Physical Therapy

Once again, I have to express extreme thanks to everyone for the phone calls, e-mails, cards, gifts and visits. Your thoughtfulness and kindness mean so much to us during this prolonged struggle.

I started physical therapy (PT) this week, about two and a half weeks after the surgery. Mostly, the goal is to keep good range of motion going in the shoulder and to help with some of the nerve damage from the surgery. I actually came out of the surgery better than the surgeon anticipated. During my 1 week surgical follow-up visit, he was checking the strength of some muscles. He seemed genuinely surprised that I had any use of some muscles commenting that he was sure that he had removed the nerve that went to that muscle. But it still worked. Good for me. Anyway, I was doing pretty good until the PT started. Now, I am pretty darn sore.

Sessions start with a massage first. The therapist, Dr. Howard Knudsen, uses some tools that he says were developed by an orthopedic surgeon. He uses these tools on the skin with cocoa-butter, rubbing back and forth. He says that this increases circulation to the skin and muscles underneath. He is focusing on the areas that are sore mostly. It makes some interesting looking skin for a few days after.

Most of my soreness isn't associated with the surgical site, but rather in my upper right arm. I have complete numbness above the incision through the arm pit and the underside of my upper arm. I mean it is really dead. Can't feel a thing. But, from the area of the upper arm moving toward my elbow, the felling comes back and there is one area about the size of a silver dollar that is really sore. It feels like a really bad sunburn when it is touched. There are a couple of other areas that are sore too and he works them all over.

He does tome range of motion stuff with my shoulder and then finally has me use a weighted swivel devise that works my rotator cuff. Needless to day. I can feel all of it.

Monday, I will head back up to the cancer hospital for infusion of more chemotherapy drugs. This is a five day admission, just like my previous two times. The drugs run into the central line in my chest (it is the white thing dangling from my chest on the second to the last picture - it's been in me since February) 24 hours a day for the five days they keep me there. Then I return at three week intervals to do it all over again. My hair has just started getting long enough to comb again. Three weeks from now, I probably won't have any again. Oh my vanity!

God bless you all. Thank you so much for your prayers. We need them and so appreciate them.

Jim and Family

Metastatic Cancer

Hi everyone! Just an update from yesterday's posting. I obtained a copy of the CT scan report. Essentially, it shows that while I was being treated with radiation (focused on the primary tumor), the cancer in my lungs has continued to grow. As I stated yesterday, I'll be going into the cancer hospital for aggressive chemotherapy starting on August 4th, 5 days at a time every three weeks. This is what I have feared most. I don't like feeling sick and I didn't like how I felt last time when they did this chemotherapy. At least, I know what to expect this time. So much for my hair growing back.

Here is the technical part of the CT scan report dealing with my lungs, for anyone interested:

Again demonstrated are innumerable soft tissue densities: Nodules
scattered randomly throughout both lungs. These are increased in size
and number when compared to the prior examination. There is an 18 mm x
21 mm right upper lobe subpleural nodule noted on image 15 which
measure 13 mm by 14 mm on the prior study. At 18 mm in diameter left
upper lobe of subpleural pulmonary nodule on image 15 measured 5 mm
previously. There is a lingular pulmonary nodule measuring 12 mm in
diameter on axial image 26 which measures 6 mm previously. There is a
right middle lobe pulmonary nodule on axial image 36 which measures 10
mm in diameter on today's study, which was not well seen on the prior
study. A 10 mm in diameter left lower lobe nodule on axial image 55
measured 4 mm previously. Innumerable other smaller nodules
demonstrate interval increase in size or interval development compared
to prior study. This no evidence of pneumothorax. There is no
effusion.

Again, I can only repay your kindness and prayers with thanks. I do thank everyone for their love.

Jim

Hi everybody. We are most thankful to everyone for their continued prayers and well wishes. Thank you so much.

My daughter, her husband and their two children brought me a wonderful bear while I was in the hospital recovering from the surgery. It is absolutely amazing. Watch the video above to see what I am talking about.

I had my appointments at the hospital today (surgeon and oncologist). A CT scan was done of my chest, but official results weren't available at the time of the doctor's appointment. However, they did say that from their viewing of it that there didn't appear to be any new lesions and that the previous lesions hadn't grown very much. That sounds great to me.

The surgery appears to have been very successful. The pathology report indicates that all surgical margins were clear of cancer all be it by 1mm in places. The surgeon explained that to get the preferred 3cm margins in this surgery, my entire right arm and the right side of my chest wall would have to have been removed. That would have been a very drastic procedure and difficult to survive. He feels that the fact that I still have a functional arm and the surgical margins are clear is a wonderful achievement given the circumstances.

We now are facing more chemotherapy to go after the cancer in my lungs. It will be the same as before. Hospital admission for 5 days of continuous infusion every three weeks for a total of four sessions. After the second session, they will do another chest CT to see what the lesions are doing.

We are looking forward to getting all of this over with. Your continued prayers, kind thoughts and support in so many ways is sincerely appreciated.

Jim & Patti.

Post Op Recovery #2

Once again I cannot effectively express my most sincere thanks and appreciation to everyone for their kind thoughts, calls, notes and comments. We so appreciate the friendship, associations and most of all prayers.

I was able to come home on Saturday evening. We arrived here at about 5:00 p.m. I climbed into my recliner and was very pleased to be somewhere comfortable. There aren't very many (actually none) comfortable chairs at the hospital. My back was bothering me something awful by the time we left there.

Sunday was uneventful at home. Resting and watching some good old movies on the TV with my sweetheart and seeing a few visitors that came by the house. Yesterday, was much harder. I was very tired. So tired in fact that I decided to go to a local hospital and have my blood checked. You see, my HCT (hematocrit) had dropped on Friday to 29 and the surgical team had wanted to give me a blood transfusion. I asked them to wait and when they checked my blood later in the afternoon, it had increased to 30.4. However, Saturday morning, it was down again to 29.1 and they offered a transfusion again. I declined and asked them to recheck the level again later. It was up to 29.9 so they let me go home. My fear yesterday was that it was way down and that I had sabotaged myself by not having the transfusion then. Fortunately, the level had improved to 34, so it wasn't that that was making me feel so punk.

For the most part, my arm was giving me fits. From my shoulder to my wrist, it felt as if my arm had been beaten with a baseball bat. Heat, position, narcotics, nothing seemed to help. It was just plain uncomfortable all day long.

Since the surgery, I have had a drain in my wound. Today, I was able to have it removed along with all the bandaging that had been in place since the hospital. Imagine, large, bulky mass of of gauze covered by adhesive tape. Once all of this was removed, my arm has felt much, much better. I think all of the gauze was pushing on a nerve or something. I am glad it is gone. I am still covered in steri-strips from stem to stern and all my skin sticks to it's self from the soaps and stuff they used during surgery. But I do feel better.

OK - HERE IS THE GROSS PART. IF YOU DON'T WANT TO SEE GROSS PICTURES, STOP NOW. PROCEED AT YOUR OWN RISK.




This is at the beginning of surgery. I am unconscious (thankfully) and the OR team is preparing my skin with antiseptic. You can see the mass of the tumor kind of hanging there in the armpit area.







This at the point in the surgery when they removed the tumor (in surgeon's hands). You can see the big hole it came from and the position my arm was in for over 3 hours. No wonder it hurts!










Here is a shot of my armpit with all the bandage material and the drain hanging out of it.





















The bandage actually came off pretty well. The tape really hurt. You can see the steri-strips over the incision. The keep the skin together without a lot of stitches that would have to be taken out otherwise. In order for them to stick, the skin is covered with glue. You can also see the central IV line that I still have in my chest. It has been there since February 29th, four and a half months.














Here, the bandage is off. The drain is at the back and my skin is sticking. Yuck.












Cutting the stitch that holds the drain in place then yank, out it came and it didn't really hurt. Dr. Harline (my family practice supervising physician) was kind enough to do this for me. He said about 8 inches of drain was inside me. Sorry, I didn't get a picture of that.






And finally, here is a shot of the entire incision, about 23 cm when we measured it in clinic today. Again, you can see my skin sticking together. There is no armpit hair. I haven't had any there since the chemo. Radiation treatments must have had something to do with that too. I wonder if I will ever get any hair back there.

So, that is about it. Patti and I are scheduled to meet with the surgeon and the oncologist next Monday. I have a chest CT scheduled prior to those appointments. I am hoping for good findings and praying for a miracle for the lungs. The chemo treatments I already had were supposed to be the best there is for sarcoma and that is when it spread from my primary tumor to my lungs and spine. So, it will be interesting to see what they have planned next.

God bless you all. Thank you for your prayers.

Jim & Patti

Post Op Recovery

Good morning everyone. It is Friday, two days since my surgery. I am still in the hospital, slowly improving and feeling a little better each day.

Yesterday, I was quite tired after a very restless night. Frequent checking by the nurses kept Patti and I up a lot of that night. Pain management wasn't very good initially. I had an IV pump with narcotics in it. All I had to do was push a button and it would give me some medication. The problem was that the medication made me feel groggy and weird and wasn't very effective at pain control. Fortunately, I was able to switch to Lortab, an oral pain medication and my pain control has been much better since.

I spiked a little fever for a couple of hours last evening, but that seems to have resolved now. The wound is still draining into the collection bulb, but much less today than it was yesterday. All in all, I can't complain. I'm feeling pretty good, just sore if I bump or move suddenly.

I've had some visitors and phone calls which I appreciate. Thank you.

I probably won't post anything again until I am home in the next few days. I haven't heard yet when that will be. Just waiting for now.

God bless you all!

Jim

The Day After

This is Clint again. My dad, Jim, isn't feeling so well today so he and my mom asked that I give everyone a brief update. The tumor pictured below was actually bunched up into a ball about the size of a large orange or a grapefruit. The picture was taken after it had been cut up a bit and laid out on the table.

Jim is in quite a bit of pain today, and is suffering from nausea, but is doing well otherwise. Patti spent the night at the hospital with him and said that they both got as much rest as can be expected at a hospital (with nurses coming and checking on Jim every couple of hours, etc.)

We all love you Dad, and we're very happy to hear that you made it out of the surgery yesterday with no complications. We wish you a speed recovery from the surgery, and a quick resolution to the remaining cancer in your body.

Surgery, Play by Play

This will be a running update of today's events as they progress. Each time something changes or we hear from the surgery team, I'll post it here so that all of you can stay up to date. I just want to take this opportunity to say thank you to everyone for your constant and continued support. I know my parents have felt an overwhelming sense of love and compassion from friends, family, co-workers, etc. So many people have expressed their concern for my dad's welfare and are praying for him. My dad mentioned last night that so many people from so many different faiths have been praying for him that the only way he won't recover is if that is God's will. It is difficult to tell all of you how much all of this has meant to us as a family, but I do want to express appreciation on behalf of all of Jim's family - thank you very much.

Clint

This is a picture of the tumor after it was removed. The ruler above it is 1 foot in length!

• 7:00 p.m. - Dr. Randall just came out and spoke with us. Patti is very relieved - she has been pacing in anticipation for the last 45 minutes to an hour. Overall, the surgery went well. Dr. Randall is very pleased with the outcome, especially considering the size of the tumor and how it was wrapped around so many nerves. He said there were only two nerves damaged in the removal, both of which tie into back muscles. The only difficulty Jim should have as a result is doing pull-ups – which I doubt he has even attempted in the last twenty years. :-) The OR just called and said we could go wait for him in his room. So, the next post should be from Jim himself. Thanks again for all of the support – we're all very excited to have this behind us.
• 5:20 p.m. - A nurse just came out and let us know that the tumor has been removed and that they are now closing, which will take about an hour. After that is done, the surgeon (Dr. Randall) will come and let us know more of the details.
• 3:23 p.m. - We just received the first call from the OR. The surgery has started and everything is going well so far.
• 2:00 p.m. - They just kicked all of us out of the pre-admit room and took Jim to the OR. We have been told that the procedure could take anywhere from 2 to 5 hours. The OR nurse will call with updates every so often. Jim has been in a great mood the whole time – completely relaxed, joking around with his providers and generally just being himself. Patti is nervous but is holding up extremely well.
• 12:55 p.m. - A nurse is in the room trying to start an IV on his left arm, but struggling.
• 11:35 a.m. - We are in pre-admit room three, on the third floor of the Huntsman Cancer Hospital. Jim has changed into a gown and stockings and is waiting for an IV.
  

Good morning to everyone. Today is the big day. We are headed to the hospital for surgery. Fortunately, we don't have to be there until 11:00 a.m. so we got to sleep in. Wonderful!!

Thanks to everyone for the e-mails, phone calls, cards, notes, food baskets and goodies. I am overwhelmed by the outpouring of love and support. I even woke this morning to a banner in my front yard with balloons and blessings. I don't know what to say except thanks and I so appreciate the prayers.

We met Monday (two days ago) with the surgeon and again discussed surgery. He explained that his intention is to leave my arm, but he will have to remove a lot of tissue around the tumor and this will involve some nerves. At the least, this will leave me with some weakness in my shoulder area. Depending on how involved the other nerves (brachial for medical people) are will determine what function I have left in my arm or hand. I have had quite a bit of numbness in my radial and medial nerves over the past month or so. I don't know if that is because of the radiation treatments or damage from the tumor. Fortunately, it seems to be mostly transient - lasting only a few minutes when it is at it's worst.

We were told to expect a 3-4 hour surgery today. I doubt that I will be able to post anything new here myself, but I have asked my son Clint to post a couple of updates throughout the day as things progress, so check back often for details as they are posted.

God bless you all. Thank you!

Jim