"DIC" paraneoplastic syndrome in ICU after ovarian cancer removal - mom's experience

While it would be great if anyone has an experience with DIC (Disseminated Intravascular Coagulation) syndrome... I think that's it... that they want to relate, I also just wanted to jot down my mom's experience in ICU today in case it's of interest to anyone else who's going through gyncecological cancer surgery.

My mom had a pretty extensive surgery late Monday to remove ovarian cancer from her abdomen (main mass was about 14 cm by 11 cm last I heard).

She has been needing a lot of blood and went into the intensive care unit (after the recovery room). It's midday Tuesday and she's still there. Here's what has happened mainly...

She's on a ventilator to help her breathe (hates that) with a nasal tube to take away anything she might cough up from her stomach. Her blood pressure wouldn't stay high enough and that prevented the ICU nurses from being able to administer 'enough' IV painkiller safely to really dull the pain as much as was needed.

Mom had 6 units of blood in surgery and recovery, and at least 4 plus some other blood products since, in ICU. Her blood pressure would go up more to a safe spot when she got the blood, and then drop again in a little while.

While my main worry was the internal bleeding possibility, that according to the surgeon is not what is happening.

Mom's surgeon got in really early this (Tuesday) morning and came out to update me. He says the low blood pressure and need for blood products isn't due to bleeding but that her body has been consuming clotting factors as quickly as they're made - apparently it's one of the more common (cancer) 'neoplastic syndromes' he sees. Something to do with tumors secreting all sorts of weird substances and having strange effects. So anyway if I got the initials right the particular syndrome she's going through is called DIC.. Disseminated Intravascular Coagulation. Here's a link that describes it in more detail:
http://www.ncbi.nlm.nih.gov/books/b...d.section.39549

Ultimately once the surgeon was in the way they treated the situation was vitamin K, fresh frozen plasma, some other stuff. So anyhow her blood pressure was back up to a reasonable level today. They gave her a bunch of these blood products today and have been able lately to back off on the quantity of them they're supplying... which I think is a good sign.

They did a kidney ultrasound - results not back just yet - to try to make sure she has nothing structurally wrong with her kidneys... as the blood syndrome she's been enduring can have some effects on the kidneys. (Hopefully temporary.)

The surgeon says 95% of the time this syndrome can be corrected in ICU but 5% of the time it's not really controllable.

Here is a longer and more general article about paraneoplastic syndromes, in case it's of interest to anyone:
http://www.emedicine.com/med/topic1747.htm

Just wanted to let you know that I am keeping you and your mom in my thoughts...and an RN that works in an ICU, I have seen this many times...it is a tough road and I have seen it go both ways...Keeping you and your family in my thoughts and hoping for a fast recovery...

Thank you Zambezi.

My dad went through this as part of multisystem organ failure and septic shock (from an infected heart cath site). Although he is OK (well, relatively speaking) now, 13 years later (he's now 74) it was a long and not easy course for him. In recent years he has been the treasurer of their synagogue, in spite of prostate and colon cancer.

Neoplastic syndromes are tricky. A LOT of biochemical changes occur rather rapidly. And pelvic cancers often have a lot of blood supply, which is a rapid change to the pelvic circulation. There's all the stress of surgery, too, especially on the liver.

It's not an easy situation, but if your mom is in a cancer center, she has her best shot at beating this all. It sounds like she is a fighter, as are you, and that also makes a real difference in outcomes.

May you & your family find the strength that you need at this diificult & sad time. I understand this all too well from my own experience with my dad. It's also a time when you have to make many difficult decisions. But my dad has survived 13 years, seen three grand-children born and two weddings. There are survivors.

Big ,

Audrey

I had DIC after I gave birth to my son 2 years ago. I had an amniotic fluid embolism and developed DIC. My kidneys and lungs failed, and I was put into a coma. I was on 24-hour dialysis for almost 4 weeks. The doctors said there should be no lingering side effects from my kidney failure. They basically said that they work or don't work. How is your mom doing now?

I had never heard of this. You can be sure I will be adding your mother to my good thoughts and prayers.

May your mom recover completely, and thank you for educating us about this.

I wanted to stop back in and say thank you everybody for your care and warm thoughts. My mom did not make it through her hospital saga but passed away in January. She did go peacefully, and had someone with her - myself or a friend - throughout the entire stay. Despite how things turned out the environment throughout her entire illness was very supportive and while she did have some pain/discomfort it was for the most part controlled (although the pain meds folks never seem to get to one's room early enough, you know - patients in the hospital have times when they could use more painkiller - even when they're on just small doses). There was plenty of time to talk and visit and she once said after surgery that the most remarkable thing about it was that she found out how many people loved her. (Friends and relatives came out of the woodwork to stop in, call and send flowers, etc.)

The whole thing went this way: Her primary MD did an exam after she complained of abdominal discomfort, and he found her uterus was enlarged, which it shouldn't be in a woman her age. He sent her in immediately for ultrasound and scan and those found a grapefruit-sized mass. Between one and two weeks later (in which time her CA-125 results came back high - although not astronomically so) she had optimal debulking surgery by a gyn onc. He found a large pap serous carcinoma presence in her female organs and omentum - as well as the bowel but took all visible spots. The bowel resection was supposed to have been less than a foot in length and supposedly once it healed wouldn't cause other digestive issues. She wound up in ICU, got off a ventilator, had a neoplastic episode (DIC), got through that, got released to a regular room, had a dehissing incident that necessitated a second surgery right away (hematoma under the wound closure etc.), wound up back in ICU, got off the ventilator, got back to a regular room, stayed there awhile, then the doctors thought she was well enough to have a chemo treatment in-hospital and they didn't want to put it off much longer because it apparently had been a fast-moving cancer. So she had that (Taxol and Carboplatin, if I recall) one day, was released to a rehab facility the next (mainly mobility issues), one day later had that 'third day' chemo pain/discomfort, and four days later suddenly showed signs of kidney shutdown. That is, once copious light-colored urine output was just scant and dark. (By this time she had told us she'd decided she didn't want to do chemo again or other big interventions - but the doctors did not have any big clue that she was going to decline in health.. she'd rallied through everything else.) She spent the rest of that day mainly slumbering but rousable with no pain - you could wake her up and ask and she'd say she was fine. She peacefully left that evening with no frightening very-end-of-life crisis or anything like that. The day she died, one oncologist took a look at her and thought she had ascites related to a cancer recurrence. Her main onc said after her death that it was definitely sepsis but happened so fast he suspected a bowel rupture.

Because of all the things that can happen post-surgery, in an illness or hospitalization, I think it's a really good idea to have a competent friend or relative with you literally round the clock.

Thank you again for all your care and prayers.

-RT