What the Pathology Report Says

This is the biggest piece of information of the entire process, even more revealing than surgery, because to get the pathology report, pathologists must dissect and microscopically examine every tiny bit of tissue that they took out of Bill, so that they can better understand the status of his cancer.

The results are as follows (and if anyone wants a particular detail, because you are experienced with these things, and know what the details are about, email me, and I will provide that. This report will be very surface, for obvious reasons):

According to my reading and intensive research on the report and its terminology, here is what I THINK it says:

He had bladder cancer, urothelial--transitional cell carcinoma. We knew that. He had two cancers in his bladder and one area of granuloma. We knew that, too. His cancers are the highest grade, most aggressive kind. We knew that, too.

The cancer did break through the outside of the bladder and was visible there without microscope (macroscopic, they call it).

Cancer was also found in two lymph nodes near the bladder. That was the news we most didn't want to hear, but which could have been much worse, because it could have been in a lot of nodes, but wasn't. And the nodes with the cancer are gone now.

There are a few other details if you want them by email. Not all of you would want those, I realize.

The big surprise was that he also had prostate cancer. Dr. Walther didn't mention that this morning. I wonder if doctors purposely only give you the merest edge of information at first to avoid shocking you.

The prostate cancer is called adenocarcinoma, Gleason grade 3 + 3 = 6, (which means it is relatively well-behaved cancer type), bilateral, organ confined, with perineural invasion, but no spread to lymph nodes at all. Prostate is also removed, so hurray for that, too.

The next thing that happens is this:

1. Bill gets to go home tomorrow for sure! HOORAY!

2. We'll have a home nurse. HOORAY!

3. We come back in 2 weeks to get the stitches out and to get tests done on his kidneys to see if he qualifies for more chemotherapy.

Oops gototta go help him walk. sending.

love to all

God is good.

Sorry it Took Me That Long to Google the Terms

I'm composing the post now. Should be up in less than a half hour.

Got Pathology Results: Reading Them; Will Post Within an Hour

Not as good as we had hoped, but fantastic compared to what it could have been!

Dr. His Bladderness stopped in briefly when I wasn't here yet, and gave Bill a brief bit of information. He had intended to give him the report, I guess, in a couple weeks when we come back to get stitches out. But because I called so many times and left messages with everyone over there, I suppose--I guess--I do not allege!--that MAYBE that made him come by and give Bill a brief overview.

Of course, BRIEF OVERVIEWS so not satisfy Desperately Inquisitive Individuals like myself, so I continued phone calls until the nurse finally printed me a copy, which I am reading, and which contains a lot more news that Dr. Himselfness gave us.

I'll post the news after I read it; it's long.

See you in about an hour.

Grateful to God that it isn't all that bad!

Bethie

Last Post of the Day, Tuesday Afternoon

Great news! Home this week!

Dr. Walther's Chief Acolyte just came by and said that His Supreme Doctorness is ready to release Bill either tomorrow afternoon (Wednesday) or Thursday.

They will set up a home health nurse in Blowing Rock to take care of Bill's wound issues right in our house. Good thing it won't be me doing it.

We are excited beyond description to get out of here! The ride home might hold unexpected events, and I have no idea how to do it, if Bill is still on his IV, or has to go to the bathroom suddenly in a public restroom, or starts leaking from his central vertical surgical incision. Oh man. I wish a nurse could ride with us!

Well, with all the prayer surrounding the cowboy, nothing will probably challenge us.

I'm going to start rolling things down to the car tomorrow, from the hotel room, as in PACKING!

AAAAAAAAAA! This is just so amazing!

(Still no pathology report. The Acolyte prevaricated just a teensy weentsy bit by saying, oh those reports take three weeks, so he won't tell you until you come back in a few weeks for a followup exam. Ooops. She didn't know that His Waltherness already told us it takes only a week to ten days. We also left a message with Dr. W's nurse today to please help us get that report asap.)

We got that joy joy joy joy down in our cowboy hearts!

PRRRRRRRRRRRRRRRRRRRRRRRRRRAYER WORKS!

Gratefulness overdose!

Nuthin New, All is Well

Either I'm really tired, or Bill's and my brains are running on low batteries, but we can't think of anything to say today.

"Bill, tell me something to say."

"Tell them the Die, Die story. Or that thing the nurse said yesterday, although it probably wouldn't be funny in a blog."

Okay. So there's a nurse here named Diana, nicknamed, Di. See where this is going? When Bill was at his sickest, the intercom came on his room. The operator was looking for Di. So she says, "Di, Di, Di. Looking for you. Di." This is probably not something one says over a hospital intercom, where people are already a little concerned about the Grim Reaper. Poor Bill.

The other anecdote he suggests is this: As mentioned before, he is covered in tubes and wires, and every time he gets up, it takes almost ten minutes to untangle them, unhang them, rehang them, etc. So at one point, Bill was standing up, trying to get one fluid bag unwrapped from the wires of another fluid bag, and I was leaning my head under his arm, trying to straighten out three IV cords, and the nurse was reaching behind him, trying to get his stomach tube out from around his waist. We were all stuck in this tube-intensive cluster, and suddenly, she says quietly, "Group hug."

I'm sure it couldn't possibly come across as funny in writing as it did at the time. But, when she said it, Bill and I nearly fell out. Actually, I think some serosanguinous fluid literally DID fall out. Of Bill's stitches. From laughing so hard.

Yeah, that anecdote I should probably delete, but I'm too tired.

He gets some more xrays today, then they let him try soft food. I'm sure he will be fine. He isn't throwing up at all any more.

The only thing I remain concerned about is his moderate (two-inches long, so far) wound dehiscence, but according to the megavolume of articles I've read (including, yes, some appellate findings from dehiscence lawsuits--oops--the medical gang here doesn't know I'm a lawyer)--they are doing okay with their treatment of it. But they were too slow starting, and something really bad could have happened, but it didn't, and I feel pretty secure that it won't, as the situation seems to be resolving, although he has to get re-stitched, and help me Jesus if they send him home with just me to figure out what to do if his incision blows apart any more than it already has.

To give you a sense of what I'm talking about, and what "wound dehiscence" is, here is line from the appellate judgment I read this morning: "It happened suddenly, after a cough, and plaintiff was able to catch her intestines before they landed on the floor."

Wow.

I never want another link sausage as long as I live.

In other news, we have no pathology report yet. Could be any time. I will post that instantly.

God is Light.

So Far, Still Looks Rosy!

By the end of today, Bill's spirits were great. He was joking with the nurses, and despite several dramatic episodes of various types, still, overall, there are no dangerous medical situations pending.

He is able to try sipping water tonight, and if that goes well, he can try soft foods.

He continues to wake up internally, and the trajectory is completely positive.

I still have my own concerns about his incision situation, and Bill shares them after I read him the info I found online, but, come on, the medical people at Duke MUST know more than Bill and I know about why his incision is doing such strange things. Right?

Two cowpokes with a google education couldn't possibly be right while all the doctors in training that stop in for 2.5 minutes a day are....unconcerned. RIGHT?

No, honestly: nothing to worry about. Let's all just be happy that the corner has definitely been turned! (Yes, I know, all ye English profs reading this: passive construction. Bad Beth!)

Love and thanks to you for sticking with it this long!

God is love.

Much Better!

The sleepy cowboy intestines seem to be waking up. This would mean the foreseeable end of the ileus problem! And THAT would (this is me assuming--no one said this, but still...) mean he could go home, once he can eat!

The only things left to resolve are:

1. He still can't eat or sip water yet, but I'm going to guess they let him try water soon.

2. They are concerned about a new thing--his incision. They aren't sure what is going on with all that flow (the flow which, to get them to really notice, Bill and I had to put on a dramatization of Armageddon in the hallway yesterday, as you recall). I wasn't here when the doctors came in, but in his half-asleep report, Bills says it seems they took out a bunch of his stitches and are letting his incision get air, and they are making him roll down to x-ray to figure out what is going on with it. He is on intravenous antibiotics again.

BUT! It can't be THAT serious of a concern, because they told him to walk and see what the incision does, in terms of draining. That doesn't sound to me like they're very worried. But if you have Genetic Pessimism like I do, the thought has already reached your mind: WALKING WITH HALF OF HIS STITCHES OUT? IS THAT REALLY A BRILLIANT PLAN?

3. The pathology report. Maybe today? If that thing comes back clear, you're going to be so sick of seeing me post photos of people celebrating...wait. It's Lent. Not supposed to be in celebration mode during Holy Week. Ummmmm. Okay, I'll post photos of NUNS celebrating. That should keep me within the Lenten parameters of sombriety. (Is sombriety a word?) (Do nuns dance?)

Giddy here.

I Think He's Sleeping

When I left our boy, he was pretty sleepy.

I still think he's better, even though it was a pretty rough day.

At the end of the day, around six, he started throwing up a lot, and I got worried extra, because he was choking on it, coughing and coughing. I think his abdomen isn't strong enough to get it out, and then he can't breathe, but I don't want him to get pneumonia from inhaling that stuff.

I also googled the dayights out of his condition, and it seems to me that they used a part of his intestines called his "distal ileum" to make the inner tubes from his kidneys to his side. And now what's left of his intestines near the distal ileum, where the cutting and tugging took place, is freaked out of its mind and has shut down.

From the diagrams I could find online, it looks like this distal ileum is about in the center of his abdomen. And since his stomach is also sort of paralyzed, then the shutdown must go from his stomach, at the top of his digestive system, down to the ileum, about halfway down. The lower part of his system is probably fine, but there's nothing there, so no real way to know.

So that's probably more information than anyone wanted at dinner time. hahaha

But overall--overall--he seemed better today. The ileus might not be better, I agree, but his health seemed better, just his overall health, because, after all, yesterday, he was literally starving from living on sugar/salt water for eight days. Today he had good stuff that looked like milk.

Actually, it looked like pina colada mix, and for a brief moment, I thought, hmmmmm, a little pina colada mixed into that bag--could it REALLY hurt?

JUST KIDDING!

More tomorrow.

Also, for those of you who might be anxious to hear how the pathology report comes out--I plan to post the news INSTANTLY after we get it. So if it isn't posted, that means we are still waiting.

Thank you for your unbelievably faithful and long-lasting love and care!

Your cowpeople

Bill Gotz a Lotz of Strings Now

Mid-afternoon report:

The news stays improved! Bill has more tubes, wires, and convoluted strings in him, on him, through him, and around him than a drunken hammock-weaver, but he is holding his ground!

After a shaky start, the overall picture is of an improved Bill. Definitely improved!

Insert huge sigh of relief.

Details:

1. He has thrown up a lot. That's due to the ileus: his entire digestive system is in lockdown mode, including his stomach. He still isn't even allowed to sip water. But they changed his anti-nausea meds so that he can be on them constantly, not just AFTER he upchucks.

2. He was awake a lot today, and seemed to be more a part of the human race than yesterday. He's back to sleep all afternoon, though, but rest is good.

3. He had two rather impressive dramas today. Both occurred when he tried to walk. Drama (1) After getting about 300 feet, blood started dripping on the floor in the hall and then started kind of pouring out. A maintenance man started freaking out and yelling in Spanish, and Bill got scared, and we didn't know what to do, so a nurse said, just get him back to his bed as quickly as you can. By the time he got back, the whole front of his gown was saturated, blood was all over the floor, running down his legs, all over his socks.

When the nurse inspected his stomach to find out where it was coming from, she saw it was his stitches, his main incision this time. When she took the bandage off, which was soaked, blood mixed with water was literally flowing UP out of the stitches of his main abdominal incision, flowing upward! Like a fountain--not a huge fountain, but literally bubbling UP higher than the stitches, before it poured downward again. I was HORRIFIED, and he was quite upset, too.

"What IS that? Is that supposed to happen?" I said, not all that calmly. The nurse said she thought it was okay, but would page a doctor.

No one ever came.

Then he threw up some more.

But later in the day, after the flowing wasn't happening any more, he wanted to try a walk, figuring that if the flowing blood happened again, we would get a doctor to come.

Drama (2) So off we went, him leaning over his walker, me dragging this pole with 800,000 tubes and bags hanging on it.

About 50 feet into the stroll, KABOOM! Here comes the blood again, pouring on his gown, rolling down his legs, creating a lovely river walk right in the middle of the hall.

We went right back to his bed. And THIS TIME, it worked. After they got all THAT cleaned up, a doctor came.

The doctor was a great explainer and very patient. She could see the little fountain flowing out between the stitches in his belly, and she worked on him a while. Turns out that it's not dangerous, but they will watch it. He has necrotized fat and a non-dangerous clot under his incision. If it gets worse, they have to remove his stitches and re-enter his abdomen and insert a sponge and drain. We certainly hope it doesn't get to that point.

But she said he is in such a state from so long without nutrition, that healing can't happen at the normal rate. So where normally, stitches would close him up, he is remaining open, so that the contents of his abdomen are passing through his stomach wall.

Oh, my disappearing appetite.

So he has a GIANT bandage on that now, and has no plans to try another walk. Walking makes it really pour out, which is good for relieving pressure, I suppose, but bad for his aesthetic experience, and for the maintenance man's blood pressure.

4. Apart from that, ileus is really now his only problem, but it has such side effects. He has so many bags running down tubes into his arm and sides that I can't even count them all.

But even with all that, he really seems to have stabilized, and seems more refreshed, with his new milky looking intravenous food.

I'll write the next time I hear something. Tomorrow, I think we get the pathology report. That's when we find out if he had any microscopic cancer cells that spread outside his bladder.

But for now, he's sleeping, and it's a better day!

Love and thank you.

A Little Better!

I just got here, so I don't know much new, but Bill looks better, is perkier, seems more awake.

The first thing he told me was that he is still throwing up. So that's not good, as his stomach drain was supposed to help that, and they hadn't given him his anti-nausea meds. What the heck?! They waited until he started throwing up to give them (intravenously). I don't get it!

But he has a new white bag of nutrition on his IV pole, so maybe that's helping.

Now, he is even going to try going for a walk.

I have a feeling he's turned a corner, here! I'll write more later.

Love from him and me!