Blood Work

Another week looms and another test.  On Tuesday I take my husband for a CT Scan and some blood work to get a sense of where things are at. There is no doubt that he is at risk with a depressed immune system.  His hemoglobin remains quite low, but without the blood work we don’t know if it has improved at all.  The blood transfusion didn’t seem to make a significant impact on his level of health at all.  Physically he uses his walker to move around the house and is quite wobbly without it.  Cognitively, he has a delay in processing, when you ask a question there is a definite lapse before it registers and he responds.

His appetite has been a challenge.  This is saying something since he has been an awesome patient from the get go.  Prior to this, when I put a meal in front of him, despite it tasting too sweet or too salty, he usually managed to get it down.  Not for the past week.  His appetite had completely gone which put me into full blown crisis mode.  I don’t usually try to guilt him into anything but this last week I did.  Amazingly on Saturday he finally started to eat again.  Now comes the task of building him back up again.  When this journey started I found a recipe for geared towards building up cancer patients called Magic Mineral Soup, and today the house smelled of  simmering veggies as I made a large pot of broth.  Hope springs eternal.

The visiting nurse was in three times last week.  She’s an awesome resource and does a great job in reading my husband’s moods.  She has established a rapport with him and seems to know when to air out concerns that may have been swimming around in his brain without him really even knowing it.  During her visit on Friday she talked to him extensively about anemia and how it can make a person feel.  My husband’s hemoglobin was at 84 when they administered the blood transfusion and the nurse didn’t think he got much benefit from it. Consequently it is likely that he is still severely anemic, but the blood work on Tuesday will determine this conclusively.  However, until then she wanted him to realize how the symptoms and issues he is having align with that of anemia.  This discussion was important since in my husband’s mind the symptoms and issues he is having mean the cancer is spreading and he is, as he stated more than once to me last week, dying.  And really, when you consider the type of cancer he has, which is lung cancer, and the symptoms of anemia there’s no wonder he feels the disease is on the move.  As WebMD states:

Symptoms common to many types of anemia include the following:

  • Easy fatigue and loss of energy
  • Unusually rapid heart beat, particularly with exercise
  • Shortness of breath and headache, particularly with exercise
  • Difficulty concentrating
  • Dizziness
  • Pale skin
  • Leg cramps
  • Insomnia

(Source:  WebMD.com)

For now we wait a couple of days and then go for some tests.  Once we get the results back from that we will decide on next steps.  We have talked about how hard the chemotherapy and radiation together were on him physically.  I doubt that we will consider doing both in the same treatment cycle again.  Indeed, radiation is something that seems to knock him down further than the chemo, so I don’t know about any more radiation.  Again, discussions and decisions will be made after we receive the results of the CT scan and in consultation with our Oncologist and GP.

CT Scan x 2

CT Scanner

CT Scanner

Tuesday of this week was CT scan day for both siblings, my husband and his sister.  Both are seasoned vets of the CT scan now.  When my sister-in-law was in the hospital over the last few months she must have had four scans at least.  My husband is now on his fourth or fifth related to his cancer.  Their appointments were, by happenstance, back to back at the same hospital.  I was the designated driver and so off we went.

Both were scheduled to have CT scans with contrast.  Both were instructed to take the oral liquid as well as have the contrast injected through a vein in their hand.  For those unfamiliar with a CT scan, a good overview is provided by the Mayo Clinic on their website as follows:

“A special dye called a contrast material is needed for some CT scans, to help highlight the areas of your body being examined. The contrast material blocks X-rays and appears white on images, which can help emphasize blood vessels, intestines or other structures.

Contrast material can enter your body in a variety of ways:

  • Oral. If your esophagus or stomach is being scanned, you may need to swallow a liquid that contains contrast material. This drink may taste unpleasant.
  • Injection. Contrast agents can be injected through a vein in your arm, to help view your gallbladder, urinary tract, liver or blood vessels. You may experience a feeling of warmth during the injection or a metallic taste in your mouth.
  • Rectal. A contrast material may be inserted in your rectum to help visualize your intestines. This procedure can make you feel bloated and uncomfortable.”  (Source: http://www.mayoclinic.org/tests-procedures/ct-scan/basics/how-you-prepare/prc-20014610)

After a previous CT scan with contrast my hubby was quite nauseous and vomited for the three days immediately after.  So he had decided to refuse to take the contrast completely.  After discussions with the nurses he was informed he could decline the oral but the injection was necessary and without it the radiologist would not do the scan.  One of the nurses reacted strongly to him declining the oral liquid and told him quite emphatically that vomiting was not a reaction.  Kinda funny when you think about it since vomiting is identified as a potentially minor to moderate reaction on a multitude of pages related to ICCM and barium and gastrografin contrast used for CT scans.  For example, Australia’s Inside Radiology provides this information:

“Allergic reactions almost always occur within minutes of the ICCM being given. However, 2 to 4 in every 100 people have a late reaction (up to 1 week but usually within 2 days) after an ICCM injection, consisting usually of an itchy rash, swelling of the face or nausea. These delayed reactions generally require only treatment of specific symptoms and they resolve promptly.

Minor

Minor reactions occur in about 3 in every 100 patients who receive low–osmolar, non-ionic ICCMs, which are the commonest contrast agents used in Australia for CT scanning and angiograms. These reactions include:

  • Flushing in the face
  • Nausea and / or vomiting
  • Mild itchiness

Almost always these types of reactions do not require any special treatment and generally take only minutes to go away.

Moderate

Moderate reactions consist of severe or prolonged vomiting, a generalised rash, or swelling of the face, mouth or throat, making it harder to breathe and swallow. These reactions often need drug treatment and occur in less than 1 in 1000 people.”  (Source:  http://www.insideradiology.com.au/pages/view.php?T_id=21#.VK7NJ2B0ycw)

Anyway the CT scan was necessary and both he and his sister went ahead with the injection but not the oral drink.  I spoke with our nurse from Oncology and advised her what had transpired and she indicated that the CT scan with the injection should be sufficient and as a precaution to give my husband a couple of antiemetics (anti-nausea pills) to stay ahead of any potential reaction.  Today is Thursday and he appears to be on track which is a good thing.  He sees his Oncologist next week to find out the results of the CT scan as well as a shoulder x-ray that was taken during the same visit.

My sister-in-law, however, is at the being of her journey.  She had her CT scan on Tuesday, her picc line was inserted on Wednesday, she has the visiting nurse coming today to do a flush on the picc line, and tomorrow she has her chemotherapy education session and blood work in anticipation of her first chemo treatment next Wednesday.  Her treatment cycle has been determined as every two weeks for the next six months.  She has a great attitude going into this.  Just put your head down and push through, every day puts her closer to the end of the treatment.

Needless to say we are still feeling our way through this whole process, thankful to family and friends for all their support and assistance in oh so many ways.

Getting the News

It’s been months since we first received the news that my husband had cancer.  Up until now it was just too hard to relive those initial days but for the benefit of those who don’t know how it happened – here is our story.

It was Wednesday, June 25, 2014 when I took my husband to Emergency.  He’d been complaining of a sore back since the May long weekend.  He’d dug up my garden that weekend, using the good old fashioned shovel instead of borrowing his buddy’s rototiller.  He thought at the time that he may have pulled a muscle and by the beginning of June he had visited the family doctor who prescribed rest as the answer.  Through this time he continued to ride his bicycle to work, play tennis with his buddies and do all the normal things one does. However, on the evening of the 25th of June he was in significant pain, not only with his back, but he had started to experience a pain in his chest.  Although he didn’t want to go to Emergency, he knew something was wrong and allowed me to take him over.

Due to the fact that he was experiencing some pain in his chest we were processed through quite quickly.  They did some blood work and hooked him up to an ECG to monitor him.  After a couple of hours the ECG was removed and his numbers appeared to be okay.  The Emergency Room doctor was not satisfied with any of the results that had come back, he felt that there was definitely something at play here and asked my husband to stay overnight so he could arrange for a CT scan for first thing in the morning.  That settled, I left for the evening advising my husband that I would go to work in the morning and then swing by to pick him up around noon – if he needed me sooner to call me at work.

When I arrived at Emergency at noon on Thursday the Triage Nurse took me right back to my husband and asked me to wait for the doctor.  A little odd, but okay.  I asked my husband if he knew what was up and he stated he had no idea.  The doctor came in, this was a different doctor from the one who had admitted and dealt with my husband the night before.  He started off by telling us he had some difficult news for us.  He had the results of the CT scan and it showed that my husband’s pain in his back was attributed to his T10 and T11 which were deteriorating as a result of bone cancer.  There was also a lesion at T6, as well as some deterioration to his sternum.  After he told us this, the doctor paused.  In that brief lapse of time I remember my husband just looking at me.  We were shocked beyond words.  Finally he said to the doctor, “Well I didn’t see that coming.” A brief and flat statement.  However, that was not the end of the doctor patient conversation.

The doctor stated that unfortunately the CT scan also showed widespread lung cancer, both lungs.  The main tumour appeared to be located adjacent to my husband’s heart.  He stated that his observations were very preliminary that we needed to speak to our family doctor as well as an Oncologist.  The doctor stated that it appeared to be at least Stage 3 cancer.  Although the ER physician chatted through a few other things at this time we were no longer listening.  We were together but apart, both of us lost in our own thoughts.  When we left the hospital we went home and sat outside on the deck.  There were a few people to call, but first we had to do some strategizing.  We needed to figure out how much we could share with our family and friendsWe needed to see our family doctor to talk this thing throughWe needed to find out how cancer could get to stage 3 (although it turned out to be stage 4) without any real indicators.  We needed to find out what happens next.

This was our world from June 25 – 27, 2014.  Everything turned upside down and we weren’t ready for it.

Surgery Update #6

It was a day filled with worrying.  Worrying whether progress was being made, why it seems to be taking so long for my sister-in-law to bounce back and, in general, what is going on.  Although we continue to worry we did get the results of the CT Scan.  The results were encouraging as they did not identify any further concerns or issues.  The fact of the matter is she had two surgeries in a very short period of time and it is just taking her that much longer to bounce back.  Today they did make some modifications to her treatment plan including increasing her level of food intake, providing a digestive aid to get things moving and changing the antibiotics she is receiving.  She continues to have some congestion in her lungs, so hopefully the new antibiotics will remedy that.  She remains sedated and intubated at the present.

Knowing that it is time and patience versus another concern or health issue alleviates the strain somewhat but not completely.  It’s a long road back and we need her to start the journey.  There is an irony in this whole episode with my sister-in-law.  When she was diagnosed with cancer my husband chided her saying, ‘You’re probably Stage 1, that’s nothing, a little surgery and you’ll be cancer free.’  I have to say that her experience has been terrifying, equally as fearful as my husband’s at Stage 4.  Cancer at any stage can have monstrous, life-altering implications.

Surgery Update #5

Yesterday was not a great day for my sister-in-law.  Unfortunately they had to increase her level of support on the respirator as well as provide some medication to stabilize her blood pressure.  Earlier in the day apparently she had become quite agitated so they also had increased her sedation to settle her down a bit.  I spoke with a good friend about this and she mentioned that it could, in part, be caused by nicotine withdrawal.  My sister-in-law has a long history of smoking and has tried on numerous occasions to quit – unsuccessfully.  She’s not a heavy smoker but certainly she can be called a long time smoker.  The hospital can prescribe a patch to address this – if we think it is an issue.  This decision will have to rest with her son – I’ve put it forward and that’s all I can do.

This morning she woke up with a bit of a fever.  They have administered some medication and it appears to have brought everything down, but the concern is why does she have a fever?  The surgeon who performed her surgery has been in and done a physical review and is satisfied in that regard, however, he has asked for a CT scan on a priority basis to determine if there is something else going on that is not visible to the eye.  She has been wheeled down for a scan and now we wait to see what the results are.