, a temp of 102, and general weakness, recurred necessitating a trip in the Granger rescue unit to Medina Hospital where they eventually decided that what he had was C-Difficile, an infection contracted in hospitals! A disease specialist called in from Southwest General Hospital in South Cleveland identified the C-Diff--an infection that is virulent and often very hard to quell. Now, after a couple of weeks, Paul appears to be winning the battle and his strength is returning.
Cleveland Clinic didn't identify C-Diff. The Medina doctors did. Perhaps, because they were so focused on his lung, the Clinic did not look elsewhere to solve the problem. And Paul says the food at Medina Hospital is much better than the dreck they serve in Cleveland. Thank you Medina General Hospital!
Cirrhosis of the Liver Confirmed
Nearly a month gone since my last post. Time for an update. We are still alive. It's been two months since Paul had the cancer removed from his lung on April 15. Today it's hard to find any evidence that surgery took place--the incision is completely healed and has disappeared. But we were really such innocents when we tripped off to the Cleveland Clinic for that procedure. We anticipated that after about eight weeks of recovery, he would resume his normal life. We didn't take into account other factors but they did appear in the form of pneumonia, return trip to the Clinic, and then an ER rush to Medina Hospital for what we thought was another bout of pneumonia, only to learn (through the intelligent resources of a Southwest Hospital disease specialist) that what Paul had was C-Difficile--an aptly named infection because it's difficult to oppose--an infection contracted mostly in hospitals and passed most often by hand contact. C-Diff has a way of draining the patient's strength, stamina, and imune system and can only be combatted by one or two powerful anti-biotics. As of now though, Paul's made a lot of progress especially the last few days.
Medicare has provided him with visiting nurses and a physical therapist and they come twice a week. They report to his doctor on his progress and help him remain optimistic. Three days ago the tide seemed to be turning when he helped Philip build a railing from the house to the garage--one of those jobs he had put off for years--but really needs it now. Paul stood and supervised while Phlip did the carpentry work. We're all pleased with the result.
In the meantime, a visit to the Clinic last Friday confirmed that I do have some form of liver cirrhosis. The first sign of something wrong was from a blood test done earlier by fam physician who found elevated liver enzymes in the blood sample.Then a local specialist diagnosed from observations that it's liver cirrhosis. Also, a Clinic gastroenterologist, after doing an endoscopy, suggests in a letter to fam physicial that it's cirrhosis. Following that, Dr. David Barnes, Clinic liver and hepatitis specialist. sent a series of blood tests to the lab and read the MRI screening that seems to confirm the diagnosis. But the cause is still a mystery and more tests will be done. I'm not an alcoholic and I don't have hepatitis, and I'm not in pain. Autoimmune? Feel the same as I always have done.
The confirmation of cirrhosis stunned me to the point that I wasn't too swift in asking questions, but as soon as I hit the highway questions came up in my mind thick and fast. I was able to reach Dr. Barnes over the next couple of days and he was able to set my mind at rest to a large extent. Here are the things we discussed:
Liver cirrhosis doesn't equate with liver failure. I could die of something else before liver failure caught up with me.
He will continue to work and follow it.
Pain isn't typical.
Will arrange for a vaccination against hep A and B.
A biopsy can be given--it's the gold standard for diagnosis but he prefers not to unless necessary.
A cirrhotic lung's tissue is scarred. the tissue separates into nodules--spheres--looks like marbles in a bag.
Liver transplant at my age is not an option, although I got the feeling that he doesn't rule it out. I have a feeling though that the liver has to have failed before they do that?
Medicare has provided him with visiting nurses and a physical therapist and they come twice a week. They report to his doctor on his progress and help him remain optimistic. Three days ago the tide seemed to be turning when he helped Philip build a railing from the house to the garage--one of those jobs he had put off for years--but really needs it now. Paul stood and supervised while Phlip did the carpentry work. We're all pleased with the result.
In the meantime, a visit to the Clinic last Friday confirmed that I do have some form of liver cirrhosis. The first sign of something wrong was from a blood test done earlier by fam physician who found elevated liver enzymes in the blood sample.Then a local specialist diagnosed from observations that it's liver cirrhosis. Also, a Clinic gastroenterologist, after doing an endoscopy, suggests in a letter to fam physicial that it's cirrhosis. Following that, Dr. David Barnes, Clinic liver and hepatitis specialist. sent a series of blood tests to the lab and read the MRI screening that seems to confirm the diagnosis. But the cause is still a mystery and more tests will be done. I'm not an alcoholic and I don't have hepatitis, and I'm not in pain. Autoimmune? Feel the same as I always have done.
The confirmation of cirrhosis stunned me to the point that I wasn't too swift in asking questions, but as soon as I hit the highway questions came up in my mind thick and fast. I was able to reach Dr. Barnes over the next couple of days and he was able to set my mind at rest to a large extent. Here are the things we discussed:
Liver cirrhosis doesn't equate with liver failure. I could die of something else before liver failure caught up with me.
He will continue to work and follow it.
Pain isn't typical.
Will arrange for a vaccination against hep A and B.
A biopsy can be given--it's the gold standard for diagnosis but he prefers not to unless necessary.
A cirrhotic lung's tissue is scarred. the tissue separates into nodules--spheres--looks like marbles in a bag.
Liver transplant at my age is not an option, although I got the feeling that he doesn't rule it out. I have a feeling though that the liver has to have failed before they do that?
Tuesday, May 22, 2007
"I've Already Decided to Admit You to the Clinic"
I'm sitting on a bench in warm spring sunshine outside the Crile Building and while waiting for the valet-parking guy to bring my car so I can drive home after visiting Paul in the H Building, I think about the worries I've had for him since he came here last Sunday (the 20th) when his situation seemed life-threatening. There's a little green park across the way with a paved walk bordered with little flowering trees and it's the only pretty thing in sight. To look at it is to be consoled. All the rest as far as I can see is huge construction jobs with cranes poking the skyline as the Cleveland Clinic continues to expand in all directions.
We're learning about illness as we're going along because until recently nothing really serious has happened to us until Paul learned he had a cancer growing in his dilapidated lung. Hospitals haven't been high on our list of visits. The lung disease until now hasn't stopped him from enjoying life's pursuits and ironically just before the operation he was particularly vigorous. The op put paid to that, as was expected, but unexpected were the complications that have since arisen.
Last Friday (18th) Paul developed congestion, sniffles and a mild temperature. When Cheryl, the physical therapist visited in the afternoon she noticed that the vigor he had on Wednesday had gone away and he couldn't manage her very easy exercises, and when in the evening he felt even worse, I decided to get him to the Medina Hospital E.R. where after the usual triage wait--about an hour--they put him to bed, gave him oxygen, and set about putting him through every test and procedure possible, including a multitude of blood works, x-rays, Cat scan, eko cardiogram, etc. But after all that the dr. in charge decided not to admit him, because she could only establish that he had some fluid near the incision area--but not pneumonia. Seemed strange to me that she wasn't ready to anticipate its development.
Saturday the 19th at home was miserable as Paul felt no better, and in the middle of the night he fell on the floor as he got out of bed to go to the bathroom. So early Sunday morning I sped him up to Cleveland and the Clinic's ER. There they immediately put him to bed and a doctor examined him right away. Again he went to X-ray, but the doctor said to us, "I don't really care care what the X-ray reveals. I've already decided to admit you. Obviously you are ill and need our help." Dr. Wilson seemed very young (as most of them do these days in our old eyes) but she spoke with a confidence that speaks volumes about the Cleveland Clinic.
So by early Sunday afternoon Paul was installed in a room in the H Building and hooked up immediately to IVs feeding antibiotics straight into his veins and I returned home with big feelings of relief that he was in the best hands possible. Never again will I take him into Medina ER. Medina is excellent for non life-threatening events, and the staff are kind and competent, but for Paul, with the very first suspicious signs, he'll be on his way back to Cleveland. Live and learn. Or, perhaps, Learn and Live!
Now it's Tuesday evening and what a difference two days have made. He has come a long way, even from yesterday when he needed two people to help him walk a few steps to being able to walk on his own for a few yards. He's become interested in his fellow patients (two in a room) and the unusual cases they represent and enjoys every meal that's put in front of him.
His lead doctor told him that late on the night he was admitted a team of doctors gathered to discuss approaches to his case (sort of like the doctors in "House M.D." I gather.) The lead is Ves Dimov, M.D. and a quick look at his bio on the Clinic's website tells that he's from Sofia, Bulgaria and one of his interests is perioperative medicine--a specialty concerned with what can happen "around" an operation. He also calls himself a "hospitalist" and I must look that up because it's a new word to me. Not only do patients come from around the globe, but the medical staff does as well.
To be continued.......
We're learning about illness as we're going along because until recently nothing really serious has happened to us until Paul learned he had a cancer growing in his dilapidated lung. Hospitals haven't been high on our list of visits. The lung disease until now hasn't stopped him from enjoying life's pursuits and ironically just before the operation he was particularly vigorous. The op put paid to that, as was expected, but unexpected were the complications that have since arisen.
Last Friday (18th) Paul developed congestion, sniffles and a mild temperature. When Cheryl, the physical therapist visited in the afternoon she noticed that the vigor he had on Wednesday had gone away and he couldn't manage her very easy exercises, and when in the evening he felt even worse, I decided to get him to the Medina Hospital E.R. where after the usual triage wait--about an hour--they put him to bed, gave him oxygen, and set about putting him through every test and procedure possible, including a multitude of blood works, x-rays, Cat scan, eko cardiogram, etc. But after all that the dr. in charge decided not to admit him, because she could only establish that he had some fluid near the incision area--but not pneumonia. Seemed strange to me that she wasn't ready to anticipate its development.
Saturday the 19th at home was miserable as Paul felt no better, and in the middle of the night he fell on the floor as he got out of bed to go to the bathroom. So early Sunday morning I sped him up to Cleveland and the Clinic's ER. There they immediately put him to bed and a doctor examined him right away. Again he went to X-ray, but the doctor said to us, "I don't really care care what the X-ray reveals. I've already decided to admit you. Obviously you are ill and need our help." Dr. Wilson seemed very young (as most of them do these days in our old eyes) but she spoke with a confidence that speaks volumes about the Cleveland Clinic.
So by early Sunday afternoon Paul was installed in a room in the H Building and hooked up immediately to IVs feeding antibiotics straight into his veins and I returned home with big feelings of relief that he was in the best hands possible. Never again will I take him into Medina ER. Medina is excellent for non life-threatening events, and the staff are kind and competent, but for Paul, with the very first suspicious signs, he'll be on his way back to Cleveland. Live and learn. Or, perhaps, Learn and Live!
Now it's Tuesday evening and what a difference two days have made. He has come a long way, even from yesterday when he needed two people to help him walk a few steps to being able to walk on his own for a few yards. He's become interested in his fellow patients (two in a room) and the unusual cases they represent and enjoys every meal that's put in front of him.
His lead doctor told him that late on the night he was admitted a team of doctors gathered to discuss approaches to his case (sort of like the doctors in "House M.D." I gather.) The lead is Ves Dimov, M.D. and a quick look at his bio on the Clinic's website tells that he's from Sofia, Bulgaria and one of his interests is perioperative medicine--a specialty concerned with what can happen "around" an operation. He also calls himself a "hospitalist" and I must look that up because it's a new word to me. Not only do patients come from around the globe, but the medical staff does as well.
To be continued.......
Wednesday, April 25, 2007
Good Recovery for Paul After Lung Cancer Surgery
Paul is showing a very good recovery today after undergoing four hours' surgery at the Cleveland Clinic yesterday. This morning his color was good and he chatted with Philip, Kim, and me quite readily. He asked me to print off crossword puzzles and bring them along next. This afternoon they removed him from the ICU to a room up on the ninth floor in the thoracic step-down constant nursing unit . There they will re-introduce him to getting back on his feet.
He had in effect two procedures. The first surveyed the lymph nodes in his right lung. Fortunately, they were fine. The second op opened his chest, spread apart the ribs, and removed the cancerous growth at the periphery of the left lung. In doing so, they took only ten percent-of the lung--a good outcome. Phil and Wendy spent most of the day with me yesterday and P and Kim visited this morning. We're very happy with the way things are going right now.
Because the Cleveland Clinic campus is so large I did a lot of walking yesterday and today--and don't feel any the worse for it, either! Last evening when I walked in front of the lobby of the Inter-Continental Hotel, I saw a group of people surrounding an elderly middle-eastern couple who were climbing into a large, black European-looking car. They looked very regal. (A lot of gold glistened about them). One chap in a long, black raincoat stepped menacingly toward me--a bodyguard I guess.
I fell into bed gratefully last night in the Guest House. License plates on cars in the lot came from nearly every state in the union, and while waiting around yesterday I talked with people from San Francisco, Idaho, Kentucky and places in between. I thought, well, Cleveland is a gloomy town much of the time, and the weather is nothing to write home about, but we have the Clinic right here--and that's worth a thousand blessings.
The TV in my room brought in Abu Dubai, Saudi Arabia, Kuwait--and a Syrian movie was playing on another channel.
A cousin, whose wife is recovering from a cancer removal under excellent British National Health care, expressed the following sentiments in an email today:-
"We have found that talking about the illness somehow lessens its bogeyman severity. Forgive me for doing so when you have your own concerns. "
(Thank you David. I agree and I think we share some of the same verbal genes).
Now I'm back home this evening caring for the cats. They don't seem to have missed me at all.
Love, and forgive me for running on, but it's good for my sanity and system.
Stephanie
Thursday, April 5, 2007
My Endoscopic Ultrasonography(EUS) Set for Next Monday
Sunday, February 25, 2007 around midnight, before falling asleep a very sudden feeling of nausea presented itself. That salty taste the precedes vomitting. Got to the bathroom in time for a rush of vomiting and diarrheal. Sat on the toilet with my face in a plastic bowl. Returned to bed, but repeat attacks followed. Finally only bile was left to come up. I became severely dehydrated. Paul called the Granger rescue unit to take me to Medina Hospital ER. I was there until about 11 a.m. the following day. Later I found they did an ultra sound and other tests, but because of the medication they gave me I slept through until mid-morning.
About a month earlier I had a similar attack, although not quite as severe, and went to the ER for that. Followed up with family physician, Dr. Hoynes, who suspected a flu bug going the rounds. The second attack gave him second thoughts and he recommended I see a local gastroenterologist, Dr. Bashour, in Medina.
Saw Dr. Bashour on March 6. Upon examination he said he suspected a blockage somewhere in the biliary tract--perhaps by an errant gallstone. (My gall bladder was removed in 1975). He also suggested possible hepatitis or even liver cirrhosis, based on my having had a blood transfusion in 1983 at the time of my hysterectomy. He wanted me to have a ERCP at Medina Hospital and set it up for March 12. I told him I had developed a sore throat and the feelings of a cold, but he paid no attention to that. He sent me to Medina Hospital for blood tests, but did not order xrays or scans. The blood tests revealed no hepatitis, but the scans revealed an enlarged liver duct.
The next day a full blown cold appeared and developed into a lung infection and near pneumonia by the end of the week. I canceled the ERCOP! I then had a chest xray done and that showed the lung infection. During the two weeks for the infection to go away I did some thinking and decided not to return to the Medina gastroenterologist and contacted the Cleveland Clinic where I got an apointment for June 4.An assistant there told me to have Dr. Hoynes order Cat scans and an ultra sound, and I had them done at Medina hospital. Dr. Hoynes said he would try to get me in sooner, but not hearing from him in two weeks I called the Clinic endoscopy department on April 3.
A very helpful assistant, Rachel, said they were booked weeks ahead. I told her how difficult it could be for me caring for Paul properly after his lung surgery--probably two weeks hence--if my gastro problem had not been dealt with. The following morning she called and said she had managed to get me a slot with Dr. Vaccaro on Monday the 9th. She said I had sounded so stressed she just had to help me out.
On the 9th in the morning I will have a consultation with Dr. Gregory Zaccaro gastroenterologist, followed by an endoscopic ultrasonography(EUS). Hopefully we will get some answers to why I had the two attacks and what's going on with my liver and esophagus.
The following day, Tuesday April 10, Paul has an all-day visit to the Clinic, seeing an oncologist, having heart stress tests, etc., and consulting with Dr. Sudish Murthy in the afternoon. Hope I'm able to go along with him.
About a month earlier I had a similar attack, although not quite as severe, and went to the ER for that. Followed up with family physician, Dr. Hoynes, who suspected a flu bug going the rounds. The second attack gave him second thoughts and he recommended I see a local gastroenterologist, Dr. Bashour, in Medina.
Saw Dr. Bashour on March 6. Upon examination he said he suspected a blockage somewhere in the biliary tract--perhaps by an errant gallstone. (My gall bladder was removed in 1975). He also suggested possible hepatitis or even liver cirrhosis, based on my having had a blood transfusion in 1983 at the time of my hysterectomy. He wanted me to have a ERCP at Medina Hospital and set it up for March 12. I told him I had developed a sore throat and the feelings of a cold, but he paid no attention to that. He sent me to Medina Hospital for blood tests, but did not order xrays or scans. The blood tests revealed no hepatitis, but the scans revealed an enlarged liver duct.
The next day a full blown cold appeared and developed into a lung infection and near pneumonia by the end of the week. I canceled the ERCOP! I then had a chest xray done and that showed the lung infection. During the two weeks for the infection to go away I did some thinking and decided not to return to the Medina gastroenterologist and contacted the Cleveland Clinic where I got an apointment for June 4.An assistant there told me to have Dr. Hoynes order Cat scans and an ultra sound, and I had them done at Medina hospital. Dr. Hoynes said he would try to get me in sooner, but not hearing from him in two weeks I called the Clinic endoscopy department on April 3.
A very helpful assistant, Rachel, said they were booked weeks ahead. I told her how difficult it could be for me caring for Paul properly after his lung surgery--probably two weeks hence--if my gastro problem had not been dealt with. The following morning she called and said she had managed to get me a slot with Dr. Vaccaro on Monday the 9th. She said I had sounded so stressed she just had to help me out.
On the 9th in the morning I will have a consultation with Dr. Gregory Zaccaro gastroenterologist, followed by an endoscopic ultrasonography(EUS). Hopefully we will get some answers to why I had the two attacks and what's going on with my liver and esophagus.
The following day, Tuesday April 10, Paul has an all-day visit to the Clinic, seeing an oncologist, having heart stress tests, etc., and consulting with Dr. Sudish Murthy in the afternoon. Hope I'm able to go along with him.
Tuesday, April 3, 2007
Paul's Visit to the Cleveland Clinic--April 2, 2007
Yesterday, April 2,we kept a full day's worth of appointments at the Clinic.
As it looks now, Paul will probably undergo lung surgery within the next two or three weeks at the Clinic's hospital.
Yesterday's tests included a molecular imaging procedure in the nuclear medicine department at the Main Hospital followed by a CAT scan of his brain in the radiology department . The afternoon was taken up first with three pulmonary function tests in the Crile building including a walking function that showed a need for oxygen, which the technician who walked with him supplied.
In the latter part of the afternoon we visited first Dr. Sudish C. Murthy, thoracic surgeon, and later Dr. Gildea, pulmonary disease specialist--he has been seeing Paul since 2004. Both have extensive biographies online at the Clinic website and are regarded as tops in their fields. They were liberal with their time, friendly, compassionate, and welcomed our questions and concerns. They were the exact opposite of the stereotypical arrogant specialist one finds in literature, movies and sometimes in real life!
Both had reviewed Paul's case file and earlier scan results (done in Medina), as well as the results from the morning's tests. Murthy's first concern was finding the exact spot on the left where Paul's cancerous growth is located. (The Medina scans weren't that good, and he has ordered another scan taken at the clinic next Tuesday). The options for Paul appear either surgery or radiation, or both.
As Murthy put it, in surgery we can't give up much lung tissue for an operation, and if the growth is in the middle of the lung it will present a difficulty because not only must the growth itself be removed, there must be enough lung tissue surrounding it to ensure that the cancer is removed properly. The result could be that the whole lung might have to be removed. If the growth is near the edge of the lung, it can be removed together with surrounding tissue, but even this would take some of the lung away. Any amount of lung tissue removed is serious for a patient suffering from interstitial lung disease
Radiation can burn away the growth, but collateral damage to the lung is a possibility.
Murthy wants Paul to have another CAT done at the clinic next Tuesday--to zoom in on the growth's position--and also a heart stress test on a treadmill to gauge the ability of the heart to handle the surgery. He pointed out that whichever therapy is chosen, we mustn't do the wrong things for the right reasons. We must expect Paul to have a reasonable chance to get through the therapy and have an expectation for an effective recovery with half a lung if that's what the picture turns out to be.
Our final visit for the day to Dr. Gildea yielded a difference in opinion. He is absolutely against radiation. for Paul's diseased lung. As he put it, "it could set off a firestorm in Paul's diseased lung." But he will conference with Murthy and they will bring other specialists into the debate and will come up with their best possible option.
For surgery, Paul will be in the hospital for about a week and recuperation time will take about eight weeks.
The Clinic resembles a small city. It has its own Intercontinental Hotel (God knows how much it costs to stay there--affordable anyway or the Saudi princes who come over for their regular checkups). We took used their own bus service--the greenline, blueline and whiteline run regularly between buildings. There are also indoor skywalks between buildings and for our last appointment I pushed Paul in a wheelchair from one building to another. Parking spaces for handicapped tags are close to the building and cost just $5 for the whole day. A Bon Pan cafe in the Crile building (where the pulmonary department is located) offers delicious food all day long.
Our next step is to keep the appointments for next Tuesday (April 10) for cat scan and heart stress tests. After they've been reviewed, the doctors should be able to come up with their next step.
As it looks now, Paul will probably undergo lung surgery within the next two or three weeks at the Clinic's hospital.
Yesterday's tests included a molecular imaging procedure in the nuclear medicine department at the Main Hospital followed by a CAT scan of his brain in the radiology department . The afternoon was taken up first with three pulmonary function tests in the Crile building including a walking function that showed a need for oxygen, which the technician who walked with him supplied.
In the latter part of the afternoon we visited first Dr. Sudish C. Murthy, thoracic surgeon, and later Dr. Gildea, pulmonary disease specialist--he has been seeing Paul since 2004. Both have extensive biographies online at the Clinic website and are regarded as tops in their fields. They were liberal with their time, friendly, compassionate, and welcomed our questions and concerns. They were the exact opposite of the stereotypical arrogant specialist one finds in literature, movies and sometimes in real life!
Both had reviewed Paul's case file and earlier scan results (done in Medina), as well as the results from the morning's tests. Murthy's first concern was finding the exact spot on the left where Paul's cancerous growth is located. (The Medina scans weren't that good, and he has ordered another scan taken at the clinic next Tuesday). The options for Paul appear either surgery or radiation, or both.
As Murthy put it, in surgery we can't give up much lung tissue for an operation, and if the growth is in the middle of the lung it will present a difficulty because not only must the growth itself be removed, there must be enough lung tissue surrounding it to ensure that the cancer is removed properly. The result could be that the whole lung might have to be removed. If the growth is near the edge of the lung, it can be removed together with surrounding tissue, but even this would take some of the lung away. Any amount of lung tissue removed is serious for a patient suffering from interstitial lung disease
Radiation can burn away the growth, but collateral damage to the lung is a possibility.
Murthy wants Paul to have another CAT done at the clinic next Tuesday--to zoom in on the growth's position--and also a heart stress test on a treadmill to gauge the ability of the heart to handle the surgery. He pointed out that whichever therapy is chosen, we mustn't do the wrong things for the right reasons. We must expect Paul to have a reasonable chance to get through the therapy and have an expectation for an effective recovery with half a lung if that's what the picture turns out to be.
Our final visit for the day to Dr. Gildea yielded a difference in opinion. He is absolutely against radiation. for Paul's diseased lung. As he put it, "it could set off a firestorm in Paul's diseased lung." But he will conference with Murthy and they will bring other specialists into the debate and will come up with their best possible option.
For surgery, Paul will be in the hospital for about a week and recuperation time will take about eight weeks.
The Clinic resembles a small city. It has its own Intercontinental Hotel (God knows how much it costs to stay there--affordable anyway or the Saudi princes who come over for their regular checkups). We took used their own bus service--the greenline, blueline and whiteline run regularly between buildings. There are also indoor skywalks between buildings and for our last appointment I pushed Paul in a wheelchair from one building to another. Parking spaces for handicapped tags are close to the building and cost just $5 for the whole day. A Bon Pan cafe in the Crile building (where the pulmonary department is located) offers delicious food all day long.
Our next step is to keep the appointments for next Tuesday (April 10) for cat scan and heart stress tests. After they've been reviewed, the doctors should be able to come up with their next step.
Subscribe to:
Posts (Atom)