Things are happening very quickly. On Thursday night, Marye had a very difficult time breathing. It was very shallow and painful, and we kept her pretty heavily sedated all night, though it didn't really bring her much peace.
On Friday, we saw the cardio team about the heart failure. The heart enzyme tests did not show a recent heart attack, so it's likely that the adriamycin she took back in 2005 is what caused it. Since her heart is not pumping well, she was retaining a lot of fluid, which is what was making it so hard to breathe. The other problem they found yesterday was that her liver enzymes climbed pretty dramatically, from below 200 to over 800. The doctors attributed this to the excess fluid that was built up and not flushing through the liver. To combat all of this, they gave her a drug to dilate the blood vessels into and out of the heart. That should make it easier for the weakened heart to pump. There is a delicate balance though, because it can lower her blood pressure, which is something they don't want to do. They also gave her Lasix, a diruetic, to help her pass the fluid.
By Friday afternoon, she started to pass water, her blood pressure remained stable, and she was breathing a lot easier. She complains of general, achy pain, but cannot really put her finger on anything specific, so we're continuing with the Dilaudid for pain. Overall, she looked somewhat better on Friday, so we figured the lasix and drugs to dilate the blood vessels were helping.
After today's blood work (they take blood every morning), I was told that someone ordered another CT scan of her liver. The GI doctor came in to say that instead of the liver enzymes going down as expected, they jumped to 3,000. There are several possible explanations, but the most likely one is that there is decreased blood flow to the liver, causing some necrosis and the enzymes being released in large numbers. My thought was that this was due to the recent diagnosis of heart failure, but he said, no, it wouldn't jump so dramatically so fast. He's thinking either a) there is a clot in the vessels that feed the liver, or b) there are swollen lymph nodes that may be causing a blockage. Hence, the CT scan. Depending on what they find, there will be some plan to deal with it. I don't know what they might come up with, but they do have ways of dealing with it. How effective they are is another story.
Overall, it looks less likely that she's going to rally through this. I was hoping that she might get to come home, even for a bit. I'm not very confident of that, now. Her liver is not "shutting down" per se, but it is suffering from many of the side-effects of cancer. They're all interrelated, and she just doesn't have the strength to fight all of it. Even if they get the water off and the blockage to the liver cleared (two pretty big "ifs"), she still has pretty severe heart failure. At this point, we're just trying to keep her comfortable while we deal with each issue.
I'm sure I'll be posting again very soon.
-Chris
