Discharge and Departure

After a three-and-a-half day stay in the hospital, Dad was discharged from Seton Medical Center on Monday (May 4) in the early afternoon. Over the weekend he received a total of four units of whole blood and at least one unit of platelets. By Sunday, all of his blood numbers were acceptable with the exception of his platelets, which were still well below normal. Drs. Moskowitz and Weber both expressed satisfaction with his condition and explained that his platelet count was moving in the right direction and his body would continue to regenerate platelets as time goes on. They also both condoned his discharge from the hospital as well as his planned trip to Missouri on May 5.

Even though his blood numbers are OK, he continues to feel very fatigued and his appetite was almost nonexistent until Monday afternoon. He has been experiencing a strange sensation when starting to eat, with hot flashes, flushing, clamminess, etc. either after the first bite or even when seeing food. This sensation has been decreasing and he has been able to work through it when eating. He also has some pain in his lower back that appears to be muscular in nature.

His fatigue and appetite have been slowly improving and after much consideration, the decision was made for him to travel to Missouri on Tuesday, as scheduled. After a delay of several hours, his flight left SFO for St. Louis at 4:51 PM Pacific time, projected to land at about 10:12 PM Central.

Readmission

Dad has been readmitted to the hospital at Seton Medical Center. Starting in the early evening of Thursday, April 30, he became extremely fatigued. We consulted with Dr. Weber on the phone and after checking his temperature and finding it to be 101.9 degrees Fahrenheit, Dr. Weber prompted us to take him to the ER at Seton. He was admitted to the 10th floor of the hospital sometime around 5:00 AM on Friday, May 1.

Blood tests showed that several of his blood counts were significantly out of the normal range (on the low side), including his white blood count and platelets. He was given a unit of platelets and two units of whole blood on Friday with another two units of whole blood being given to him today (Saturday).

The high fever was explained as being neutropenic in origin, stemming from the low white blood count. His temperature was back to normal shortly after arriving at the ER where they gave him a strong antibiotic. His temperature has been normal ever since.

Dad is currently scheduled to fly direct from San Francisco to St. Louis on Tuesday, May 5. We expect him to be in the hospital until at least Monday, so there is a chance his travel may need to be delayed, but we continue to work with his doctors and monitor his condition.

Update for April 24, 2009

I am happy to report that Dad has tolerated the third chemo (administered on April 16) much better than the first two. Many of the same symptoms appeared around day four or five after the treatment (most notably fatigue) but since then he has been gradually improving. There are three reasons that come to mind to possibly explain his improved response:

• Dr. Weber lowered the dosage of two of the drugs (see this blog post for details)
• His body may be "getting used to" the treatments somewhat
• The radiation treatments for his hip has made the pain he was feeling there much less of an issue

He has been taking short walks most days and his appetite is also gradually improving again. He hasn't experienced any mouth sores yet. Sleeplessness has been somewhat worse that before the treatment, but better than the first two treatments.

Third Chemo Treatment

Dad is having his third chemo treatment as I type this, a day earlier than scheduled to accommodate family schedules.

Dr. Weber adjusted the dosages of two of the drugs: Alimpta from 900 to 700 and Carboplatin from 600 to 400 (not sure of units, but the relative change is what's significant). This reduction will hopefully result in fewer complications in the weeks following the treatment.

[Posted with iBlogger from my iPhone]

Update for April 14, 2009

Since Dad was discharged from the hospital on Tuesday, April 7, he has been feeling quite well overall. The highlight of the past week has been a visit from his sister, Emma, brother, Sonny, and nephew Rick visiting from Connecticut and Maine. He was even up for a three day trip north to Redwood National Park that included a short jaunt into Oregon.

Here is a summary of his present condition, in no particular order:

• Pain (head/neck/shoulders and the hip) still continues to be an issue. He is using Fentanyl patches (total of 150 mcg/hr), changed every two days and also taking acetaminophen and liquid morphine as needed for breakthrough pain. The headaches don't seem to have much correlation with anything (activity level, fatigue, time of day, hunger, etc.) although sleeping at night does seem to have a positive effect. Likewise, the pain medicine is sometimes very effective and other times not at all. We are continuing in our efforts to manage his pain effectively.
• Edema in his feet and lower legs has been much less pronounced. He has been wearing compression socks intermittently to help control it.
• Fatigue has been much better than prior to his most recent hospitalization, but he still gets tired at different times during the day and generally takes at least one or two naps a day. When napping, he doesn't necessarily go to sleep but the rest seems to help. As the hip pain improves, he has been able to walk quite well and he goes for walks most days. He has not needed to use his cane much when walking; he has not yet gotten a walker, although he has a prescription for one.
• His mouth sores seem to have healed almost completely, which is consistent with the timing after the first round of chemo.
• Constipation is an ongoing problem, most likely a result of the pain medications. He is taking several forms of laxative and stool softeners and also eating prunes, etc. He has complained of some external bleeding, most likely from a fissure.
• His appetite has been fair since leaving the hospital, with several smaller meals or snacks throughout the day.
• While in the hospital, he stopped taking Ambien as a sleep aid and switched to Restoril. He is currently taking 22.5 mg nightly with fairly good results. He is also taking a melatonin tablet each night (available over the counter).

Dad's next chemotherapy treatment is scheduled for this coming Friday, April 17. As I mentioned before, Dr. Weber plans to reduce the dosages by about 20% in an attempt to reduce the side effects.

Chemotherapy Results

The original chemotherapy plan called for three treatments to be followed by a CT scan to assess its effectiveness. This would have resulted in the scan taking place around April 24th.

Due to Dad's negative reaction to the second treatment, Dr. Weber ordered a CT scan on Wednesday, April 1. On April 2, Dr. Weber shared the results, which indicate that the primary tumor has shrunk. This is very promising news and indicates that the chemotherapy is working.

Dr. Weber would like to continue with the treatment with three more to be administered before checking again and possibly two or three more after that. He is aware of Dad's negative reaction and is considering adjustments to the drugs. He has also changed the date of Dad's third treatment from April 9 to April 17.

Dad will remain in the hospital for the time being, most likely until his radiation treatment concludes next Tuesday, April 7. Blood tests also show that some of his counts are low, so they will continue to monitor his blood and assist him with other symptoms he's experiencing, including mouth sores, pain, and fatigue.

Blood

The doctors ordered a blood test early this morning and discovered that his blood count (both red and white) are low. Therefore, they are in the process of giving him two units of blood, which will take about six hours to complete. He should be feeling somewhat better this evening with the full affect being realized by tomorrow.

At this point, we are unsure of when they will discharge him, but he may end up staying until the radiation therapy concludes on April 7.

[Posted with iBlogger from my iPhone]

Radiation Treatment

One of the biggest problems Dad has been experiencing is hip pain on the right side, which originated when he slipped (but didn't fall) when walking down stairs. He has an approximately 5x3 cm cancerous lesion in his pelvic bone, which has caused the bone to be compromised and is most certainly the cause for the pain. He has been having an increasingly difficult time walking.

After consultation with Dr. Weber on March 20 during the chemo treatment, Dad consulted with Dr. Wu, a radiation oncologist whom he had met briefly at the hospital during his first inpatient stay; the consultation took place on March 23. She recommended a radiation treatment plan to begin on March 24 consisting of 10 total visits on weekdays, concluding on April 6. This schedule was delayed by one day due to his admission to the hospital. Each visit will last about 30 minutes (most of which is prep time; actual radiation time is only about two minutes per visit).

The goal of the radiation therapy is to stop growth of the lesion in order to reduce the pain and hoprfully allow the bone to heal. He should begin experiencing some relief from the pain by the end of the treatment, but the benefits won't be fully realized for a few weeks after treatment has concluded.

Dr. Wu informed us that Dad's form of cancer, adeno carcinoma, responds well to radiation therapy. However, therapy for all of the lesions in his body is not an option because the dosage would be too much for him to tolerate. Radiation is recommended when there is only a primary tumor (i.e., if the cancer hasn't metastasized) or when there is a significant risk associated with a well-defined lesion. In Dad's case, the risk is fracture of the pelvic bone.

The only side-effect expected is some burning, itching, and dryness of the skin on the hip (front and back) where the radiation beam is to be directed.

[Posted with iBlogger from my iPhone]

Update for March 24, 2009

As noted in my earlier post, Dad was readmitted to Seton Medical Center this morning for severe fatigue. Tasha is staying at the hospital with him tonight.

His condition is largely the same as when he was admitted:

• He is extremely fatigued and needs help moving between the bed and the bathroom
• He feels cold even though his body temperature is normal
• He has not eaten and has no appetite
• He has taken some small drinks of water and has a saline solution hooked to his IV to hydrate him

They have run several tests, including blood tests, an EKG, and a chest x-ray. Some of the blood tests, including a CBC, came back normal, as did the EKG. Other blood tests have not been completed yet. We're unclear on the reason for the chest x-ray, but it may be to compare with the chest x-rays done during his previous admission to the hospital.

At this point, it's unclear for the underlying cause for his symptoms. Dr. Weber paid a visit late in the day today and indicated that the most likely explanation is the chemo treatment administered on March 20. The chemo drugs may need to be adjusted for the next application, which is scheduled for April 9. We will also have a discussion with him about the expected benefit of the chemo in general vs. the potential side effects.

There's no way to know how long he will be hospitalized, but my gut feeling is that it will be a minimum of three days.

I will be making more posts with further details regarding other aspects of his care.

Readmission to Hospital

We are currently in the process of getting Dad readmitted to the oncology ward at Seton Medical Center. He is extremely fatigued and has experienced a marked decrease in appetite over the past 24 hours. He slept poorly last night and suffered from diarrhea at about 4:00 AM. We came to the hospital for his first radiation treatment this morning, which has been postponed until he is feeling better.

I will do my best to post more updates regarding his care soon, including plans for radiation therapy and pain management.

[Posted with iBlogger from my iPhone]

Update for March 15, 2009

Apologies for not posting for a week. A lot has been going on; for now I will post a high-level update and provide details in the next few days.

• My sister, Tasha, arrived here on Tuesday, March 10 from Hawaii. She will be staying for about a month.
• We consulted with another oncologist, Dr. Ruth Marlin, on Tuesday, March 10. That consultation was not for a second opinion so much as a complement to Dr. Weber's care and in fact we were referred to Dr. Marlin by Dr. Weber. I will post details of that visit once we receive a copy of her report.
• Dad had a rough week since my last post, hitting his low point on Tuesday, March 10. His fatigue, pain (head and hip), and mouth sores have been the primary concerns. We consulted with Dr. Moskowitz (his attending physician at the hospital) on Friday, March 13, primarily about pain management. He has suggested some changes in the pain medication, which will be be trying this week.
• Dad's next chemo session is scheduled for Friday, March 20.

I will be making additional posts soon.

Chemotherapy Drugs and Treatment Details

The drugs Dr. Weber has prescribed for Dad's chemotherapy include the following:

• Alimpta
  
• Carboplatin
• Avastin

The first two are standard chemo drugs and the third attacks the blood vessels of the tumor.

In addition to these drugs (which are all administered intravenously during the actual treatment), Dad is also taking Decadron orally for four days around the chemo (day before, day of, and two days after) to prevent the rash that can occur as a result of the Alimpta. There is one final pre-treatment drug that he is given in the office called Kytril to reduce nausea.

As explained by Dr. Weber, the plan is to complete one round of treatments, which consists of three visits at three week intervals:

1. February 27
2. March 20
3. April 10

They will monitor his blood (first check is scheduled for March 9) to be sure his body is tolerating the drugs; the chief concern is the Carboplatin, which can cause bone marrow toxicity.

After the third treatment on April 10, they will run a CT scan to see how the cancer has responded to the first round of treatments. If spread is either stopped or even countered, this will be considered success and they will continue with the same drugs. If the drugs prove to be be ineffective, Dr. Weber will adjust them in an attempt to find an effective solution.

Update for March 7, 2009

Over the past couple of days, Dad has had many ups and downs. He has not felt as bad as his worst nor as good as his best and there have been many fluctuations. His symptoms include:

• Fatigue: Sometimes he can hardly sit up or keep his eyes open, other times he is able to walk a half mile with me. He rests by lying down on the couch and closing his eyes but not always sleeping. His mental acuity seems to correlate inversely with his fatigue.
  
• Sleeplessness: The Ambien seems to have been helping but his sleep is still disrupted several times each night. He rarely stays in bed for more than 6 1/2 hours. He naps a few times a day although sometimes he just rests.
• Headaches: His headaches have been quite bad, even relative to his baseline, which was pretty severe to begin with and has been for years. He continues to describe them as being more on the top of his head rather than the back or sides, which is more the norm for him.

His appetite has been quite good (I plan to post details about his diet soon). We have experimented a bit with his pain medication to try and find the right balance with the Vicadin and the Fentanyl patch. Ideally, he would be less dependent on the latter. I also have concerns about the interactions among all the drugs he is taking, which we will discuss with the doctor at our next consultation. If any of his symptoms get dramatically worse, we will of course call.

Medications

Below is a list of the medications Dad is currently taking. We are also tracking dosage, frequency, etc. but for purposes of the blog I will just post a list. Let me know if there are any questions about any of them. There is a mixture of prescription and over-the-counter drugs.

Once a day, taken in the morning:

• Stool softener and laxative
• Magnesium
• Vitamin B6
• Aspirin
• Finasteride (generic for Proscar)
• Centrum Silver
• Folic Acid

Twice a day, morning and evening:

• Lovaza

Once a day, taken in the evening:

• Niaspan
• Flomax
• Zolpidem (generic for Ambien)

As needed:

• Mucinex DM
• Vicadin
• Fentanyl (generic for Duragesic)
• Nexium
• Dexameth (generic for Decadron)
• Rhinocort Aqua

Update for March 5, 2009

Dad's first chemo treatment took place at Dr. Weber's office on Friday, February 27, 2009. It took about three hours to administer and he felt no ill effects when in the office or for a few days afterward.

On the evening of March 2, he misjudged the bottom of the stairs when walking down and nearly fell. As a result, he experienced some pain just below his right hip near the top/back of his thigh.

On the evening of March 3, he suddenly felt extremely fatigued, sleepy, and cold and also experienced a severe headache on the top of his head in spite of having put on a new fentanyl patch earlier that day. He went to bed somewhat early and slept for at least six hours straight; this is the most continuous sleep he has gotten for the past several months. He continued to have the same symptoms in the morning, with a break when he felt better for an hour and a half mid-morning, during which time he took a shower.

He and Bette had appointments with Terry Grenchik at 2:00 PM on March 4, at which time he consulted with her about the hip/leg pain and the fatigue and heacache. She gave him a prescription for a muscle relaxant (which has not been filled) for the pain and suggested that the other symptoms are likely a result of the chemotherapy and/or cancer.

I consulted with Dr. Weber on the phone late on the 4th and he agreed that Dad's symptoms could be a delayed response to the chemo and didn't think there was anything else we should be doing at this point.

First Post

The purpose of this blog is to keep track of Dad's health, cancer treatments, reactions, etc. Below is a brief summary of the events leading up to where we are today.

Dad and Bette stopped in for a visit to San Francisco on February 12, 2009 on their way from Hawaii back to Missouri. The original plan called for them to leave San Francisco on March 4. On the evening of February 19, Dad felt very ill and hardly slept, with various symptoms ranging from indigestion to fatigue. On Friday the 20th, I took him to see our family doctor, Terry Grenchik (who is actually a nurse practitioner). Based on her concern about pneumonia, she sent us to the emergency room at Seton Medical Center in Daly City, California. A chest x-ray showed a mass in his right lung, which prompted more tests and his admission to the hospital. He remained in the hospital until his discharge on February 26. During his stay, he was diagnosed with stage four lung cancer, which had spread to the lymph nodes in the chest and several bones. The primary mass is near the top of his right lung. While in the hospital he began consultation with Dr. Robert Weber, an oncologist, and began chemotherapy on February 27.

Future posts will be to track how he has been feeling, progress with his treatment, medication he is taking, etc.