A little more on the lung problem

I continue to feel about the same. Happy, not sick, not in much pain, but very short on air. I bought one of those pulse oximeters to watch my oxygen level in the blood. It's hanging out in the low 90's, for those of you who know about such things. If it hangs out lower than 88, that warrants the full time lug-around-an-oxygen-tank deal. Most folks are around 98-99. Before the last couple months, mine was around 96-97, even with the two lung surgeries.

Since my last blog article, I have had one doctor at MD Anderson and a physician's assistant both tell me in email correspondence that there may actually be something they can do in case this airway does not open up. I may be a candidate for a pulmonary stent, not too unlike the kind of thing they do for coronary disease. Only it goes in an airway, not an artery. The person to decide such a thing would need to be a pulmonologist or thoracic surgeon, and they would need a recent CT scan from which to make the decision. So this is speculation now. I have a CT scheduled at MDACC in a couple weeks on Aug 17 and am going to see if I can get an appointment with my thoracic surgeon that week.

But in the meantime, I am hoping, praying, and -yes- expecting that the airway will open up as the radiation finishes off its work here in the next week or so. If that happens, there will be no need to even think about a stent.

The picture to the right was taken about a month ago. It shows the markings for aligning the radiation machine. The radiation was focussed mostly in the center of my chest.

Atelectasis

Turns out the reason I feel like I'm not getting any air is that, indeed, one of my lungs is not getting any air. The pulmonoligist called me yesterday afternoon after I got a chest x-ray and told me I have "atelectasis" of the left lung. My left lung is not functioning. He suspects the lymph node tumor has completed pinched off the left airway. The picture on the right is from wikipedia (it's not me), but shows atelectasis. The xray report reads "total opacification of the left hemithorax."

My CT scan 6/24/2010 showed that at the time, my left airway was beginning to get squeezed. That was one of the big reasons for the radiation - to kill that tumor and give me breathing space. The one ray of hopeful news is that radiation has delayed effectiveness. I still have a couple weeks for the radiation to beat down that tumor and reopen the airway. But the bad news is that if it does not open up in a week or two, he thinks it never will. In that case, we find out that the cancer had too much of a head start on the radiation.

I am not without hope that the airway could indeed open. There have been a few other small signs that the radiation is indeed working. And the doctors at MD Anderson did say that we needed to wait about a month after the radiation before scanning to see how it did. It has been two weeks.

It's like yesterday I was a manager looking in on an employee (the radiation) before a deadline to see how the job is coming along. Not well at all. "But," he replies, "its not yet the deadline." Well he better get working.

So, my praying friends, I have a specific and urgent request to you for prayer. That the Lord might open my airway here in the next week. For "in his hand is the life of every living thing and the breath of all mankind." (Job 12:10)

Radiation complete, hoping for better breathing

I chose to go forward with the radiation, and have now completed it. I went to Houston for a little over five weeks to undergo the daily treatments at MD Anderson. The doctors remained optimistic that this radiation could kill most, or even all, of the cancer in the center of my chest, where they radiated. The esophogeal pain was not too bad and is already gone. The fatigue and wear on my lungs, however, is another story.

Between the two lung surgeries in 2007 and the maximized radiation to my lung area, my breathing is in pretty bad shape. I expect it to improve, but it has been slow going. It is painful to breath deeply, or to regain my breath after just walking a bit. I'm going to see a pulmonologist at Presbyterian Hospital in Dallas tomorrow to check out why I'm still having such a hard time. I have to admit I cannot help wondering if I will ever be able to breathe freely and not constantly fear physical activity lest I cannot find air.

Air is a very good thing. I need more.

A hopeful radiation plan

I met with Dr. Crane today. He is the radiation oncologist who will lead my ratiaion therapy. He looks like he could be playing first base for the Astros. But I suppose the academian in him chose to radiate tumors instead.

He gave me a better impression than I left the hospital with yeterday. He believes he can afford to be very aggressive with the radiation. He will go after every tumor that they can see. I had thought they were just going after the immediate problem areas, where there is pressure on the airways. Due to my good response from radiation in 2005 (wow, was that five years ago?), and the fact it did not do any extraordinary damage, he believes he can give me a lot of radiation. There is increased risk with this dose I may get a third new cancer (I've had two so far in my life), but the real problem is the cancer in me now.

He believes this will almost certainly relieve my breathing and coughing symptoms. And he thinks that while it is likely there may very well be a bit of cancer left somewhere in the areas that they treat, he is aiming to get everything they can see now. His goal is to "control" my cancer such that the next problem would be "somewhere else". This could buy me even a couple years. No promises, of course.

His assistant showed me the CT in detail today. It is amazing how the airway seems only the slightest bit restricted, and only on one side. Yet sometimes lately I feel like I'm drowning. The whole system is so sensitive. It is difficult to believe that zapping all over the place with radiation could actually be a good thing.

I have a couple more appointments tomorrow. Then back to Dallas for the weekend before beginning radiation in Houston on Wednesday. Treatment will be daily for about five weeks. The side-effects are expected to be quite difficult. The esophogus gets hammered in this process, making it difficult and painful to swallow for a period of about four weeks beginning a couple weeks into the radiation. I spoke to another patient who has had similar radiation and it sounded tough. A month of pain for a couple years of life seems like a pretty good deal. Gird up thy loins, self. Have mercy, O Lord.

By the way, while I was in the hospital last week, we got an offer on our house, which we accepted. Closing and moving the remaining furniture and junk will be tricky while I'm in and out of Houston, but it will be good to get that behind us. Albeit bittersweet.

Radiation planned

The lymph node tumors in my chest are still growing at about the same rate. For example, one went from 3cm to 3.5cm. But of greater concern to Dr. Eng is my increasing shortness of breath. And with the post-nasal drip from my cold last week, the coughing has been very bad, even scary. The nodes are constricting my airways. Not good. She wants to radiate the lymph nodes and thinks that will likely improve my breathing significantly. It will be 3-5 weeks of radiation, then three weeks of recovery, then probably back to the trial chemo drug plan. I meet with the radiation oncologist at MD Anderson tomorrow to find out the details.

The coughing has subsided a bit, probably as I get over the cold. My WBC counts are still far too low - as low as they were when I was admitted into the hospital last week at Presby-Dallas. (Incidentally, I did get out after two days - didn't update the blog) MD Anderson is reluctant to put me in the hospital now, especially given I have no fever. I agree.

Right now, it's hard for me to think about anything other than catching my breath back, so the radiation plan sounds good to me.

Admitted into hospital

Quick update. I had a good time in Bethany with Christine and Mark. But the last day, developed fever. It came and went and I was able to make it back to Dallas. Yesterday, I was scheduled for chemo, but delayed it a day due to the fever, which continued to come and go. Today, I went in for chemo and instead of giving it to me, they are admitting me into the hospital because of my low white blood cell count. My doctor says I am "on the edge" and could get very sick very quickly and he wants to avoid that. I'll be a t Presby-Dallas. Hopefully, this will be short.

Trips coming up

This week is exciting because I will be travelling to Delaware to see Christine. My brother-in-law Mark is helping out, flying to meet me in Baltimore for the three-hour drive out to Bethany Beach, where Christine's folks live. It will be good to see her. Both of our health situations has us so frustratingly stuck.

Upon returning after a few days, I will go down to Houston for a checkup trip (already? yes.) Dr. Eng only wanted to wait six weeks to keep on top of things. I really hope things are stable. My cancer blood marker was down to the 6's after slowly climbing this year from under 4 to the 7's. On the other hand, I've had a couple of discouraging signs - I seem to feel some pressure, tightness, dull pain, in my chest. Either my mind's playing tricks or something is up with the cancer. Could just be from coughing a lot.

Also, I've coughed up blood several times in the past couple weeks. It was not the first time. I've done so maybe once a month for many months. At that frequency, it didn't mean much to the doctors. We'll see if this is significant now that it is more often. I must say it hits you deep. To cough and cough and then have that taste in your mouth. You know, that bloody lip taste. Only it is not a cut, but the cough. Then there's this quick, heightened, mental montage - knowing, hoping not, probably is, not again, then looking. Red. Such a let down. In the movies, it's always the first sign of a bad health storm approaching. Does it have to be?

Funny thing - this is really the first physical sign I have ever had of the cancer. All my physical problems over the past seven years have been from the treatment, not the cancer itself. Not much I can do, so I just keep pressing on, praying, enjoying, and hoping perhaps for some good news.