Month: December 2017

My Legs Got #swole

by Dan Tran

After about a week at home my legs started to get a bit sore. I figured it was from laying in the hospital bed for a week and sitting around all day at home. After all, I had the compression devices on my legs while I was at the hospital to help prevent blood clots from occurring. Friday, exactly a week after being discharged, I went on my first real outing to The Circuit, a local barcade in Richmond that we’d wanted to check out for a few months now. I had a great time, but standing for 3 hours playing games was probably not ideal, even with my brace on. The next day I woke up to sore legs again, but this time I noticed some swelling in my right ankle. I had seen a case of DVT (deep vein thrombosis – a.k.a. blood clot) the prior year in my rotation in the ED (Emergency Department) so I knew what to look for. There wasn’t too much swelling (you couldn’t tell if you weren’t looking at it), but just enough for me to call the neurosurgeon. He told me to go to the ED to check for DVTs. Luckily, we’d had a revolving door of visitors since we arrived home from the hospital so my brother-in-law took me to the ED while Varisara stayed home with Avery.

When we got to the hospital, I had trouble walking to the ED. I had to sit down immediately when we got inside as my leg was in pain just from the short walk. I was quickly seen and they performed the ultrasound. Low an behold, there was a DVT in my right calf, just as I had suspected. What I did not expect was that there was also a DVT in my left calf as well. When it rains it pours, huh? I knew that Lovenox, a blood thinner, was usually given for inpatient hospital stays to help decrease the chance of a blood clot forming, but since I had spine surgery I was unable to get the prophylactic shot due to the risk of an epidural hematoma.

With the lung lesion and an increased heart rate of 110 bpm, the doctors also recommended that I get a CT scan on my chest to rule out the possibility of a pulmonary embolism.  I’d been getting alot of “just to be sure” scans and procedures recently so I wasn’t too surprised.  Luckily, the chest scan came back clear.

To manage the DVTs in my legs I knew I’d need to be on blood thinners; probably for the rest of my life now with the cancer. The on-call oncologist came by to talk me through my options: pills that could be taken orally or Lovenox shots that would need to be administered in the abdomen. You would think that’s an easy decision, but the shots have been proven to be effective while the pills have yet to be confirmed. Additionally, the Lovenox could be reversed quickly if needed. Although I did not look forward to the idea of getting shots twice a day, I thought it wise to go with the sure thing and picked the Lovenox. The first few times, I administered the shot myself and that was not fun. Varisara started giving me the shots after the second day and she has only stuck herself once (so far).

 

 

The Waiting Game #goheavy

by Dan Tran

IMG_6596

The days following the surgery consisted of getting fit for my back brace, physical and occupational therapy, and a barrage of doctors and nurses constantly in and out of my room to check on recovery, administer medication, and start planning for next steps. Not only was I recovering from major spine surgery, but I also needed to get started with oncology.

The radiation oncologist arrived the day after the surgery to discuss the plan to take care of the lesions in my spine that the neurosurgeon wasn’t able to get out during surgery. Although the wound needed to heal from the surgery, we wanted to get started with radiation right away to prevent any further growth in the spine. We planned to start the radiation treatments 2 weeks after surgery, however, preparations would be done while I was still in the hospital for recovery.

The medical oncologist also came by to check on me. We knew the tumor was metastatic, but we still were not sure of the source. We could only assume lung because that was where the only other mass was found, but preliminary results were not expected until 2-3 days after surgery. When we finally received the results, they were very vague and actually caused more confusion than clarity. The preliminary results still were unable to confirm the cancer source, but also indicated that a possible gastric source could not be ruled out. Even though the CT scans showed no growths in the GI tract, the medical oncologist ordered a colonoscopy and endoscopy just to be sure everything was clear. I was thrilled. I expected to be discharged on Friday and hoped these new tests didn’t extend my stay in the hospital.

The scopes were scheduled for Friday morning at 11am, which I wasn’t told until 5:50pm Thursday night. I had to be NPO (i.e. nothing by mouth – no food) starting at 6pm and I had not planned accordingly. I was looking forward to warm cookies from Insomnia that evening, but those would have to be put on the back burner in exchange for a lovely clear liquid diet and a 2 gallon container of golytely that I needed to consume by the next morning to clear out my GI tract. They should call it goheavy rather than golytely. If you have not had the pleasure of trying golytely, it tastes like seawater. I finished half the container Thursday night and woke up Friday morning to complete the torture. I finished at 9:20am, proud of myself for getting through it without vomiting and ready for the procedure.

The nurse came in to tell me that my procedure was pushed back to 1:30pm because I did not finish the golytely 2 hours prior to the scheduled start time. I was never told about the 2 hour protocol and I was not happy. Hungry and ready to go home, I was frustrated that I had to wait for an extra 2.5 hours. The scopes came and went, confirming what the CT scan had previously shown; the GI tract was clear.

I was finally discharged Friday evening (see picture above), just in time to spend Christmas at home. Final results for pathology were not expected for at least another week.

In Patient’s Clothing #spinesurgery

by Dan Tran

The day after I was admitted to the hospital, they took MRIs on the rest of my spine to see if there was anything else we should be worried about.  I hadn’t been able to lay down flat for the past month without having excruciating pain.  Unfortunately for me, MRIs require you to lay down flat and not move for about a couple of hours depending on how many pictures they needed.  They had administered some IV pain mediations for me, which I thought would make the experience better. I think they overdid it a little bit because I started to feel nauseous during the whole procedure.  I had to request Zofran in between the scans, which helped a little, but imagine being hot, nauseous, and in pain stuck in a metal tube.  After two grueling hours of being in and out of the MRI, I was finally done. The scans on the rest of the spine and brain came back clear; the first good news we’d received since entering the hospital.

I was on a cocktail of various medications of steroids to help with the swelling and opioids to manage the pain, but for the first time in over 6 weeks I was starting to feel a little better physically. With the swelling and my pain under control, the neurosurgeon and I decided to have the surgery Monday to ensure the best team was in to perform the operation. The neurosurgeon pushed his other cases scheduled for that day so that I could be the first of the day at 7:30am.

The procedure took nearly 4 hours to complete and I lost 1.2 liters of blood, but the neurosurgeon was able to remove the tumor that was compressing T11. He fused together my spine from T10 to T12 to replace the support that was previously being provided by the tumor. I was sent back up to my room for recovery while the tumor had been sent off to pathology for testing. A frozen section confirmed the tumor was metastatic. All we could do now was wait for the final pathology results to confirm the source of the cancer.