Update Re: Houston, We Have A Problem...

[Murray Charters <mcharters@xxxxxxxxxxxxxx>]

Mornin' All,

just a quick message to relay yesterday's happenings...

* * *

Brenda's and my day,
she was with me all the way.

We checked in at VGH Admitting around 12:00 Noon, Aug 13, 2003

I was there for a routine out-patient procedure -  thoracentesis - (draining of 
the pleural effusion that is
restricting the capacity in my left lung).  I handed the admitting person my 
wrist band from the previous week, my CARE
Card, and checked in in a few minutes, (they were expectin' me) and proceeded 
down one floor to a Day Bed area just
down the hall from the Broncoscopy suite. Get yer duds off, put this skimpy 
gown on backwards, old hat stuff!!  Wait
for the porter t' wheel ya down the hall...

Soon I was in the Broncoscopy suite, where I had a Broncoscopy last Thurs., for 
biopsy of the tumor found in the upper
lobe of my left lung.  Ahh.. there was a familiar face.  Anne hooked up the 
ECG, applied the Blood Pressure Cuff, the
finger clip monitor, and tested the equipment... Old hat!  Ready t' roll....

Dr. Ayas was to tap the pleural effusion on Wed. Aug. 13th. at 13:00 Hours...  
He was late... 13 minutes... not that
I'm superstitious...

He intended to use a biopsy needle to drain 1 to 1.5 litres of fluid... which 
would allow my lung to expand, restore
temporarily my lung capacity, possibly allow me to rest a bit easier and get a 
decent sleep...

The  thoracentesis procedure also allows biopsy of the pleural effusion.

Dr. Ayas explained the procedure and I signed the consent form.

This was 'sposed t' be a quick outpatient procedure / roughly 1 hour plus 1 
hour rest and observation, after which I
would return home.

They had me sit up, bend slightly forward over a bedside table.  He prepped the 
area on my back, applied a local
freezing and got started. That's when Parkinson's showed up in the form of 
hypotension... Suddenly I felt dizzy, my
blood pressure dropped, and my heart rate ticked down into the 30's...  I had 
forgotten to warn them that I'd
experienced hypotension before... I was probably somewhat dehydrated as well... 
fasting, fluids only from the night
before... I think I only had two glasses of water... one with each set of 
Parkinson's meds... I'm sure I went pasty
white... almost passed out!

Now I needed an IV tap... and Oxygen... Sooooo ... lay back and relax, suck up 
some Oxygen... IV tap in, wait....

About an hour late we resumed the thoracentesis procedure... Things were still 
not going as planned... Dr. Ayas had
difficulty getting the fluid to drain... Finally we had about 750ml of clear 
straw colored fluid... Not all that's in
there, but enough for today...

An imbalance between the venous-arterial pressure and the pressure within the 
pleural space (oncotic pressure) causes
transudative effusions. Transudates contain few protein cells and little solid 
material content and have a clear, pale
yellow color.

Dr. Ayas explains that this fluid looks fine under the circumstances.

In due course they wheeled me down the hall for a chest Xray to confirm where 
we're at now... One from the front, one
from the left side... Okay... "Kodak" moments are finit..  Back to the day bed 
area for rest and observation... It's
15:30 now...

I get apple juice and my Parkinson's meds at 16:00 right on time... (I have my 
own meds and my 3 ring binder with me)

Dr. Ayas reappears around 16:40... He has seen the Radiologist, the Xray is Ok. 
and I can be discharged.

Wait... Wait... we have a few questions... When will we be informed of the 
results of this biopsy?  (perhaps Friday,
but more likely Monday)

If this biopsy is negative then is the 3 cm. (roughly) tumor in my lung the 
primary cancer for sure? (the oncologist
will make that diagnosis)...

What do we call that tumor?  What type of cancer cells do I have so far? (It is 
an "adenocarcinoma" probably in Stage
3A)

HHHhhhmmmmmmmmm....

adenocarcinoma, bronchiolo-alveolar
A carcinoma thought to be derived from epithelium of terminal bronchioles, in 
which the neoplastic tissue extends along
the alveolar walls and grows in small masses within the alveoli. Involvement 
may be uniformly diffuse and massive, or
nodular, or lobular. The neoplastic cells are cuboidal or columnar and form 
papillary structures. Mucin may be
demonstrated in some of the cells and in the material in the alveoli, which 
also includes denuded cells. Metastases in
regional lymph nodes, and in even more distant sites, are known to occur, but 
are infrequent.


What's next? (Wait for this biopsy, consult with the Oncologist)

The IV comes out, the vital signs monitor is switched off, and I don my street 
duds...

It's 17:00 hours...

I learned one small lesson... remember to think about Parkinson's and 
hypotension when you have any hospital
"procedure"...

It is better to discuss this upfront and be fully prepared... (I had my 3 ring 
binder, we had briefly dicussed my meds,
but hadn't considered hypotension or dehydration...

I hope you all keep on smilin' and doin' your very best...

I am!

cheers ...... murray


* * *
Murray Charters <mcharters@xxxxxxxxxxxxxx>


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