Christine's First Surgery

Post Operation - Day 7

Christine had a good day today, despite being woken up quite often to be checked up. To be fair, aside from just one or two exceptions, the care that Christine has been provided has been excellent. The registered nurses and support staff have all been absolutely fabulous. It is hard to believe that it is only one week since some pretty serious surgery, and that Christine is coming home tomorrow.

With the help of the occupational therapist, Christine was able to shower. She felt so much better after this. Throughout the day, all of the home supplies were delivered, so there are no excuses for the level of care to drop…
RN-05
Here is one of the registered nurses administering Christine's pain medication
OT-03
Here is the occupational therapist preparing Christine for a shower.
Speech-02
This is the speech therapist teaching Christine how to adjust the valve to speak Texan.
Physio-02
This is the physical therapist, trying to prevent Christine hitting the turbo button

Post Operation - Day 6

Before I get into the nitty gritty of the events of the day, I have great pleasure to report that Christine's lab analysis of the tumor and lymph nodes came back clear, and the cancer has not spread anywhere else!

The day didn't start very will with doctors showing up at 5:45, waking Christine up to change her tracheostomy tube to a smaller size. This made no sense to us, as Christine was perfectly comfortable with the size she had. Seemingly, it is a way for them to determine whether the trach tube can come out permanently. We have learnt later that this wasn't really necessary. It just managed to annoy Christine unnecessarily, and cause her face to swell up again. Seems this doctor is not capable of listening to her patients needs and pain levels. Christine is looking forward to filling out the survey.

The day perked up when the plastics doctor arrived and promptly removed the boot and two if the drainage bottles. This has given Christine a lot more freedom, and the knowledge that she will not need a skin graft at a later stage. One less surgery to worry about!

Scar-01
It is quite a neat scar! This looks way better than we thought. Before the surgery it was thought that there would be a large hole in her leg, filled up with something called Integra. Fortunately, Christine's skin was too thin for their initial plan, so they had to revert to a Plan B.
OT-02
This is the occupational therapist, who went through the details of Christine's departure on Saturday. Now Christine can speak eloquently, she was able to give feedback as to the care and attention. As you know this ranges from absolutely fantastic, too very poor. All was taken on board… We also had visits from the speech therapist, and the dietician. Both have over 30 years experience, and provided some very valuable information. All visitors seemed to be obsessed with bowel movements. I bet they have a sweepstake going…
NurseA-01
Nurse Andy administering Christine's Pina Colada. He also drained the waste bottle, and cleaned the tracheotomy tubes. I'm ready!
Bootless
Christine, bootless, and without two of the drainage bottles. She managed two laps of the nurses station with ease! She has now been given a walker with wheels…
Chair
I moved the living furniture around, with some help from John. It is designed so that no-one can accidentally bump into Christine.

Although Christine will be at home on Saturday, I am not allowing any visitors for at least five days. This will give us some time to adjust to our new living regime, give Christine time to chill, rest and sleep as she needs. Once we are happy that Christine is strong enough for visitors I will post a schedule for visiting.

Since Christine still has the tracheostomy tube, open wounds, and her immune system weakened, she will very vulnerable to germs. If you have even the slightest sniffle, please do not come. Any visitor will have to thoroughly wash their hands, and wipe using antiseptic gel (thanks Lucille for this advice). I know that you all want to visit, but I hope that y'all understand my decision.

Post Operation - Day 5

You Facebook junkies will know that Christine had a bad afternoon and evening. This was caused by one junior nurse, who needed to take the trach class that Christine and I did, and the patient care partner, who failed to take Christine’s vitals, failed to get the registered nurse when requested, failed to help Christine to get to the bathroom and failed to requested pain medication. All this caused an immense amount of stress, raising Christine blood pressure sky high, and caused her to cough severely, which caused her swelling to get much worse.

This morning though, there was a great team of nurses, the registered nurse, and the patient care partner, and some others who have been excellent today. The doctors came early today and changed the tracheotomy tube to a smaller more mobile one. The early report is that it is very much better than the one that Christine had before, and she is in much less discomfort. They are still talking of her coming home on Friday, but we will put our foot down on that idea.
RN-04
This is the registered nurse applying the pain meds. She even had me administer the feeding tube later!!

Here is Christine, showing the photo sent by Agatha Hollanders of her Happy Place, with a turtle popping up to say Hi!
Facetime
Christine was further buoyed by a FaceTime call from Robert, Nicola and the grandkids!
Speech-01
The biggest highlight for the day was when the speech therapist, fitted a Passy-Muir valve on Christine's trach tube. After a few tongue and breathing exercises, Christine took a big breath and spoke. As the day went on, her speech improved continually. Looks like the nurses had better be on best behavior, and I will certainly have to wear my earwigs tomorrow!

Another piece of good news was that Christine was able to wear her own clothes again, which must be wonderful.
CF-Walk01
Here is Christine on her rounds. If you zoom in closely, you can see the purple speech valve. So small, but so effective!

Post Operation - Day 4

Christine had decent night, although had a dry and sore throat from the tracheostomy suction tube being administered heavy-handedly by a couple of the nurses. It seems different nurses have different methods. This is the worst bit for Christine, and we won’t be sorry when the tracheotomy tube has been removed. Although the swelling seemed less than yesterday, the coughing caused by the tube, makes it worse than perhaps it should be.
RN-03
This is the registered nurse administering pain killers. She does it properly….

The good news is that Christine is able to wiggle her big toe, which is good because it was thought that the nerve that controls this function would have been cut during surgery. She feels numbness in her jaw which is a good thing and was predicted. She is fed four times a day via the feeding tube. Christine did another lap around the nurses' station, walked to the conference room, and sat in her chair and did her exercises. She is now quite exhausted!

Dr. Pytynia’s team of doctors visited and checked Christine over. They are still very pleased with her progress. She may be put on a smaller tracheostomy tube tomorrow.
WhiteBoard
Dr. Garvey’s Fellow came and checked Christine over. Again, very pleased with the progress. He still expects to remove one of the drains soon and take her boot off on Wednesday. Here he is wondering why there was nothing new on Christine's whiteboard!
TrachClass
Nurse giving her tracheostomy class. She also does it properly too…

We are also in the process of watching a bunch of training classes in preparation for when we eventually go home. These are videos showing how to change the drains, the use of the tube feed, and a tracheostomy video.

Christine is still not well enough for visitors at the moment.

Post Operation - Day 3

Christine had a bad night as she was taken off one of her pain meds, Tramadol. She was in quite a lot of pain, particularly in the jaw area. Her leg was OK though. She struggles with the production of saliva, but now has a suction tube to take care of this. The swelling on her jaw has come back again, but we were warned that this would happen.
Resident
Dr. Pytynia’s resident physician visited and checked Christine over. He was very pleased with her progress and said she was doing really well considering the surgery was only two days ago.

The Doppler monitor sounds really good, and confirms that the blood flow in her jaw is working. Thankfully he put her back on the pain meds, which she will be given every six hours. He checked to see if Christine could breathe without the trach, but the swelling in her mouth was still too bad for this to happen.

Dr. Garvey’s fellow came and checked Christine over. Very nice chappie and an excellent bedside manner! Again, very pleased with progress, and wants her to start walking around the ward to help the healing process and to prevent blood clots, etc. He expects to remove one of the drains tomorrow, and take her boot off on Wednesday.
CF-02
Later, Christine walked all around the nurses' station, I am so proud of her progress!

Up until now Christine has been fed constantly via a feeding tube. Today she will be fed with at normal times, still via a feeding tube. This means she will have one less wire plugged in for most of the day, which will be quite a relief.
RN-02
Our duty registered nurse gave us a demonstration on how to change the feeding tube. The Doppler wire is also detached until it is needed.

We will have to watch a bunch of training classes in preparation for going home (not any time soon). These are videos showing how to change the drains, the use of the tube feed, and a tracheostomy video. There is an on-site tracheostomy class tomorrow which I will attend.

Christine is still not well enough for visitors at the moment.

Post Operation - Day 2

Christine had a good night, and is still progressing well, although still communicating via the white board. I think that the swelling on her mouth has gone down quite a lot since yesterday, so that is encouraging. She keeps on top of the pain meds, which makes her feel as comfortable as possible. All of the wires, although quite necessary, are a bit of a nuisance. She was able to watch Lewis win the Monaco Grand Prix, however the excitement proved exhausting, so she had a good sleep after that!
CF-01
With assistance, Christine can now get up and shuffle around with the IV stand as her constant companion. The nursing staff are fantastic and provide the best possible care and attention.
RN-01
Some pain meds being administered by the registered nurse.
OT-01
The occupational therapist did some shoulder exercises with Christine. Tomorrow she will be expected to do a lot more, perhaps some walking!
Cards
We are grateful for the cards, and all the words of encouragement, however she is still not ready for visitors just yet, although this little monkey sneaked in whilst nobody was looking.
Cargill

Post Operation - Day 1

Christine is in good spirits considering all that has been done to her. The surgeons visited first thing and they were very happy with progress. The registered nurses pop in every hour or so to check that all is OK. She is on a feeding tube, and an IV for drug medications. There are also many diagnostic wires attached. She is breathing through a tracheostomy tube and they have a Doppler blood flow monitor that shows that the rejoined arteries are working well.
Physio-01
A physiotherapist with 40 years experience, came today and, after a number of breathing and leg exercises, was able to have Christine get up and sit in a chair for an hour. This was an amazing achievement, and I am incredibly proud of her determination! Tomorrow the plan is for her to walk, and to sit in a chair for two hours.

Surgery Day

MDA
Andy and Christine departed for MD Anderson at 4:15am for a 5:15 check in. Hardly any traffic, so we were there in plenty of time!
SurgeryDay
Christine went down for her surgery at 7:05. At the 10:30 call, was informed that surgery actually started at 8:30 and her vitals have been stable. Dr Pytynia is working on the jaw area, and Dr Garvey is working on her leg. I wonder if we get a two for the price of one…
Next update at 12:30, when we anticipate that Dr Pytynia will be finished with her bit.

12:30 report. Vitals still good. Dr. Pytynia and Dr Garvey still hacking away. They have been joined by Dr. Hofstede, who is a dental surgeon. The next update will be at 2:30 (tooth hurty … haha)

14:30 report. Vitals still good. Dr. Pytynia and Dr. Hofstede have finished their tasks. Dr Garvey is now reconstructing the jaw and joining all the veins and blood vessels. Hopefully, everything will be completed by about 16:30. I will be heading back down to the hospital shortly, so this will be my last blog entry until I return, later this evening. I will be updating Facebook, of course!

Final report. Christine finally came up from recovery at 21:10, and I got to see her at 22:00. The surgical procedures were apparently successful, however there will be a very long healing process. She is on a cocktail of pain medications, with periodic doses of morphine. When I finally got to see her, she was pretty beat up and tired, attached to all sorts of tubes. She is unable to speak at the moment, which adds to the frustration. I will visit her again in the morning and perhaps give a better update then. I know that some of you will want to visit, but I cannot see that happening for a few days, if at all.
PostSurgery

Surgery Consultations

May 21st - PET Scan

May 23rd - Consultations
Andy and Christine went to the in the MD Anderson cancer center in Katy and met with Dr. Pytynia and Dr Lindquist, who is a very capable Resident Physician. They went through the final plans for Christine's surgery, and were able to answer all of our questions and concerns. The PET scan was reviewed in detail, and the tumor showed up very clearly.
DrP-01
They also met with Dr. Savage who is a speech therapist, who explained that Christine would not be able to speak through her mouth until all of the tubes have been removed and the swelling had gone down. On Monday, after the surgery, speech tubes will be put in place. One of the side effects is that once everything has settled down, Christine will only be able to speak Texan.


Dental/ Reconstruction Consultations

Since Andy was recovering from knee surgery, Carol-Ann kindly went with Christine to the MD Anderson medical center downtown Houston. This was probably a good idea anyway, as she was able to ask some very good questions that Andy could never have imagined. They met with Dr Chambers who is an oral oncologist, and Dr Garvey, who is a specialist in reconstruction surgery. With each doctor they discussed the planned dental work and the jaw reconstruction that would be needed for Christine to completely recover. Dr Garvey is the considered the main man for this procedure, so they felt that they were in very good hands.

CT Scan Consultation

May 13th - CT scan of head

May 14th - CT scan of legs

Andy and Christine met with Dr Chun, who specializes in radiology. Having reviewed the preliminary CT scan, he wasn't sure that Christine would need radiology, but still went through the process. He also felt that the cancer had not spread to the lymph nodes. He was a very deliberate and confident man.


First Consultation

Andy and Christine met with Dr. Pytynia and her staff in the MD Anderson cancer center in Katy. Dr. Pytynia will be the lead surgeon, and team leader for Christine's procedures. She specializes in head and neck cancers. She reviewed the biopsy and report from the remedial surgery performed by Dr. Winterstein the previous week. She proposed that an aggressive approach would be taken, which would be to remove the jaw bone and tissues, as well as some lymph nodes from the neck.