Focusing On The Positive

    Since my update two days ago, so much has happened. Some of it is good, some of it is frustrating. When we first came down here to Stanford, the plan was for the doctor to place another drainage bag on the other side of Nathan's liver, keep him for an overnight stay to monitor him and to make sure that he doesn't develop an infection and then release him the next day. Unfortunately, that is not what happened. We hit a snag in Nathan's release and he is still being monitored for his condition. Since the details of the events are a bit lengthy, I will simply post a day by day description of the highlights for each day.
    July 11- Day of procedure--> Interventional Radiologist placed another biliary drainage for the other side of his liver. Nathan was moved from recovery to an observatory section of the hospital where they monitored his vital signs and make sure he didn't develop a high fever which could indicate an infection. Nathan was pretty sore and tired and spent a lot of time resting. During this time, he was allowed to drink fluids and had no restrictions on his diet. Later that night, he developed a fever and the nurses monitored him closely to manage his pain. He was on two different types of antibiotics to stave off any possibility of infection, and they were still hopeful he would be able to come home the next day.
    July 12- Fortunately, Nathan's fever dissipated by the next morning and the doctor wrote discharge orders for Nathan to be released in the afternoon. While I was getting instructions from the doctor and nurses for postoperative care and packing up his belongings, it was fairly evident to me that Nathan was in no condition to be released. He still seemed very weak and still hadn't been able to walk around at all. His pain seemed very intense, but we hoped that by taking things slowly, we could get him ready to leave. When Nathan sat up and I started to get him dressed, he got very nauseous and sat still for approximately 45 minutes. After remaining still for a long time, he got more nauseated and vomited up quite a bit. Neither myself or the staff had realized that his digestive track had slowed to a halt. Again. It was during this time, that they also realized that his fever had returned. Because of these conditions it was determined that he would not be able to come home. This was very unfortunate, but at the same time I was relieved because I didn't feel he was well enough or strong enough to be discharged in the first place. The plan was to keep him again overnight in hopes that he would get a good night's rest and be better in the morning. They also chose to move him to a private room and give him a lot of attention and additional monitoring. I think this was an excellent choice on their behalf.
    July 13 (today)- Nathan's fever broke and his temperature remained stable throughout the day, but unfortunately the nausea had returned and once again, he vomited a few times. The doctor came back and checked on him a few times and listened to his stomach and said that it's just moving slowly. The nurses continued to give him a high amount of attention and care. They also gave him two types of anti-nausea medications (one of which made him drowsy) and dilaudid (a strong pain medication) and he was able to get some quality rest. They currently have him on a liquids only diet, as well. During the evening hours he was able to walk down the hallway and back which is great improvement and progress on his part. At this point, we are taking it moment by moment and trying to get him back on track and healthy enough to be discharged, but that will take a little bit of time. We are hoping that he will continue to improve throughout the night and best case scenario, come home tomorrow.

We also got some promising news about Nathan's recent blood test results when he and his dad met with the liver cancer tumor board last week. One of the purposes of the blood test and the past blood tests was to measure his cancer marker numbers, his bilirubin levels and other seemingly confusing things that I don't really quite understand. That said, I do understand the cancer marker and bilirubin results and there has been some definite improvement and positive response to the biliary drain bags. Before the drain bags were placed, his bilirubin levels were the following.
   June 15th: 15 mg/dL
   June 16th: 16.7 mg/dL
   June 28th: 15.6 mg/dL
   July 3rd:  13.8 mg/dL
While these numbers are still way above the normal range (.3-1.9 mg/dL), it is still good news! It means that the bags are doing their job and with having two drainage bags, they should come down even more.
For his ca 19-9 (his cancer markers) the results were the following.
  June 15th: 60 U/ml
  June 28th: 132 U/ml
  July 3rd:    76 U/ml
    Once again, these numbers are still higher than normal range, but it is also an indication that his body is responding favorably to the drain bag(s). It also hopefully means that his liver functions will continue to improve with added treatment and his impending chemotherapy. The added benefit with that is getting him to the point where he is eligible for clinical trials.
   Please continue to pray for emotional and physical strength for Nathan and the family. The plan was for Nathan to begin his first round of chemotherapy in the middle of next week, but that doesn't look like a possibility. We had first delayed his chemotherapy because we felt that he needed to gain some weight and improve his liver functions and while it looks to be that they are improving, we have taken a step or two back with his weight gain. Before getting the second drain tube inserted Nathan had made great strides in his energy levels and weight gain, but now we have to refocus our attention on doing that again. I want to say a big thank you to all of you who are supporting all of us through this ordeal. The outpouring of love has been a tremendous help and we couldn't do this without you. Take care, God Bless.