Pam is back in the hospital again and is facing some really serious surgery - again. We need everyone's prayers. Apologies in advance for the length and detail of this e-mail, but its hard to communicate this verbally over and over so writing it is more efficient.
On Thursday night, at about 7:30 pm Pam was admitted to Alvarado Hospital on an emergency basis. The titanium cage in Pam's neck is tearing through the back of her throat, and she now has literally a "hole" about three inches long exposing the cage and her spine. She has been in a lot of pain the last week but we couldn't figure out why until she peered into theback of her throat and "tinked" the cage peaking through with a chop-stick. Ya, yuck.
The surgeon who performed her neck surgery two years ago (Dr. Kim) was initially concerned that the cage is somehow slipping. The initial x-rays and CT scan with radioactive contrast confirmed last night about mid-night that her spine is solid and the cage has in fact NOT slipped. This is the good news.
For those of you who never knew, or forgot, a brief description of the artificial structure in her neck is important in order to understand Pam's current predicament. Two years ago Pam's C-2 vertebrae collapsed from a paraganglioma tumor invasion. Dr. Kim removed the tumor and almost all her C-2 vertebrae in the process. In order to stabilize her neck, he screwed rolds with titanium bolts from C-1 to C-3 creating a splint like structure over the C-2 vacancy gap. He then took titanium cage, and wrapped the gap around the bolts and rods. Then, in the mysteries of science and our bodies miraculous powers of healing, he took bone from her hip and implanted it on/in the cage to grow, graft and connect C-1 to C-3 through a "bone fusion." So now, hopefully, the bone graft/fusion has firmly stabilized C-1 to C-3. End backstory.
Now for the bad news. After having seen today, a spine surgeon, a neurosurgeon, an ENT (ears, nose & throat) surgeon, pulmonologist, and pain doctor, they all feel that Pam needs major surgery to take out the cage, for two reasons. First, they think it might be pushing through the back of her throat. Second, they indicate that there is too much risk of major infection since it is an open "dirty wound" from being exposed to the bacteria from the mouth. The ENT specialist told us tonight there is no way to clean the cage and make it sterile. So just closing the hole at this point, without more, is not an option.
Adding complexity - Dr. Kim doesn't know if Pam's spine is strong enough to withstand life without most or all of the cage. Therefore, tomorrow Pam will undergo more CT scans and an MRI to determine if they remove the cage her neck will be stable. In other words, if the bone fusion is strong enough without the titanium cage part. If so, then they'll proceed to remove the cage in a surgery possibly Monday or Tuesday. If not, then they will determine how to remove less of the cage, or how to re-stabilize the area if they take the cage. This later procedure may actually end up taking two separate surgeries over several weeks.
Further, we have the problem of the hole in her throat. The doctors cannot be sure what has caused this hole. Some theories: 1) the titanium cage has rubbed on it from the back side, pushing through, 2) two years ago, Pam had heavy duty radiation treatment on the area, thus weakening her soft tissue, 3) her current chemo-therapy drug (Sutent) is causing weakness in her soft tissue, and/or 4) some or all of the above. The ENT doc indicates, depending upon his further examination, he may have to graft skin from another area of her body to the back of her throat, which he says is really tricky and difficult because of the location of the hole. He also said he may be able to close it other ways, but he can't be sure. He indicated that a skin graft may actually cause a third and separate surgery depending upon the other issues discussed above.
On top of all this, Pam is in current considerable pain and discomfort, besides being really scared. For some reason she is vomiting about every two hours: theories range from gagging on the hole to reactions to medications. She has a hard time swallowing, can't eat, can't drink, and can't sleep because she can't get comfortable. Also, whenever she pukes, you can only imagine where its going . . .
OK. Dr. Kim tells us we'll know more of the plan after tomorrow's tests. He indicates that the earliest she'll have her first surgery, is Monday or Tuesday. There is a team of at least three surgeons who have to align their schedules in order to make this work. They also have to coordinate with the oncology (cancer) people because she still has seven paraganglioma tumors that could secrete adrenalin if she's cut open . . . which adds another whole layer of additinal beta-blocker drugs she has to take pre-surgery to lower her blood pressure and block her brain from reacting to the adrenalin. As you can see, there is a lot going on here.
It just wrenches my guts out to see her in so much pain, discomfort and fear. I just want to break down in a heap of tears and sobs, helpless. We are all scared . . . Cody just sobbed clutching mom before we left for the hospital, and Pam was so brave for him.
Please pray for Pam, Kassy and Cody. Please pray for the doctors' wisdom, level judgment and steady hands. Please pray for successful procedures landing Pam back in our arms and home soon.
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