Miss Diagnosis: Bilateral Adrenalectomies

Wednesday, July 22, 2009

Bilateral Adrenalectomies

We spent the night prior to surgery in San Francisco. We were up at 4:30, out of the hotel at 5:30 and at the hospital by 6:00. They called us back to prepare at 6:45. As opposed to the last surgery this prep was completely different. Everyone was more relaxed, the anesthesiologist hung out with us, Dr. Duh came by to chat, and the IV wasn't a problem. They rolled her away from us at 7:30. Someone form the hospital checked in with us and gave us updates every hour or so during surgery. At 2:30 Dr. Duh came to find us and tell us how it went while his team finished up with her. He is really great, he acts as though he has all the time in the world to talk. He said it all went well; her adrenals looked like "Cushing's adrenals", inflamed. He also said she had a lobular spleen, nothing to worry about.

In recovery they were giving Alex Morphine that wasn't working and Fentanyl that was. The switched the Morphine to Dilaudid and that helped with the pain.The pediatric floor was full so they put Alex into an overflow of ped's on another floor for the first night. It was nice, because she got a private room and a nurse with only 2 patients. After 24 hours they switched her into a shared room in ped's.

Because of the recent Crohn's flare they brought in the ped's GI team. With the nausea prior to surgery it was hard to gage what was what and they really wanted her to eat. After the first two nights in-patient they told us she could leave once three things happened; she needed to eat something (she had literally not eaten anything in a week besides 3 bread sticks and 10 Ritz crackers), she needed to get off the IV pain meds, and onto only Vicodin, and she needed to poop (that had been a week as well). After 3 nights she had eaten and gotten off the IV, so they let her leave without a bowel movement.

The ride home was interesting. They gave her a Vicodin before we left and called the Rx into the pharmacy at home. That meant we had to race for home to get her next dose. Sunday afternoon traffic was heavy but Brian did his best to drive 80 mph despite it. She was feeling awful by the time we got her meds, but we made it from dose to dose in 4 hours.

On to recovery!
.

1 comment:

judycolbyJuly 22, 2009 at 5:09 PM
And things will only improve from here.!
ReplyDelete
Replies

Add comment

Transphenoidal Pituitary Surgery- From the UCSF web site

What happens during surgery?
The surgical removal of the pituitary adenoma is performed by a technique called a transsphenoidal operation. The word 'transsphenoidal' describes the path the surgeon follows to reach the pituitary gland. The word comes from 'trans', meaning 'to cross or pass through', and 'sphenoid', the name of the cavity (the sphenoid sinus) that is passed through to reach the pituitary gland. Newer techniques and improvements in technology now allow removal of these tumors without the need for an incision under the lip or within the nostril. The surgeon begins the approach by entering through the nostril on one side. The surgeon uses a brilliant fiber optic light to illuminate the internal anatomy, a microscope to magnify the area of surgery to 12 times the actual size, and very tiny microsurgical instruments especially designed for this particular operation. The surgeon guides the surgical instrument into the nasal cavity and an opening is made in the sphenoid bone. The sphenoid sinus is entered, and then an opening is made in the wall of the sella turcica to expose the pituitary gland. The adenoma can be readily distinguished from the normal pituitary gland tissue and is removed without removing the normal gland. After the surgeon removes all the tumor tissue, the small cavity that is left is treated with alcohol to destroy any tumor cells that may remain. This cavity is then sealed, sometimes with a piece of fat that the surgeon removes from the patient's abdomen. The surgeon then applies a biological 'glue' that helps seal the pituitary area from the nose and promotes natural healing. No nasal packs are used with this approach.