Today (Monday, July 30) seems like a good day to update everyone on Mom's current health situation, since she's having talc pleurodesis via robotic-assisted thorascopic surgery tomorrow morning (Tuesday, July 31), while getting any holes or tears in her diaphragm repaired at the same time. Confused? Allow me to explain . . .So how did we go from "starting dialysis soon" to diaphragm repair surgery? Like this:
July 24, 2012 (Tuesday) -- Mom started peritoneal dialysis training today at the PD clinic. Before going any further, I need to define the word "exchange" in this context. In peritoneal dialysis, an exchange is a complete cycle where they drain a bag of dialysis fluid into the abdomen, let it sit for a time period known as the dwell time, then drain the dialysis fluid out of the abdomen after it has absorbed impurities through the peritoneum. (By the way, each bag of dialysis fluid is 2000 milliliters, which is 2 liters, which is just over 2 quarts, which is half a gallon.)
Mom's first exchange went fine, but she started feeling some discomfort during the second exchange so they stopped and immediately drained it. They thought maybe the catheter was irritating a nerve during the filling process, but then they thought she might be constipated, causing the fluid to rise higher than it normally would. They told her to go home, take a laxative, and they'll try again tomorrow.
July 25 -- Second day of PD training. Once again, the first exchange went fine but she started feeling really bad during the second exchange so they stopped. They sent her to get a chest x-ray to hopefully find out just where the end of the catheter is and determine why she's experiencing so much pain. Peritoneal dialysis should not cause any pain.
July 26 -- Mom met with the nephrologist at the PD clinic today. (This is not Dr. V, the nephrologist she has been seeing for years. Once you go on dialysis, you are under the care of a nephrologist at the dialysis clinic.) Her nephrologist is now Dr. S. He talked to her during the second exchange, which went a little better but still caused her some discomfort. Based on yesterday's chest x-ray he thinks she may have a hole or a tear in her diaphragm, due to the amount of fluid around her lungs. That means she can either do hemodialysis or get the hole in the diaphragm closed up and try PD again after that heals, which he thinks would be about four weeks. As you can probably guess, Mom the globetrotter would like to stick with PD, so Dr. S said he'd look for a surgeon for her.
In the meantime, she’s on a very strict diet of low potassium and phosphorous to avoid the need for hemodialysis in the interim. Dr. S has also prescribed a heavier dosage of Lasix (furosemide) to reduce the fluid she has retained as a result of the hole in the diaphragm. Due to the amount of fluid in her chest cavity, she is becoming exhausted with minimal exertion. So today wasn’t really a good day.
July 30 (Monday) -- Mom's appointment with the surgeon is scheduled for 3 PM today. The surgeon's office called her this morning and said that due to a cancellation they have an opening for surgery for tomorrow (Tuesday), and would she like to be penciled in there pending the results the appointment this afternoon. Mom and I agreed to go ahead and do that, since time is of the essence.
So we met with the surgeon at the 3 PM appointment. After he took Mom's medical history and did a brief exam, he pulled up her chest x-ray on his computer and it showed a lot of fluid around her right lung. He then explained his recommendation, which is a procedure called talc pleurodesis. It involves applying a surgical talc to the outer surfaces of the lungs and the inner lining of the chest cavity, which causes inflammation, essentially causing the lungs to adhere to the walls of the chest cavity due to scarring. That more or less closes up the cavity above the diaphragm, so any fluid that leaks past the diaphragm really has no place to go. A side benefit is that it prevents the possibility of a collapsed lung, because the lungs will be attached to the walls of the chest cavity. Regarding the diaphragm, there's really no way to know for sure what's going on there without taking a look. He said it's hard to tear the diaphragm even with violent coughing, so it could be a congenital defect she's had since birth, or it might be that it just doesn't completely close off the top of the abdominal cavity for whatever reason. He won't really know until he goes in and takes a look, so that aspect of the surgery really is exploratory. That's why he recommends doing the talc procedure, so even if the diaphragm isn't repaired, or if it fails later, the cavity above the diaphragm will be closed off. We both felt good after talking to the surgeon and Mom decided to proceed with the surgery Tuesday morning. He said she'd be in the hospital one or two nights, then completely healed within 10 to 14 days.
Speaking of robots, the surgeon said the traditional way of doing this type of surgery would be to make a large incision in the side and spread the ribs apart to gain access. There is obviously lots of post-op pain associated with that. He's a big advocate of robotic surgery now, and he said with robotic surgery they only make four small incisions in the side, and there is no need to spread the ribs because the instruments are so small. I looked at his web site (www.jettmd.com) and learned that the robotic equipment he uses is the da Vinci Surgical System, so naturally I had to check out their web site (www.davincisurgery.com). That site had lots of great stuff for a geeky engineer like me. If you want to watch the robot in action but would rather not look at a surgery video, there are many many videos of it on Youtube where it's being used to peel a grape. Just search for "davinci surgery grape."
Next up: Robots!