Rubbing Salt in the Wound – Blog 50

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I have mixed feelings for having had Dad home for Christmas. Whilst his presence on the morning of Christmas Day was undoubtedly a good thing, his overall health was suffering due to the sodium tablets he was taking.

He had begun to show signs of dehydration, though this was known to be a side effect of not being able to have much fluid. I do however, have faith and confidence that the Oncologist knew what was going to happen and partly this was why a home visit had been scheduled five days after going home. This meant that any concerns could be addressed and sure enough, the day after the home visit, when the results were known, we were informed that Dad needed to return to hospital.

The most unexpected result was that his sodium levels had all but returned to normal with the blood tests revealing it to be at 134mEq/l with the normal range being between 135-145. Therefore, the sodium tablets had done the trick. Unfortunately, just to rub salt into the wound, dehydration had started to cause Renal Failure with his kidneys starting to malfunction and give way.

His Creatinin levels had reached 6.7mg/dl with normal levels being between 0.6-1.10. Creatinin is a waste by-product that is filtered through the kidneys via the blood. The Urea levels were also way to high with his results being 156mg/dl with normal range being between 10-50. Urea is produced in the liver then passed and filtered through the kidneys until being released via urination.

Returning to the Hospital (Lluis Alcanyes), we reported directly to the A&E department where Dad was pretty much seen straightaway and taken into the Emergency Observation Ward; he was put on four drips. One drip was an Isotonic Saline solution, another containing Bicarbonate Soda, another with Sodium Chloride and the final containing a Paracetamol solution for the pain.

You could see a change in him after just an hour though we had been informed that we needed to wait to see a specialist as there were concerns regards the overall kidney condition and they were not sure what line of treatment, if any could be taken. A few hours passed by and he was then transferred to a ward to receive continued observation and the required drips to help the kidneys effectively ‘reboot’. If this failed, then, and only then could dialysis be looked at as an option. Therefore, having returned to hospital on Wednesday we were looking at a discharge date of New Year’s Eve. This is clearly depending on what happened over the course of these 3 days.

The first night was the worst with him experiencing crippling pain. Fortunately, this eased once he ‘demanded’ to have the urethra tube removed at 2:30am. He described the pain as worse than giving birth. I am not going to broach the ‘man vs woman’ pain argument. All I will say is that Dad does not feel pain easily.

The test results we received on Thursday morning were promising. Whilst he was still severely dehydrated, with the nurses now pushing him to drink as much water as possible, the Creatinin levels had improved going from 6.7 to 4.4. This effectively showed that the kidneys may just at this stage ‘reboot’ as hoped.

Psychologically he is not in too bad a place, though still struggles to grasp what is really going on. He has however, had a word with his immune system’s army, including, Jim, Simon, Spartacus, Florence, Marie and Gibbo and informed them all to get their act in order. Errrr…… don’t ask!

Friday (today) had its own complications with his drips not being able to be administered. Basically, he fiddles with the wires which in turn, causes the drips to stop working properly. It then causes the blood to flow back up through the tube and stops it working altogether. This itself would not be so bad, however as his body is slowly giving up it is becoming increasingly more difficult for them to find suitable veins to administer the drips through.

The results we received showed a further improvement with the Creatinin level now being at 2.5 mg/dl and the Doctor felt that the results should be back to normal in the morning. She was also almost happy to let him come home today though was fearful that he would not continue to drink the required amount of water. This time he is now back to minimum 2 litres of water per day with a Mediterranean diet to be followed. Basically, healthy food and no crap.

We now find ourselves in quite a vicious cycle. Should Dad be allowed home tomorrow as planned, the worry is that the Cancer is now so advanced that the sodium levels will nose dive as they did just two weeks ago. If this happens then no cancer treatment including chemo or immunotherapy can be discussed. Treatment would then have to be given to fix the sodium levels which in turn, would more than likely, cause renal complications again. This does not even take into consideration the fact the cancer is continuing to grow and travel through the blood.

It has already been suggested, and we do have to be realistic about this, that there will only be so many times these ‘top-up’ treatments can be given. It is highly unlikely, even at this stage that he will ever advance to Chemo or Immunotherapy treatment stages. The thought of him being allowed home tomorrow, only adds to these concerns. Whilst he does seem almost ready it’s just impossible for us to know how he will react and what will happen next. It also does not help that he is a big kid when it comes to drinking water and makes drinking 2 litres of the stuff seem like he is being tortured. Suggestions on a postcard greatly appreciated.

The hope is that when home, he will have enough energy to at least go out and see the local sites, if nothing else.

The best thing about it is that we will also be getting some visitors over the coming few days. David is making a return on New Year’s Eve, Steven and Nicola will be appearing on the 2nd January and Dad’s two sisters; Margaret and Glenda as well as his niece Belinda will be making an appearance on the 4th January. At time of publication, these will all be surprise visits to give him a boost and encourage him that life is worth fighting for.

The last few weeks have been tough. Dad has been tearful, emotional, has not seen the point in going on and struggled with pains, dizziness, nausea, headaches, confusion and major fatigue. Regardless though we will be seeing him into 2017.

Happy New Year everyone. Love from The Bob Garratt & Co xxx

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Praying for a Miracle – Blog 49

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Writing today’s blog has been something I have been dreading all week. Being a realist, the news expected from today’s Oncology appointment always felt as though it was never really going to change anything due to the advanced stage the Cancer had reached.

There was the hope that a Christmas Miracle would occur but having already discovered how aggressively Dad’s cancer had spread, the likelihood of walking away from today’s news, feeling positive, was always going to be a tall order.

The medical report from earlier this month makes for grim bedtime reading and this coupled with how poorly he has been this week has just made it feel that things have started to come to a head.

Don’t get me wrong, this week has had some incredible highs. My brother and his two kids came over and we all got to spend some incredible time together. It was particularly special being able to watch him spend time with his grand-kids who he adores. The problem is, he has still been recovering from his spell in hospital and his energy levels and thirst for life is at an all-time low, the lowest since this all started last year.

Today also didn’t get off to the best of starts with Dad taking a turn for the worse with the same symptoms being experienced from just a couple of weeks ago. Having got to the hospital early, they did a blood test and confirmed that the results were bad and that his sodium levels were once again very low.

The fact that his sodium levels have plummeted so quickly is not a good sign. Due to the control the Cancer now has on his body, treatment options are extremely limited, with any option unlikely to provide any significant amount of improvement without potentially impacting his quality of life.

Two options have been discussed:

Option 1 was that a third round of Chemotherapy could be administered. It was made clear though that the likelihood of this providing a good result was slim. The Cancer has grown in mass, strength and intelligence. Such with antibiotics it is finding a way of fighting back thus causing the positive effects of the Chemo to be reduced if not simply eradicated.

Option 2 was for him to take part in a clinical trial which is being run from the hospital in Valencia. This is known as Immunotherapy Chemo. In short this is a new class of cancer treatment that works to harness the innate powers of the immune system to help fight the Cancer. However, little is known as to the impact this will have on Dad with the advanced stage his Cancer has reached, especially considering the growth and spread that has now occurred.

Awkwardly though, neither option can even be considered at this stage, due to how unwell he is. Chemo could kill him and Immunotherapy is just an unknown entity.

So, Mission 1 is to help him recover from the low sodium levels in his body. Rather than keep him in hospital this time, they have given him the choice to be at home for Christmas (with home visits planned). They felt this would be better for him psychologically.

Therefore, he has been given some sodium tablets to take each day for the next week. The problem is that he has been placed on a restricted liquid diet meaning he is not to drink anything, other than a minimal intake of water. The reason being that the fluids would simply flush out the sodium which his body needs time to absorb. The side effect of this is that dehydration could set in causing its own problems and meaning the home treatment would need to cease with immediate effect. We would then have to take him to hospital for ‘Plan B’ to be activated which would be the all day sodium drip with ongoing observations.

The doctor is keen for the home treatment method to occur first as she wants him home for Christmas. No commitment has been made over the time my Dad may have left but it has been suggested that we are now talking a matter of weeks, as opposed to months. The doctor asked what he wanted in terms of ‘the end’ and he responded saying that he wants it to happen in Spain. Dad also asked if the end was imminent and her response was simply “I hope not”.

Dad, as you know by now, is a fighter. He is aware that the end is now drawing closer, though is not allowing himself to give up. Despite feeling terrible and having discussed some extremely morbid topics today, he still managed to find time to ask after all the nurses whom he wanted to say Merry Christmas to. He even managed to steal a couple of crafty hugs.

Also at this stage I just want to take this opportunity to thank everyone for their support. Regardless of how bleak the news and outlook is, we remain strong, focused, resilient and together as one.

Christmas is a time where families, loved ones and friends gather to share a laugh, argue with each other, over-indulge and tell bad jokes. I can assure you that our Christmas this year will be no different. The gloomy grey cloud can wait, for now we celebrate life and the time we have.

Christmas Miracles do happen. We were blessed with yet another one together.

Merry Christmas one and all xxxxxx

Tipping the balance – Blog 48

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Monday seemed to come around very quickly and Dad ended up having a full body scan. This itself was a slightly worrying sign as we had just been expecting the normal scan to see where the Cancer was within his lungs

Either way though with the scan done, the results were expected today.

The news is not as favourable as we had hoped for. The Cancer has returned and spread quite aggressively. The last scan result earlier this year indicated that the Cancer activity had reduced significantly and, with little or no activity, he was officially declared as being in remission/partial remission.

This is no longer the case. Cancer has returned and is equal to the size that it started at in June 2015. In addition, it is now of equal amount in both lungs whereas before there were just traces in the second lung. Furthermore, it has spread to the Pleura which is the membrane that covers the Lungs and has also moved into his Liver. All sites in terms of Liver and Lungs have multiple individual tumours. This is not good news.

The good news however, is that he has been allowed home today due to his salt levels having improved and is pleased to have had some fresh air. Having spoken with him on Skype he is looking tired and sounds exhausted though in part this is relief at being home. He has said that he doesn’t really know what is going to happen but he isn’t giving up. He is also thinking of those around him and what he can do to help them….

None of us truly know what is going to happen at this stage. There are still many unanswered questions. Can the tumours be removed from the Liver? Can he have more chemo? Can he cope with more Chemo? Will it make any difference at this stage? Which path should he take in terms of life expectancy vs quality of life? None of these have I an answer for.

All I do know is that an oncology appointment is scheduled for December 23rd. We will at least know more at that stage. Decisions can then be made as to what happens next.

For now though….he is home, he is still getting in some Bob Garratt humour and has not given up. None of us have.

Who’s in control? – Blog 47

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I’d hoped that this blog would be an upbeat and jolly lead up to Christmas. Unfortunately, I feel it’s now going to be a bit of a mash up of good and bad.

As you will know, Dad turned 72 on November 27th and had a lovely day. The Spanish trio took themselves off for a nice meal in Gandia and generally just let their hair down for a change and splashed out a little. Some of their friends also nipped round for tea and cake and everyone was in good spirits.

David & I even managed to spring a surprise trip to them on November 30th and we had a couple of wonderful days with them, having been shopping on the Wednesday and taken a day trip to Javea on the Thursday. I even saw my Aunt Margaret last Sunday (Dec 4th) and informed her just how well Dad was getting on. For all intent and purposes, he looked and acted like Cancer was a thing of the past. He honestly looked like his old self.

What a difference a few hours can make….

I’ve delayed providing an update for a few days as I felt there wasn’t much information I could have conveyed without causing unnecessary worry or concern. Last Sunday, Dad took himself off to bed early and said he wasn’t feeling too good and was a little light headed. By midnight the 3 of them were in the local hospital. A sleepless night and hours of worry later it transpired that his sodium levels had hit rock bottom once more.

The good thing is that this is a recognised condition for Lung Cancer patients. The bad thing is that it appears to be a clear sign that the Cancer is making a comeback. The Cancer cells tend to eat away at the body’s salt levels which in turn leads to neurological issues such as confusion, difficulty to think, headaches as well as nausea and faintness. I guess the worrying thing is that this is how it all started last June.

His scan results were expected on Monday 12th December, which is when I had originally intended to do a blog. Clearly there had been some very biased ‘hope’ as to the news the scan would bring.  This scan however, has not yet taken place due to waiting for my Dad to respond to the treatment he is receiving to increase his sodium levels.

This itself is a painfully long and drawn out process. In part this is down to the drip that must be given. If salt levels are increased too rapidly then severe and life lasting brain damage could be caused. Too slowly though and the body could weaken further. The other complication is how Dad is coping with being back in hospital. He is irritable, aggressive and not responding well at all. As a result, he is fidgeting with the drip and causing it to not function correctly. In his head, he cannot understand why it can’t simply be poured in quickly to allow normal service to resume. This though isn’t helped by the low sodium levels causing him not to think clearly. There is also the fact that he has openly admitted that he is desperate to not have to go through chemo again. The realisation that his Cancer is not going away is eating away at him both physically and mentally.

The fact of the matter is this simply could be a blip. Until we get the scan results, no one can truly know where my Dad’s health is. On the face of it, this is not good news. It feels like he has done a full circle and the Cancer is doing exactly what we expected, fighting back.

At this stage I can’t really say anything more without speculating. After 6 days in hospital, the sodium levels are back up to 75% though it has taken this long to get it there. The irony is that the water intake argument has been thrown out of the window. He is now limited to a maximum of 1 litre per day so as to not dilute the body’s salt level thus reversing the drip’s effectiveness. In some respects, he can be smug knowing that less on this occasion is more.

The scan will hopefully be performed on Monday with the results known shortly afterwards. At that stage the doctors will be able to decide as to what course of treatment will be required next. This is good. It should mean that there are still treatment options available.

We won’t know any more until after Monday and I will be sure to keep you all posted. Mum and Alan are doing a terrific job at finding the balance between being the supportive family and having to be hard nosed in terms of giving Dad what he needs whether he likes it or not. And trust me, my Dad can be a stubborn sod when he wants to be.

I’m sorry the news is a little vague and not as we had hoped. Please remember though he is strong. Cancer can be cruel at the best of times. Regardless of this being a blip or not, he is showing that the fight can and does go on. He is not ready to leave this world and is still aiming to be around for a good few years yet. And in any case, Steven & I need him to be back at full health as he still owes us both a car if we beat him at Squash or Badminton. Seems a little unfair taking him on in his current state…