Things have been a bit hectic. Recently Muttie went in for a surgical biopsy of the breast and then underwent another surgery to create a new fistula so that she can be ready for the chemo and subsequent removal surgery.
At first they told her that she would probably undergo a few weeks of chemo before they removed it but after the initial biopsy results they modified that to three months (give or take what the final biopsy says and how the treatment goes).
Right now we are awaiting the results of the final biopsy which should not only pin point the type of treatment/drugs but get a more accurate duration time. We should know by the end of next week.
Pictures taken on Saturday of the breast in question.
Do NOT look if you are squeamish. GRAPHIC pictures:
http://hoshi-picspam.blogspot.com/2008/11/biopsy.html
Saturday, November 01, 2008
Tuesday, September 09, 2008
Clarifications
Seeing as how I was projecting my personal feelings and such about being given information that I either already know or could look up (My "I'm not a gorram idiot" reaction that I generally get when people try to explain things to me cause I can google just fine); here is a complete educational 101 on dialysis as well as a re-iteration of some of the points of the situation and the public health care system here in Alagoas to help paint a complete picture of the whole mess.
First off: explanation of what the Kidneys do
They remove salts/waste as well as water from the body. They also do other functions like produce hormones that signal the need to create red blood cells or absorb calcium. One of the possible signs of deteriorating kidney function is high blood pressure, otherwise it is fairly silent. Other than hypertension (high blood pressure), slight puffiness and a bit of lethargy; most people won't even notice their kidneys are going bad until they have less than 10% function left. At which point the water retention compounds and one feels/looks bloated and one gets side effects like nausea or cramps, and elevated Creatinine/Urea in a blood test can be detected as well as anemia and possibly osteoporosis (weak/soft bones) due to the kidney's function in Vitamin D production/absorption balance. As it gets worse the urination decreases until it stops completely, at which point it is deadly. As long as you have urinary function you are not in immediate life threatening danger. The public hospitals are so full they generally won't take you unless you are critical, are a transfer, or you are on the top of the list diagnosed as kidney failure within a month (space allocation is given in that order so transfers, who may actually live a few months when removed are still given higher priority)
Cancer:
The system here isn't that capable of treating early stage cancers immediately. Now if some of you can recall, before the biopsy, I mentioned that it was painful. Traditionally the onset of cancer isn't painful so that alone cause a major delay in my mother's treatment; the doctors weren't too concerned about a biopsy so delayed scheduling it. The list is usually so long and cancer growth vary from patient to patient that they can't even do a proper triage. After a few months of appointments my mother was told she would have to have dialysis first to make her healthy enough to undergo surgery as she wasn't a good surgical candidate and couldn't be placed on the list until she was. The cancer however has been painful since it was a small little lump and has grown very fast (currently the size of an orange and has broken the skin) - the pain has had her crying, unable to sleep, and at times bent over incapacitated.
Dialysis:
When Kidneys fail one must have their blood cleaned in another filter. Peritoneal dialysis (PD) is done by less than 10% of Brazilians. Not only is the infection rate a problem (and PD isn't as effective and as long term), the medical system prefers hemodialysis (HD) as the cost is spent on hospitals, doctors, nurses and orderlies (over PD, whose costs go mostly to the main surgery, the chemicals/drugs, and lab tests).
HD means your blood is extracted and cleaned by a machine then returned to your body. Blood must be removed which means they have to access it somehow. Arteries are protected by nerves and one can cause permanent damage on these nerves if not handled properly. Veins are fragile and don't hold a lot of volume, they tear easy and get irritated (constricting/narrowing the passage and possibly blocking) after being poked often (most medical dramas/books/movies will stereotypically refer to junkies-IV drug users as the patients they have a hard time putting in lines, taking blood, etc). Multiple canulations ("sticks"/pokes) can cause the vein walls to harden and reduce volume, which in turn make it harder to "stick" again and pull into the machine (patients can literally run out of access). Also Dialysis needles are large bore gauge (thick) to accommodate the speed and volume drawn and all of this means a regular vein couldn't handle it 3 times a week (dialysis standard in a hospital all around the world; even in the US/UK - twice a week is for those with substantial residual kidney function and every other day is recommended for obese people). On a positive note, here in Brazil the free system pays for 4-5 hours sessions, a little longer than the US.
An access is created to allow for HD to occur. An AV fistula is a vein that has been joined to an artery which, due to the difference in pressure and volume, causes the vein to expand to accommodate the higher pressure/volume. This vein is not only made larger but stronger by this; making it perfect for multiple canulations. This however takes 30-45 days to mature before it can be used. (The free system doesn't deal with grafts as they are costly so I won't go over what they are) The final option is a catheter. They are the most risky as they clot easy and aren't as effective. Generally they are only used when a fistula doesn't/hasn't matured yet.
Yes dialysis is dangerous/risky. Clots, bleedouts, heart attack, air bubbles, etc can kill you. As well as increase risk of infections (sepsis (blood), endocarditis, (heart) and osteomyelitis (bone))
Since the wait to get into a hospital was quoted as over a month on the free system we chose to start on the private system and become a transfer. (This is why we requested money from family and friends to aide in paying for this in June) We did receive promises to help from friends and assumed family would help too so we pawned family jewelry to come up with some of the rest of the money ourselves and started my mother on HD via catheter (on June 18th). The system paid for the fistula surgeries (the first one had failed within 10 days and the second (created July 14th) has just gone into use as of Sept 1st). She has since been transferred (Aug 8th - They were nice enough not to suspend the treatment at 5 weeks when I thought they would and allowed us to go 2 more weeks with an outstanding bill while we waited for her to be transferred to the system) so there are no more dialysis bills being incurred (Only the outstanding R$1500/US$1000 for the three weeks we haven't paid for yet; Though it would be nice to get the jewelry back too but right now that is secondary) The catheter was removed on the 5th so no more unsightly tubing sticking out of her neck.
Back to the cancer:
The two months of dialysis has made her a surgical candidate and she had been quoted 6-8 months until she can get it removed via the public system/list or R$15,000/US$10,000 privately. However because the system is a bit corrupt (powerful people influence the list), people can pay some money (R$1000/US$670) under the table to the doctors to get placed on the top of the list. It looks like one of the politicians we have contact with (it is election time) may even foot that bill which means she could go under the knife as soon as there is an opening in the hospital (probably this month or next) - the doctors would use the hospital government supplied equipment and be paid by the system so the money is a bribe to have it done quickly/soon.
The chemo/radio therapy (about 6 months) would be paid by the system and if successful, in two years (if no re-occurrence of cancer has emerged) she would be considered a candidate for transplant. I still have to undergo testing to see if I am a possible match/able to donate at that time.
That, in a nut shell is the whole kitten-kaboodle. Hope that helps clarify things.
First off: explanation of what the Kidneys do
They remove salts/waste as well as water from the body. They also do other functions like produce hormones that signal the need to create red blood cells or absorb calcium. One of the possible signs of deteriorating kidney function is high blood pressure, otherwise it is fairly silent. Other than hypertension (high blood pressure), slight puffiness and a bit of lethargy; most people won't even notice their kidneys are going bad until they have less than 10% function left. At which point the water retention compounds and one feels/looks bloated and one gets side effects like nausea or cramps, and elevated Creatinine/Urea in a blood test can be detected as well as anemia and possibly osteoporosis (weak/soft bones) due to the kidney's function in Vitamin D production/absorption balance. As it gets worse the urination decreases until it stops completely, at which point it is deadly. As long as you have urinary function you are not in immediate life threatening danger. The public hospitals are so full they generally won't take you unless you are critical, are a transfer, or you are on the top of the list diagnosed as kidney failure within a month (space allocation is given in that order so transfers, who may actually live a few months when removed are still given higher priority)
Cancer:
The system here isn't that capable of treating early stage cancers immediately. Now if some of you can recall, before the biopsy, I mentioned that it was painful. Traditionally the onset of cancer isn't painful so that alone cause a major delay in my mother's treatment; the doctors weren't too concerned about a biopsy so delayed scheduling it. The list is usually so long and cancer growth vary from patient to patient that they can't even do a proper triage. After a few months of appointments my mother was told she would have to have dialysis first to make her healthy enough to undergo surgery as she wasn't a good surgical candidate and couldn't be placed on the list until she was. The cancer however has been painful since it was a small little lump and has grown very fast (currently the size of an orange and has broken the skin) - the pain has had her crying, unable to sleep, and at times bent over incapacitated.
Dialysis:
When Kidneys fail one must have their blood cleaned in another filter. Peritoneal dialysis (PD) is done by less than 10% of Brazilians. Not only is the infection rate a problem (and PD isn't as effective and as long term), the medical system prefers hemodialysis (HD) as the cost is spent on hospitals, doctors, nurses and orderlies (over PD, whose costs go mostly to the main surgery, the chemicals/drugs, and lab tests).
HD means your blood is extracted and cleaned by a machine then returned to your body. Blood must be removed which means they have to access it somehow. Arteries are protected by nerves and one can cause permanent damage on these nerves if not handled properly. Veins are fragile and don't hold a lot of volume, they tear easy and get irritated (constricting/narrowing the passage and possibly blocking) after being poked often (most medical dramas/books/movies will stereotypically refer to junkies-IV drug users as the patients they have a hard time putting in lines, taking blood, etc). Multiple canulations ("sticks"/pokes) can cause the vein walls to harden and reduce volume, which in turn make it harder to "stick" again and pull into the machine (patients can literally run out of access). Also Dialysis needles are large bore gauge (thick) to accommodate the speed and volume drawn and all of this means a regular vein couldn't handle it 3 times a week (dialysis standard in a hospital all around the world; even in the US/UK - twice a week is for those with substantial residual kidney function and every other day is recommended for obese people). On a positive note, here in Brazil the free system pays for 4-5 hours sessions, a little longer than the US.
An access is created to allow for HD to occur. An AV fistula is a vein that has been joined to an artery which, due to the difference in pressure and volume, causes the vein to expand to accommodate the higher pressure/volume. This vein is not only made larger but stronger by this; making it perfect for multiple canulations. This however takes 30-45 days to mature before it can be used. (The free system doesn't deal with grafts as they are costly so I won't go over what they are) The final option is a catheter. They are the most risky as they clot easy and aren't as effective. Generally they are only used when a fistula doesn't/hasn't matured yet.
Yes dialysis is dangerous/risky. Clots, bleedouts, heart attack, air bubbles, etc can kill you. As well as increase risk of infections (sepsis (blood), endocarditis, (heart) and osteomyelitis (bone))
Since the wait to get into a hospital was quoted as over a month on the free system we chose to start on the private system and become a transfer. (This is why we requested money from family and friends to aide in paying for this in June) We did receive promises to help from friends and assumed family would help too so we pawned family jewelry to come up with some of the rest of the money ourselves and started my mother on HD via catheter (on June 18th). The system paid for the fistula surgeries (the first one had failed within 10 days and the second (created July 14th) has just gone into use as of Sept 1st). She has since been transferred (Aug 8th - They were nice enough not to suspend the treatment at 5 weeks when I thought they would and allowed us to go 2 more weeks with an outstanding bill while we waited for her to be transferred to the system) so there are no more dialysis bills being incurred (Only the outstanding R$1500/US$1000 for the three weeks we haven't paid for yet; Though it would be nice to get the jewelry back too but right now that is secondary) The catheter was removed on the 5th so no more unsightly tubing sticking out of her neck.
Back to the cancer:
The two months of dialysis has made her a surgical candidate and she had been quoted 6-8 months until she can get it removed via the public system/list or R$15,000/US$10,000 privately. However because the system is a bit corrupt (powerful people influence the list), people can pay some money (R$1000/US$670) under the table to the doctors to get placed on the top of the list. It looks like one of the politicians we have contact with (it is election time) may even foot that bill which means she could go under the knife as soon as there is an opening in the hospital (probably this month or next) - the doctors would use the hospital government supplied equipment and be paid by the system so the money is a bribe to have it done quickly/soon.
The chemo/radio therapy (about 6 months) would be paid by the system and if successful, in two years (if no re-occurrence of cancer has emerged) she would be considered a candidate for transplant. I still have to undergo testing to see if I am a possible match/able to donate at that time.
That, in a nut shell is the whole kitten-kaboodle. Hope that helps clarify things.
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