Realtime Hospital Issue - Looking For Any Guidance

[Jandrews]

My wife's mom (my MIL) is 75 and has been in excellent condition, i.e. worked up until about 2 years ago, drives all over, travels via air to visit, etc... This past Sunday, she started having severe stomach pains at home, to the point where she considered calling 911. She took some sort of pain medication that she had at home, and made it to Monday. On Monday, one of her sons took her to the emergency room, where they apparently ran a battery of tests, and potentially a CT scan (information is scant as I got it 3rd hand). The ER doc indicated that he was fairly certain that she had Ovarian Cancer, as they observed a large mass on her ovary, and potentially more that had migrated to her stomach. She was sent home with some pain medication and scheduled to meet with a surgeon next Monday.

Yesterday, at home, her feet began to swell, and she could not eat or go to the bathroom. They took her back to the ER today, where she is currently as I am writing this. My wife is there with her, and just a few minutes ago indicated that she is now throwing up blood. I am getting text messages, so I don't have much to go on. My wife said the ER staff is either not around, or not communicating much.

Since I am home with the kids, I thought I would post here to see if any docs had any opinions or guidance or observations. I don't think she has even "officially" been diagnosed with the Ovarian Cancer yet, but the ER doc from Sunday said he was fairly certain. What is the general prognosis? Any thoughts on her current condition with the swelling feet and throwing up blood? Obviously, this does not sound good, but I am trying to figure out what may have occurred since Saturday when she was out and about driving around, to the point that she is at now.

To make matters worse, my wife's dad (my FIL) is also in the hospital with advanced COPD. He was in bad shape, and the whole family has been focused on him. Now this with mom, really, completely out of the blue.

Any thoughts and all prayers would be appreciated.

Thanks,

JA

[m21sniper]

Tell your wife to walk up to the nurses station and DEMAND some answers.

Beyond that, i can offer you only my best wishes.

[A930Rocket]

No answers but best wishes and prayers sent.

[Jandrews]

That is EXACTLY what I told her Bill. Thanks for the kind thoughts.

JA

[Oh Haha]

Originally Posted by a930rocket

no answers but best wishes and prayers sent.

+1

[911mnypt]

I am sorry you are going through this...its a painful part of life.

Be demanding and don't wait for answers from the Doc's, they see hundreds of people and unless you grab them by the throat it will get dragged out.

Take care,
Richard

[Heel n Toe]

Call your wife and get her to ask the nurse to look on her chart and see if there is a record of them having done a CA-125 on her Monday.

If the tests, scans, and the CA-125 indicates O.C., she should be scheduled to see an oncologist, not a surgeon. Nothing against surgeons, but trust me, that's who she should be seeing.

About 16 years ago, I began to learn more than I'd like to know about O.C. Won't go into details.

More info here: http://www.webmd.com/ovarian-cancer/default.htm

[Jandrews]

My wife just reported (via text msg) that they are now moving her to "Internal Medicine". I assume that is out of the ER and into a hospital room? If so, that seems like a good sign, at least for the short-term.

Heel n Toe, my wife will be heading home shortly, and I will ask her about the CA125.

Thanks,

JA

[Heel n Toe]

I don't know if Internal Medicine means something different when it's spoken of as a part of the hospital, you would have to get some feedback from some of the doctors here. It could mean she's stable enough that she doesn't need the higher level of observation/care of an ER.

I go to a practioner of Internal Medicine instead of a General Practioner... by choice. He was recommended to me by a friend, and he is the best doc I've ever had.

The textbook definition: Internal medicine - Wikipedia, the free encyclopedia

[pavulon]

Vomiting blood is of concern. Vomiting lots of blood is an emergency.

It's difficult to armchair quarterback this sort of thing but it sounds like she needs to be admitted and managed in the hospital as marked bleeding leads to anemia/and or electrolyte problems which may lead to blood pressure/heart rate/rhythm issues that can be poorly tolerated by elderly folk. Her labs and vital signs will need to kept track of as well as her mentation. Elderly folk can experience changes in mentation that cause all sorts of problems (i.e. disorientation, falls and fractures).

Ask someone to go over the results of her CT scan with you soon. Did the patient ever discuss her wishes for such a situation?

Good luck but this stuff would have me gravely concerned.

[Jandrews]

Thank you very much, pavulon. I know it is difficult to offer any advice from here, but I truly appreciate your thoughts.

The swelling feet and the vomiting blood (I have no idea how much yet) certainly do have me/us gravely concerned. I am just wondering what is causing that, and whatever it is, how it could be such a dramatic change from just a few days ago.

Interesting that you mentioned mentation twice. What is the linkage here?

And when you ask if she ever mentioned her wishes for such a scenario, do you mean such as living will? I just want to make sure I am following your questions so that I can potentially address these with my wife and the rest of the siblings.

Gratefully,

JA

[pavulon]

People can't really have their labs continuously monitored with ease. Labs can be monitored closely but that requires obtaining blood from a patient who's already bleeding. Blood pressure can be continuously monitored with a arterial line or some other less common devices but that takes place in an ICU for pretty ill folk. Heart rate/rhythm can be monitored continuously pretty easily.

Subtle (or marked) mentation changes can be monitored by family that know the patient well and can be early indicators of changes in lab values and/or blood pressure (blood supply to the brain). Little things can be clues but can make folks paranoid as well.

Be pleasant and thank the hospital staff as much as you can. Right or wrong, they'll take better care of your loved one if they like you.

Again, best of luck!!

[sammyg2]

Prayer sent, asked the Lord to give you all strength and to watch over your family.
It doesn't sound good but he'll be there for you to help you deal with whatever happens.

Sometimes we're a bunch of A-holes here but it's OK if you lean on us, we won't mind. We are at our best when things are bad.

[nostatic]

I'm not a doctor...wait, I am a doctor, just not the right kind. Have been through various health issues with parents and friends. Take with a grain of salt. My ex had ovarian cysts that were quite large. Ended up being scary but a non-issue. But in cases like this probably best to assume the worst and hope for the best. Agreed with others that it doesn't sound good, but sitting around with no information and an active imagination is probably the worst of all worlds. Try to stay positive for those around you, and good thoughts sent.

[Rikao4]

you have 3 or more problems going..
cyst..down the line that has to be taken care of..
old folks don't handle surgery as we do..
the vomitting of Blood..
how much, fresh or old (looks like coffee grounds...)
? are their infusing blood..or clear fluids..
I'm sure a hemacrit test ( clotting factors)was done Sat..
any difference ..how much..

swelling (edema) she's retaining fluids..(kidney's ?)

not a Dr..but I played in many ER's ...

oh and he's right be nice..
it will go much further than stomping your feet..

Rika

[Tobra]

As I understand it, elderly, post-menopausal women do not get ovarian cysts. If she has OC and it has spread(metastasized) to her stomach, that is very bad. Swelling could be mass pressing on vascular structures, lymphatic problems secondary to bad stuff in that system, heart failure, a lot of stuff.

She is probably on the medicine service at the hospital, need an oncologist.

Your wife and her mother are farking terrified right now, keep that in mind if the missus makes a move like she is going to snatch one of your eyeballs out of your melon, or is a bit short with you.

[sluk]

Could be several separate issues at work here.

1 vomiting blood - could be from stomach ulcer(s) caused by medications - usually NSAIDS such as Ibuprofen, or ulceration from other causes.

2. Ovarian mass in this age group most likely cancer but need to confirm diagnosis. CA 125 will help. Any weight loss or gain? Any ascites- (Fluid collecting within the abdomen)? (Should be present on CT scan. Ask if her clothes/pants were getting tight or loose).
If the mass is large enough it could compress the pelvic veins leading to swelling of one or both legs.
Ovarian cancer can lead to bowel obstructions, but does not often spread to the stomach.
Often ovarian cancer has few if any early symptoms and is not diagnosed until it is a late stage (Stage IV).
Oncologist is helpful but a surgical gynecology oncologist would be needed to perform a staging laparotomy to diagnose and stage the disease.

Best of wishes to you and family.

[pavulon]

Any news here?

[Jandrews]

Thanks for asking, pavulon.

No significant changes yesterday. According to my wife, just that one incident of vomiting blood, and she said it was a "smallish" amount. She was apparently able to eat a little yesterday, and seemed to have a little more color in her face.

She was visited by the Oncologist, who apparently indicated that he saw two additional "masses" in her chest area, one near her heart and one on the other side near her ribcage. She has an official "appointment" with this doctor on Monday, but until then, that is all the information we have. I asked about the CA-125, and we believe she has had this, but do not know the results. I also indicated to my wife to have the Oncologist review any films with her so that she can get specifics about what they are seeing. (This whole family is bad about not getting information. They don't know what pain medication she is on either, and don't appear able to ask the questions to become informed. Frustrating for me, but I don't want to push her and make her feel bad, either.)

This obviously does not sound good at all, with the multiple masses sited. Does this sound like something that surgery would be recommended for? What are the other alternatives? Chemotherapy? Radiation? "Keep her comfortable"? I am shocked at how quickly this seems to have advanced to this stage, and I am concerned about how long she can realistically go on without some kind of intervention. Also, even if surgery is prescribed, is it likely that would help for any significant period of time?

Thanks to everyone for thoughts and prayers.

JA

[pavulon]

I'd agree that it sounds like tough sledding. It sounds like some sort of metastatic disease that may or may not respond to treatment (chemo). Surgery would be a tough sell unless it was intended to improve quality of life or solve some problem that I'm not seeing (there could be several)...any treatment involves doing a risk/benefit equation only those involved can do. Unfortunately, her age is not working for her.

I'd try to not get bogged down in the fine details of her care (which pain meds she is on...) and try to think bigger picture. If she can reasonably participate in difficult discussions/decisions, that would probably be best. Your oncologist should be able to guide you. A question to consider asking of him/her is "what would you do if she was yours?"

Hopefully this helps in a very difficult situation for all involved.