Quick Decision Means Surgery this Morning

The past week has flown by with CT scans, doctor rounds and surgeon searching, but Brianna would disagree. She has been naucous off and on all week, and has hardly eaten a thing because of it. It's very frustrating for her, because all she wants to do is feel well. (I mean who wouldn't??) Like the strong woman she is though, she made it to the roof several times for the exercise and fresh air. It was also a nice escape from all the horrible jack-hammer noise that goes on all day just below our room. We nap with ear plugs and can barely hear each other over the noise, which persists for hours sometimes, and begins as early as 6:30 am! Sometimes my chair or feet vibrate on the floor from the construction below.

However, the biggest news is two-fold. First, Brianna had a thorough CT scan late Thursday. We were so happy to hear that there is no aspergillus anywhere else in her body! All her organs are functioning well and she does have some fluid build-up in areas, but that will go away as soon as she's off some of the strong medications she's on.

The second piece of information was that the effusion, or fluid around her lung, has grown. In fact, it has possibly collapsed the second lobe of her infected right lung, and is beginning to affect the top lobe. The pressure has grown so that it is even shifting some of her organs over.

So Dr. Ken Weinberg, the head of the bone marrow program here, decided to get a thoracic surgeon's opinion on the best approach in dealing with this. They enlisted Dr. Richard Whyte the head of Thoracic Surgery at Stanford, or the adult side of the medical center. After careful evaluation yesterday morning, it was suggested that they take a staged approach in treating the lung infection. And, take this approach quickly, because obviously Brianna's lung has not gotten better.

Dr.'s Weinberg and Whyte, Lizzi (our nurse practioer who cares for us), Darci (our dear Social Worker), Brianna and I met yesterday afternoon late to discuss surgery for this morning.

Dr. Whyte's approach is to go into the fluid-filled area surrounding the lung with a scope and to place a chest tube. What he finds will determine if the surgery becomes major surgery with removal of a portionof it. If the fluid drains easily and is not infected, a chest tube will be placed in order to alleviate the pressure on her lung. She would have it for seveal days, and it will allow her a couple weeks to get her platelet counts up. She's been very dependent on donors right now. Then, when her new marrow can hold its own platelets, the major surgery would be planned to remove the diseased lung tissue.

On the other hand, if Dr. Whyte finds that the fluid is infected and filled with pus, he would proceed to remove it as well as the fungal affected parts of her lung. This is majory surgery going in through the side under her ribs. It becomes riskier too because her body is not making platelets to help in clotting. But Brianna is ready to have this done, she is so tired of the pain and coughing. Of course, I'm praying it's just the scope and tube today so that the bigger surgery can be done when her body can handle it better.

The doctors have lined up all sorts of platelets for her. She can't have just any ol' platelets either. Because of all the previous transfusions, her body has built up antibodies to certain HLA types. So it was also a major consideration among the doctors here whether they should proceed with the procedure today if the blood bank wasn't able to supply a enough units of HLA specific platelets.

So here I am at 8 am, our room is packed and Brianna is sleeping while we wait for the call from the OR that they're ready for her. She will spend tonight in the pediatric Cardiovascular Intensive Care Unit (CVICU). Anytime a bone marrow patient has to go to the ICU, they have to pack up their belongings and be ready to give up their room to another patient. We don't know how many nights she will be there, but I won't be able to sleep in the room with her and we can't keep our transplant room. Depending on what happens inthe next couple of hours will determine where we will be. No matter what, I will be sitting by her bedside in the ICU until I know she's doing well.

If surgery is just the scope and tube, it will take about an hour. If it's major surgery to remove part of her lung, it will be three hours. There was a lot of planning that took place about where to have the surgery - the adult side or pediatric - and where she will recovery - adult ICU or pediatric. I think our doctor's plan makes so much sense, because Brianna is a young adult and an adult surgeon is used to working on patients her size. Whereas, the CVICU deals with immune compromised patients who have had heart and lung transplants. They know the kind of immune suppression medications she's on and they often work closely with the bone marrow transplant team.

When I asked Brianna how she feels this morning, she is nervous. But she is happy that something will be done. I have to say, we are so relieved that her white count is stable - it's been holding around the 5.3 to 5.6 range - and now the lung infection can be dealt with. As always, I ask for your positive thoughts and prayers for the best outcome this morning, so that Brianna will begin her journey of total recovery again.