After the radiation therapy (which only took about 20 minutes), the time he was under anesthetic was used to good advantage and a PICC line was installed in his upper right arm.
Since he wasn't intubated today we did not need to go to the PACU and went straight back to his room on the pediatric floor. It was busy with quite a few doctors coming through all afternoon.
Doc H2 came by and we discussed his current and future treatments. He suggested Temozothlomide, a chemo drug that tends to be used in concert with radiation therapy, providing an additive benefit to the radiation. It was originally developed for brain cancer but it has also been shown to do well with sarcomas. There is some risk because it is part of the cytotoxic drug group of which we have mostly gone through already. This is an oral drug but since Alan just loves taking medicine orally (not!), we will take advantage of the NG tube. It's a little uncomfortable for Alan to keep it in even if Pedi Surgery is ready to take it out (which they aren't), but it makes it easier to administer the chemo.
Doc HJ came to check on Alan's stomach. The x-ray still showed a lot of air in his belly, so he really hasn't been getting much relief in the gastro-intestinal tract. To keep things from getting worse, she is putting the NG tube back on vacuum to get some air out and Alan is no longer allowed even clear liquids by mouth - just ice chips. This will help ease the stomach bloat and prevent diluting the oral chemo.
We talked with both doctors about strategies to deal with the abdominal obstruction. The main concern in the short term is to protect the kidneys and bowel. If we can do that we can buy time for Doc H2 to come up with a good post-radiation plan.
Doc HJ went into more detail on exactly what the tumor is doing. It is pushing on the rectum, pulling it tight and curving it like a bow string. She doesn't want to do a colon diversion since the surgery would mean a delay in radiation treatment. She is going to try to drain air and stool from his rectum with a tube - basically a bowel version of the foley catheter. This is something she can do while he is sedated for radiation therapy, hopefully Thursday or Friday.
For pain management today, we switched from a peripheral IV to a PICC line once the floor pediatrician viewed the chest x-ray confirming the placement of the line. We were going to give him Dilaudid in the PCA but the machine couldn't be programmed with the low dose that Alan's age and weight required, so we've switched back to Morphine and IV Tylenol for now. We are starting with a fairly low rate on the PCA, but with a bolus available from the nurse every two hours and an 'on demand' augment available every twenty minutes (a clicker connected to the PCA pump has a button that will allow one of us or Alan to administer a 'shot' of morphine when it lights up green) if needed.
We need to change the dressings on the nephostomy tubes every few days, so the nurses took care of that at the same time they switched Alan from the peripheral IV to the PICC line. We gave him a quick wash with the bathing wipes too. Alan was NOT happy about us messing with him but we got a lot accomplished during this time.
Finally, we noticed just a little bit of blood from the foley catheter. Urology stopped by and examined him and said that tends to be fairly typical because kids move around, and so that area gets rubbed a lot by the catheter. That was a relief!
Waking up after radiation
Alan's "template" for radiation treatment
Fruit Ninja on the iPad (he's a blur!) and Sponge Bob on the Touch Pad. Alan loves his gadgets!
No comments:
Post a Comment