Wednesday, September 29, 2010

Brain Surgery

I finally fell asleep late last night despite my intention to get to bed early. Instead I spent the evening sitting bedside for several hours waiting to hear the results of a late evening CT scan. I had just finished reading Lance Armstrong's book "It's Not About the Bike" to Phil from his Kindle around 5:30 p.m. yesterday when Phil started twitching his arms and legs and squeezing my hand. This continued and increased and it became obvious that he was having a generalized seizure. He was unable to respond to me although his eyes were open. The nurses came in immediately and started taking vitals, etc and the doctors were called. In summary, it only lasted about 2 minutes and he had no lasting effects. His CT was normal and he's had none since. It was just another indicator of the infection and swelling in his brain and the need for immediate surgery.

Surgery got underway at 7:30 this morning as planned and Phil was smiling and mellow, ready for what was ahead of him, yet subdued.

By 9:45 he was finished and Dr. Ghosh came to give us his report. He had indeed found a large abscess (3cm or about 2 inches) in the frontal lobe and was able to remove all of it. In doing so he confirmed that the source of the infection in the brain came from the eye and sinus infection. Although he had wanted to identify the infectious pathology in the OR he was unable to so we won't have those results for another 2-3 days. Phil did very well in surgery and had no complications and we are all breathing a huge sigh of relief.

So, Dr. Ghosh debrided the abscess and put in a paracranial flap to increase the efficacy of the antibiotics. Phil got his titanium plate and is now a million dollar man. He will have a repeat CT scan tomorrow to see that everything is holding steady and once the pathogen(s) been identified and a plan of treatment is in place, he could come home as soon as Monday.

When he wakes up in the Medical ICU I will tell Phil how he's been covered by the prayers of hundreds. And I will tell him how God works through people like Dr. Ghosh to perform nothing short of a miracle today.

Monday, September 27, 2010

GPS Surgery

For those of you who don't live in San Diego or follow our local weather, it is hotter than Hades here. I mention it because it has added a little something to the backdrop of our lives right now. While our time together has been sweet it has also been hot and intense. Yesterday Olivia spiked a fever of 102 and this morning my stomach didn't feel so good. It was bound to happen. On top of it all, although Phil has a nice big room, "the corner office" is a full exposure room almost all day and he (and his visitors) tend to roast. An extra fan has been brought in to keep him cool. As if he hasn't got enough to deal with...

After a weekend in which I was treated to sleeping in, being cooked and cleaned for and having all my laundry done by my sister-in-law Michelle, I am back to reality and we have received the results of today's MRI.

There were many words we didn't want to hear when talking with our physicians today, but unfortunately we heard several of them. The frontal lobe process looks ominous and it appears to Dr. Ghosh the neurosurgeon that an abscess could easily be forming. In his words, if he were to send Phil home, something "catastrophic" could " blow up" at any moment that could be devastating if not "life ending". Very graphic words with a clear message.

Phil needs to have a small scale surgery to determine once and for all what the infectious source is in his frontal lobe. There is a deeper brain infection going on as well but those areas are not amenable to surgery. So at this point a biopsy/debridement will be undertaken in the frontal lobe. He will have a high falootin' GPS MRI tomorrow to place markers to use during surgery then have the actual surgery very early Wednesday morning.

On a scale of 1 to 10, Dr. Ghosh rates this a 2 - it aint nothing! We're just going to open up the braincase, remove some tissue and replace it with a small titanium plate, ok? Anyone grow up with Steve Austin, the 6 million dollar man? That'll be Phil, minus the new eye because he gets to keep his. So far that part looks stable.

Please don't take me wrong here with the humor and levity. I am scared and exhausted and wrung out and sick to my stomach. I am also hopeful, relieved to finally be doing something about that damn thing in his head, and a witness to the power of God's people in prayer. My husband is willing to undergo a surgery that carries above average risks and is only a stop-gap measure. But he's still fighting. So, I've got to find things to laugh about. There have been too many tears of late.

Friday, September 24, 2010


Phil is resting today as we all are; catching up on sleep and catching our collective breath after the whirlwind of the last several days. His parents have arrived and my brother Peter and his family have driven down. There are still a few more members yet to come in over the next days as we gather to be with Phil and enjoy our time together as family.

Unless there are any changes I will be taking a break from posting as we rest, recharge, and enjoy one another. The last time we were all together like this to join our two families as one was at our wedding 15 years ago. It will be a sweet time of communion, thanksgiving and prayerful petition to God for all that He has done and for all that He has yet to do.

I will be back here on Monday. May the Lord sustain you as I know you will be feeling the absence of news of our dear Phil. Know that he is in the hands of the great physician and in the arms of his loved ones as you hold him in your hearts and prayers.

Thursday, September 23, 2010

Phil's Progress

Since my last posting, the decision was made to repeat Phil's MRI this morning before going to surgery. His surgical team felt that with the invasive nature of the surgery, Phil's underlying fragility, and the many risk factors, it behooved them to gather up to the minute information before taking him to the operating room. Additionally, his immune system has just begun to function on it's own and they wanted to give him every opportunity to mount his own response to this infection, to better equip him for the challenges of surgery.

Clearly, whomever said no news is good news hasn't sat around waiting for an MRI to be completed. However, the wait was worth it. The scan showed that there has been more improvement and Phil's immune response has made a difference. His eye is definitely better since yesterdays MRI. It also shows that the infection has been spreading through the venous system into he brain and not through the dura, which basically means that the antifungals should be able to penetrate the infection given more time. So, NO SURGERY IS NECESSARY TODAY. In fact, Phil will continue his current course of treatment and have his next scan on Monday - 4 days from now!!! This is the first good news we've had and we couldn't have been happier to receive it.

He will need the antifungals for at least 6 weeks and chemotherapy is still on hold. Surgery is still a very real option and not one of us is deluded into thinking Phil is out of the woods. This is still a day to day existence of prayer and thanksgiving and enjoyment of one another. Family is gathering and we continue to ask for and bask in your enormous outpouring of prayers, love and support. Team Conrad continues to grow as word has spread of Phil's fight and we feel connected to you in a powerful way.

Let us celebrate Phil's victory today. Livestrong!

Wednesday, September 22, 2010

All In

We are no longer living day to day around here, time is now marked in 12 hour increments. That's how quickly things are changing and progressing.

Phil had another MRI this morning and the cultures have yielded more definitive results. Today has been a big and unfortunately, very difficult day. The cultures show absolute evidence of a mixed bacterial and fungal infection in the sinuses and henceforth in the brain. The fungus is called Mucormycosis and is very common in diabetics and immunosuppressed patients. The MRI shows advancement since yesterday of the infection to involve new portions of the brain. So despite having been on high doses of antibiotics and antifungals, ground is not being gained.

The optimal treatment for this fungus is surgical debridement, which although radical, is Phil's best chance for eradicating the infection. Combined with his antifungals, tomorrow morning he will be having a very involved neurosurgery to remove his left sinuses, his left eye and orbit and portions of his left brain that are infected and non-functioning anyway. It's hard core -- as if it wasn't before. During the next several weeks his chemotherapy will have to be put on hold lest any further immunosuppression allow the Mucor to take the upper hand.

We are awaiting the final debriefing from the team of surgeons and are covering Phil with our prayers and love. We (Jeff, David, Anita and I) are also telling stories and laughing a bit too. Phil is tired and a bit fearful for tomorrow's events but he is also ready to go. He's not one to sit back and do nothing if there's something to be done. He's going for it. Bravest man I know, facing down terrible odds and "fighting a raging fire in the middle of a hurricane".

If Phil were playing poker, I'd say he was all in. Trusting God, and all in.

Tuesday, September 21, 2010

Surgery Update

The surgeon has just come out to talk with us and Phil has done well this morning.  He ruled out fungal activity and was able to clear the left sinuses. Thanks be to God--best scenario for today though there are many issues that remain. He will have an MRI tomorrow morning for further information about how to proceed. It looks like it is bacterial and we will have to wait for the cultures for treatment decisions to be made. He is not out of the woods by any stretch and we are grateful for each positive bit of news. He has some blood clots in the area that concern the surgeon and the neurosurgeon will weigh in on them soon. More news as we get it. Love you all.

On Our Knees

Today's blog is going to be short and to the point.  There are too many details to report and frankly they change with the hour yet don't change what you really need to know.  Phil needs prayer and lots of it.

As I am typing this he is undergoing surgery to diagnose the cause of this horrible infection in his brain.  Since I last posted, the infection in and around his eye has worsened and it looks like we are dealing with a particularly "wicked" fungal infection (to quote Dr. Kossman).  He and the 3 or 4 other specialists who've been consulted in this case are very concerned about the infection because it is extremely difficult to eradicate short of surgical debridement.

Debridement means going in and cleaning things out and since we're talking about the brain, well, you can grasp the gravity of the situation.  As of today Phil has lost the vision in his left eye and there is reason to worry about the right eye as well.  Fungal infections can spread quickly so information needs to be gathered quickly as well so the appropriate therapies can be continued or started.  

The goal for today's surgery is diagnosis, not therapy or cure.  That much has been made clear to us.  Having said that, our hopes for today are for an uncomplicated surgical course, sufficient biopsies that will lead to productive treatment and no further surprises or obstacles.

The kids and I are surrounded by family and good friends, including Jeff Breland, and feel the love and prayers that have been pouring in.  Phil is in excellent hands and Dr. Kossman has brought in the county's finest specialists in ENT oncology and neurosurgery.  The rest, as ever, is in God's hands.  

Saturday, September 18, 2010

Sweet Dreams

I'm sitting here next to Phil, the two of us "canoodling" according to the nurses, in his single hospital bed.  This is a strange place to be writing the blog from, but it works for today.  He's asleep, more or less, his slumber punctuated by the occasional fitful dream wherein he appears to be conducting an orchestra or perhaps, filing things.  As an observer, I really can't tell.  You see, I've never actually seen my husband dream.  Usually I am asleep right beside him, not sitting next to him for hours at a time watching him reach for unseen objects or listening to his snippets of conversations or partially delivered speeches .  It is both educational and instructional but at this juncture I have to say it is mostly unsettling.  

He was like this all of yesterday and it was sobering, in case you couldn't tell from my post.  The infection combined with the fatigue and all the meds really had him wiped out.  When I called Phil's cell phone this morning I really wasn't expecting him to answer.  When he did I was beyond thankful just to hear his raspy voice.  What's more, he told me he was reading his Kindle -- I about choked on my coffee!  Talk about a turn around.  He still sounded terrible but he was reading, focusing, and using his mind Glory Be to God.

I was really anxious to see him and talk through all that had happened in the last 36 hours; to see what he remembered and make certain he understood what was going on.  When I finally got everything handled at home and got over to the hospital I walked in to find him in much the same condition as yesterday - conducting his magnum opus.  Turns out he was getting another unit of blood and was totally snowed on 50 mg of Benadryl to prevent an allergic reaction to the blood products -- so he's completely gonzo, zonked, out-of-it, looped, in la-la land again.  Crap!  What have you done to my husband - I wanted to talk to him!  This time though, I get it.  It's not all infection and bad news making him act this way.  I have that little gift of having heard his voice, the clarity in it and the focused intent in his words to hang onto.  

Today being Saturday, apparently no physician in their right mind wanted to round on the patients before 3 o'clock so I timed my visit just right.   I was here in time to get the report of the day straight from the oncologist and infectious disease doc's mouths and things are indeed looking better.  It is so very good to have their objective report because even as a trained medical professional, it is difficult to know what to make of such a difficult situation when one is personally involved.

His blood cultures are indeed growing out a bacterial infection, E. coli.  Before you freak out -- we're not talking about the tainted hamburger meat type or the flesh-eating bacteria here.  Just plain old garden variety E. coli.  That's not to say it is harmless but just don't go losing your minds.  The ID folks believe his port should be fine and they are making several changes to his antibiotic regimen.  He was apparently on 5 when I thought he was on 3.  Shows you what happens when you grab a cat nap.  He will continue on ceftriaxone as well as the antiviral and antifungal.

His CSF cultures have yet to grow any bacteria which is good news.  The rest of the studies will be in later in the week - things like Valley Fever, toxoplasmosis, herpes, etc.  The outliers so to speak.  Until then it's stay the course.  

Phil will get more RBCs today to boost his anemia and begin to get Neupogen (a more rapid acting agent) to stimulate WBC cell production.  Once his WBCs come back he should rebound much more quickly and feel significantly better.  Lastly he will see the ophthalmologist to begin some exercises to regain the use of the muscles in his eye and prevent any further losses.  

He's got his work and recovery cut out for him.  It really amazes me to think, he's only completed one cycle of chemotherapy.  Yikes, just 4 to 6 more to go.  Think we'll stick with taking those one day at a time.  For now, so what if Phil likes to conduct orchestras, or file things, or compose speeches in his sleep?  I think it's great that he's dreaming these few days away in a medicinal fog - God know he's earned it.


Friday, September 17, 2010

I Hate Cancer

Don't even know where to begin this one.  It's only been a day or so but I've lost all sense of time again.  Wasn't it just the other day I was practically bragging about how wonderfully everything was going?  Reveling in the blah-ness of it all?  Extolling the merits of being underwhelmed?  Well, let's just say that ship has sailed.

It started out simply enough in the mid afternoon two days ago.  A mild headache, nothing a few Tylenol couldn't take care of.  That is until a few Tylenol couldn't take care of it and Phil had to move on to the big guns.  By that evening we were making a call to the doctor because 10 mg of oxycodone weren't doing jack-squat and he was in excruciating pain whenever he moved his left eye.  Fortunately for us, and one of God's small mercies, Dr. Kossman was on call.

Before I continue, I have to say this.  It really can't be understated how awesome it is to reach your own doctor when you call the on-call service in a crisis.  There is no explaining to do, no background to give, no time wasted.  You just hit the ground running.  And who's voice do you most want to hear when you're in crisis but the one who's been holding your hand and shepherding you through?  So, when we reached Dr. Kossman I already felt better for Phil and whatever the hell was going on with him.  The Captain was at the helm.

Back to the drama that was unfolding in my bedroom (don't even go there).  After much discussion we decided to try other options for pain relief rather than spend the night in the ER and would check in with Dr. Kossman first thing in the morning.  Despite our best laid plans however, it was a long, pain-filled, sleepless night.  In the morning, because Phil had developed double vision in his left eye and numbness across the left portion of his scalp during the night, we were sent to an ophthalmologist.  By now Phil could barely open his left eye and it was bulging a bit.

After a very thorough eye exam, the working diagnosis was that he had an evolving cranial nerve palsy of the III and V cranial nerves.  The III nerve controls the movements of the eye muscles and the 1st branch of the V nerve controls the sensation across his scalp. Some inflammatory process in the brain was to blame for this.  But what?  Tumor?  Infection?  He needed an MRI STAT.  Sounds like a scene from ER -- but unfortunately it wasn't.  To say he looked like shit is to be flattering and I know he didn't feel much better.

Dr. Kossman, being the consummate physician he is, wanted to order the MRI himself and who am I to stop him?  The guy is freakin awesome.  On a crazy busy clinic day, he walked across the street and spent 30 minutes looking over Phil's MRI from one month ago with two neuro-radiologists before seeing us to discuss our next move.  He's just that kind of doctor.  Oh, and he worked us into his already unforgiving schedule.   When he took Phil's blood it showed the obvious -- profound anemia, next-to-no platelets, and only 200 WBCs.  That alone would make anyone feel like crap but combine it with a bulging eyeball, headache, postchemotherapy, and no get the picture.  When given the option to go home after the MRI or go in the hospital for pain control and support, Phil cried "Uncle!" and he got a bed on 3 South faster than I've ever seen.

Things happened pretty fast from there on out.  He had lots of labs drawn including blood cultures.  He was given IV fluids and 2 units of RBCs and platelets.  He had his MRI.  A neurologist (Dr. Evans) consulted on his case.  An infectious disease specialist (Dr. Mayer) consulted on his case.  Dr. Kossman came and rounded on him at the end of his day ~ 8:30p.m.  More blood was drawn.  More platelets were hung.  Vancomycin (an antibiotic), Acyclovir (an antiviral), and Amphotericin (an antifungal) were all hung.  Pretty much the whole kitchen sink was going into the guy.  

And here's why:  According to the MRI the cranial nerve palsy is due to an inflammatory/infectious process going on in and around the L orbit and in the cavernous sinus deeper in the brain.  Shit, his brain is infected.  That's serious.  No wonder there was so much damn foot traffic through his room this evening. Those were my thoughts on the drive home from the hospital last night, when I could start wrapping my mind around what was going on.  It's amazing how long it takes things to sink in when you're in crisis mode.

Today as I write this we now know that his blood cultures are all growing bacteria, gram negative rods for you medical folks.  It is not uncommon for neutrapenic (immunosuppressed) people to grow gram negative rods in their blood cultures.   However, this suggests that Phil may have two separate processes going on.  Dr. Mayer believes that to be the case.  He thought out loud to me that his port could be the source of this blood infection and he will do everything he can to sterilize the blood with the antimicrobials to save the port.  Otherwise he'll need a new port down the line.

As for the infection in the brain, he doubted that was related to the bacteria in the blood but he won't know until the cultures and studies come back in several more days.  Phil did have a blood patch in late August with his first spinal tap which if done with infected blood could have been a source of contamination.  However, Dr. Mayer believes the timing is too far out.  So, we will watch and play the waiting game.  Meanwhile, Phil is very tired, weak and out of it.  Thankfully, he is also mostly out of pain.  

As for the rest of us, well, what can I say?  Our trains are ultimately hitched to Daddio's.  Over the last few days the kids have been spending a lot of time with their Aunt Terry and cousin Josh.  Thankfully and in further evidence that God is a genius, we have them nearby to love on the kids and provide distraction, comfort and a sense of routine.  For Bennett and Olivia, their stress has been showing up with bad dreams and emotional outbursts or for instance, last night Bennett having a "bad headache".   

I think it was at breakfast yesterday when I told Bennett I needed to call the doctor about something and out of nowhere he shouted "I hate cancer!"  I just looked at him and said "I do too honey, we all do."  There was nothing else to say to that.  He nailed it.

Monday, September 13, 2010

Living Strong

According to the online Free Dictionary, to be "underwhelmed" means to fail to be excited, stimulated or impressed.  Considering that just a few weeks ago Phil was in the ER with a killer headache and an extreme drug reaction, I'd say that his response to chemo this go-round has been a bit underwhelming.  Got to say I'm more than happy to take this one easy and avoid the roller coaster of catecholamines (adrenaline) that have been responsible for making my already thin hair fall out and for churning a hole in the lining of my stomach.  Yes, I'll take a bye on that, thank you very much.  

Don't get me wrong, Phil is definitely exhausted as evidenced by his extreme fatigue yesterday morning after emptying half the dishwasher.  In fact, he was right on schedule, a mere 2 days after discharge from the hospital, on a day we'd predicted as a "blue day" on our master calendar.  

For a little background on our schedule concept, imagine a big ol' desk calender.  In planning this months chemo out and making our best guesstimate about how he might be feeling, Phil and I went through this month and circled each date in green, blue and red marker.  Green would correspond with a great day filled with energy, blue would be either a declining or ascending day in or out of chemo and red would represent a very down day with the worst of energy and side effects.  

Right in step with our predictions he is hitting the downward slope into the blue and red zone over these next 4-5 days.  Physiologically this corresponds with his WBC, RBC and platelet counts all dropping to very low levels (pancytopenia) and the dead cancer cell levels rising in his body.  He has to drink lots of fluids to clear out those bad boys, becomes at risk of infection and feels totally spent.  What a party!!  Too bad he's got no energy to enjoy it.

On the upside he points out that his appetite is good and he eats ice cream 3 times a day.  The kids just don't understand why they can't join in with him.  Earlier this week his brother David visited and came bearing gifts.  Now  Phil sports a cool AC/DC skull cap that brings a whole tough look to his repertoire.  Combined with the baldness, he looks kinda bad-ass.  Until he laughs.  Then his dimples show and he smiles and he just can't sell it anymore.

Today is definitely a red zone day.  He is all couch all day and he is hating it.  Having said that, he has slowly caved to technology and come around to the Facebook world as most of you know.  He spends quite a bit of time responding to you all on there and has loved reconnecting to his past.  Most exciting though, he has become very passionate and energized about researching the Livestrong site.  Phil has paired with a survivor of TLL and will be connecting with him to share stories, etc and relate with him in a way none of us can.  I am so thankful for this new avenue for him and can't wait to see what comes of it.  Phil is also very excited about getting more and more involved in the bigger Livestrong organization and has been looking into that as well.  Livestrong Day is October 2nd and I'll be posting some more ideas about that soon!!

Last of all Phil has been TOTALLY blessed by our friend Garry Johnson and his amazing help with sleep through hypnosis.  Garry has been so gracious to send us MP3s for Phil to utilize for sleep, pain management and for harnessing the incredible power of the brain in healing.  It has been huge!! Thank you Garry, your work is powerful.

I too am figuring out what I need to be doing.  It's not too complicated.  I clearly need more sleep.  I need to eat right and man-o-man do I ever need to get some exercise.  Like we say around the Conrad home, if Mom don't feel good, don't nobody feel good.  And although it's a bit of a stunner that it came to me this late in the game, I realized yesterday (for about the 10th time in my life) that if I don't take care of myself, no one else will.  So,  today begins a new routine of putting myself first when I can and when it's appropriate and letting more things go that aren't that important.  

We continue to look forward to our next visitors and to what we'll learn about each other through these times together.  We also continue to work on ourselves through this amazing process of healing and dealing.  There is still much to be learned and much to be unlearned.  We still require so much grace with one another and from God and we know we always will.  Thankfully on Team Conrad there are forgiveness, reconciliation, ice cream and friends aplenty.

Friday, September 10, 2010

C'est la vie

Phil's been doing great this time around in the hospital, remaining upbeat, energetic and productive all the while managing to charm and befriend the nurses.  Having learned a thing or two (or three or four...) through the last round of chemo he has done some things this time through that have made all the difference.  

He set himself a routine which begins with morning hygiene then progresses to daily exercise which consists of walking two laps around the 3 South nursing station with his "significant other".  I am referring of course to the old ball-and-chain IV pole he can't go anywhere without because she is literally plugged into his chest through the port-o-cath.  Yes, my man has found another companion and he spends every waking (and dare I say sleeping moment) with her.  I'd be jealous but his new companion is extremely possessive and demanding and often wakes him up in the night with her constant chatter.  She demands attention and can be finicky and uptight.  She is a real high maintenance bitch and that is something I've never been accused of being.  Well, not to my face anyway.

Anyway,  he has also had a constant stream of visitors this go round and that has made the time fly by.  From me and the kids, to Tricia Reece (my BFF from WA who was here to help us settle in and get a handle on LIFE -good job by the way), to his brother David, my nephews Jason and Josh (the bald ones),  Mother Teresa (my sister), and my parents Pete and Joan Lehmann, he's had no shortage of well-wishers.  His room is usually full and occasionally SRO.  

His spinal tap went well and he's shown no signs of spinal headache and we're all breathing a sigh of relief.  He'll go through a few more maneuvers before discharge but it's looking really good so far.  He's been transfused with 2 units of blood and that pale ghostly look is gone.  If you're on Facebook you can see the pallor in his profile picture as plain as day.  Now he's got his rosy cheeks back as well as the energy he lost.  He must feel like half a million bucks by now!  

Overall this chemo has been more well tolerated than the last but we'll have to wait and see how precipitous the fall will be once he comes home, likely later today.  He's been on a much lower dose of dexamethazone (steroids) so he's less likely to drop hard on the roller coaster, but again, this is new territory for us.  

We expect to learn a lot in the coming days.  Thankfully, we are more prepared now and have a little more experience under our belts.  But it is what it is and will be what it will be.  C'est la vie.

Wednesday, September 8, 2010

Tres Hombres

Jason Lehmann

It was my mother's birthday the other night and since she'd just had knee replacement surgery the family gathered at her place to celebrate.  Phil was feeling pretty good and led the way into the house while I brought in our things.  The next thing I heard was "No way!"  Having anticipated that Phil would be losing his hair this week my two nephews had shaved their heads in solidarity.  

Josh Lehmann
Most of you don't know these guys so let me vouch for their character.  I don't know too many twenty-somethings (males no less) who willing give up whole weekends to move their aunt and uncle, clean out storage units, endure endless hours of XBOX with self-centered 8 year olds, run errands at the drop of a hat, and shave their heads knowing that they will likely be mistaken for chemo patients themselves.  Josh is 6'8'' and weighs around 165 lbs and Jason isn't much "shorter".  I always think he is short by comparison but he must be about 6'3".  A real peanut.  Shaving their heads took cahones and a great deal of love and respect, feelings I know they both have for Phil.  

Those of you who do know Jason and Josh know they are a breed apart.  These are the kind of guys you want in your corner when you need to lighten up.  Solidarity and lots of laughs.  Very cool.

With The Church Man

Second Verse Same as the First

Second verse, hopefully not the same as the first.  Well, hopefully not totally the same.  He had some serious ups and downs the first time but his response to the chemo was dramatic and excellent and we'll take that part again.

Phil is in the hospital again, this time voluntarily and on schedule as of yesterday morning.  This is the beginning of Round B for Cycle One for the chemotherapy during which he will receive high dose methotrexate.  The methotrexate is given as a lethal dose which if given alone would literally wipe out his bone marrow.  That's actually kind of the point because that's where these bastard cancer cells are replicating and making trouble.  However, wiping out his marrow at this point would be problematic and won't be allowed. 

He will also be given a "rescue medicine " called Leucovorin which helps to clear the methotrexate from his system.  Once the methotrexate levels are low enough in his blood he can come home again, probably in about 3 days.  Generally, this regimen is not as difficult to tolerate as Round A. 

Today is day 2 of this regimen and that means he is due for his second spinal tap.  He has a great attitude and a proactive game plan to try to avoid developing a spinal headache like he did before.  He will be receiving two chemo agents in his spinal tap today instead of only one, thus cutting the number of taps he will have by half.  He will also lie flat for 6 hours instead of just 4.  Lastly, his doctor will challenge him with a whole series of maneuvers to ensure that he has no symptoms of spinal headache prior to being discharged home.  If he shows any symptoms at all he will be given a blood patch and made comfortable.  

The likelihood of him developing a spinal headache again are actually fairly low and his anxiety about this happening have faded with time.  Having said that, if it does happen, Phil and his doctor have discussed plan B.  A small reservoir can be surgically implanted under the scalp with a catheter that delivers medication to the ventricle.  We're hoping against it but glad for options.

In case you were under the impression that Phil was above reproach, let me enlighten you.  Sweet Phil has gone to the dark side and resorted to performance enhancing drugs.  He got some Procrit yesterday so unfortunately for him, he won't be competing in any professional cycling races for the next two years because Procrit is a trade name for epoeitin.  Yes friends, our man Phil is a blood doper.  Looks like he'll be serving out a ban from the sport for a while.  In addition, he'll be receiving a much needed blood transfusion today as his HCT is still low and he's got the pallor to prove it.  

All kidding aside, Phil's spirits are great, we just finished up an awesome visit with Tricia, my best friend from WA, and  Phil  was able to enjoy two get-togethers over Labor Day weekend.  Having cancer isn't the sum of who he is and although he'll come home from this hospitalization and his WBC count will plummet, his energy will bottom out and he'll become dependent on all of us around him again, he's seen that he can handle it and that he does bounce back eventually.  

Our life has become a roller coaster that we're all learning to ride and even occasionally throw up our hands and say "weeee" on.

Sunday, September 5, 2010

Wounded Healer

Hot tea with honey and lemon.  Tomato soup.  Really sharp cheddar cheese.  Ice cold water.  A comfortable place to rest.  A good book.  Music from the past.  These are just a few of the things that have brought Phil comfort these days.  Simple pleasures yes but much more than that.  Each in its own way has brought him something that is restorative, either to his physical body, his mind or to his spirit.  When everything else is falling away it is the simple things that remain to sustain him.

The stirring of a cool breeze.  Playing with the kids.  Going shopping and being out in public.  Four hours of uninterrupted sleep.  An appetite.  Normal digestion.  Human touch.  Being comfortable in his own skin.  Understanding his body.  Doing things for himself.  Exercising and pushing himself to his limits.  Energy.  These are just a few of the things that Phil doesn't take for granted anymore. 

And now, neither do I.

Recently I had a conversation with Jefferson Breland, the 4th Conrad brother, our best man, and friend of Phil's for 42 years.  He shared so many profound and moving things with me but one or two stood out in particular.  He spoke of how much he is learning from Phil and how much Phil has to teach all of us.  Wow.  Jeff nailed it, for me certainly.  (I mean what is marriage if not a crucible to learn everything you thought you knew about yourself and didn't ever really want to know?). 

All snark aside,  in our line of work as PA's, Phil and I often talked about Henri Nouwen  the Dutch pastor and teacher who's name is synonymous with the phrase "wounded healer".  Over the years, we both strove to bring our wounded-ness into our practice of medicine, something Phil absolutely excelled at.  He just has a way about him and he is willing to be an open book.  That's brings me to the other thing Jeff said.  Over all the years Jeff's known him, "the one thing that keeps showing up for Phil is nurturing".  

Both these qualities are what make Phil such a good PA, friend, father and husband.  As a PA he really knows his ortho but he is also able to nurture relationships and foster friendships where others often fail.  As a husband and father I don't know if he fully realizes the many ways he has taught me and the kids.  He is now showing me what matters when everything falls away and the body revolts.  That tomato soup and ice cold water can sustain you.  

For now, while the battle goes on, I want him to know what I see him teaching our kids.   He is showing them how to fight for life and be valiant in the face of fear and uncertainty.  He is showing them to continue to laugh at things that are funny, cry at things that are sad, and to carry on with the day to day routine.  Showing them that if you don't feel too good you still get out of bed and live the day God has given you.    And he is showing them that relationships are what matter and that God has blessed us beyond measure -- even in the midst of cancer.

Wounded. Healer. Phil Conrad.  Love you babe.

Thursday, September 2, 2010


Things here have actually been fairly quiet this week.  That's not to say we haven't been doing anything.  On the contrary.  Phil and I, with the help of Trenna and Rene, spent a full day moving the rest of our boxes out of the garage and into their respective rooms of the house to eventually be unpacked.  What wasn't going inside was set aside to be stored long term in the garage shelving we'd brought with us. Once started we quickly realized there wasn't going to be enough shelving and we'd either need to get our hands on some more OR make some decisions about what we really needed to keep (another way of saying get rid of some shit).   

     At this point I have to interject that Rene has a work ethic that puts most people to shame.  He is the energizer bunny and a warrior about whatever he does.  He is an officer for the Chula Vista Police Department and an officer in the Navy Reserves (EOD - explosive ordinance disposal).  Our dinner table conversations are fascinating as he regales us in a humble and self-deprecating manner about his various adventure with land mines, the dolphin sonar training program, gang-bangers and thugs.  

When Phil and I returned from running an errand, we found that a shelf had been purchased and assembled and all the boxes we'd set aside for it had been shelved, categorized, and summarily dealt with.  Ladies and gentlemen, I give you Rene.  

At several points during the day I would ask Phil, "how you doing honey?"  To which his answer was "I'm alright, I'm alright".  As the day went on it turned into "I know" or "I'm going to stop soon" or "I've got about half an hour left in me".  At the end of the day, as he's laid out on the couch with his hoodie pulled over his eyes he eventually says, "I should have listened to you."  Uh-huh.  No shit Sherlock.  What is it with you guys?

At the risk of sounding and seeming and actually being outright sterotypical I am going to ask again.  What is with you guys?  By "you guys" I of course mean you men who, although you are married and have been married long enough to know that your lovely wife knows you better than she knows herself,  you still don't seem to heed her gentle advice.  Now, Phil and I have been married 15 years this past July and I would like to think we have grown past this but... hope springs eternal.  So, if any of "you guys" out there can shed any light on this phenomenon please enlighten me.   However, I have digressed from the topic.  Let's get back shall we?

As for the title Avatar, I'm not talking James Cameron here, in fact, he has sucked so much money and fame from the title that he may even own all rights to the mere word by now.  No, I'm talking about Avatar:The Last Airbender.  Bennett turned us on to this Nickelodeon series last year and it is a really good quality anime cartoon.  The movie however leaves something to be desired, sorry M.Knight Shyamalan.    The lead character, Aang is the last airbender and sports quite the cool "hair style".  

This being the week for hair fallout Phil had a cool idea to surprise the kids, especially Bennett.  His beard was getting pretty scraggly and when he woke up a few days ago with a lot of hair on his pillow he decided to put his plan into action.  There are quite a few Chaldeans in this area who emigrated to this area about 5 years ago.  Several of them run a chain of mens full service barber shops called Mr. Cut and Phil inquired there about getting a traditional straight razor shave and "special haircut".  He explained about his chemo and said he'd be bringing in a picture of what he wanted.  No problem they said.  

Phil came home one relaxed dude.  The facial shave he said was a "thing of beauty" and amazing.  It was so relaxing and Ahmad (or Kevin) as he goes by here in America was great.  He worked hard not to lose any more hair than was necessary and was a really cool young guy.  The way he talked about it, I think the whole experience was moving for Phil and kinda spiritual.  

When Bennett came home from school he was very surprised and let out a huge "No Way Dad!" and Phil was quite proud that he'd struck the right chord.  If there is an upside to all your hair falling out from the poisonous side effects of chemotherapy it has to be looking like a hero in your son's eyes.

That's What I'm talking About

Lean Mean Fightin' Machine

Father and Son