Thursday, June 30, 2011

Cancer Grace and a new paradigm for cancer treatment

Dr. Jack West, oncologist at Swedish Medical Center in Seattle, has a wonderful broadcast up on YouTube about becoming an educated cancer patient and participating in your own treatment.  I urge all of you to take a look:

Tuesday, June 21, 2011

Off to visit my mother

I am leaving tomorrow for a 5 day visit to Lexington, KY.  Mom is 87 so one never knows when the next visit will occur.  Travelling used to be such fun, now it is something to be dreaded.  I realize that the government is trying to keep us safe but there has to be a better way to screen for terrorists. 

I wish I could say that the surgery has been an unqualified success but my voice, while somewhat better, is still quite faint and raspy.  I had a hearing today and at the conclusion I was given leave to file my closing statement in writing rather than try to talk because I had just about exhausted it.  Good discipline for paring down my questions, however.

I had an appointment last week with Dr. Merati and his residents and learned that it may take as long as 3 months for the swelling in my vocal cords caused by the operation, to go down.  Who knew they were this sensitive? The swelling not only interferes with talking, it makes breathing difficult still, although it is not a spasm, but more of a sustained obstruction when I inhale upon exertion.  I am supposed to learn how to breathe better when I next visit the speech therapist, so am hopeful that some of this will resolve with time and better breathing.  Imagine that.  All these years and I could have been doing it better.

So Bon Voyage and talk with you when I get back!

Friday, June 10, 2011

Science project--why organic.

Mad props to Nancy Nall for posting this on her must read blog. 

I have had so many friends diagnosed with cancer recently, I can't help but wonder about our indirect consumption of chemicals as a catalyst.

Sunday, June 05, 2011

It's a Beautiful Day

Yesterday, June 4, 2011, my daughter, Sarah Alice, graduated from medical school.  It was a perfect Seattle summer day--no clouds and the temperature was in the high 70's.  On days like this, you forget the previous 6 months of dark and rain and simply live in the moment.

Graduation was at Hec Edmundson Pavilion at 10am and, of course, Sarah had to be there at 8:30, so Matt drove her down and I struggled  dress and remember everything.  Camera?  check.  Cell phone?  check.  Ipod?  Check. Flowers?  Oops.  So after Dan, Sarah's boyfriend, showed up and Matt was ready, we stopped and got purple and yellow roses to give our new doctor after the ceremony.

Raced into Hec Ed, picked up a program, found some seats and opened said program.  Discovered that Sarah was not only honored as the ACP Outstanding Internal Medicine Student from Washington state and for her membership in Alpha Omega Alpha, but that she had been conferred  the Georgiana Kirby award.  Given by the friends of the University of Washington, the Georgiana Kirby award "is awarded to the graduating medical student who has demonstrated outstanding dedication to his or her studies and clinical work, and has shown the compassion for patients that is embodied in the ideal physician."  Each of the 267 graduates was called by name and came up to receive their hood and diploma, as their achievements and residencies were announced.  I should have had a noisemaker app attached to my IPOD because I could not yet make any sort of sound, other than vigorous clapping when Sarah's name awards and residency was announced and both Dan and Matt were too shy.  I thought of all the days I had spent at the sidelines of her soccer games and swim meets, yelling at the top of my lungs, and I guess Sarah was probably grateful for the the temporary loss of voice.  Ah, but it used to be so much fun...

Lots of pictures with family and friends outside afterwards.  Lots of hugs and some tears.  The sun actually started baking us, and Sarah was roasting under her robe, green hood and squashy cap.  So she decided that she did not want to go to a restaurant for celebratory brunch,  but instead wanted to go to the pool.   We went to Metropolitan Markets and picked up picnic lunch fixings, went home and got ready for the pool.  Had lunch at home so we could polish off a bottle of champagne and then spent several relaxing hours in the sun with the familiar splashing and other water noises, basking in the sun and talking with friends.  Every so often, I'd get a question, "You know what, Mom?"  "No, what, Sarah?"  "I'm a doctor now!"  So everything that she did the rest of the afternoon became anchored to that new fact, including her pickleball and basketball victories.  Life does not get much better than this.

About 5:30 we closed up shop because she and Dan had to go out to dinner with her father and his wife.  Matt and I had tickets to the U-2 concert at Qwest Field.  I'd purchased them a year and a half ago, but the concert was postponed last June because Bono had unexpected  back surgery. 

The trip downtown was uneventful and we found parking in the International District which meant a brisk walk to Qwest field in the sunshine.  Our seats were up in the third level, southeast side, but in the front row.  At one point we had an usher come iover and tell us we were in the wrong seats and made us move, but when we got up a level he admitted his mistake and gave them back to us.  After that things settled in very nicely.  Our seatmates welcomed us back warmly and our  neigbors to the south collected everyone's favorite songs so we would know who to cheer and point to when they came on.   Matt's was "Sunday Bloody Sunday" and mine was "Better than the Real Thing," which is not part of their canon.  Both were played and mine was the first song of the concert!  Began well and just got better as the evening wore on.  This turned out to be the emotional high point of the evening:

Absolutely one of the peak days of my life.  

Friday, June 03, 2011

Three Days Out from thyroplasty (vocal fold surgery)

Tuesday, May 31, at 5:30 am, my daughter and I were in line at the Surgical Pavilion at the University of Washington.  Check in went quickly but I was pretty tired  because when the nurse asked what kind of surgery I was going to have, I responded "thoracotomy" rather than "thyroplasty."   Sarah will never let me live that one down.  Sarah went with me to pre-op where I donned yet another flattering hospital gown.  The anesthesiologists came by to chat and install an iv line on the top of my left hand.  One of them told me an anesthesiologist joke:  How can you hide $100 from an anesthesiologist?  Hide it anywhere in the hospital after 3 pm.

At about 7:30 I was wheeled into surgery.  It was a room crammed full of monitors, machinery and all sorts of things.  I had somehow thought that surgeries were sterile, empty spaces.  Not so.  I was shifted over to a narrow surgical table and given a donut pillow for my head and a horizontal one under my knees.  They draped me for surgery, which consisted of dropping a shower curtain down from the ceiling and sticking it to my chin, so I could only see directly above me. Then they injected the anesthetics to numb my neck so they could cut me open.  Two residents did all the grunt work with the incision--they stood close to me to make sure that I could not move during the procedure. It was actually a nicer experience than had they used a straight jacket approach.

Several times I felt whatever it was that they were using to make the incision.  To me, it felt like my neck was being sawed with a rotating bendable, wire brush, so I hollered, and they gave me more good drugs.  I had to stay awake  during the entire procedure, because I had to vocalize so they could make the proper placement of an implant that was just the right size.  So what would happen is that they would put in the implant, have me say "eeee"  or count to five, or hum, and then take it out and work on adjusting the size and put it back in and work on positioning it.  Eventually Dr. Merati stepped in a fine tuned the size, shape and positioning and we were done.  The two residents sewed me back up, chatting about the number of weddings they were scheduled to attend this summer, which was a rather interesting experience to actually be the chopped liver at the time!

It turns out that the cartilage in the vocal fold area was extremely soft, making it difficult to size and adapt the implant.  There's a system out there that uses pre molded implants, five different sizes, and I had asked Dr. Merati about it before surgery.  So in the middle of my surgery he remarks to me, "This is why we can't use the Montgomery process." 

If you are really interested, you can see a thyroplasty surgery here.  My surgery lasted probably 2 1/2 hours, a bit longer than usual, because of the softened cartilage.  Dr. Merati told me in a phone call yesterday that my cartilage was the softest he had ever dealt with, and probably was a function of the radiesse injection a year and a half ago.  He sent a piece of the cartilage out for analysis but there was nothing unusual found from the sample. 

I spent the night in the hospital and was discharged before noon on Wednesday.  Went home and slept most of the day, so I could go to Sarah's medical society honorary dinner at the faculty club that night.  It was truly a wonderful experience because before each of the new members were given their certificates,  part of their nomination applications (which were written by faculty and peers) were read.  Each one of the new members was terribly impressive.  I was sitting next to the featured speaker, a pediatric cardiologist from Rochester, NY, and she murmured that she doubted she would have made it these days given the achievements that were noted.  Truly a humbling experience. 

Along the way, I dropped wearing a gauze bandage over the 3 inch incision--it was too rough.  So what if I look like Bride of Frankenstein with those ugly ass black stitches on the front of my neck?  Like my father used to say when I was in tears over a botched haircut, "At least I don't have to look at it."  Funny how I now rather enjoy that saying, when I used to hate it so much.  We'll see how many double takes I get at Sarah's graduation tomorrow.

Yesterday was supposed to be an infusion day--the ct scans showed the tumors either had not grown or were shrinking a small bit, but the clinical trial managers back east decided because of the thyroplasty surgery, that I had to wait for two weeks.  I hope that doesn't give the tumors a new lease on life, so to speak.

My current voice is really rough, but that's in part because of the swelling occasioned by the surgery.  I'm having a bit of a problem swallowing as well, which I also attribute to edema.  But the pain, which was significant the first day, has largely disappeared.  I'm  just glad I never got that thoracotomy (which is the removal of part of one's lung).