SURGERY - Date set for next round

Patti and I met with my cardiothoracic surgeon yesterday. He felt that I was doing well and that I looked well. We talked about the next surgery and he decided that Monday, March 9th would be the date he will go after the tumors in my left lung. So that is the plan now, less than two weeks away. I cannot even begin to explain the emotions that come up when I think of going through this again. With God's help, all is possible.

During our conversation with the surgeon yesterday, I learned some things about this first surgery that I did not know. Of course, he tells me that he had this conversation with me while I was in the hospital, but I don't remember any of it, so this was all new to me.

Essentially, I lost about one third (1/3) of my right lung during the operation. The largest tumor, the one he reported was about the size of a baseball, had progressed beyond lung tissue and was invading the area in my chest called the mediastinum. This is the area between the two lungs where the heart, large blood vessels, wind pipe, esophagus (food passage), thymus (a gland), lymph glands and such hang out. The doc reported that the tumor had invaded the thymus gland and the phrenic nerve (goes to the diaphragm) so those were removed as well as the tumor and any lung tissue that appeared to have disease in it. No wonder it hurts to take a deep breath now.

In my last posting, I included a picture of some of the lung tissue that was removed, but I wasn't sure what it was. So, I'll post it again with another one showing the major resections of lung tissue from this first surgery.

















The first picture is the one I posted previously. This is the largest section removed and is the one that was invading the other structures described above and described as being about the size of a base ball. The second image, with two pieces of tissue shows what was removed from the lower lobe of my right lung. Both of these pieces contained tumor. If you click on the images, they will enlarge and you can see the rows of staples along the edge of the tissue where it was cut away from healthy tissue.

We read the pathology reports yesterday and learned that all surgical margins from this operation were clear meaning that the diseased tissue was all contained within what was removed during the surgery. A great blessing.

Thanks so much to everyone for your continued prayers. Your prayers and blessings from God are what keep us going and give us strength to face the next day. God bless you all.

Jim & Patti

I'm Still Alive

Dear friends and family, I am alive. There were a couple of moments when I doubted whether I'd make it or not, the recovery has been better than I had feared, but rougher than I had hoped.

I was discharged from the hospital on Tuesday afternoon. Since arriving home, I have struggled for physical strength and emotional stability. Thanks to my eternal companion, I am finding both.

I have no recall whatsoever of events on Wednesday following the surgery. I was on heavy doses of morphine and ketamine for pain control. Normally, in this type of surgery, the anesthesia and pain teams like to place what they call a thoracic block - about the same thing as an epidural when a women is having a baby - to provide pain control after surgery. This obviously would have been higher up in the spine than that done for having babies. Anyway, my blood platelets were still low enough that the pain team didn't feel comfortable doing it as the risk of complication would be too high. Thus, I ended up being heavily sedated for a couple of days.

I recall very little of Thursday either - I was still under the influence. Patti tells me that I was quite conversant and that I spent a great deal of time promoting the benefits of a career as a PA to a nurse that was thinking about PA school.

I also recall seeing a good freind of mine from my fire department days - 20 years ago - who is now the fire marshal at the hospital. I guess I happened to see him walk past my room so I called him in to visit. I remember the fact that I saw him and we visited, but I have no recall at all about what we talked about. Sorry Dave!

Thursday afternoon, I was transferred from the University of Utah Hospital to the Huntsman Cancer Hospital via ambulance. Clint already mentioned that in his post. My purpose in mentioning it is that I DO remember that. It was uneventful other than somewhat painful to move from bed to gurney and then to another bed.

I have a large incision on my right upper back. It is healing well and isn't too bothersome for the most part. If I bump it or something, I definately know that it is there.

I had two chest tubes hanging out of my side for several days after the surgery. I think it was Sunday that they finally took them out. Now that was an experience. Bandages were removed that had been in place since the surgery. Sutures holding the two tubes in place were cut and the PA from the cardiothoracic surgery team said, "take a big breath and hold it." Out came the tubes with one long pull. I was amazed to see how much of the tubes were actually inside my chest. I'll include some pictures below. The best way I can describe the sensation of having them pulled out would be to compare it to being turned inside out.

After the tubes were out, I seemed to improve a little each day. I was on oral pain meds after the second day from surgery - Friday I guess. My biggest challenges were coughing. That hurts like the dickens and on one occasion while I was letting myself recline gently into my bed and trying to protect my tubes and incision, I coughed really hard and felt something terribly painful in my chest pop. Right along my breast bone on the right side, right at the bottom where ribs attach, I felt like I had been shot. To this day, this spot is the source of most of my pain. It hurts to move, to breathe, to laugh and most of all to cough. I also found that the hospital beds are really hard on my back. I have had the worst back ache since the surgery. That has been my biggest challenge. I just can't seem to find anywhere to get comfortable. Either the front or the back of me just aches intensely.

Yesterday, out of stupidity or something, I skipped a dose of pain medicine. Wow, did I ever pay the price for that choice. It took a couple of scheduled doses of pain medication after that before I got back on top of it. Last night was probably the best night I have had since the surgery and today, for the first time, I am finally starting to feel a little better.

I struggled with oxygen levels at the hospital. As long as I was on oxygen, my levels were fine. Every time we tried to get me off the oxygen, my blood oxygen levels would drop and I'd have to go back on the oxygen. When it came time to send me home, they sent an oxygen bottle with me and told me to stay on it for a week. So now, I am dragging this long tube around behind me that is attached to a machine in the livingroom and blowing oxygen in my nose all the time. I don't mind the oxygen, but the tube over my ears really makes them sore.

Not much else to report at this time. I spend most of my time trying to get comfortable. My digestion has been a little messed up, but that will improve with time I am sure. Here are some pictures.

Here is a picture of part of the lung/tumor resection.













Wednesday in intensive care at the University of Utah Hospital.












Thursday in "Specialty Care" at the Huntsman Cancer Hospital. Some of my family came by for a visit: My brothers Mick and Derek, my sister Melody (from California) and her son Jordan (attending law school at the Univ. of Utah).









Getting ready for chest tube removal. My head is at the left with my right side up in this view. My new incision on my back and the chest tubes hanging down on the right.










A "better view." Incision on the back, chest tubes below. There are sutures holding the tubes in place that had to be cut. The long sutures were placed at the time of surgery and will be used to close the holes once the chest tubes are pulled out.













Here is a picture of the chest tubes once they were taken out of my chest. You can see where the sutures are that were used to hold them in place. These were at the skin level. Everything above the sutures was inside my chest. Oh joy! No wonder it felt so good when they pulled them out.












And finally, here is a picture of Bill Wong, PA-C that removed my chest tubes and also provided post operative care for me. A great guy!

Post Op Day 2

Jim and I are sitting in his room at the Huntsman Cancer Hospital. For anyone who has not seen one of these rooms, they are absolutely amazing. They are more like a nice hotel than a hospital room – except for the tubes, machines, and bed of course. From the hardwood floors, to the more than adequate square footage, to the excellent room service, we couldn't ask for a better place. He was able to move here yesterday, but had to come via a three-minute ambulance ride, even though the U of U hospital and the Huntsman Hospital are right next to each other and connected by a couple of indoor walkways. Apparently it is protocol, just in case something happens during the transport.

I (Clint, Jim's son) am still posting because the pain medication Jim has been on has been really fogging up his brain. He attempted to post something yesterday but couldn't really focus and kept falling asleep as he tried to concentrate. The doctor's have permitted him to stop taking Morphine and Ketamine, and to begin taking Lortab, so hopefully he will be able to start thinking more clearly very soon.

Yesterday Jim's blood sugar was at 179 (it should be between 60 and 100), so he had to receive a shot of insulin to get it back down to normal levels. They just took his level again a few minutes ago and it was 114, low enough that he doesn't have to take more insulin. He still has a chest tube, but the volume is steadily decreasing. Once again, we as a family want to take the opportunity to thank everyone who reads this blog and supports my dad and the family with calls, emails, comments, prayers, donations, and everything else. It is amazing, and truly moving, to see how many people love and care about my dad. We'll keep you updated as his recovery progresses.

He's Out!

The surgery is already complete and everything went well. The surgeon feels that he was able to get all of the tumors, including a piece that was starting to grow into the fat surrounding Jim's heart. It was definitely a good thing that he had the surgery now and not later, or it would have soon taken over the heart. The surgeon also removed the remainder of Jim's thymus (Jen says it is used when humans are young to develop their immune systems).

Jim will soon be taken to the surgery ICU where he will need to stay for at least 24 hours. Once he is coherent, we will be able to go visit him, but the doctor said we would have to give it about an hour and a half.

I will post some pictures of the tumors (and chunks of lung) that were removed a little later, for some reason they aren't uploading right now. The surgeon said that the main tumor was about the size of a baseball.

The "Right" Side

Jim's surgery is just getting underway, even though they took him back over an hour ago. He was in good spirits while in his waiting room, and is anxious to get this behind him. The anesthesiologist came out and told us that he is doing well. He will be breathing on only his left lung throughout the procedure - this is accomplished through a special intubation tube, which actually has two separate tubes. The two tubes allow the surgery team to only inflate the lung they want. All we can do now is wait, and it will probably be a couple of hours before we hear anything. Thank you to everyone who is fasting and praying on his, and our, behalf today.

SURGERY - Here We Go!

OK, we got the final word this afternoon. I am scheduled as the first case for my surgeon, 8:30 a.m. tomorrow morning. I was instructed to be there by 7:00 a.m. to check in at the registration desk. That means that Patti and I and the kids have to leave here about 6:00 a.m. to drive the 45 miles to the hospital. Hey, it's better than having to check in at 6:00 a.m. like we've had to do a couple of times before.

Yesterday (Monday) was pre-op day. I had some blood work done at the cancer hospital in the morning and then met with my oncology team at 10:00 a.m. My white count had improved to the 4.2 level (I needed it to come in above 4) however, my platelets dropped to 75,000 - the minimum acceptable for the surgeon. They were at 86,000 on Friday. The Temodar cancer drug messes with all of these levels for weeks and weeks after taking it. Since I took five courses of it and the effects are cumulative, well, I guess I can't expect anything different.

I also met with the research coordinator for clinical trials and discussed the trial the oncology team is trying to get me qualified for. It is called ARIAD and is investigating the effectiveness of a new drug on sarcoma. Sounds quite interesting to me. I have 13 weeks from the last dose of Temodar to start the program, so I'll have to recover from surgery quickly to get started on it. I think they said that I have until the 27th of March to start. If all goes well, my second surgery should be on the 11th of March, plenty of time.

After the oncologist, I went to the University of Utah hospital for surgical prescreening. I had another EKG, was examened by a PA by the name of "Tatum" who works on the cardiothoracic surgery team and then I was examened by a Fellow from the anesthesiology department. I had an indepth interview with both of them and with a nurse who asked me about everything in my life. It's amazing what stuff you forget until someone asks you.

Finally, they got a urine sample and took 4 tubes of blood for testing. It is most likely that I'll be getting some blood transfused during the operation, so they have all the tests going now so that they will be ready to go for tomorrow.

Patti is still not feeling very well, but is showing some improvement. She plans on being at my side come hell or high water.

Check back here occasionally for updates tomorrow. Thanks for all the prayers and offers of help.

God blees you all.

Jim

SURGERY - testing my heart

During the visit with the cardiothoracic surgeon on Wednesday, we discussed my overall health and current medications. I have a scalp folliculitis (pimples on my scalp) that I have had for years. I take a penicillin tablet every night and that keeps it under control 99% of the time.

Also, I have high cholesterol. I have had that for most of my adult life. Actually, all of my adult life - for as long as I can remember. I haven't always taken very good care of it. In fact, I ignored it for many years. I was always of the opinion that I'd rather die of a massive heart attack than rot away of some other disease. (see what I get?)

About 5-6 years ago, I started taking Crestor for my cholesterol and it has worked exceptionally well. Because of my history of high cholesterol, the surgeon wanted to be sure that my heart function was normal. He ordered testing.

Yesterday, I underwent a chemical stress test of my heart. I was given a drug called "dobutamine" while hooked up to an EKG machine and while an unltrasound technician was taking pictures of my heart. Everything went well and the preliminary report was that everything checked out OK.

I am very glad that the nurse and technicians administering the test warned me about one specific side effect of the drug. While it is designed to make your heart beat faster and stronger - the desired effect, it also creates a VERY STRONG urge to urinate. Had they not warned me about this before the test, I'd have been off the table and headed to the nearest restroom. I have only experienced that same intensity related to the need to urinate when I have had a prostate infection (twice in my life).

I have more testing on Monday (blood) with hope that we can move ahead with the surgery on Wednesday. I'll update things when we have the results.

Jim

SURGERY

Hi to everyone. I am amazed by everyone's kindness and attention. I am often asked when I will again update this blog by family, friends, neighbors and even strangers. Thank you everyone. If by some small measure, someone is inspired or encouraged by what it written here, then this has been worth it.

Patti and I met with the cardiothoracic surgeon yesterday. I had a CT scan in the morning that showed only minimal changes in the existing lung tumors. There were no new lesions and no significant increase in size of any of the others.

The surgeon reviewed the CT images and then discussed his plan. Essentially, next week on the 11th, I'll go in for surgery. This will be at the University of Utah Medical Center in Salt Lake City. The caveat would be that my blood has to have recovered sufficiently by then to allow the surgery. If not, it will be put off until the next week, on the 18th.

He explained that the goal would be to survey the entire lung and remove any suspicious tissue and of course remove the obvious tumors. This would all be done through an incision about 5 inches long on the right side of my chest. I can expect to be in the hospital for 3 to 5 days and then in about a month, return for a repeat performance on the other side. The right side will be done first because that is where the largest tumor is. Check out the CT images posted previously.

It has been five weeks since my last chemotherapy. I am just now starting to feel like I have some strength coming back. Last week was totally exhausting. Each day is a little different. Some days are pretty good and some just aren't. I still have this nasty chemical taste in my mouth that is really annoying, but food is finally getting better and the nausea seems to be easing off some.

God bless you all. We will try to keep you posted on the developments as they unfold. On the day of surgery, I'll ask my son to post updates here to keep everyone posted on how the surgery is going.

Jim