Tuesday, November 30, 2010

John's Hospital Contact Information

John will be recovering at Overlake Hospital Medical Center for a couple of days.
1035 116th Ave NE, Bellevue, WA  98004.

To email John, go to https://www.overlakehospital.org/email_patient.aspx.  Address it to "John R. Carlson" and hospital staff will print it out and bring your message to John's room (Mon - Fri).

To reach John by phone, call 425-688-5000, extension 479151.

To visit John at the hospital, go to South Tower, 5th Floor, Room 506 (a nice private room with a view of downtown Bellevue).

The closest place to park is the South Parking Garage.  To get more parking information go to http://www.overlakehospital.org/patients.aspx?id=480.

Maps and directions are at http://www.overlakehospital.org/about.aspx?id=456

For more Visitor Information, go to http://www.overlakehospital.org/patients.aspx?id=358

Report from surgeon, 9:15PM

The surgeon came down and told us that he got the kidney out just fine with laparoscopic surgery.  John is heading to the room for nursing care now.  We are headed to the South Tower to meet him.

Post Anesthesia Care, 8:45 PM

About 8:45 PM, according to the monitor of patients' status in the Waiting Room, John's status has changed to "Post Anesthesia Care."  That is, John is in Post Anesthesia Care Unit for recovery.  We are not yet allowed to see him.

Closing to Recovery, 8:25 PM

The Family Waiting Area at Overlake Hospital has a large TV monitor scrolling surgery patients' current status.  A patient's status begins at "Check-In" through all of the steps to "Complete." 

Since we've been in the Waiting Room, John's status has been "Procedure in Progress." 

A few minutes ago John's status changed to "Closing to Recovery."  This means that John's surgery is nearing completion and he will be moved to the recovery area when finished.

We expect to talk with John's surgeon soon.

Prior to surgery, we were told that John would be in recovery for about 1.5 hours before we'd be able to see him again.

John is doing OK in surgery, 8 PM

At 8 PM a nurse just came into the waiting room to let us know that John is doing OK.  He'll be in surgery about another 30 minutes.

To Surgery at 3:45 PM

John and daughter Echo
It's been a day of delays, but John is now in the surgery room.  We arrived at the appointed 9:30 AM check-in time and got into the pre-op room where Echo, John's daughter, joined us about 11 AM.  We expected John's surgery to begin at 11:30 AM. 
Brother Bill trimming John's
mustache so tape will stick

Come to find out, the surgery room that John was suppose to go into was still being used.  So, we waited and waited.  Finally, the hospital arranged for John to go into another room. 

About 3 PM John's brother Bill showed up, followed shortly by the Operating Room Nurse and Anesthesiologist. 

So that tape would stick well to John's skin, some of his mustache needed to be trimmed.  Bill did the favor. 

Half a mustache, mid-trim.

At 3:45 PM, John was wheeled off to surgery.

The doctor indicated that John's surgery could take as long as 6 hours.  I will blog more when we find out anything new.
Anesthesiologist & O.R. Nurse prep'ing John

John off to surgery
Update:  We got the report that the incision was made at 4:31 PM.

Monday, November 29, 2010

Surgery Information

John is going into surgery tomorrow at 11:30 AM.  I'll blog John's status as the day progresses.  We were told that the laparoscopic surgery takes about 4 hours.  Then, John will probably be in recovery for about 1.5 hours before I get to see him in his room.  I will blog John's contact information at Overlake Hospital once I know it.

Friday, November 26, 2010

Laparoscopic Surgery

John's CT results show that the swollen lymph nodes under his liver are essentially the same size.  So, John will have the laparoscopic surgery to remove his right kidney instead of the more invasive surgery to also sample a swollen node. 

Finding out that the lymph nodes have not grown is the final factor in John's decision to go with laparoscopic surgery.  Other factors include: 1) kidney cancer typically does not go to these lymph nodes, 2) the swollen nodes are in a "treacherous" area, 3) there's only a 50% chance that the surgeon can safely sample a node, and 4) the chevron incision requires a much longer recovery period.

By not sampling a swollen lymph node John will not know if the cancer has spread, nor will he qualify for most of the clinical trials.

With this change, the urologist needs to get a different surgeon to assist him.  If she isn't available on Tuesday, they may postpone the surgery for a few days.

In addition to getting the CT scan today, John also had his pre-op visit at the hospital.  Afterward, we watched the Harry Potter movie and enjoyed a Mexican dinner ... yum!

Thursday, November 25, 2010

Happy Thanksgiving

Today we enjoyed Thanksgiving dinner at Echo's home ... very yummy.  I love spending holidays with the grandkids.  Lane is becoming such a big boy.  And Luke, the youngest, is exploring his world ... learning how to fall without breaking an arm or getting a black eye.  Unfortunately, Jasper, our eldest grandchild was sick and couldn't join us.
Setting the Thanksgiving table.

Grandson Luke sporting
a new shiner along with his
two-day old cast
Tomorrow is a big day.  John has a pre-op visit at the hospital and another CT scan.  The scan is to see if the lymph nodes have changed. 

If the nodes have grown, John will likely continue with the chevron-incision operation on Tuesday.   Otherwise, the surgery date may need to be postponed until a different surgeon who has expertise in kidney laparoscopic procedures can assist.

After all of the medical appointments tomorrow, John and I will see the new Harry Potter movie then go for a Mexican dinner as an early birthday celebration.

Tuesday, November 23, 2010

Surgeon, Turkey, and Snow

Looking out the basement door this morning
to our small stand of birch.
John talked with the surgeon late yesterday.  He provided some valuable information.  He confirmed that the lymph nodes are in a "treacherous" location.  But the surgeon let us know that he would be safe and avoid going any place during the surgery that would put John's life at risk, even to the point of not sampling the lymph nodes if he couldn't safely reach them.  That put our minds a bit more at ease. 

When I asked that he estimate the likelihood of being able to reach the lymph nodes safely, he said 50%.  Such a low probability shocked me.  I wish we had that information when John made the decision about which surgery to have.

In addition, this surgeon reiterated that kidney cancer usually doesn't travel to the location of John's swollen lymph nodes.  And, like the UW urologist, he said that if it were him, he would not have the more invasive surgery.

John still wants to know if the cancer has spread, however.  So, he's asked for another CT Scan.  If the swollen lymph nodes have gotten even bigger, then he'll probably go for the more invasive surgery.  Otherwise, he'll opt for the less invasive laparoscopic surgery.  The CT Scan is scheduled for Friday.
Gretchen says, "Let me in Ma,
it's cold out here!"

Today John is scheduled for his pre-op visit at Overlake.  But, we are snowed in and the temperatures are in the teens and low twenties today.  Brrr.  I've called about rescheduling.

I'm glad this is a slow growing cancer, because the slow pace of getting this all done is driving me bonkers.

In the meantime, I'm trying to plan ahead.  I cooked a turkey yesterday and froze most of the meat, stock and dressing to make meals while John is recuperating.  Today I'm slow cooking a ham and will freeze most of that too.
This Morning

Yesterday Morning
It snowed all of yesterday, into the evening.  Today and tomorrow the temperatures are supposed to stay low.  It's time to make a pot of turkey vegetable soup, cuddle up next to the fire, and read a good book.

Friday, November 19, 2010

New Information, More Questions

We got a call yesterday from John's urologist.  He said that they may need to remove John's gallbladder in order to gain safe access under the liver where the swollen lymph nodes are located.  The gallbladder is healthy; so, this is considered an "incidental" removal.  He indicated that John can live fine without a gallbladder. 

John is upset over the possibility of loosing another organ.  But, mostly, he's concerned about becoming more susceptible to infection.  We have an appointment to talk with the surgeon late Monday, and will decide how to proceed from there.

Thursday, November 18, 2010

Decision Made

Last night John decided to go for the larger chevron-incision surgery to both remove his right kidney and sample the swollen lymph nodes under his liver for metastasis.  Choosing this higher risk procedure would let him know for sure if the cancer has spread and put him in a better position for future treatment options. 

Wednesday, November 17, 2010

Decisions, Decisions

John is still weighing the pros and cons between the laparoscopic surgery to remove his right kidney, and the chevron incision to sample the swollen lymph nodes as well as remove the kidney.

We were hoping that this decision would become clearer after meeting with his urologist yesterday.  Instead, John is still up in the air about his best course of action.  The chevron incision is more risky because the swollen lymph nodes are close to a large artery, and recovery is longer because muscles must be cut through.  But, this surgery is the only way to know if the cancer has metastasized to the lymph nodes.  The laparoscopy is less risky with a shorter recovery period.

Regardless of which surgery John selects, he wants to enroll in a clinical trial.  New immunotherapy drugs show promise at shrinking metastasized tumors, and perhaps preventing the spread of kidney cancer.  Most of these drug trials require metastasis of the cancer.  So, if John choses the safer laparoscopic procedure, we won't know if the cancer has spread and, thus, he won't qualify for most of the clinical trials.

Anniversary flowers for Suanne ...
John is such a romantic,  but he thinks he's
girly for liking flowers so much ... LOL
Yesterday and today I've been searching the clinical trials and their inclusion requirements.  I'm also trying to figure out if it makes sense for us to keep or change our current medical insurance so that John has access to as many immunotherapy drug trials as possible.  Open enrollment ends on the 30th, the same day as John's surgery; so, time is short.

Both John's urologist and the urologist that gave a 2nd opinion say that either surgery is a reasonable choice, they just tend toward a different first choice.  Stay tuned ... John must decide soon ...

On a lighter note, John and I had a fun time for our anniversary.  We both played the slots a bit, John coming out ahead, and I with a loss.  The seafood buffet was good, too!

Friday, November 12, 2010

Our Anniversary and Other Happenings

Hubby John at Lane's Bday Party
(Lane's Dad, Joe, in the background)
Our wedding anniversary is tomorrow, but we are starting our celebration tonight at the Snoqualmie Casino's seafood buffet.  Since John missed going to Maine this past October, we figure he can get some lobster this way :).  We've been married for 17 years!

Lane opening his gifts

On Wednesday, Grandson Lane turned 5 years old.  Happy Birthday Big Boy Lane!

The UW has yet to put the rest of John's radiology CD's on their computer system so their urologist can finish giving us his second opinion.  I'll call again on Monday.  Waiting is frustrating sometimes.
Little Brother Luke
on a Big Slide

Tuesday will be a busy day -- John will be consulting with the surgeon, getting his pre-op physical, and donating blood for his surgery.  
Lane and a friend.
These bouncy slides are
fun for high-energy play.

Thursday, November 11, 2010

Nov 30th Surgery Date Set (and a few updates)

John's surgery date is set for Tuesday, November 30th at Overlake Hospital in Bellevue, WA.  He is making arrangements to donate some of his own blood in case it is needed during surgery. 

John will be talking with his urologist on Tuesday about whether or not to do the risker surgery to get at the lymph nodes as well as remove his right kidney, or to do the less invasive laparoscopic surgery to only remove his kidney.

Today, we'll talk with the cardiologist and get the complete run down on John's heart tests.

Tomorrow, we hope to talk again with the urologist who gave us his second opinion, as he's had time to review John's many radiology scans since 2007.

Monday, November 8, 2010

A Second Opinion Preview

We got up very early this morning and drove into Seattle for John's second opinion.  After reviewing the latest CT and PT scans, this urologist confirmed that John has more than a 90% likelihood of having renal cell carcinoma.  In addition, he concurred that John needs to have his right kidney totally removed because the cancer is quite large.

This urologist, however, did not agree that the swollen lymph nodes next to John's liver need to be biopsied or removed.  In this doctor's (and a colleague's) experience, kidney cancer does not typically spread to lymph nodes near the liver.  Also, these swollen lymph nodes did not show positive for cancer on a PT scan.   That is, the lymph nodes do not look "clinically suspicious" enough  to warrant the risks associated with an invasive surgical procedure. 

Furthermore, if a lymph node biopsy did showed positive, then cancer cells are very likely already throughout John's body anyway.  This urologist explained that new drugs show promise at shrinking metastasized kidney cancer, but they don't do well when it has only spread to the lymph nodes.

But, before this urologist firms up his "official" second opinion, he wants to thoroughly review all of John's radiology scans, including those from 2007.  So, we should hear back from him in a few days.

If John decides to go ahead and get the lymph nodes next to his liver removed, it'll mean an invasive surgery with a large chevron incision on his abdomen.  If he decides to leave the lymph nodes intact, the right kidney will likely be removed using laparoscopic surgical methods.  Laparoscopy is less invasive, reducing both hospital and recovery time significantly, as compared to the use of a chevron incision.

Regardless of his choice of surgery, John will follow up with regular scans to make sure the cancer has not spread.

Friday, November 5, 2010

Heart is Good

The internal medicine doctor's office called this morning to let John know that his heart test came out negative.  Good news.  As a preventative measure, they are starting him on a beta blocker before his surgery.

Thursday, November 4, 2010

Brief Update

On Monday and Wednesday of this week, John went in for tests to check his heart health.  Monday's procedure was a stress test; and Wednesday's was a rest test.  We are scheduled to learn the test results from the cardiologist a week from today.

On Monday of next week, we will be meeting with another urologist for a second opinion.  We are still waiting to consult with the surgeon that will be doing the chevron incision to reach the lymph nodes by John's liver.

John seems to be over his cold.  I'm about a week behind on my cold and hope to feel better next week.