The Dentist Visit

Yesterday we went to the dentist.  Our Oncologist had requested a dental check up as part of the ongoing treatment plan for my husband’s cancer. My husband’s bones are quite thin, brittle and fragile as a result of the bone cancer and the subsequent radiation.  He’s already had an injection of  a bone strengthening agent which he will get every six months.  The Oncologist has also recommended a bone “infusion” as part of my husband’s treatment.  This will be administered at home through the use of a drip.

Prior to commencing the therapy my husband required a dental inspection to ensure that all is well.  One of the potential side effects of the drug can be osteonecrosis of the jaw, which is quite painful as healthy bone tissue in the jaw dies.  Needless to say, this side effect can cause the patient all sorts of grief.  The treatment cannot commence without a dental inspection to ensure that there are no major issues with the patient related to the teeth and jaw.

When I had made the appointment I had advised the dentist that my husband was on a blood thinner as part of the cancer treatment.  This was important and meant that they deferred cleaning his teeth.  When we attended the dentist’s office we went through all the medications that my husband is presently on, after which they did some x-rays and an inspection.  He passed with flying colors.  We also talked about thrush and bacteria in the mouth.  The dentist and the dental technician gave us some great tips on how to prevent mouth sores and keep thrush at bay.  We left with a prescription for a mouth wash in the event he develops mouth sores.  I will hold on to the script and hopefully won’t have to get it filled.

I think the dental appointment was very important – regardless of whether he takes the infusion or not.  It helps to know that your teeth, jaw, etc., are in good shape and that you have no issues brewing there.  So I think it was a good thing, however, I do have questions about the “infusion” and what that means.  He’s getting an injection already for his bone density, what will the “infusion” do, does he need both? What’s the difference?  Are there any side effects to the infusion?  What does it do in the body?  What is the timing for it?  I want his chemo to have optimal effect and not make the body work twice as hard at processing another treatment at the same time.

We see the Oncologist next week – lucky guy – so many questions, so much to learn ..

Blood Clot – Day 4

Another day of restricted activity, enough to make a man crazy.  He’s still a little woozy and not confident on his feet.  The visiting nurse came and did check in to see how things were going.  The leg has gone down slightly but definitely not in a uniform manner.  There are large indentions in his flesh where the fluid has gone down, specifically above the knee and on the cheek of his butt, but at least it is a visible sign of the clot dissolving.  His colour, demeanour and even voice would suggest things are improving. Not the quick fix we had hoped for but still things are moving forward not backward!

I spoke with our nursing contact in Oncology to determine if his dosage from chemo treatment 1 to chemo treatment 2 was changed and she advised he had received the exact same dosage, there were no changes.  We considered a couple of things that could be contributors to the absolutely horrific week he had last week.  Naturally, the developing blood clot was likely one of the main factors making him feel so lousy.  He also got thrush at the same time, which could just be bad timing.  We talked about the need for regular bowel movements – he’s been very good up until the last few days.  I think we are on day 3 of no movements, and this was one thing that concerned the nurse, so a bowl of stewed prunes tonight after dinner will hopefully help in this regard.  By the end of our phone conversation the nurse had gathered a fair bit of information from me with respect to his existing condition.  She plans on calling me back on Thursday to note if any more improvements have been made.

Overall a bit better day on all fronts.  The furnace got installed, the car got fixed, the hydro agreed to come and look at my damaged tree.  All those mundane things that for some reason became so overwhelming are resolved or in the works and off my plate.  Amazing what a difference one day can make.

Fear is the Enemy

So no doubt about it, this was a tough day.  There was no break, no relief over the course of the day for my husband.  He felt lousy, was light-headed, nauseous and naturally, non-communicative.  He didn’t want to talk about anything, no questions, didn’t want the chatter of people around.  It was like he was almost in a suspended state.  The nurse came and went, but we, rather I had a chance to ask some questions.  This was almost a week after his second chemo treatment – shouldn’t he be feeling better?  She had taken all his vitals and done her assessment and basically said, here’s the thing – with this disease you don’t know.  This looks to be all related to his chemo and his thrush and so, likely, this will be his worst day.  But, and it was a big but, the thrush is a nasty thing – it makes taste go off and as a result it can making eating and drinking enough a bit of a challenge, which means tomorrow could be more of the same.  So she will be back in the morning to see how he is doing.  If he hasn’t improved then we call oncology and have them weigh in.

From my perspective as caregiver, this day was one of my hardest.  He was shutting down and unable or unwilling to answer my questions.  Didn’t care if he ate or didn’t eat, didn’t really want to drink.  It was hard to get him to take his pills.  It all adds up to a giant stress and causes me high anxiety – does it mean that something else is going wrong?  There always is some sort of constant fear gnawing away inside of me.  As I tuck him in for the night I see how fragile he has become, its a painful indication of the toil this disease has already taken on him, and we are only at the beginning of the battle.  I am acutely aware of how quickly happiness can be snatched away from me.  Fear is the worst thing; it’s faceless, voiceless and insidious, it creeps into your soul and steals away your joy.  I have to remind myself that fear is the biggest hurdle to get over and it will be that way every day while this battle is on.

Thrush

One of the things we were told about in the chemo education class I attended was the likelihood of thrush.  Because of the aggressive nature of the treatment and the resulting weakening of the immune system, cancer patients are far more susceptible to thrush.  It can be quite painful and looks awful, a sticky white paste on the tongue and white coated sores on the back of the throat.  Well today, despite rinsing his mouth routinely with a mix of salt, baking soda and distilled water, my husband woke up with a sore throat.  This sent me into panic mode, since it may be thrush, but it could also be something more dangerous like strep throat – where there is fever for me, there is fear. 

Fortunately he was fairly forthcoming in telling me that his throat was sore.  He has sleep apnea so it is not uncommon for him to wake up with a sore throat.  For instance if he takes off his CPAP mask and sleeps for a couple of hours without it on, the combination of snoring, holding his breath and mouth breathing can mean he has a sore throat in the morning. 

Today when he woke up he asked for soft foods for breakfast since his throat was sore.  So we had the discussion about what “kind “of sore, like dry throat sore, acid reflux sore, etc.  I got out the flashlight, looked at the back of his throat and there was a visible patch of white.  I took his temperature, which registered normal, and then I called the doctor.  For now, we have a prescription for an oral rinse designed to address thrush.  We also likely have an appointment at the doctor’s office tomorrow.  This all changes if he does develop a fever, in which case, out comes the fever card and off we go to Emergency.

Here is an excerpt from a website that provides a fair bit of information on thrush, I’ve pulled out a few sentences that give a tiny bit of information on thrush:

Oral thrush is an infection of yeast fungus in the mouth and throat. It is caused by yeast fungus – called Candida yeast – that settles in the mucous membranes lining the mouth and throat. This gives the condition its name “oral candidiasis”. … Oral thrush is one of the most common adverse effects of cancer treatment. Chemotherapy can aggravate the mucous membranes and weaken the immune system, which means that the fungus can spread more easily.”  (Source:  http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0046251/ retrieved September 6, 2014.)