Thursday, April 28, 2011

New Uniforms

Do you have an outfit you regularly "go to"?  Around here we call it our "uniform".  Phil and I have a few variations on the theme of our "uniform" but it looks something like this. His consist of a pair of flannel pajama pants or long Champion cotton workout shorts and a T-shirt and some shearling slippers or flip flops depending on the time of year.  Mine varies between fleece sweats or Victoria Secret black yoga pants and a T-shirt du jour with slippers or flip flops.  There is usually a heating pad or rice pad associated with this ensemble by the end of the day.  Like an old sweater that feels comfortable because one wears it all the time, you might not notice right away when there are holes in the elbows or that you've got a big snag somewhere.  Frankly, you may not even care because it is, after all your favorite sweater, or at least, your most comfortable one and gosh darnit, it isn't called your uniform for no reason.  

My point in telling you this little tidbit from our daily life is that our other "uniform" for the last 9 months has been cancer.  We wear it every day, every night, everywhere we go.  And take it from me, it doesn't go with anything I own and tends to clash.  It's hard to hide and accessorize but I try.  Anyway, when we heard just the other day that Phil is in some kind of remission we were both completely dumbstruck.  We weren't prepared for such amazingly good news! We are always prepared for more bad news because he isn't feeling 100% normal yet and because for the last 9 months we've always heard bad news.  It was a weird experience to hear "You're in remission!" while looking at him and seeing that he felt like crap.  After hearing it though I know we both felt that our old uniform had changed.  But now what?  He isn't a cancer survivor quite yet.

The day after hearing the remission news he saw Dr. Mayer the ID specialist who told Phil he needed more testing to get to the bottom of this pleural effusion that has been hanging around since he left the hospital.  A pleural effusion is excess fluid that can accumulate in the fluid-filled space that surrounds the lungs.  Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during inspiration - hence Phil's shortness of breath, cough and general fatigue.  He also has fluid around his heart, a condition called pericarditis, which was studied earlier in the week with a trans-esophageal echocardiogram.  It was found to be essentially normal -- at least no infection was found and nothing needs to be done for the fluid around his heart at this time.

As for the pleural effusion, Phil will have a thorocentesis today wherein a needle is inserted through the back of the chest wall into the pleural space and the fluid will be removed and sent for testing.  The cause of the pleural effusion will determine therapy.  Needless to say, we will be very anxious to receive these results early next week.  When we see Dr. Kossman on Friday of this week he will tell us his thoughts about what's next for the lymphoma and the final steps for kicking it's ass to the curb once and for all.  

YES, it's ANOTHER BIG WEEK for Phil and Team Conrad.  We'll be getting a shiny new uniform so to speak.  This time around Phil's got normal functioning bone marrow and no mass in the chest.  Feels like a more level playing field.  Hopefully just a few more details to take care of.  Prayerfully, we submit this yet again to our Lord and Savior who has seen us this far. 

Tuesday, April 26, 2011

Flat broke and busted, but in REMISSION!

I was sitting beside the pool talking with Trenna watching the kids swimming in the incredibly warm water of our solar heated pool (in late April) when I heard Phil's quiet voice behind me.  "Can I talk to you for a minute?"  I turned around and he was there, teary-eyed and red faced and I knew something serious was up.  I walked back into the house and asked if he wanted to go into the bedroom to talk.  "I'm in remission", he replied with a quavering lip.  He had talked with Dr. Kossman about his bone marrow biopsy results from last week.  (I am overdue on some blogging)

For a long moment I didn't know what to do.  Now he was really crying and lately he's been looking kinda rough around the edges, not like someone who's in remission from stage IV aggressive T cell lymphoma.  You see, ever since he came home from his last hospitalization he's been feeling  pretty beat up and hasn't really bounced back like he eventually does by now.  It could have something to do with the shear number of surgeries he's had, the volume of chemotherapy he's endured and the pericarditis he currently has.  But that's just the tip of the iceberg.  It doesn't take into account the emotional, spiritual and financial toll this whole cancer business has taken on him/us.

Eventually the words he'd just spoken registered with me and the origin of his tears became clearer to me as well.  We hugged and held each other and cried and spoke soft words of thanks be to God in each others ears.  We couldn't believe it.  We still can't.  It feels miraculous and mysterious and overwhelming.  My wounded warrior, Iron Man, Outlier has battled the enemy within and pinned it to the mat, surrendering an eye and a portion of his brain in the process but never complaining and never ever saying quit.  I am in awe of his stamina, his attitude and his fight.  He is Livestrong personified and I am privileged to care for him.

There is still more chemotherapy ahead to finish this fight.  We meet with Dr. Kossman at the end of the week and will learn from him what lies ahead.  For now, we know he describes this as "amazing" and that Phil's bone marrow is full of normal cells where before there was only lymphoma.  To be here after only two cycles of therapy is truly a gift from God.  He is merciful and responds to the prayers of His people.  

Thank you for your prayers and petitions on our behalf.  We are humbled and grateful and our faith is strengthen and encouraged.  We have our own resurrection story!

Saturday, April 9, 2011

With and Without You

Phil is "treading water" as Dr. Kossman likes to say but a better description might be to say he's "climbing the walls".  We both are in our own way - he's in his uncomfortable hospital bed, just biding his time waiting to be hale enough to undergo more testing and have an immune system capable of sustaining him at home.  I'm at home and the hospital, caught between two masters, caring for him and the kids and trying to balance both while not losing myself, my sanity or my temper.  

Parenthood is definitely not for sissies and single parenting, well, my hat goes off to you folks and then some.  Add in a routine migraine, any one of a myriad of emotions from the kids, some generalized grief and don't forget, we've got 2 weeks off for Spring Break!  I am actually really looking forward to the downtime with the kids, it's just that close quarters and free, unstructured time can get dicey.  I've got lot's of plans and ideas and I'm praying and working that the family and visitors coming this way next week will make it work out.

Meanwhile, back to our main saga.  Phil continues to receive RBCs and platelets, ride the roller coaster of GI complaints and wait ever so patiently for his bone marrow to begin manufacturing WBCs again.  Each day seems to creep by with a mini-adventure of some sort.  We've had some nice visits with friends, the kids have had extended visits to watch movies, do homework at the corner office table and do their most favorite thing of all -- get junk food out of the vending machine down by the staff lounge.  Phil is going on almost 2 weeks in the hospital this time around (having barely 36 hours at home between admissions) so his highlight with the kids is hearing about the triumphs and tragedies that make up their days.  Recently Bennett ate a Sour Cream and Onion flavored cricket and some meal worms at the San Diego Zoo and Olivia has 2 new loose teeth and has graduated to reading to the H level readers.  And it was this week that Bennett verbalized his deepest fears and hurts to us.  So painful as parents and yet, we are so thankful he did.

In more deep and painful ways than I can express it's a crucible to parent and be a wife and lead a family while a husband has cancer.  No one has it easy.  It is hard and painful to be 9 years old and able to comprehend and imagine what it could be like to have your dad die.  It is hard and sad to be 6 years old and have a mommy who is often too tired to play like she used to.  And it is hardest of all to be Phil, sitting in the hospital day after day after day after day just waiting for his body to make WBCs so he can get on with the next thing, knowing it's not the last thing.  And knowing that we're here feeling all this, for him, with him, without him.

Monday, April 4, 2011

Second Verse, Same as the First

Well that didn't take long. We're back in the big house again, Alvarado, that is. They even saved our corner room for us! My super star husband is digging deep once again to deal with more crapola. Like I say, "Shit happens, carry a big shovel!"

Last night Phil really started hurting from the pleurisy and struggled to find a comfortable position just to be in. Earlier in the day he'd noticed a rash on his arms and legs and we thought he had developed a reaction to one of the antibiotics from his hospital stay. Yee-ha! Something else to add to his list of miseries. Benadryl was taken, promptly turning him into a zombie which the kids found amusing at dinnertime. When he finally turned in for the night it took at least 3 minutes for him to walk from our family room to our bedroom ~ scary slow. And this morning he got short of breath taking a shower. This is Phil Conrad I'm writing about here ~ runner of high altitude trails, skier of double black diamond runs, climber of Olympic Peaks, ultimate frisbee player, cyclist, tennis player, swimmer. This was hard to watch, and more so because he was in agonizing pain. He couldn't take a full breath and his chest and left shoulder hurt with most movements, especially when leaning forward. He had to sleep sitting up yet even that was uncomfortable.

By the morning he had a fever of 101.2 and his blood sugar was elevated. It was time to call Kossman. We had a follow up appointment at 10:15 but it seemed likely he'd want to see Phil sooner. Unfortunately the good doctor was so slammed that all he could do was have us come half an hour early to get started on labs. Fortunately, at the rate Phil was moving, we'd just make it on time! Once there, it was obvious he'd be going back to the hospital. He was still febrile so blood cultures were drawn and his hospital chart was called for along with his previous cultures from microbiology. Kossman did a thorough exam and found Phil's lung capacity was diminished. At the least Phil was septic, neutropenic (he has a WBC count of 200 total), had a pleural effusion (fluid in his lung bases), and probably had a viral exanthem (rash). So back to the hospital he goes for IV antibiotics, antifungals, pain meds, fluids, blood products, a chest X-ray, EKG, more labs, and a couple of consults.

Once here the action was fast and furious. Within 1 hour of admission he'd had his port accessed, labs drawn, EKG done, chest X-ray taken and admission intake put into the computer. Amazing. Oh, and he'd had a delicious (right) lunch delivered to his room as well. So, now we wait to hear the results and let the nurses hang their bags of IV fluids and antibiotics and pain meds.

Hopefully the news will come quickly. If there is an effusion Kossman will have to decide whether or not to "tap" the lung. With few WBCs there is definitely risk involved in tapping the lung to remove fluid. But there are therapeutic and diagnostic benefits to doing it as well. We shall see. In the mean time, my family and I will see about getting Phil some more humane meals while he has to be here. They have excellent patient care but their menu falls far short.

Saturday, April 2, 2011

Home Again

It's Saturday now and Phil came home earlier today.  All his studies were normal, his nausea has subsided, he ate a good breakfast and his pain is much much better. Whew.  Thank you God that he is through that crucible.

Bennett and I stopped in after an early baseball game (in which Bennett hit a triple and drove in 2 runs by the way) and found Phil freshly showered, packed up to go and listening to music on his computer.  To say he was ready to make his exit would be putting it lightly.  He's spent a lot of hard time in these corner rooms of Alvarado hospital over the last 7 months. Of course there is more hard time to come; but that's not today.  

Today is about going home to his comfortable bed, really good food, to being loved on by me, the kids and Trenna and Rene's family.  Today is for celebrating Bennett's enthusiasm about hitting a triple and winning his first game of the season.  It's about cuddling with Olivia and listening to her read from her journal and all her favorite books.  It's about watching NCAA Basketball games and hanging out in his sweats -- not a hospital gown, pulling an IV pole around.  Today is about whatever he says it's about.  It's not about cancer, at least for awhile. 

Friday, April 1, 2011

Another Long Day

What a long day yesterday was - for Phil I mean.  I actually faired well up until the end of the evening which I'll get into later.  Mostly I kept Phil company while we waited to hear the results of the tests he went through.  With the fever he had in the night the initial work up included the obligatory urine and blood cultures, a chest x-ray, and an MRI of the sinuses and brain.  About midway through the day Dr. Mayer (Infectious Disease) came in for a bedside consult and Dr. Mansfield (Oncology ENT) had us wheel on over (literally) to his office across the street so he could look in Phil's sinuses with his sophisticated equipment.

During morning rounds with Dr. Kossman Phil mentioned that he'd started having a cough and a pain in the middle of his chest when he took a deep breath.  It was sharp and very painful.  Dr. Kossman didn't hear anything in the lung fields and wanted to see the chest xray results.  He thought it could be an irritation to the pleura (lining of the lung) from the methotrexate and wanted to keep an eye on it through the day.

By 5 p.m. everything was looking fantastic and we'd confirmed that there was nothing growing in any of his cultures, his chest x-ray was totally clear, his MRI was awesome - no signs of any active processes and the Mucor and previous infections were completely resolved.  Dr. Mansfield had taken a look at the sinuses and down Phil's throat and declared everything there to look great with no signs of active infection.  So, while this was all really great news, we still had no culprit for the source of the fever.  

During the consults with both Dr's. Mayer and Mansfield Phil mentioned the chest pain.  While neither heard any abnormal lung sounds, both were concerned about the pain as well and the need to rule out a more significant cause like a pulmonary embolism (a blood clot in the lung - potentially life threatening).  As we got back to Phil's room he was suddenly in so much pain he couldn't sit still and starting to have difficulty breathing deeply.  He called for morphine and finally settled down.  At this point the phone rang and it was Dr. Kossman, ordering a spiral CT scan to rule out the pulmonary embolism.  Now Phil has azotemia (a type of decreased kidney function) and the CT scan requires a dye which is excreted by the kidneys.  To make a long story short, there is risk to his kidneys of further worsening function so he'll be getting a LOT of fluids through the night to flush them to minimize this risk.  Between the pain and the fluids the poor guy may not be sleeping much tonight if you know what I mean...

Fortunately spiral CT scans only take about 10 minutes to do and we had the results quickly.  There was no pulmonary embolism and we were able to learn that the 13 cm mass of lymphoma tissue that was initially in his chest at diagnosis is gone; it is now <1cm of scarred tissue.  In other words, Dr. Kossman says it is "essentially nothing".  Well that was worth the risk to find out I'd say!  So, again, we're back to thinking that Phil probably has a viral respiratory infection or a pleuritic irritation from the chemotherapy.  Morphine is the treatment, to keep him comfortable until there are signs pointing to another diagnosis or way to manage it.

I said I did well until the evening.  When I was getting ready to go for the night Phil started to have more chest pain and was really hurting.  We called the nurse and got him the morphine but it took so long for him to get comfortable.  There was nothing I could do to make it better.  I just had to wait it out with him until the relief came.  And it took at least 20 minutes.  That was a long time.  Finally he felt comfortable enough that I felt comfortable enough to go home to the kids.  What a bugger.