This morning Nelson was scheduled for a scan of his superior vena cava, one of the main veins flowing into the heart. Among Nelson’s problems is a narrowing of this major vein at the critical juncture where three other veins join. It’s much like three rivers coming together and flowing collectively back to the heart: one from each arm and a third from the head.
In Nelson’s case, there is a small mass trying to take over that critical space where the three veins merge. As it’s been growing, the pressure of the mass on the vein has been threatening to seal it off entirely.
This morning’s scan showed that what doctors suspected was true, and this important vein was at risk of closing or clotting. “If those things happen,” the doctor said, “we’ll have a more complicated problem.”
After today’s early morning scan, we made our way to the radiology department to find out if radiating several of Nelson’s hurting bones would relieve his pain.
Our group included Nelson, his wife Ann Sophie, baby Will, Nelson’s sister Linnea visiting from Florida, and me. Mayo Clinic welcomes one and all, and they had no problem with us all squeezing into the small exam room.
During the next hour the doctor gave us an hour-long course on radiation therapy and where it might help Nelson as we wait to begin systemic treatment.
Today his pain has escalated considerably, reaching 10 on the pain scale, unless he’s under the influence of powerful pain meds. Even then, it only calms to about a six.
His breathing has become intensely difficult again, despite yesterday’s draining of the lungs, and he felt faint, like his heart was ready to malfunction. He said he hoped not to have to go to the ER tonight for the third time in two weeks for breathing issues, but thought it was possible.
The doctor showed us scan pictures with highlighted places where cancer was metabolically active, i.e. growing, and suggested where radiation might arrest it or even shrink it. Nelson was reluctant, wanting to wait until the big picture treatment goes into effect in another week or so.
After this appointment, we made our way through a maze of long hallways to a different Mayo building to meet with a doctor who for 21 years has worked at Mayo putting stents into veins and arteries.
He showed us the scans of Nelson’s troubled vein (white up-and-down stripe in the picture) that had been taken earlier in the morning. The narrowing of the vein was evident. He suggested that the lack of circulation in the superior vena cava might be the reason Nelson is coughing uncontrollably. It also might be contributing to his feeling of panic over not being able to get a good breath.
After talking with Nelson for 30 minutes, the doctor’s assessment was that he should perform surgery to install a stent a.s.a.p. and get that blood flowing properly again. At the conclusion of our meeting, we listened in to multiple phone calls between doctors on Nelson’s team while we waited for their final decision. The result was that they wiped away tomorrow’s multiple appointments in favor of the stent surgery.
The schedule was quickly rearranged, and the surgery was set up for tomorrow. It will take place under full anesthetic in one of the hospitals here, and may involve an overnight stay, depending on how he does. We are glad this operation will take place and that the doctor who will perform it has two decades of stent-experience.
By this time in Nelson’s long, exhausting day, he gratefully accepted a ride to navigate the many endless halls and tunnels of Mayo’s different buildings. The staff quickly pulled up a wheelchair complete with “an escort” with a happy disposition who pushed so fast I could hardly keep up.
Next we proceeded to the lung doctor who had pulled fluid from Nelson’s lungs yesterday, wondering if the process needed to be done again, since his breathing was extremely labored. But this doctor told us his lungs hadn’t accumulated enough liquid to need draining before tomorrow’s surgery. He, too, made phone calls to other team doctors as they discussed Nelson’s case.
From there we wheeled our way to another building for a pre-op Covid test. And after that, at long last, we rolled toward the car. Nelson was thoroughly worn out but was also encouraged because of the upcoming surgery. May the Lord look with favor on this son/husband/father as he goes into tomorrow with hope in his heart and confidence in his God.
“Do not throw away your confidence. It will be richly rewarded. You need to persevere so that when you have done the will of God, you will receive what he has promised.” (Hebrews 10:35-36)
