A family focuses on comfort through a changing course

CAPTIONS / IMAGE LABELS MYYL Gallbladder cancer PATIENT FOLLOW-UP RECORDS Guo Guanglan · 84 · Xiangyang, Hubei English translation · Original medical images retained CASE RECORD · Gallbladder cancer · 84 Guo Guanglan had gallbladder cancer with reported liver and lymph-node involvement. The family describes a poor prognosis given locally. She had poor appetite, marked weight loss, severe pain, abdominal bloating and difficulty passing stool. FOLLOW-UP Symptoms fluctuated initially, and jaundice also developed. The family stayed in contact while the treatment plan was adjusted. Later they reported less pain, jaundice and vomiting, better eating and bowel movements, and better spirits. The original record retains the difficult periods as well as the improvement. CHAT PANEL S196-P01 Guo Guanglan · Gallbladder cancer With her condition, how long might she live? That is what I wanted to ask. Voice message: 15 seconds. 15″ Voice message: 37 seconds. 37″ Voice message: 29 seconds. 29″ I do not quite understand. The local doctor said two months if her health was good and half a year if it was poor. [As transcribed in the source.] I wanted to ask you because you see more of these illnesses. If she takes the medicine, how much longer could she live? Earlier prognosis discussed by the family Voice message: 35 seconds. 35″ Does my mother still need more examinations in hospital? Is the diagnosis definite in your view? Is it advanced or an intermediate stage? Our local doctor did not give me a clear answer and asked for more tests. But if she has another biopsy, she will know. She is perceptive, so we have been afraid to arrange further tests. CHAT PANEL S196-P02 Guo Guanglan · Gallbladder cancer 2 Apr 15:04 Voice message: 60 seconds. 60″ Yes, I understand. I mean that you have more experience. My siblings and I chose Chinese medicine from the beginning. When we were told conventional treatment could not help, we hoped Chinese medicine might. Every extra day matters. As her children, we mainly want her not to suffer. I heard this illness can be very painful at the end. At her age, that was hard to accept when we saw the results. If she is less distressed from day to day, that makes things easier. Seeing her in pain is very hard for us too. Please do your best for her. Family recalled a message Family describes its priorities Voice message: 19 seconds. 19″ Please tell the doctor to do everything possible for my mother. Our family will cooperate. Above all, we hope she does not suffer and can have more time… [cropped] CHAT PANEL S196-P03 Guo Guanglan · Gallbladder cancer Hello, MYYL care team. This prescription is the same as the last one, but my mother has had pain more often this time. She had two episodes in the first half of the night and was sweating with pain. The daytime pain is milder and bearable. Is the disease getting worse? She says both sides of her chest hurt, like bloating. 16 Apr AM 10:46 First two courses: symptoms still fluctuated Voice message: 10 seconds. 10″ Voice message: 10 seconds. 10″ Voice message: 18 seconds. 18″ Voice message: 3 seconds. 3″ Voice message: 19 seconds. 19″ She did not mention pain beside the navel. She says both sides of her chest hurt. Earlier the pain was in the bones at the back; lately she describes it as pain in both lungs. Voice message: 57 seconds. 57″ CHAT PANEL S196-P04 Guo Guanglan · Gallbladder cancer Voice message: 9 seconds. 9″ She vomited three times during a painful episode the day before yesterday, and once again this morning. Voice message: 15 seconds. 15″ She did not vomit when she was not in pain. Two days ago she brought up food three times. This morning there was white and yellow material in it. Voice message: 5 seconds. 5″ First two courses: symptoms still fluctuated Voice message: 6 seconds. 6″ Voice message: 25 seconds. 25″ Voice message: 10 seconds. 10″ Voice message: 33 seconds. 33″ Her stool is black. She burps after eating, but not when she has not eaten. During the pain, it is across the front of her abdomen and also her back… [cropped] CHAT PANEL S196-P05 Guo Guanglan · Gallbladder cancer 30 Apr 午13:02 Voice message: 10 seconds. 10″ Voice message: 14 seconds. 14″ That explanation makes me less frightened. At first I was terrified that the disease was getting worse. Are you saying this is not the final stage and is normal? 30 Apr 14:00 Voice message: 15 seconds. 15″ Voice message: 6 seconds. 6″ Earlier course: jaundice developed 30 Apr 14:15 Okay. 3 May AM 09:57 Hello, MYYL care team. Please tell the doctor that my mother has developed jaundice over the last two days. What should we do? Her face and eyes are yellow. CHAT PANEL S196-P06 Guo Guanglan · Gallbladder cancer Earlier course: jaundice developed 4 May AM 09:36 Is this what advanced disease looks like? She seems unwell, keeps wanting to sleep and retches but cannot bring anything up. 4 May AM 09:42 Voice message: 10 seconds. 10″ CHAT PANEL S196-P07 Guo Guanglan · Gallbladder cancer 11 May AM 10:04 Later: less pain reported Hello, MYYL care team. How does my mother's tongue look? She is no longer reporting pain, but the jaundice has not gone down. Is that a good or bad sign? 11 May AM 10:23 There are eight days of medicine left. Could the doctor see her in the next two days and assess whether the disease is worse or controlled? There is a dull ache in her abdomen. CHAT PANEL S196-P08 Guo Guanglan · Gallbladder cancer Okay. I wanted to ask whether she is getting worse or improving, and whether we should reduce the medicine further. During this prescription she has not had the same pain, only a dull internal ache. It is much less than before. Please ask the doctor to assess her. For the jaundice, she has also had injections and other medicine, and I take her into the sun daily. Her face seems less yellow now; a few days ago the skin was very yellow. Voice message: 54 seconds. Later: family reports less pain and jaundice, and better appetite 54″ A few days ago I was terrified. She barely ate and vomited after eating, and had two nosebleeds. She mostly slept all day and had no strength to sit up for long. Yesterday and today she seems more alert and is eating again. At lunch she wanted noodle soup and had a bowl; in the morning she had millet porridge. In the evening we usually cook or steam an apple and give milk powder. Sometimes she has another serving around 5 am. These two days look better. When we last spoke I feared there was no hope. She had injections for a while and has stopped them these past two days. CHAT PANEL S196-P09 Guo Guanglan · Gallbladder cancer 12 Jun AM 09:18 Hello, MYYL care team. Are you there? 12 Jun AM 09:23 Later: less vomiting and better eating reported Hello, yes. Has something happened? My mother has five days of medicine left. Please tell the doctor she has vomited twice in the past two weeks and still has occasional mild pain. Her stool is a little hard and she has used glycerin enemas a few times. Over the last two days an egg-sized lump has appeared beside her navel. Did you photograph or video the lump? Does it move, or stay in one place? Is it soft or hard? No. I was not sleeping beside her. It is hard and moves when pressed. She has been eating fairly well for the last two weeks, but has lost quite a lot of weight. CHAT PANEL S196-P10 Guo Guanglan · Gallbladder cancer It is hard and moves when pressed. She has eaten fairly well these past two weeks, but has lost a lot of weight. She tells me she feels worse day by day, in a way she cannot describe. When walking she feels something dragging down in her abdomen. She likes to lie down and watch television because that feels more comfortable. She seems fairly alert to me, but has lost a lot of weight. She is less put off by oil and salt in food. 12 Jun AM 10:51 Family reports better spirits and eating We will ask the director to see her this afternoon. Okay. Will you be at home around 2 or 2:30? Yes. Okay. Her digestion is a little better. If the liver and bile ducts are obstructed and digestion remains poor, there can be an aversion to oily food. CHAT PANEL S196-P11 Guo Guanglan · Gallbladder cancer How has your mother been over the last few days? Quite good. She is eating okay and her spirits are good too. Later update: family reports overall improvement and renewed hope Voice message: 21 seconds. 21″ Thank you. Are boiled apples and pears okay? She has light food and clear pork-rib soup. We use very little oil in cooking. My mother has no teeth. Mostly she has clear rib soup, noodles and boiled vegetables; steamed buns and corn porridge for breakfast. Voice message: 7 seconds. 7″ Voice message: 14 seconds. 14″