Current Timeline

Timeline at 10/31/2011

A short post to review  (1) current symptoms probably from tumor  (2) symptoms of chemotherapy  (3) current functions  (4) known illness timeline to date

1. Current Symptoms:
Occasional coughing...3 to 10  huh! huh! huh!s. No paroxysms which might include coughing to point of gagging which was present a few weeks ago.

Previous chest pains, front and back, and worse on inspiration have subsided.

2. Symptoms from treatment:
Corticosteroids (dexamethasone, prednisone) have taken my appetite through the roof. I had been losing weight and normal appetite had been depressed, but I've gained 10 lbs in less than 2 weeks and I have had a craving for carbohydrates.

My blood sugar has doubled to over 200. Corticosteroids promote diabetes.

I may have 1 to 2 episodes of skin flushing per day, where I feel very warm for an hour or so.

The onset of side-effects from chemotherapy infusion started at about the 48 hours mark with a feeling of aching and tiredness in both legs, most prominent around my hips and knees. The pains have continued to ache but there are now multiple short, sharp pains, some less than a second, some up to 10 or 15seconds.  They are not overwhelming by any means, but they keep me from drifting off to sleep.

3. Current function:
From the 4th until the 11th of October I was miserable. I was told not to take Ibuprofen until after bronchosopy and biopsy in order to reduce my risk of bleeding. During this week, I had incredibly irritable airways--anything could set me off coughing in long paroxysms that would frequently end with gagging. None of this has occurred again since being able to use either Ibuprofen (or other Non-steroidal Anti-inflammatory drugs) or Corticosteroids, like decadron and prednisone.

I'm able to climb one flight of stairs at normal rates without being short of breath. Two flights makes me stop to catch my breath.

I do have times where tiredness grabs me very quickly and I use those opportunities to try to nap and get in an hour or two of sleep.

4. Review of known illness timeline.
Naturally you go back and try to piece together the emerging awareness of the illness. The book "The Doctor, The Patient, and His Illness," was written by Michael Balint in the early 1950's. I have found no better writing about this process (but the book is relatively expensive). He compares the initial awareness of the illness as akin to an artistic process (now you just have to read this book, don't you?). After a struggle with trying to find a meaning or name for what is happening, the patient may share this occurrence with another (which begins the externalization of the process).

Here is my recollection for what it is worth--hard to believe that it comes from the mouth of a non-believing physician.

Smith Island 1987:  I am lying in bed and feel and deep, sharp, searing, pain in my left chest which feels like it is going to explode. My teeth and jaw hurts. The pain lasts less than 15 seconds. There are no after effects. On that day and for the next 19 years there is no recurrence or body sensations that call this incident to mind. My internal, mythical representation is? I was hit by a disease lightning bolt that planted a seed, or a diseased cell has reached out to the gods and called in a "smart bomb " that contains a potential illness. I am still smoking cigarettes at the time and still trying to quit as I had been doing for the past 15 years. I stopped completely for 12 times for 1 month or more before successfully stopping cigarettes.

Las Vegas 2004: Loss of daughter and mother. Plunged into work to push away paralysis of grief. Traumas lower immune functioning.

Las Vegas 2006: I begin to experience occasional episodes of pressure in the center of my chest that pushes backward between my shoulder blades. It is a "squeezing" sensation, the pain beginning at a relatively low level of 3-4 / 10 and gradually increasing over a minute or so to a 9/10 where it hangs for a couple of minutes before subsiding. I feel jaw pain when it occurs. Pain described in this manner can be heart-related, esophagus/stomach related, lung related, etc. I have maybe 3 or 4 instances a week for a couple of weeks. The week or two time period, I would characterize as an episode, a grouped set of instances occurring in a definable, relatively short amount of time. These episodes occurred every two or three months or so.

Las Vegas 2006: I have a radiologist friend who offers to let me join a study using x-ray imaging to collect data that must usually be gathered by angiography of the coronary arteries (the feeders to the heart and source of heart attacks...like the Left Anterior Descending Artery..."the widow maker."). The technique is interesting but not important for my story. I didn't find a clear, non-technical description in a brief look at WEB, but here is a link you may find interesting..

http://www.rochestermedicalcenter.com/Cat%20Scan.htm#uses

Las Vegas 2006: I received a gated CT of heart that eliminates coronary artery disease as a likely culprit for back discomfort.  A nodule is seen in the Left Upper lobe. I have a history of childhood TB exposure. Total body scanning is negative for any significant activity at chest nodule. It is just sitting there. The Nodule is followed by CT scan and chest x-ray...nothing happens during the next 2 years. Cancers are believed not to just sit around but to grow from the outset.

CA 2007: Have moved and changed jobs after death of father-in-law. Lots of work to end a practice and sell it in Las Vegas, to come to CA to find jobs, housing, etc. Wife and I unable to find work in same institution. She gets a job 12 miles from new home.  I have travel to central valley and live there 4 days a week for work.

I develop zoster, an indication of possible reduction in immune competence which is also important in cancer detection and combat within the body. I also suffer a vitreous detachment in left eye at that time.

CA 2010:  About to retire from brief 5 year vesting period in State of CA which will give me a little retirement income while I find another type of practice. I am anxious about how I will next employ myself.

MT 2011 Jan : I go to visit former office worker dying of breast cancer with liver and lung metastases. We have a great couple of days. I catch a "flu-like illness" that lasts 3 weeks.

CA 2011 Feb: Have a productive cough. I know that I have chronic bronchitis. I begin a two week course of a tetracycline and it resolves.

CA 2011 Mar: Develop painful swelling in right ankle diagnosed as gout. Use of gout meds causes me belly pain and back pain, some of which appear to mimic the episodes experienced in Las Vegas in 2006.
I am aware that onset of gout can be associated with malignancy but INSTEAD OF FACTORING IN MY CIGARETTE SMOKING HISTORY I go to the GI person and ask for the endoscopy to see if I have a major problem in the upper GI. I also schedule a colonoscopy to search screen for malignancy there.... never get around to it because medical events overtake the indication for the test. My biggest cancer risk was from prior Tobacco smoking. A chest xray in March would have been indicated and may have changed my stage from the currently incurable to one with possibility of cure. The retrospectoscope...I see it all the time in medical practice.

CA 2011 Apr: I use a CPAP machine. I notice a much heavier accumulation of post nasal mucous in AMs but don't think much of it. I'm not coughing.

CA 2011 June: My second episode of gout  in same ankle. This time Ice packs are most helpful. I'm also not feeling like myself. I take a part time job in a central valley prison.

CA 2011 July:  Another episode of gout, very severe in left great toe. Have made myself go back on Colchicine.

CA 2011 Aug: Onset of cough, minimum sputum.

CA 2011 Sep: I feel like shit. I do have a cough.

Sept 16 I go to my GP and tell him I need a Chest XRay which was done on Friday Sept 16. I see the x-ray and know it is bad. Most likely dx CA. better diagnoses are Community Acquired Pneumonia, TB, and Valley Fever. I give the sputum for TB and Valley Fever. I am scheduled for a three week trip to the East Coast, driving an RV and visiting along the way. I take meds for Community Acquired Pneumonia and head out on the trip but get sicker. I turn around and return home after 5 days.

Sept 30    I get a ct scan that shows CA. I immediately get on a phone to a lung center. I tried UCDavis...get a low level person who tells me a bunch of rules required for admission.

I call Stanford and am immediately switched to nurse coordinator for thoracic cancers. She gets information from me, identifies sources of medical records, schedules me for an appoint on the 2nd business day.

Oct 4      First evaluation at Stanford--review of records, physical examination, plan for staging

Oct 6      Pulmonary Function studies locally

Oct 7       Brain MRI  appears clean

Oct 10    CHEST/PET chest.....shows disseminated disease. This changes the nature of my pending bronchoscopy. Not need to stage because already Stage 4 and I'm looking for Herman Cain's doctor!

Oct 11    APPT with Lawyer...medical will, power of attorneys, etc.

Oct 11    APPT with locol oncologist Palchak who makes me more comfortable with steroids.

Oct 12    Bronchoscopy at Stanford

Oct 18    Tumor Board and consult at Stanford  was offered Clinical Trial not run by Drug Company

Oct 19     Met with Dr. Palchak who told me I was being offered state of art.

Oct 24     Blood work done prior to chemotherapy

Oct 27     Phone consult with study nurse re: drugs to be started before chemo. Discuss chemo complications.

Oct 27    Obtain meds faxed in orders from Stanford to Local drug store. Take prep meds.

Oct 28    First chemotherapy.

Oct 30    After 48 hours, first significant symptoms from chemo--bony pain in long bones.

TIme from awareness of cancer to treatment about 30 days. Cautious workup saved a much more difficult surgery on Oct 12. They knew it was Stage IV and were able to forego staging biopsies, since these would be irrelevant.

Have taken some tylenol and codeine today. Will look into medical marijuana as a method of control of nausea...the other drugs make me too sleepy. I'll let you know about this process.