Thursday, October 16, 2014

Caregivers - Riding the roller coaster with the patients

Let's face it, cancer is a family affair. While only one in the family may be afflicted, most of the immediate family becomes intimately involved. And within that group, there is usually a specific person designated as the “caregiver,” the one who watches and monitors all the daily activities of the patient.

These responsibilities include the administration of medications, the changing of wound dressings and visiting the the doctors with the patient, to name only a few.

Often, the caregiver has a better grasp of what the patient needs than the patient. This makes sense because the patient may be on several medications, is faced with fatigue and simply has a lot on his or her mind. Further, in my case, I was really "out of it" for several days after my initial surgery, so Vida, my caregiver, had to stay informed on what was going on. She also made the necessary preparations prior to my release for my homecoming which involved making sure the proper equipment was in place, like the oxygen tanks, the suction machine and the nebulizer.

I was also unable to drive for several months after the surgery and had to go to the hospital for 7 ½ weeks of radiation and chemotherapy treatments. In addition to these, periodic doctor and therapist appointments were constantly required.

From the day I went home in March, Vida has kept daily records of every medication I take throughout the day, the time they were taken and the dosage. Often, this was needed when we went back to the doctor for a medication review. We easily knew what was taken and how many of each. The doctor was then able to determine what changes may have been required. The records were also used once when we were told to call for an ambulance due to a reaction I was having. The paramedics needed to know precisely what I had been taking.

We had a visiting nurse when I got home in March as well. She would take my vitals, check on the wounds from surgery and report back to the doctors on anything unusual. Insurance cut her off after a few visits, so she spent time showing Vida how to change the dressings and went over the supplies we would have everything we needed.

Caregivers also give emotional support. The title of this blog is the cancer roller coaster and the caregiver follows the same ups and downs as the patient. But since they were not on medications, recovering from surgery or undergoing serious treatments, the caregiver tries to stabilize emotions of the patient and when he or she is feeling down, they will try to build me back up. Likewise, they jump at the opportunity to celebrate the triumphs as well.

A positive attitude is one of the key components for a successful recovery, so even if Vida was down, she would have to do her best explain all the good that is happening despite any brief dips. And she demonstrated her care for me by doing just that.

Cancer is a difficult disease to deal with. As much as the patient may try not to think in that direction, the possibility of death comes into sight, even if the cancer was not considered terminal. The caregiver knows this, and Vida knew this. Every time the roller coaster takes a dip down, a certain fear factor sets in. The patient and the caregiver need to come to terms with this and support one another. There isn't any choice but to make the most of any situation that comes along. That's simply what we have to do.

ChooseHope.com offers a framed caregivers poem that I got for Vida as a gift. The poem reads:
Thank you for standing by me and lending an ear.
For helping me out by just being near.
Thank you for cheering me on or saying a prayer.
For holding me up and showing you care.
Thank you for making me laugh and giving me hope.
For showing support and helping me cope.
Thank you for all that you've done and all that you'll do.
I am so very fortunate to have someone like you!

Written by: Linda Nielsen- Choose Hope, Inc. Copyright 2000

Wednesday, October 15, 2014

What does cancer mean to you?

I asked this question to friends on facebook to see what the response would be. For me, cancer was a scary word going back quite a long way. While I did not have a thorough understanding of the disease, I did know that many people have had cancer, died of cancer or have yet to be diagnosed with cancer.

It was like a monster hiding behind the trees in a forest waiting to jump out at innocent people of all ages. It tries as hard as it can to strangle the energy, the hope, and the life from these people.
Cancer is still far too successful to be taken lightly.


This is what others had to say:

Kitty: "It has no rhyme or reason and strikes without warning. It doesn't discriminate between social or economic classes regardless of faith or the lack of it. It brings everyone into the shadow of the valley of death. It builds incredible courage from living with a life-threatening illness. It teaches us to appreciate and live in the present moment, because there is no certainty or reality other than now."

Wendy: "scared, worried then thankful for another day, live life to the fullest...I'm 8 years a cancer survivor...."

Gwen: "Fight."

Thomas: "Loss and sadness unfortunately."

Diana: "We call it the Devils Disease!"

Ronnie: "To be absent from the body, is to be home with the Lord." Then he added: "Cancer scares me because it is a slow, horrible way to die. Death does not scare me. Living with the pain, the uncertainty and being diseased for a prolonged period does frighten me."

Debra: "Sadness ...depression. ..I am breast cancer survivor so I know about the worries ...."

Jessie: "There is a cure. Cancer is a demon working with death. But He is defeated. Because Jesus won the victory. So all you need to do is cast it from your life. If you believe Jesus is your Lord and savior and believe HE has all power over the devil then you are qualified to do it."

Ann: "Scary then hope"

Martha: "Scary stuff, and I know many many people who have won the battle. I feel you and my brother Richard will be among them."

Dlynn: It is a dark cloud that follows me ...but I defeated it once and if it comes again I will stay faithful that I can beat it again if its in the plans. Amen." 
Then she added: "    My 5 yr post bone marrow transplant scans came back clean this month! So lymphoma is most likely a thing of the past....but there are possible consequences from treatment I have to be aware of. We all have to live each day fully no matter our health history. All our days are numbered. Even for those with perfect health."

George: "There is hope"
 

     
 

Monday, October 13, 2014

How well does the medical staff communicate your condition

I mentioned in an earlier post that I first noticed the lump in my jaw in November, 2013. I have seen thirteen doctors and therapists since that time:

Family Doctor
Medical Oncologist
Radiation Oncologist
Otolarygologist
   1 - dissection
   1 - reconstruction
Pain Specialist
Proctologist
General Surgeon - Power Port
Ear, Nose, Throat Specialist
Speech and Swallow Therapist
Gastroenterologist
Pulmonary Specialist

Selfie:Waiting in the emergency room
I appreciate and respect the specialty each one has chosen. As with any group of individuals, there were some I liked better than others. But each had their own task to do and some tasks overlapped each other and that I understood.

The problem, however, is that there seemed to be very little communication between the doctors regarding my treatment. Often, doctors would disagree with each other and I was left to decide who to listen to. As a patient under professional medical care, it was awkward to hear one doctor recommend one medication only to have another tell me not to take that and to take another
instead.

We have all heard second opinions matter, but I don't see this as a matter of a second opinion; I see it as differing opinions falling under the same blanket of professionals. In other words, it was not a case of two doctors with the same specialty offering different approaches, it is two doctors with different specialties, assigned to help me within their own specialty, offering opposing viewpoints.

I was also recently told by an "old school" nurse who has been around a long time (her words, not mine!) that doctors may not share all the information you may need. Often, they will wait to see what the patient asks then answers those questions but none other. She suggested that whenever I go to see a doctor, prepare a list beforehand and bring that so those questions can be asked. It's a good idea, too, because I found myself forgetting certain questions only to remember them on the way home.

I have seen a commercial on TV for a cancer-specific healthcare facility with locations in various parts of the country. In the commercial, the group of doctors and specialists assigned to a patient gathered around a conference room table discussing treatment plans. That, to me, sounds like the right way to approach this problem with the best interests of the patient in mind.

And the fact that these doctors and specialists are in different buildings or areas of the city should not matter. Technology has that problem solved. If a 6 year-old boy can talk "face-to-face" with his 85 year-old grandfather from different parts of the country on the computer, certainly a handful of doctors can do the same.




The roller coaster heads downward again

Thanks Amy for this great poster
If you were not able to understand the concept of the roller coaster ride, here is an example.

About three weeks ago, I got the results back from my most recent CT Scan. For the most part it was great news. There was some concern about a lymph node that had grown in size since the last scan. There did not seem to be much concern, so we considered it a good report - an upward swing.

Last week, I had a scheduled appointment with my original surgeon. I was asked to bring a copy of the CT Scan report so he could review it himself. He checked my surgical scars, reviewed the scan and checked inside my mouth where I was still having considerable pain.

It was determined that I needed additional surgery. They wanted to removed the enlarged lymph node, remove two nodules from the original surgery and take a biopsy of the gums and inner lip to see why there is lingering pain.

My surgery is scheduled for October 28. Fortunately, I can go home the same day, but the surgeon said there may be another round of chemotherapy after the surgery is completed.

Thus, the roller coaster. Just when we think we are riding high and headed toward the road to recovery, we are dealt another downward spin. We get used to it, sort of. It is always our hope, of course, to just get better and put it all behind us - never giving up. The disease, however, has a plan of its own.

Friday, October 10, 2014

Prescription Medications

There aren't too many procedures performed at a hospital that don't require at least some kind of medication before, during and/or after the procedure.

With my cancer (malignant neoplasm, floor of mouth), extensive dissection and reconstruction of my mouth was required during the 8 hour procedure. Parts were harvested from my arm and leg to help with the reconstruction. A tracestomy and PEG Tube were implanted, all of my lower teeth were removed, part of my tongue was cut off and replaced with part of my arm and leg and the cancer tumors had to be removed. Mouth pain is something that has always been a 'sore' area for me.

While I was in the hospital, I was on morphine, although I don't know how much or how often. What I do know is that pain was seemingly well-controlled. I also remember, however, that there was a lot I did not remember.

Then, seven days after surgery, I was released and was given two pints of liquid Hyrdrocodone (I had the PEG-Tube and was unable to use my mouth for any purpose).

Throughout the course of the recovery, I was prescribed many drugs. Some were for various, basic maintenance but others were narcotic pain relievers. These included:
  • Hydromorphone
  • Oxycodone
  • Tramadol
  • Fentanyl (patch)
  • Gabapentin
We had to keep track of all medications taken throughout the day to make sure they were taken and also to make sure I did not take any over the prescribed dosage.

When the medical team was having difficulty determining why pain was still an issue, one suggested that I might have to find a pain level I am comfortable living with. That did not sound too promising.

Sometime I would take over-the-counter pain relievers to supplement what was prescribed, but I had to be careful since all of those come with precautions such as the possibility of liver or stomach damage.

I began to watch closely the efforts of John Morgan and the United for Care, People United for Medical Marijuana, campaign.

According to the United for Care website, there were two reasons why Morgan
supports this measure:

"The two reasons behind his vocal support of the medical marijuana legalization effort in Florida, he says, started when he saw how medical cannabis helped his father, who had been diagnosed with emphysema and esophageal cancer, relive his pain.

The second reason, according to Morgan, stems from the damage he’s seen caused by the high-powered prescription pain medications his clients are often given by a doctor following an injury.
Also, 'as a personal injury attorney,' Morgan said, 'I’ve seen people in pain who end up on oxycodone. And 16,000 people die from that every year. It’s highly addictive.'”
Honestly, I cannot say if prescribed medical marijuana would have been beneficial to me in controlling pain. I was never given the chance. But I do see the support comes from some very prominent and influential people in Florida.

I will continue to watch this campaign very closely. The State of Florida has the "Constitutional Amendment X, Section 29 Use of Marijuana for Certain Medical Conditions" on the November 4 ballot.

Again, I am not sure if medical marijuana would have helped me nor do I know if my condition would have qualified me for a medical marijuana prescription, but based on the difficulty the doctors are having controlling my pain, I remain open to any alternatives.




Thursday, October 9, 2014

Jake lost his battle against cancer

Jake
The journey we take with cancer can sometimes take a fatal turn on us. I had a cancer battle buddy named Jake. He had bone and brain cancer. I admired his courage through all of the tough times and I highly respect his wife, for being there following the course with him. She was at every turn, supporting him, encouraging him, praying with him.

Jake passed away one Sunday morning in September. He was younger than me and we both had different types of cancer. We rode a teeter totter together, it appeared. With cancer, there are highs and lows in physical, emotional and spiritual conditions. And it seemed like when he was on the high side of the teeter totter I was on the low side. We alternated for several months, up and down, back and forth.

Two weeks before he passed, Jake was at a low and some thought he could not tolerate a new treatment plan they proposed that could possibly pull him out of it. But he was stubborn, actually, it was more like he was determined, and he wanted to make the new plan work. Jake fought hard for his right to live. He exercised, he went through rigorous physical therapy and he tried to surpass that which was expected of him. But it was not enough.

The cancer was too powerful, it consumed his body, but not his soul. The doctors felt that hospice care would be best for him and his wife. So they checked into the hospice care facility and waited for Jesus to take him home. Again, he was not going to go without a fight.

He was constantly surrounded by family, friends, co-workers, neighbors, fellow church members. He waited and we waited. Perhaps he wanted to make sure that his house was in order first. Not his heavenly house, but the house he would leave behind to his wife. It seems he wanted to make sure she was cared for in all the right ways.

On Sunday morning, he passed into the arms of Jesus. He will be missed but we will never forget him and how he walked with me in my own journey with cancer. He did what he could for himself, but he always asked his wife how I was doing and where I was with my treatment.

He cared for us. And we cared for him. One day last week in hospice, I took his hand and said "Thank you for walking with me. I am still walking with you." He squeezed my hand in acknowledgment with the only gentle force he was capable of.

He sang in the church choir, and a fellow choir member noted that at about the time of his passing,"we were just singing ‘my chains are gone, I’ve been set free.’”

Rest easy, my friend. You are in good hands and so is your loving wife.

Wednesday, October 8, 2014

If in doubt, check it out!

Cancer is a brutal disease. It does not care what plans you have for the future or how many other people will be affected by your cancer. It doesn't care what you may lose in the process of trying to stay alive. Cancer does what it wants to, when it wants to and its goal is to conquer your body; it wants to kill you.

One of our greatest defenses against cancer is early detection. The sooner we realize something might be wrong and needs to be checked out, the better. Waiting allows the cancer to multiply and spread. Like the game of Risk, cancer ruthlessly takes on any part of your body as quickly as possible. It's smart enough to know that planting its seed in as many areas of the body it can will help the cancer win the battle. Clearly, it wants you to lose.

Some of us, myself included, will think something is not right with our bodies and hold off getting it checked for fear it may be news we do not want to hear. But we wait knowing deep down that not checking it out only makes things worse.  We also know that not going to the doctor will not change the condition we are frightened of.

I had a lump in my jaw and was concerned about it, so I asked my family doctor to take a look at it when I was already there for a high blood pressure medicine review. The doctor glanced at it and suggested that we will keep an eye on it.

So here was a case where I wanted to find out what the lump was, but the doctor was not concerned. This is where I should have insisted the doctor take a closer look and at least tell me what the lump was. I didn't want to wait, the doctor did.

We need to clearly express our concerns to the doctors and if they are not responsive, ask them to have another doctor come in and look at it. If there is none, seek a second opinion. It is our body and our life at risk. I have no medical knowledge, but I believe it would be accurate to say that the waiting this doctor caused allowed the cancer to spread. It was 3 months later that the cancer was finally discovered.

You owe it to yourself and to your families:

If in doubt, check it out! Early detection saves lives...


Taking a look back to where it all started

Let's take a look at how this all started, at least from the time that I became
Bruce G Larson after initial surgery
suspicious something was not right.

It started with a lump in my jaw and I had pointed it out to my family doctor last fall, but they decided it was something they can just keep an eye on. As we inched into the new year, the lump had grown larger and I was beginning to experience pain in my jaw and under my tongue, especially when eating.

I went to the emergency room at a local hospital and their determination was that I had a salivary gland stone that could likely work itself out by using lemon drops. Two weeks later, the pain was increasing, sometimes unbearable, so I returned to the emergency room. They concluded, once again, that is was the salivary gland stone but suggested I see a specialist if things don’t start getting better.

A couple of weeks later, I saw a local ear, nose, throat specialist and they referred me to an otolaryngologist. They determined the growth had to be removed. They scheduled a surgical procedure and ordered some further tests at the hospital. Initially, the doctor was not overly concerned and said the surgical process, with recovery, would take about 3 days.

However, when the fine needle biopsy results were reviewed by the doctor, she called me to tell me the news. It was determined that I had cancer and the surgery would be more extensive than originally planned. Specifically, the cancer was termed malignant neoplasm, floor of mouth, Stage III. Reconstruction of my mouth would be required.

The surgery took over 8 hours at Florida Hospital, Celebration on March 11,
Florida Hospital, Celebration
2014 and that was followed by 3 days in ICU and 4 more days in a standard hospital room for observation.

I don’t recall much about what happened during the recovery process in the hospital. A lot of the time was spent just trying to figure things out. It was not clear what was next: the chemotherapy, radiation, the healing. The way I was feeling, I had many more questions than I did before. But I knew I had to somehow regain the faith I would need to overcome this disease.

On March 17, I was released from the hospital and taken home by ambulance.
I then spent a few weeks getting used to things at home. I have the Percutaneous endoscopic gastrostomy (PEG) tube inserted in the stomach for liquid nourishment and for taking medications.

A hospice nurse came twice a week at first then once a week until the insurance

What was taken became part of my tongue
company (not the doctors) released her. But she was able to show us how to change dressings, how to properly use the peg tube and also advised us of the medical supplies we would need. She also reviewed proper use of the oxygen tanks, the suction machine and the nebulizer.

There were problems sleeping too. I was not able to lay in my bed comfortably because the neck and throat were swollen and when I would lay flat, the air supply seemed to be limited. So I slept in a recliner since I was able to adjust the angle of my throat by positioning my back and head I was supposed to start chemotherapy and radiation treatment about 4 weeks after surgery, but I had been given an antibiotic for some reactions I was having in my mouth. These evidently caused lower intestinal bleeding and I was taken by ambulance back to the hospital.

While undergoing a series of tests, it was discovered that had contracted C-Diff , but that was cleared in a couple of days. I was, however, able to get a much needed colonoscopy while anesthetized. Thankfully, just one benign polyp was found and that was removed.

The following week, the radiation and chemotherapy had to start or I would be falling behind in the recommended treatments. Certainly, I had no idea what to expect, but I was prepared to lose my hair. I even bought a baseball cap that said “Cancer Sucks,” (just in case, of course).

The cancer, by that time, was upgraded to Stage IVa.

I was not able to sleep in my bed comfortably because the neck and throat were swollen and when I would lay flat, the air supply seemed to be limited. So I slept in a recliner since I was able to adjust the angle of my throat by positioning my back and head.

This issue almost caused another set-back to the treatment. The radiation therapy staff asked me to lie down on a table so they could fit the mask that I would have to wear for each treatment. They heat the plastic mask then form it to the contours of my face.

This mask would then be clamped to the treatment table to make sure once the coordinates were established, I would not be able to move.

I explained that I was unable to breathe while laying on my back, and the doctor
Bolted to the radiation therapy table
in charge told me that I would be able to breathe. I was frightened and was not sure what to do. I asked for a different doctor since I was not comfortable with him. He, in my opinion, would not work with me to solve this problem. I was assigned to the another doctor in that department and after meeting him, I felt much better. He provided me with a prescription for Xanax to help ease the anxiety.

I spent an afternoon laying on my back in the living room, extending the amount of time at comfortable intervals. Each radiation treatment required that remain laying down on my back for about 20 minutes.

Later, I met with the oncology social worker and she took the time to sit with me while the first Xanax dose was settling into my system. She went over breathing techniques and what to do if it felt like I could not breathe.

I can’t say that I fearlessly walked into the treatment room, but the staff greeted me with re-assurances that I would be ok and that if I felt something was going wrong, I needed to release the hand grips that pull my shoulders into place. They would notice this through the cameras in the treatment room and they would come to my aid in a matter of seconds. Remember, I remained clamped to the table and was not able to move. The table is also raised about 5 feet so the radiation machine could reach any angle necessary.
I still have this mask as a "souvenir"

My first complete radiation treatment took place on April 14 followed by my first day of chemotherapy on April 16. On April 17, I had a Bard Power Port surgically implanted in my upper chest. This allowed access for the chemotherapy treatments. The treatment plan called for 37 radiation treatments consisting of 16 fields each day and chemotherapy treatments once per week.

As the treatments continued, the process kept on getting easier and easier. There were some days that were more difficult than others. This was primarily due to an excessive mucus build-up that occurs from radiation. I always learned, however, that I would still be able to breathe despite this additional blockage. On May 22, I was pleased to learn that the radiation fields were reduced from 16 to 6.

It’s odd, but these treatments became a part of me. They provided a comfort zone. Maybe because so many things were going on, so many changes in my body and in my emotions, I felt safe going to the hospital. I would know what was going to happen, for the most part. I felt like these doctors, nurses, technicians were all rooting for me and I knew that they were – and still are.

After my initial shave 4 weeks following surgery (there were sutures under my jaw from ear to ear), I hardly had to shave again. The radiation did the shaving for me. I sometimes have to ask Vi now if I got all 7 remaining whiskers after I shave.

My final treatment, as I understood it, would fall somewhere around June 14. I was looking forward to this last day and the opportunity for me to ring the “Bell of Finality,” as some call it. It is a bell that the patient rings on his or her last day of radiation treatment. I had never seen it there at Florida Hospital, Altamonte, but knew it had to be there somewhere. Perhaps in an area further away from patients to keep from startling them.

Celebrating the final radiation treatment

But it was on June 3 that I learned the next day would be my final radiation treatment. While my calculations were wrong, I was not about to dispute the hospital, this time anyway.

So, on June 4, we set out for the last treatment then gathered the staff to ring the bell. My wife, Vida, wore nice black slacks with a dressy blouse. We were ready for this wonderful event to take place. This day was historic in my journey and I felt I had earned every bit of it and so did Vida.

After the treatment, and after the CLINAC radiation machine powered down, the
Vida visiting me in the hospital
staff came in to release me from the table. I was excited and they were excited right along with me. I was asked if I wanted to keep the mask but I had already made arrangements to take it home with me.

I was putting my shirt back on and asked where the bell was so we could take some pictures. They looked at each other and said they had heard that some hospitals have a bell-ringing ceremony, Florida Hospital Altamonte did not. The bell-ringing following the final radiation treatment is a ritual at some hospitals and radiation treatment centers use the celebrate the final day. It truly is a monumental event for those who have ever been 'exposed' to it.

But, since my hospital did not participate in this program, we created our own celebration at home. It was just as rewarding if not, more so, than the celebration at the hospital may have been.

Tuesday, October 7, 2014

Introduction

Vi and I were sitting on the patio today, listening to Z88.3, Orlando FL and enjoying the cooler October weather.

We were able to look back at all that has happened since the beginning of the year. The fear, the sadness, the great confrontation with this disease called cancer. Vi has kept very good records of what has happened from documenting each medication taken and how much liquid food was taken with it, to the notes she had while waiting at Florida Hospital Celebration. 

We arrived at the hospital at about 5:00 am. Her notes followed from the time I went to the surgery staging area at about 6:00 to the time she kissed me goodbye before they wheeled me away. I was not sure what to expect and neither did Vi. For that matter, the surgeons were not sure until they actually started "dissecting." 

I had been haunted by visions of Roger Ebert after his string of surgeries. I also maintained the respect I had for him as he carried on with his normal life with his abnormal appearance. 

I recall when the surgeon came in prior to the surgery and Vi told him "We are trusting you, doctor." He replied with a simple "Thank you." He asked which leg I wanted bone taken from since they might have to remove part of the jaw. They would have then rebuilt it with the bone from my leg. Fortunately, I woke up to find that was not necessary. 

Vida's notes followed all the procedures as the nurses kept her informed throughout the 8 hour operation. The tracheostomy, the catheter, the PEG tube, the dissection of the oral cavity, the harvesting of skin and veins from the arm and leg. 

In some respects, I was the lucky one since I "slept" through all of this. But then, I was also the one that had to wake up with the results: no lower teeth, unable to talk, hardly able to move and in severe pain. 

This was March 11, 2014 and our journey with cancer had only just begun.