Critical Crossroads | 7

In this episode, we follow an important moment in Rosemarie's journey as she encounters significant health challenges that test her strength . Marking the 9-month anniversary of her diagnosis, Rosemarie faces a serious complication that leads to urgent medical care. With her family by her side, we explore the emotional and physical trials of her treatment, the decisions that shape her path forward, and the  support that helps her navigate these stormy waters. It is a episode about hope, love and cancer! Please tune in. 

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Transcript

Welcome back to "tumour, tumour on the wall" presented by hope love cancer, as we continue our journey with your host, Charlie.
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Hi everyone! Welcome back. It's August, and the updates have brought mixed feelings. Rosemarie’s CA-125 level has gone up, raising concerns. On the brighter side, the CA15-3 level has decreased, offering us some hope. As we have seen - these markers can be confusing, and should always be seen as part of a bigger picture – never in isolation. 

As we move into September, Rosemarie’s story continues with its mix of highs and lows. She's been on chemo pills - experiencing some good days. However, towards the end of August, there was noticeable discomfort. This raises the question: could it be an effect of the chemo pills or something else? 

Stay with us as we continue to uncover the next chapters together.

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Today, September 7th, is the 9-month mark since Rosemarie’s initial diagnosis. Today, on this 9-month anniversary, we are back at the oncologist's office. This appointment is not just another date on the calendar; it's a critical moment to address her recent abdominal discomfort and see how it fits into the larger picture of her treatment.

The oncologist's worry is clear as she decides to order a CT scan. This is to get a detailed look at Rosemarie's abdomen, which is essential for understanding the cause of her discomfort and any other issues that might be hiding. It will help the oncologist to spot any problems or changes that might explain what Rosemarie is going through.

The doctor also notes that Rosemarie has ascites, which means there's a buildup of fluid in the peritoneal area. 

Let's quickly recap what the peritoneum is. It's a thin layer, kind of like a blanket, that lines the inside of your belly (abdomen) and wraps around many organs like your stomach, liver, and intestines. This special blanket helps keep everything in place and allows your organs to slide around smoothly without rubbing against each other, thanks to a slippery fluid it makes. It also has important blood vessels, nerves, and tiny tubes called lymphatics that help feed your organs, send messages back and forth, and fight off germs. So, the peritoneum is super important for keeping your belly's organs healthy and working right.

Ascites can cause the belly to swell and be uncomfortable, and it often points to a serious health problem, like liver disease or cancer. In Rosemarie’s case, the ascites could be linked to her cancer or its treatment, and taking care of this issue is crucial for her comfort and health.

On top of this, Rosemarie is having a hard time keeping her food down, a problem that can make her feel weak and affect her body's ability to deal with treatment and fight off cancer. This could be because of the chemotherapy's side effects, the ascites making her feel too full or pressured, or other stomach issues related to her cancer. So, today's visit is to figuring out the best way to adjust her treatment. 

With the CT scan urgently scheduled for 8 a.m. on the 9th, Rosemarie faces the added challenge of preparing for it, especially difficult given her struggle to keep food and liquids down. Drinking a lot of water before the scan, is a daunting task for her right now, but she has done it before and is determined to do it again. She is set to see her oncologist again on the 14th to discuss the results of the scan.

Over the weekend, Rosemarie's condition deteriorates significantly. She reaches a point where she is unable to retain any food, leading to her vomiting everything she eats. Because of this alarming development, Tobie and Magda decide to act quickly. By Monday, recognising the severity of her symptoms, they decide it is crucial to get her immediate medical attention. Magda takes her to the hospital.

Upon their arrival at the hospital, Rosemarie is examined by an ER physician who quickly assesses her condition. Given the seriousness of her symptoms and a quick evaluation at her CT scan results, the decision is made to admit her to the hospital immediately. Rosemarie is moved to a special part of the hospital called the “High Care” unit. This area is for patients who need a lot of attention, but it's not as intensive as the ICU. Only very close family members are allowed to visit patients in the “High Care” unit. Rosemarie really does not want to be there all by herself. This brings up a big question: What happens if a patient doesn’t have any close family nearby? Are they supposed to stay in the “High Care” unit alone without anyone to support them. Rosemarie, not thinking twice about is, introduces Magda as her sister, allowing them to be together. This moment underlines how important friends can be in times of need, acting as family when it counts the most. Later that evening, Tobie visits too, adding to the support and care Rosemarie receives.

Rosemarie is currently dealing with a serious health problem called a distal small bowel obstruction. This means there's a blockage in the lower part of her small intestine—the long, winding tube where our bodies break down food and absorb nutrients – preventing food from moving through as it should. This blockage is causing her intense stomach cramps, significant swelling or bloating in her abdomen, and an inability to keep food down, leading to frequent vomiting.

One of the healthcare specialists made it clear just how critical Rosemarie's condition is by stating: “If she had been brought to the hospital one day later, she might not have made it.” The urgency comes from the fact that such a blockage can lead to very severe problems. Without quick medical intervention, Rosemarie was at risk of becoming extremely dehydrated, suffering from a lack of essential nutrients, or experiencing a tear in her intestine due to the built-up pressure. Additionally, food that gets trapped and can't move forward can begin to decompose, potentially leading to dangerous infections. These complications can quickly become life-threatening.

Currently, the surgeon who initially diagnosed Rosemarie and treated her gallstones is on holiday, so her care has been handed over to another surgeon. This surgeon is tasked with performing an emergency operation to remove the blockage. However, because Rosemarie is also undergoing treatment for cancer, which includes chemotherapy that can weaken her body, the surgery requires an especially cautious approach. The surgeon and medical team are carefully considering the best way to proceed with the operation to successfully remove the blockage while trying to avoid any extra risks to her health.

Her chemotherapy, which she has been having in the form of pills, can significantly impair wound healing. Chemotherapy targets rapidly dividing cells, a characteristic of cancer cells, but it also affects healthy cells that grow quickly, including those involved in the healing process of wounds.

When the body undergoes surgery, the natural response is to repair the damage by creating new cells to close the wound. However, because chemotherapy can reduce the body's ability to produce these new cells efficiently, the healing process after surgery can be slower and more complicated. This is a major concern for Rosemarie's stand-in surgeon, who is aware that her body's current weakened state and the effects of chemotherapy could lead to difficulties in healing post-surgery.

The risk of infection is also higher. A slower healing wound is more susceptible to infection, as it remains open and vulnerable for a longer period. This is particularly risky for someone like Rosemarie, whose immune system is already compromised by both her cancer and the chemotherapy treatment.

The administration of anesthesia presents another layer of complexity to Rosemarie's surgical procedure. Anesthesia, essential for pain management and sedation during surgery, carries its own set of risks, especially for patients with weakened health due to cancer and chemotherapy. These treatments can alter the body's normal response to anesthesia, potentially leading to complications such as prolonged sedation, cardiovascular stress, or respiratory difficulties during or after the procedure. The anesthesiologist, therefore, must carefully assess Rosemarie's overall health, her reaction to medications, and her current physical state to tailor the anesthesia plan, ensuring her safety throughout the surgery.

When deciding the best way to help Rosemarie, the surgeon had to choose between two main surgeries. The first option is bypass surgery, which would make a new path for food to avoid the blockage in her small intestine. This could help her digest food better and improve her health. This might be the better choice if the surgeon believes Rosemarie can handle the surgery and recover from it, offering her a chance to get back to a more normal way of eating and living.

The second option is an ostomy, a surgery that changes the way waste leaves her body, collecting it in a special bag outside her body. This could be considered safer if they think that Rosemarie might not heal well from a big surgery. It's a big change, but it might be necessary to keep her safe.

Between these two, bypass surgery might seem like the better option for Rosemarie's quality of life in the long run, because it could allow her to live more normally. But the choice really depends on how strong Rosemarie is right now and which surgery she's more likely to recover from. Special attention is also given to how anesthesia will be managed, given its risks in her condition. The choice between these two surgical options involves a careful evaluation of Rosemarie's current health status, her ability to recover from major surgery, and the long-term implications for her quality of life. 

For Renee, being in Canada while her mother is facing such a critical health crisis is extremely challenging. The distance feels overwhelming. Even if she got on a plane right away, she would not make it back in time for her mother's surgery, which is currently set for the early morning of the 13th. This situation highlights the tough emotional and practical challenges families go through during a serious health crisis, even more so when they are physically far from each other.

Renee remembers the night clearly, as though it happened just yesterday. It was night time in Canada, but morning in South Africa, which is why she had settled to sleep on the living room couch. She didn't want to keep Shawn up, knowing he had to work the next morning. With her phone's silent mode off, she lay in anticipation, eager for any update. Finding sleep almost impossible, she found herself caught between being awake and drifting off, filled with anxiety and continuously praying for her mom to make it through.

The surgery was postponed to the afternoon due to the surgeon's uncertainty. His frequent visits and discussions about finding the safest way to operate on Rosemarie only added to the tension. The surgeon's admission, "I do not want Rosemarie to die on my operating table," highlighted the care and urgency he felt, reflecting the difficult choices he faced.

Finally, the decision was made to proceed with a bypass surgery. Rosemarie was prepped and taken to the operating room. For Renee seconds stretched into minutes and minutes felt like hours, as she clung to hope, prayer and a deep yearning for her mom to pull through. While waiting for the surgery to be done, Renee booked het ticket to fly to South Africa on the 21st of September. After a long wait, Rosemarie was back in her room.

Only after the surgery they fully understood how complicated it was. The surgery left a significant mark: a long vertical cut that wrapped around her belly button and went straight down, more than 15 centimeters' long. Rosemarie seemed so tiny and delicate in the big hospital bed - really putting things into perspective for everyone. She had a bag attached to her wound to take care of any fluids, and lots of tubes were making sure she got the right medicine and nutrients, since she couldn’t eat solid food yet.

Once Rosemarie was able to pass gas again, it was a sign that her digestive system was starting to work as it should. This was also a hopeful sign that things were starting to normalise after her surgery. But, even with this positive sign, she couldn't jump straight back into eating solid foods. The reason for this cautious approach is pretty straightforward. After surgery, the body needs time to fully recover, and the digestive tract, in particular, needs to gently ease back into its normal routine.

Passing gas shows that the intestines are awake and moving, but they're not immediately ready for the more demanding work required to digesting solid food yet. Going back to a regular diet too quickly could lead to complications, like blockages or strain on the healing parts of the digestive system. So, doctors recommend a gradual reintroduction of solid foods, starting with liquids and soft foods, and slowly adding more solid foods as the body shows it can handle it. This careful progression helps ensure that Rosemarie's recovery continues smoothly, without any setbacks. 

During Rosemarie's surgery, the surgeon discovered why she was having such trouble. There were two main issues inside her abdomen. First, there was extensive peritoneal carcinomatosis, which means that many small cancerous growths had spread throughout the lining of her abdominal cavity. The protective layer inside her belly that covers most of her internal organs. Second, there was an obstructive lesion at the ileocecal valve. This valve is like a doorway between the small intestine (ileum) and the large intestine (cecum), and the lesion was basically a blockage preventing normal movement of the contents of the intestines.

The operation turned out to be very complex, because the cancer had spread so much that it was hard for the surgeon to find a safe place to connect the intestines back together (anastomosis) after removing the blocked part. The cancer spread made things difficult, because it not only affected the walls of the intestines, but also the mesentery. The mesentery is a part of the peritoneum, which is like a supportive blanket that wraps around the intestines, keeping them in place and carrying the blood vessels and nerves they need.

After the surgery, Rosemarie had to stay in the hospital for about 4 days. Given the seriousness of her surgery and condition, Tobie and Magda, insisted she should stay with them until Renee could come. They knew Rosemarie would need a lot of care, especially because sitting up wasn't easy with such a big wound. She needed someone to help her sit up, take care of the wound and help her to gain her strength back with rest and food and manage her pain. 

As we conclude today's episode, let's take a moment to reflect on Rosemarie's ongoing recovery. Rosemarie is standing at the edge of a journey she didn't choose, yet she's moving forward, step by uncertain step, supported by the love of those around her.

How will she navigate the difficult road to full recovery? Join us in our next episode as we follow Rosemarie's journey.

And remember, in the words of William Shakespeare, "And though she be but little, she is fierce." See you next time!