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question about questions.

PostPosted: 07 Feb 2012, 02:10
by pilvikki

i have some pretty serious shit happening around here and i was wondering if you mind my constantly harassing you with this, that and third? some, of course, could maybe be helpful to someone else somewhere along the way, but its your time - and i know you're not blessed with scads of it.

a lot of it would be merely an educated guess. obviously. but it beats reading reams and reams of speculation by people who don't want to put their feet into it, so they try to be nice and supportive and blardy-blah-blah. i don't want nice!

i'll give you my first case, whom we shall call steve: operated last august for having turned oriental. they were going to slice out 60% of his liver, but after 8 hrs of rummaging in his gut, and having found him full of cancer they put a plastic stent in, stitched him up. the cancer strangled the stent in two days, was replaced by steel.

he's always been moody, paranoid, suspicious, but now he's totally wacko and hardly made any sense, just ranted and raved.

is it the cancer or is it the drugs, you think? would his moods mellow out?

...or is he done for - and i should just stay away?

Re: question about questions.

PostPosted: 07 Feb 2012, 23:23
by brandtrn
Wow...I just saw this, and was about to head to bed...5 a.m. is less than 6 hours away, and it promises to be a long day tomorrow. I'll ruminate on this and post again tomorrow evening. Sorry for the wait :vrysad:

Re: question about questions.

PostPosted: 08 Feb 2012, 01:51
by pilvikki

seriously, i don't want to add to your stress levels, just thought since you've covered pretty well everything going in your career, you might have answers from some old cases off the top of your head.

i asked our common jp what was up with his ranting and raving and making no sense and was he on some heavy duty drugs - but even though the doc told me the guy's dying a lot faster than the rest of us, he could not answer that.

very selective adherence to the codes...

Re: question about questions.

PostPosted: 08 Feb 2012, 17:17
by brandtrn
Okay, since I don't have a great deal of history, I'm running on assumptions, here. I hate to admit my ignorance, but since I don't really know what "having turned oriental" means, I'm assuming, perhaps, that he was jaundiced, and they operated initially for placement of a biliary drainage tube (i.e. stent?). Obviously, the jaundice could have been caused by many things, hepatitis, cirrhosis or any other number of things. Normally, the liver is not usually the site of primary tumors, but tends to be affected by cancer through metastasis (or spread of the cancer cells). If it is, in fact, the primary cancer, cirrhosis and chronic viral hepatitis (usually types B or C) tend to be huge risk factors for primary liver cancer. Does your friend have a history of heavy alcohol use? If so, Wernicke-Korsakoff syndrome (referred to as alcohol dementia or hepatic encephalopathy) could be the cause of his behavior. It could also be caused by a metastasis of the cancer cells to the brain. Chemotherapy can often affect brain function (the term used for this is "chemo brain," which normally manifests itself as mental "cloudiness" or as memory loss and difficulty learning new things, but can also cause behavioral and emotional changes, disinhibition, irrational behavior and mood swings.

Will the moods mellow out? That's hard to say. If the behaviors are as a result of brain metastasis, eventually, yes, they will, as he becomes more and more debilitated. Also, if they are as a result of his chemo or medications, they should also "mellow out" as the drugs are discontinued, but that's not an absolute certainty. I would strongly encourage you to "hang in there" and be as supportive as you can if at all possible, simply because the odds of five-year survival post-diagnosis aren't good for liver cancer. If the liver is the primary site of the cancer, the five-year survival rate is only about 27%. If the cancer spread from a regional site, it's only about 9%, and, in the case of metastasis from a distant organ, it's only about 4%. Your friend Steve has an awful lot to deal with, and I'm sorry to hear of his illness. I'm also sorry for you having to deal with those crazy mood and behavior swings...I know that it's not easy!

Re: question about questions.

PostPosted: 08 Feb 2012, 23:01
by pilvikki

oriental = jaundiced, yes. being a smartass there...

thanks! it's all more clear now. there was no chemo or radiation, so that's not it. alcoholic, yes.

i just can't decide if he'd want to keep in touch or just be left alone... well, i guess i'll get out my asbestos suit, give him another call and see...