As a young physics student years ago I came across a dramatic photograph taken at the Princeton University. It showed the then current research system attempting to generate nuclear fusion. At the heart of it was a machine that attempted to confine a high temperature plasma. But it was unstable. So a second machine was added to attempt to stabilize the first.. But it too had an instability. Thus a third machine was added to it to overcome its instability. And so on. The photo showed all these machines lined up one after another as each attempted to overcome the deficiency of the one in front of it.
I was reminded of that photo today during Susan's chemo. Today was her big one (the third) in which both cisplatin and topotecan are infused. Since each causes nausea, they give her several anti-nausea drugs. But these in turn cause her to feel like she wants to jump out of her skin. So they give her yet another drug to overcome this effect. And since it didn't seem to work completely, they gave her a second dose. This caused her to go into a semi-somnolent state:fighting to stay awake yet having realistic dreams with her eyes wide open. Poor baby!
Despite all this, the long chemo was otherwise uneventful. We even finished an hour earlier than planned. She is now resting and recovering. Our hope is that the weekend will see a minimum of the usual side effects. We appreciate your prayers.
Just a quick note to say this has been Susan's best post-surgery week so far. Her energy levels are higher, she's been eating much better, and has suffered very little pain or "ickiness." It helped, of course, that she had no chemo this week. We praise the Lord for this "good time" and thank you for praying for her. We continue to ask for your prayer support as she undergoes the big chemo next Thursday. Thanks!
A faithful reader of this blog, and long time friend of our family, Jeff Colarusso (Newton, NJ) writes:
"It's been a great week, topped off by 3 Dishman e-mails. Reading them and looking at your web site has brought on a flood of memories of school, church, sleepovers, etc. I've spent the better part of the past three nights reading the "Susan' medical page", being moved to laughter at the "Awake O Shopper" post, and moved to tears as John described the helpless feeling of seeing the love of your life in pain. What a testimony to God's grace and comfort this page has been! I'm sure God has given you many opportunities to use this situation as a positive witness.
While reading, I've seen you talk about Dr. Munoz, and how God brought you to him through an insurance glitch. I didn't see anything on the page about exactly how you were led to him, so I was wondering if you could tell me how it came about...."
Thanks for your comment, Jeff. I thought others might be interested in the answer to your question, so I am posting it here.
The story begins way back in 1990, when Susan was first diagnosed with breast cancer--during the same year as her mother's diagnosis with the same disease. After surgery Susan began chemotherapy at the local cancer center under the care of an oncologist who eventually cured her of the disease. The same oncologist also treated her mother prior to her death in 1993. So, when Susan had major surgery and was diagnosed in May, 2000, with ovarian cancer, it was natural that she resume treatment with the original oncologist. She did, and the standard treatment put her into remission. Then in July of last year the scans and tumor marker tests indicated that the cancer had recurred. We consulted with Susan's onocologist, with her original surgeon, with a liver surgeon, and even went to M. D. Anderson for a second opinion. All agreed that surgery was not appropriate, and proposed that a second round of chemo using a single agent, taxol, would be the best course of action. We complied with this advice and indeed, the taxol seemed to bring Susan again close to a remission. Then in November her markers went up again. About that time, our insurance company (associated with my former employer with whom I am considered a retiree) and the medical oncology group had a major falling out about money. They continued at loggerheads (even now) and thus all of us associated with this insurance company were forced to find other practitioners. This was devestating to Susan, who had high confidence in and affection for her current doctor. But as in the case of Joseph in Egypt ("you meant it for evil, the Lord used it for good"), the Lord was directing us to a radically different approach to Susan's illness.
Our new medical oncologist suggested consulting with Dr. Munoz about possible surgery. He had even sent his own mother to Munoz, so this was a strong endorsement. Dr. Munoz stated very strongly that Susan should have had surgery back in July, and she should definitely have it now (February). His opinion drove me to research the medical literature on my own, and sure enough, verified his assertion that "surgical debulking" for recurrent ovarian cancer is associated with lengthened survial times. As you know from reading these pages (see for example "Life Saver") the cancer had spread much more extensively than the tumor markers and scans had indicated. Had it not been for the insurance glitch, it surely seems likely that Susan would be in very poor shape today. We are fully convinced that through these circumstances--which were hard to accept at the time--the Lord was leading us providentially to a better way. We continue to depend on that loving providence as we run the marathon of ovarian cancer.
Susan completed her 2nd full cycle of chemo (1 cisplatin + 3 topotecans) yesterday and now has next week off. Today she is recuperating from yesterday's topotecan (also known as "Hycamptin"). She's felt sluggish and "icky" most of the day, which was spent mainly lying on the couch reading. We're hoping by this time next week that she'll feel more like her old self. She continues to give herself 3 shots a day to prevent blood clots and to enhance the bone marrow development of white cells. This isn't much fun for her: she's starting to feel like a pin cushion. But she never complains. She's a great marathon runner!
We received two pieces of good news today. First, Susan had recovered sufficiently to be released from the hospital. She is now at home resting comfortably. The chemo (they used the lower dose, more about that later) caused some nausea during the night and this morning, but she seems to have recovered from that now.
The second piece of good news came from Dr. Mirtsching, who walked in her room and personally handed her the report of her last blood test. It shows her CA-125 (tumor marker) had DROPPED to 26! This indicates that the chemo is working. In particular it shows she is "platinum sensitive", i.e., her tumor still responds to a platinum-based drug (cisplatin) which, as Dr. Munoz later remarked during his visit, is the most important weapon in the battle with ovarian cancer. Because of this, less topotecan is needed (hence the lower dose) thereby reducing the risk to clobber Susan's white counts. Next month, however, they will increase the topotecan dose because--again in Dr. Munoz's words: "we need to be very aggressive with this cancer."
So, to all of you who have been faithfully supporting us with your prayers, know that the Lord has graciously responded with this wonderful outcome that "makes our joy complete" (John 16:24). Thank you!
Susan is feeling MUCH better today. So much so that we have been strolling the halls while she pushes her IV pole. On one of our strolls we encountered Susan's nurse, of whom we inquired why the chemo had not yet been started. It was scheduled for 11 AM, but not started by 1 PM. She indicated that the surgeon and the oncologist were discussing the dose. Apparently the surgeon, concerned about the cancer, wants the dose higher than planned. The oncologist, concerned about the big crash in white counts last time, wants to keep it lower. It will be interesting to see what the outcome is. My guess: they'll compromise on half way between each one's target.
Susan had a very restful night after yesterday's procedures which resolved the intestinal blockage. Today she will have chemo (topotecan only) in the hospital. Regarding the anti-coagulant, both doctors agreed that the LMWH was the way to go, assuming that Susan can successfully give herself two shots a day (they sting!!). Visitors should be OK after noon today. She is in Room 561 at Medical City, 972-566-4790.
We've really appreciated those who have dropped by to visit Susan the last few days, some from reading this web page. Today (Wednesday), however, is not such a good day to visit given the nature of some of the sensitive medical processes now going on. Thanks for understanding.
"with my God I can scale a wall " (Psalm 18:29b)
After talking with Susan's oncologist yesterday, and researching the Interent, we now realize how big a wall the Lord allowed Susan to scale. Pulmonary embolism (PE) is the 3rd leading cause of death in the US, and is often undetected except by autopsy. Its symptoms are subtle: short-windedness being the major warning sign. Looking back we can see that Susan's abdominal pain--which proved to be not so serious--was the mechanism the Lord used to get us to the ER in order to address the much more life threatening issue of PE.
Today we are in the throes of a decision about her long term treatment to prevent further PEs and DVTs (deep vein thrombosis). The latter you might have noted in the press as being a real risk to travellers on trans-oceanic flights who sit for long periods in one position. Because Susan has had a PE she is at risk for future recurrences. The standard treatment is to take an anti-coagulant for 6 months. There are two choices: 1) an "old" oral medication, coumadin; or 2) a new high tech medication known as low molecular weight heparin (LMWH). The former is hard to regulate and is less effective than the latter. But the latter has to be injected twice a day, and has as a risk the paradoxical effect of causing a massive thrombosis (blockage) in a small percentage of patients. So it's not a no brainer. To make matters even more difficult, two doctors are recommending two different medications and we have to choose. We would appreciate your prayers for wisdom in this matter.
Susan had a good night last night, helped by a dose of demerol. Today she begins the cleanout phase for her intestinal blockage now that she is able to get our of bed. We will appreciate your prayers for that also.
Yesterday Susan's legs were scanned by Doppler Radar to look for blood clots there, since "thrombophlebitis" (blood clots in the legs) are not an uncommon side effect for those with cancer. The scan showed no clots. However, Susan's comment that she felt a cramp in her left calf on Sunday night suggests that it was indeed the origin of the clot in her lung. The latter has reduced her lung capacity by 20%--temporarily until the blood thinner dissolves it. She continues on oxygen until then.
Last night Susan slept better and this morning has less pain and more energy. She's eating more as well. Yesterday she was confined to bed to lower the risk of a clot dislodging. Today they will let her sit in a bedside chair briefly. Tomorrow she will be able to walk around some. We are hoping she will be home by the weekend. We continue to appreciate your prayers for her safety during this time.
Just returned from the hospital with only a few hours sleep, so hope this is coherent. Susan's intestinal blockage was causing her much pain, but is not serious. Basically can be solved with a laxative. More serious is a blood clot in her lungs. While the clot itself is not of major concern--although it makes her short of breath--the source of the clots is. They suspect her left leg where she has experienced cramping. They plan to do a Doppler radar study to determine and eliminate the source. Currently, she is on blood thinner and resting relatively comfortably. Her sister Shari--in town for the Easter holidy--is with her while I try to catch up on sleep. We will appreciate your prayers for Susan's safety during this period, since blood clots can be very serious; and for her pain to subside as the intestinal issue is resolved.
Susan was admitted last night at about midnight to Medical City with an intestinal blockage. John will have more information this morning about what the doctors have found and whether this means that the cancer has come back aggressively or whether something else is going on.