5 liters

Friday August 20th, 2010

Today was the day I had my paracentesis, the draining of the fluid from my abdomen. Our brother, Coye, came with dad & I. It was done in the liver clinic by Dr. Lam, a PA, physician's assistant.

Dr. Lam started off by explaining the risks and benefits of the paracentesis and sign the consent. There's alway a risk for bleeding, infection and in this case, perforating my bowels. Then he went to find the best side to work from by using the ultrasound machine. He showed me how to read the screen, the fuzzy image on top was my skin, the black underneath was the excess fluid, and the fuzzy image on the bottom was my intestine. The left side of my abdomen had more fluid fill space than the right, and the site was right above my left hip.

He cleaned the area off and showed me the prefilled syringe with topical lidocaine. He told me how it'd be a burst against my skin and it would numb the area. I warned him that I tickle very easily. It was a quick, harsh, cool burst against my skin. He cleaned the area again and then used the next syringe, with a needle, to inject more lidocaine. I did feel a slight discomfort but it was tolerable. I've seen my patients @ the VA getting this done, if they could tough it out, so could I. He then showed me the pointed scalpel, I think it's a #11 (different numbers = different shapes of the tips), and he showed me how deep he'd be inserting it. It would help get the last needle/catheter in better. I wanted to see all this so I could share it with you and educate myself. The last needle was the one that made me go, "Wow". It reminded me of the one in Pulp Fiction, the length was about the size of the one they used to revive Uma Thurman's character after she overdosed. The bevel or sharp angled tip was retractable after he first inserted it to pierce the skin and then it'd be a dull tip catheter. The catheter tip had little holes in it to suck out the fluid. He showed me all this before he put it inside.

Once he got the big needle in, it was attached to a 60 cc syringe where he drew out the yellow fluid, which he'd send to the lab to make sure I didn't have an infection, otherwise I'd have to be admitted for IV antibiotics. Then he attached the suction tubing which led to a Gumco suction machine that helped drain it quicker than by gravity. It quickly filled the first collection bottle, and was replaced by the 2nd bottle. My brother, Coye, was allowed to come in. I want to document my experiences and we took pictures of my belly, the collection chambers and the catheter in my stomach. By the 3rd bottle, my stomach was getting flatter and the fluid was coming out slower. The catheter in my abdomen had to have the suction disconnected while Dr. Lam readjusted the catheter before restarting it, it was sucking intestine as the fluid decreased. He also pushed softly on my right abdomen to get the fluid to the left side. By now I was having severe right sided back pain. They tried to make me comfortable with an extra pillow behind my back.

The nurse had come in to start an IV on my left arm. I was to receive a substance called albumin. Dr. Lam said that when there's a big shift in fluid, sometimes the kidneys can go into shock and this to prevent that from happening. It was a pretty packed room with everyone present. The fluid finally stopped coming out just under 5 liters. He removed the catheter. The albumin finished @ the same time and the IV was taken out. I could see how flat my stomach became, I could also feel my enlarged liver better, and Dr. Lam joked that he gave me a 6 pack abdomen.

Then I was asked to sit up. I had a hard time breathing and the back pain was awful. Coye & Dr. Lam assisted me in sitting up while I tried to catch my breath. I was informed that with all that fluid that was drained, my insides have to readjust themselves, and that it was stretched out for so long, that I'll be sore for a while. It took a while for me to catch my breath and for my body to get used to being, what, 11 pounds lighter. He gave me 2 cups of water. I hadn't eaten before the procedure, I wasn't sure if I should or not, some you're supposed to be NPO. He told me that I could've eaten beforehand. I had an Ensure in my purse which I also drank. They assisted me into a chair and slowly but surely my breathing did get better and the back pain, but not entirely. He said that there was no rush. My oxygen saturation, which they measure on your fingertip, was 99% on room air, which is great. It was a big adjustment for my body. I also felt a little woosy. I sat a while longer until I felt a bit better and my breathing became slower.

I was given the number to call back if the swelling comes back. I was told to ask for Diane and not go through the answering service if he wasn't available. I was also told to eat a low salt, less than 2 grams/day, diet but if I should have a craving, to eat one piece of pizza instead of three.
Coye was my crutch and helped me get back to the lobby where dad was. Dad went to get the car while we waited in the waiting area. Once in the car, I tried to lay down to ease my back pain, no luck. I did sit up with the pillow behind my back.

Once we got home, I rested until dad made a salad with chicken for lunch. I laid back down and took a nap after making the round of phone calls.

Later that day, we got a nice surprise, a large tub of Garrett's popcorn, caramel & cheese, from my friend, Suzanne. LOW SALT DIET popped in my head. So I nibbled on the caramel ones more than the cheese. Oh, the cruelty of it all. She & I spoke later, she told me to be an non-compliant and to eat a handful every hour. Later dad had made Hamburger Helper, I LOVE that stuff. Jenny called home and told me not to eat it. Dad said that the whole box was less than 2 grams of salt, so I had a few forkfuls, WAH!

Later, Gabe & Lisa came by to watch a movie and to eat more Garrett's popcorn. We watched the Bounty Hunter with Jennifer Aniston & Gerard Butler, it was okay. Jenny, my sister, can't stand to watch her films, she's pretty much the same character in everything she does. Gabe was able to get all my phone numbers off my old phone & onto the new one, the lady @ Radioshack wasn't able to do that, yeah, that saves me a lot of time by doing it manually. By the end of night my back was having pain but I was standing more upright and breathing easier. I still have some rib pain but it's lower, not by my sternum, and I know it's due to my large tumor-ridden liver, again, I'm able to feel it better.

I wished my friends "goodnight" and walked them to the door. Boy was I tired, it was kind of late and I had a long day. I went to bed and zonked out with the light still on, while laying on my side.