Difficult Decisions

I know it's been awhile again since I posted on this blog, but so many things have been uncertain that I didn't want to post anything if it might not be happening for certain.

On July 18, I had a MRI scan to the brain and everything looked stable, even some small reduction in tumor size and number.  So good news there.  It looks like I will be continuing with the Tarceva and the Tagresso, taking one of each on alternate days. I had to go back to Rush for an Avastin infusion the following Monday, July 25.  This procedure is only of half-hour of actual infusing of the Avastin, but managed to keep us at the hospital from 11:30 to 3:00 with rush hour on both the drive there and back.

Dr. Bonomi, Dr. Marwaha (radiology oncologist) and I have been going round and round in discussions about radiating my legs.  Dr. B thinks it is my best and only chance of ever walking again.   Dr. M is willing to do this radiation if I want it, but doesn't seem that enthused.  The chances of actually having success in being able to walk again are unclear, but seem rather low. The side effects are potentially unpleasant (e.g. diarrhea) and the area Dr. B is thinking about radiating is rather large. Finally, the radiation would be daily for two business weeks.

If you can't tell, I am leaning against going through with it.  I really want to walk again, but I just don't feel comfortable with this procedure. This is really a tough decision.  I feel like I may not be able to withstand any more health issues or injuries, but don't know which way to go to avoid them.

The other news for this period is that we purchased something called a Liftkar that automatically carries me up and down stair steps.  Here is a link to a demonstration:  http://chicago.101mobility.com/mobility-lifter-liftkar.php .  The version we purchased proved to be less than was advertised.  When the rep demonstrated how to use the chair at our house, he made it look so easy to connect the wheelchair to the stair lift and go up and down the stairs.  In fact, the four caregivers who attended the demonstration and training - Doug, Abby, mother-in-law Pat and father-in-law Ed put in a lot of time practicing just with the chair (no one sitting in it) and still feel a bit unsure about maneuvering it.  It is also a tight squeeze to try and get it around the corner on the stairs leading to the garage.  We were also having trouble with getting the wheelchair over the threshhold of  the front door (but were able to obtain a ramp to solve that problem).  The sales rep came back to the house yesterday and he agreed to my proposal to exchange the version of the stair lift we have for a different version that has a built-in chair instead of attaching to a wheelchair. This eliminates the complexity of attaching the wheelchair to the Liftkar and slims down the size of the machine to make it easier to maneuver and manage that corner of the stairs.

My mother-in-law, who is my caregiver on Mondays and Tuesdays has not been comfortable using the Liftkar and we had a little mishap on Tuesday that really scared her, although nobody was in danger of getting hurt.  We'd had a rough day all around and it became apparent to both of us that she wasn't going to be able to continue being my caregiver much longer.  We are both okay with this and there are no hard feelings.

So now we are looking for a new caregiver for at least 2 days a week.  If anyone out there has references for strong, reliable, proficient and emotionally supportive caregivers, please send their contact information to me.

That's all for now!

Independence Day?

No sooner do I send a blog update earlier this week than I find myself at the ER again on Thursday. This time for a very red, very swollen and painful left thumb.

They did an X-ray, gave me some high-powered antibiotics and said we should keep an eye on it. That night back at home, I was in a lot of pain with the entire left hand swollen like a "hulk smash" fist.  I knew I had to go back to the hospital and would probably have to stay for a while.  After a CT and an ultrasound on the hand, they determined it was cellulitis and put me on IV antibiotics twice a day.    I didn't get released from the hospital until this afternoon  because, although the treatment is working and there has been a huge improvement, there is still some swelling.  I had many different doctors and the one charged with releasing me didn't want me to leave the hospital until the swelling was completely gone. There are no oral antibiotics I can take with my penicillin allergy that equate to the IV antibiotic I am getting twice a day at the hospital.  However, each time we spoke to this doctor, he said the infectious disease doctor could approve a home visiting nurse to administer the IV antibiotic twice a day or he could identify an oral antibiotic that I could take, even though it wouldn't work as well as the IV.   It took until today for the ID doctor to get to us and stay with us long enough to approve an oral antibiotic for me to take that he felt wouldn't interfere with my allergy.   (He is a bit skeptical about penicillin allergies and thinks they can go away after a long time.  He is thinking about doing a study about this.)

The 4th of July holiday probably prolonged our hospital stay with a lighter staff.  However, my hospital room had a window that directly overlooked a beautiful fireworks display, which made it kind of special. 

  

It has been a good time to stay in bed and rest my lifeless legs.  They feel a little stronger and I can feel the ground under my feet but they still aren't moving or balancing well.  We are soon to be at a point where we will have to make a major decision about health care workers and devices that will increase my ability to handle the stairs. I worked with some Physical Therapy people today who introduced me to a "walker platform attachment" for resting my weakened left arm in a little tray on the top left of the walker. It instantly helped me walk with the walker again, although the legs still are very weak.   Mom and Dad Pawlowski have done some research for us on a few different models of automatic stair chairs that only require one person to pull up and down stairs without being attached to the stair.  And  I'm sure there are other options to explore.

We had someone demo one version of a stair chair with me in our house and it seemed to work well. Another one is set to demo their product tomorrow.  We will continue our research on all the options we have and then make our best possible decision..

Never dull!

The Long and the Short of last Monday's Rush Visit

Hi everyone,

Here’s the latest news from my magical medical crazy cancer tour.

This past Monday, June 27, I was scheduled for an Avastin infusion for 30 minutes at Rush.  Supposedly, a relative short visit.  Somehow that elongated into 8 hours in the hospital.  I arrived for blood work at 10:00 a.m. and left the hospital at 6:00 p.m.

Here's how the time stretched out:

I have to have blood work and a urine sample done when I first arrive so they can analyze the results before they start me on treatments. The staff was running late.

Then I had to see Dr. Bonomi after he reviewed the blood work in order to get approval to make up the Avastin infusion mixture.  And we all know that appointments with him always take a lot longer than planned.  For this particular appointment, he was more concerned with my spinal issues than earlier visits and had someone schedule another consultation later that day with Dr. Marwaha, the radiation oncologist, after I finished the Avastin infusion.  This was a big surprise and really threw the day off course since nothing really changed from 11 days earlier when I had the spinal MRI and both doctors had a consultation based on that MRI.  I couldn't finish with Dr. Bonomi until Dr. Marwaha's resident came over to agree to set up the appointment with Dr. Marwaha for later in the day.

I was supposed to have my infusion done by 4:00 originally.   They got a late start. It didn't end until 5:00.  Then we were in Dr. Marwaha's office until 6:00 p.m.  All for naught.  Nothing had substantially changed in my condition and the reasons not to radiate the legs remain the same:  There is no concentrated place of cancer in the spine where they can focus the radiation; I'd have to be off both the Tarceva and Tagrisso during the whole 10-day course of treatment; and I'd have to be completely off of the Avastin for some time before having radiation because they are not always compatible and could be dangerous if taken together.

My next appointment is in three weeks, July 18, and will include an MRI to the brain and another Avastin infusion in addition to blood work and appointments with Doctor Bonomi and Dr. Marwaha.  Another very long day at the hospital.  Ugh!

Meanwhile, I continue to have my battles with my gastro-intestinal system.  As Roseanne Rosanna-Danna would say, "If it's not one thing, it's another."

I continue to get physical therapy twice a week for 45 minutes at a time.  I now have leg braces to help strengthen my legs, but so far, my legs seem to only be getting weaker. I can’t pull myself up and down the stairs without one or two people physically moving each foot up/down each step.  Hopefully, the PT will help me get stronger, but it sure isn’t happening very fast!

Hopefully, I will have no further news until the July 18 visit.

Coming up to speed with what's been going on

Hi everyone,

I know it has been a while since I shared a detailed medical update, but I’ll bring you all up to speed now on what’s been going on for the last couple months.

I’ll start with the visit to Rush in May.   I had a CAT scan to the lungs that showed stability and a little bit of reduction in the number and size of lesions in the cancer in the lungs.  That was good news, but my focus was really on the continual degradation of my legs and my inability to feel my left leg and foot and the start of losing sensation in the right foot too.  The only solution they had for me was that hopefully the Tarceva would reduce the cancer in the meningeal lining of the lower spine and that I should keep doing the physical therapy to make the muscles and nerves rebuild.  This was not a satisfying answer for me.

I had a consultation with a radiation oncologist to find out if radiation to my legs would help them heal.  Essentially, he said that radiation would not likely offer improvement, but would be something to consider to prevent the legs from getting worse.  We decided to keep radiation on the backburner among our treatment options.

Dr. Bonomi decided to have me start getting an Avastin infusion as a booster for the Tarceva.  Avastin isn’t a chemotherapy drug, but works with chemo drugs by cutting off the blood supply to the lung cancer cell and starving the cell.  I have only had two infusions so far so it’s too soon to tell if it is doing any good.  However, the tumor markers in my blood jumped significantly, which the doctor suspects is a reaction to the Avastin. 

In early May, I had a fall when I lost my balance on my walker.  At the time, everything felt and looked fine – no damage done.  But a few days later my left calf and shin and both feet swelled up to the point the skin was purple and blue and the tissue underneath it was rock hard with no give at all.  While I was at physical therapy later on, the doctor who works there looked at my feet and legs and sent me to the emergency room to have them x-rayed to make sure there was no fracture or tear.  The good news is there wasn’t – just a sub dermal hematoma (deep bruise).  The better news is there was no sign of a blood clot, which I’d acquired while in the hospital in March.  It’s the blood thinner I’ve been on for the blood clot that caused the delayed reaction of the bruising to the fall.  In spite of the blood clot being gone, I still need to get the daily blood thinner shots for another few months to make sure the clots don’t come back.

For this month, my feet have gotten progressively worse and last week, it took Doug and both of his parents to lift my feet from step to step going up the stairs.  I can’t feel my feet at all and have to be careful not to let one step on top of the other or trip as the tips of my toes get stuck on the floor. I got braces for both of my legs as part of PT to give me more strength and stability.  I think they make a little difference, but not a lot.  My “daytime” physical therapy finished yesterday. From now on, I am at “outpatient” physical therapy twice a week for 45 minutes each visit, still with the same PT provider organization. 

In spite of the outward problems I am having with my feet and legs, the MRI scan I had on Thursday of this past week showed stability in the meningeal lining of the lower spine and may even indicate a slight improvement in the amount of lesions there. Dr. Maurerwa, the radiation oncologist, sat in with us to look at the results of the MRI to the spine and we all once again agreed it wasn’t the right time to do radiation to the legs.  Dr. Bonomi decided it was time to add Tagrisso to the cancer treatment mix along with the Tarceva.  The idea behind this is that the particular medications in Tarceva work well for the mutations in the brain and the spine.  The Tagrisso medication has a lot of success with the lungs and other areas where the cancer has metastasized.  The hope is that, between these two drugs, all the cancer in my body will be kept under control.  It’s a new frontier in the cancer landscape so we are just experimenting to see what will work.

The fact that we don’t have a pre-defined path for treatment is disconcerting to me.  But I am glad the medical staff is willing to try new things to help me get better.

So that’s what’s been going on with me.  It has been a very challenging time and there has been some rough news to process. I’ve been given little hope by some medical practitioners that I will walk again.  But Dr. Bonomi still keeps that as a goal.  At least I got that going for me.

Latest CAT scan results and medications

I had an appoint for a CAT scan to the lungs, blood work and consultation with Irene and Dr. Bonomi this past Monday, April 25.

The scan showed stability and even a slight reduction of size of the nodules in the chest.

There were no scans for the brain and spine - that will occur on May 23rd - so no new information available at this time on that.

Dr. B. wants me to add Avastin to my medical regimen.  He thinks it might be a boost to the Tarceva and make it more effective. Unfortunately, it is delivered via infusion so will add even more time for me in the hospital, which is already a long day every three weeks.  But if it can make things get better, it's worth it.

Dr. B strongly supports the Rehabilitation Therapy work I'm doing 3 hours 3 days a week.  He thinks the combination of Tarceva and Rehabilitation is my best bet for a recovery.  I sure hope this will work.  I am feeling more challenged by the lack of independent mobility, strength and stability than anything I have encountered so far throughout my dealings with cancer.

Radiation Consultation, Physical Therapy, and Wooden Railings

Yesterday, on Dr. Bonomi’s recommendation, I had a consulting appointment with Dr. Gaura Marwha, a radiation oncologist, to get his opinion of whether radiation to the Cauda Aquina (Horse’s Tail) would remove or reduce the numbness I feel in my left leg and foot.  After checking my reflexes and hearing my history with the cancer dispersing through the meningeal lining of the brain and spine, his recommendation is to just be watchful and stay on top of the MRIs.  He said that the best the radiation would be able to do is prevent the cancer in the meningeal lining from getting worse.  He thinks that the Tarceva and the physical therapy are the best hope for the numbness to go away and the balance and strength to get better.  I was not surprised by this conclusion. 

I think I have found a good way to handle the rigors of the physical therapy as of today.  I had been pushing hard to do the exercises quickly and efficiently over the past couple of weeks and I’ve wiped myself out to total exhaustion.  Today, I took a different approach.  I was deliberately slow and took several rest breaks throughout the 3 hour therapy session.  I was able to stay fairly fresh and complete all the exercises the therapists wanted me to do. 

Since 10:00 a.m., we’ve had a couple very skilled men putting in railings for me to help me go up and down the stairs.  They just left here at 7:00 putting finishing touches on the railings.  They’ve come up with some really great solutions.  You’ve never seen so many wooden railings in a house!  But they are beautiful wood and the house still looks good.

Overall, it seems that things continue to get better.

Slow but steady progress

On Monday, April 4, I had blood work and an appointment with Dr. Bonomi, my oncologist, and Irene my oncology nurse.  Both of them are very happy with my progress and think I am doing really well.  They feel that I am a lot more alert and acute than I had been a couple weeks ago. They are also satisfied with the blood work results.

I am not at all satisfied.  My balance is still way off and I am dependent on others to stabilize.  I am using a walker to get around.  Dr. B and Irene see this dissatisfaction as exactly the proof that I will get better.  I hope they are right, but I can't get back to normal quickly enough.

Doug noticed that in the two instances where I had a seizure, it was five months after the Tarceva was stopped. Dr B agreed to a steady dose of Tarceva that will be less irritating to my stomach.  We've also cut down on the steroids to two a day.

Dr. Bonomi also recommended I consult with Dr. Gaura Marwhaa about trying radiation on theCauda Equina (Horse's Tail) at the base of the spine.Like the meningial lining in the brain, the spine has a meningial lining that has been affected by cancer.  It is possible that that is what is causing the numbness to my left leg and foot.  I have a consultation set up for this Tuesday, April 11 with Dr. Marwhaa.  It will be interesting to see what he has to say.