NOT AT HOME

After spending the day with Rea, I decided the stay over at her house since Jan is away on business.  We went out to dinner and she began the feel nauseous and headachy.  Little contractions went on all day and proceeded until midnight when Shuie took her to the hospital.  As of 7:00am the contractions have not gone full blown and she is waiting for the doctor to decide whether to send her home or induce her.  And so we wait. I will run a few errands here in NJ and wait for Shuie or Rea to call and let me know what is the next step.

Isn’t it amazing? My Higher Power had a plan for me.  I am through the chemo and feeling better each day and I have this little window before the surgery starts to assist my daughter at this time.  I could not have planned this better myself.  DUH! Still trying to learn that one.  There is very little I have control over in this life so I learn to accept and go on doing the best I can.  So hard but so important.

Time to shower, eat, and pray that Rea has an easy day today.  Miracles are truly everywhere.

JUST BEING

I am planning to go to NJ this morning to accompany Rea to her doctor’s appointment.  Due Date is August 25th and this little guy is very happy where he is.  But his Mommy is ready and tired.

I am gaining some strength back but still tire easily and also less nauseous.  Since the blood numbers look good, I am feeling more confident to try more things but I never know if I have done too much until after it is done.  So, for today I will prepare to do little tasks once I return to NY.

I am grateful for a cool morning and the breeze blowing in my face.  If I close my eyes, it “almost” feels like I am home at the beach.  Another one or those daily miracles.

 

Short Sloan Visit

After a long walk to Barnes and Noble, I was having a difficult time breathing so I relaxed and went to bed. The coughing continued during the night and so at 5:00 AM I took myself to Sloan.  It turns out I have a URI and that they did the blood work I was supposed to have done anyway today. The blood numbers are looking better and so it seems the chemo is no longer killing off the good cells that I need.

Today will be a day of rest and relaxation.  I am celebrating how much better I am feeling and the my body is responding to take care of itself.  But alas, it is still nap time.  Gotta give in when the calling comes.

I am so grateful that the breathing turned out to be be manageable and not another complication.  My Higher Power sure was helping this morning.  

SOLO SUNDAY

Today is Camp Simcha motorcycle Sunday.  This is the day Jan takes his motorcycle to Port Jervis with a group of 10 others and goes to Camp Simcha to give rides to children undergoing cancer treatment. Jan has been doing this for 9 years and enjoys seeing some of the children from the previous years.  This means so much to him.  Last summer I went with him and the children, even so sick, only want to go faster and faster. This year I cannot ride on the back of the cycle for 2 hours up and back so I am home solo.  I thought of driving behind them but I think it may be too long a day for me right now. The good thing is that Camp Simcha has a state of the art medical facility there but it really is too chancy at this date.  I am disappointed since watching the joy and determination on the children’s faces is such a “miracle” not to be taken for granted.  Now I understand first hand.

Our granddaughters, Simi, and Huvi are visiting in New Jersey today so maybe I will take a ride over to see them and check out Rea’s belly too.  Due date is August 25th so we are really getting closer.

I have now gone 5 days with no narcotic drugs.  I am doing well overall but am in some pain.  Tylenol just isn’t cuttung it.  But I am more alert and stay awake longer (even all night when I’d rather be sleeping) but I am happier not taking the meds because I felt so disengaged to all that is happening around me.  I know after the surgery they will be back for awhile but for now, I want to give my body a chance to recover.

Great  miracle from yesterday: My sister’s tests came back and the spot they were concerned about is benign.  We both cried on the phone when she shared the news.  I hope I have convinced you that each and every prayer, small or large, is important in helping others recoverr and for so many other reasons.

Going to try to eat, have my discussion with my higher power, be grateful and stay out of trouble today.  I can already feel my  mind buzzing about what else I can do today.  Enjoy the sunshine.

RUGALLAH and CHALLAH

Prior to being diagnosed with cancer, I did not partake of foods that had sugar or white flour in them.  I used to be teased in the teacher’s room about how healthy I ate.  I still got cancer but I was thinner.

When my son-in-law, Shuie, proposed to my daughter, Rea, I promised I would make him Rugallah when he gave me my first grandchild.  Well the time is drawing near and I think the time to get the dust off my recipe and practice is today.  Maybe the baby will decide to come also when he smells them baking in the oven.

I will also make home made challah, my specialty. When I lived in the Caldwells, I used to teach many many women how to bake challah in my kitchen but again gave it up once it was just Jan and me for the Sabbath meals.  Well, as long as we’re fired up here, I might as well try it.

Can you tell I am feeling much better?  I even had my first dinner out in a restaurant last night with our precious friends, Karin and Gerry Feldhammer.  They asked if I was game to try it and I did.  I also ate so much food I couldn’t believe I had the ability to do that anymore. Granted I came home exhausted but I am seeing glimmers of my pre-cancer life and I am determined to get back there.

For today my prayers are going out there for many people I care about who are suffering with their illnesses.  I know these prayers work and I will continue each day to remember to cast my fears and needs to my higher power. He/she is so much better at knowing what is the right path for me.  And there is a plan.  I just can’t figure it out.  Have a contented and serene day.

 

Interpretation of scans of 8/6/2008

Naturally, there are two areas of concern, Debbi’s right kidney and left shoulder. Actually, at this point it is wonderful to say that there are two areas of concern. Through the skills of Dr. Bajorin, his team, and the nurses of the Kimmel Center chemo suite (not to mention Dr. Michael, the nurses and doctors of Urgent Care) the chemo drugs have blasted back the cancer in these areas by approximately 50%. Dr. Bajorin explained that if the chemo worked well enough to accomplish this in these two areas, we can infer that any small installations or floating units of cancer cells must have been obliterated. So, if no other sites can exist, cancer in Debbi’s body is thus limited to ONLY her kidney and shoulder. If successful surgery can remove the right kidney and clean up any cancer in and around the caracoid process, we might truly be able to say the words, “Thank G-d and the medical team, Debbi is now cancer free.”

Kidney slices

Lets look at the scans in regard to Debbi’s right kidney. The MRI and Bone scans do not describe the kidney. The PET scan and the CT scan both note, in the impressions, that the cancer in the renal pelvis had reduced. Unlike previous scans, no measurements of the current extent of the mass are provided. Following the scans, I visited the MSKCC Film Library to obtain DVDs containing all scans done at Sloan Kettering. Using the write-ups of the CT and PET scans, I loaded the actual scan images and played radiologist to see if I could see, with my own eyes, and share with Debbi, the dreaded cancer that we have been fighting.

It takes a bit of getting used to to interpret the scans… literally there are about 1,000 pictures arranged in various studies and each image is like a photo negative displayed in mirror image such that the right side of the body is displayed on the left side of the image. Starting with the scans of March 12th, I was able to locate the right kidney. The study has images of horizontal slices through the body each half inch or so. The software viewer provided with the scans allows you to travel down the body from the head to the knees watching slice after slice. When the left kidney starts coming into view, the scans show a picture similar to that in Grey’s Anatomy… yup it looks like a kidney in cross section. You can see the top of the kidney and then as additional slices come into view, the renal pelvis (where the kidney deposits the urine for the trip to the bladder) is evident. Studying the left kidney gives us a basis for comparison.

Backing up the frame viewer, we found the top of the right kidney. As we progress lower, the right kidney tissues look completely different than those of the left kidney. The easiest way to describe the image is to think of the pictures in the newspapers displaying brains from cows infected with mad cow disease. Yup, it is that different than normal kidney tissues and just as scary as the mad cow pictures.  As we progress down the right kidney, upon reaching the midline, the kidney tissues begin to resemble those of the left kidney confirming the write-ups describing the cancer as being localized in the upper pole.

With the initial picture stored for quick reference, we loaded the 8/6/2008 scans and quickly found the corresponding images. While the tissues in the upper half of the right kidney did not look like those of the healthy kidney, there were stark differences between the images from the earlier dated scans. Most apparent was that the mad cow-like structures did not go edge to edge of the kidney. Rather there was a solid dark black area from the edge of the kidney on the horizontal slice forming a border around the cancerous tissues. Using the measuring tools in the suite of the scan viewer, I was able to measure the dimensions of the cancerous volume and calculate that the cancer has been reduced by approximately 50%.

Shoulder thoughts

I did look at the various shoulder scans but the more interesting story is the interplay between the PET and the MRI scans. The PET scan said that the lesion in the left scapula is larger. The MRI not only says that the cancer has reduced but it also provides initial dimensions and current dimensions of the lesion. Dr. Bajorin explained to us that in a case of PET vs MRI for the shoulder, credence is given to the MRI. That is very good because computing the volumes from the dimensions provided, we find that the initial size of the lesion was 7.5 cubic centimeters while the current volume has reduced to 3.5ccs. Thus, the volume has reduced by more than 50%.

Surgical musings

Based on Dr. Michael Zelefsky’s guidance, we have already met Dr. Russo (kidney surgeon) and Dr. Healy (Head of Orthopedics at MSKCC). Appointments are scheduled as Debbi has written and we just hope and pray that Debbi is accepted for the surgeries and that the surgeons bring their full range of talents to rid all traces of cancer. 

 

 

Results of Scans (Pet, MRI, CT, Bone)

With apologies for not taking the time to post the results earlier, and with the advisory that people who do not appreciate technical details should skip to the next post, for blog history, I am presenting critical excerpts of the reports of four scans that Debbi underwent on Wednesday 8/6/2006.

In the next post, I will present the explanation of the scan results as conveyed to us by our medical team.

PET scan

IMPRESSION: 

Compared to prior outside study 03/12/2008

1. Right upper pole renal mass has decreased in size. FDG uptake [FDG is the radiopharmaceutical that was injected 60 minutes prior to the scan and its uptake refers to the process by which the cancer cells draw the FDG from the blood system.] within the mass may also have decreased.

2. Lytic hypermetabolic lesion in the left scapula, now larger than previous, and suspicion for adjacent new lesion.

3. Resolution of previously documented hypermatabolic aortocaval lymphadenopathy.

 

MRI of Left Shoulder with and without contrast

Comparison is made with MRI of the left shoulder dated 5/1/2008

Clinical statement: Urothelial cancer of right kidney. Scapular metastasis, status post chemotherapy.

FINDINGS: A 2.5×1.3×1.1 cm scapular metastasis at the junction of the left coracoid process and superior glenoid has decreased in size (from 2.6×1.8×1.6cm). No new osseous lesion or soft tissue mass is identified. 

IMPRESSION: Since 5/1/2008, some decrease in size of metastasis in left scapula.

 

CT: Chest/Abdomen/Pelvis w/Contrast

Compared to CT chest, abdomen, and pelvis dated 6/6/2008.

IMPRESSION: 

1. Slight improvement in the appearance of the infiltrating upper pole mass within the right kidney with slight decrease in the extend of the renal vein thrombosis extending into the Inferior Vena Cava. An area of focal atrophy posteriorly in the lower pole of the right kidney may be the residua of prior infarction. Slight thickening of the proximal ureter is stable without obstruction.

2. No hepatic metastases

3. No retroperitoneal adenopathy

4. Slight increased prominence of the branching bronchiolar thickening within the lower lobe. A small left lower lobe nodule is slightly more prominent.

 

Bone Scintigraphy

Comparison: Bone Scan from 4/7/2008

Uptake in the left coracoid appears to have increased slightly in extension on the whole body images, but this could also be positional. 

Photopenia at the upper pole of the right kidney is again identified.

IMPRESSION: 

1. No significant change, the minimal extension of activity in the left coracoid could be positional.

2. No new significant abnormal uptake identified.

 

 

 

KEEPING BUSY

Now that all the appointments are made for the next treatments phase and I am slowly getting back my strength, I am planning things for my classroom.  

It’s so hard to believe that school begins again in 4 weeks!  There is much to create to get the classroom ready for the children and I will try to get as much a possible done to make it easier for my substitute. I plan to go in for a few hours at a time to help get ready for the children as well as go over lesson plans and create communication lines to help them until I return.

I have no real plans for today except Rea has said said she would like to visit.  I welcome that time with her alone right now.

I am feeling less nauseous but still feeling pain in the shoulder.  The doctor now allows me to take Tylenol so I am off all other narcotic drugs,  Thank Goodness!  I hated always feeling out of it.  The tylenol works OK but at least it takes the edge off.  I just keep praying that my blood numbers stay up so that I don’t have another transfusion or a visit to Urgent Care.  So Far So Good.

Looking forward to a quiet day and maybe adding a few more blocks to my walk.  Nice thing about NYC, the blocks are short and measurable.  Adding more every few days.  

Time for food and meditation.  I continually have to remind myself that this journey is not over and probably will never be over and I must find those things in my life that I am so grateful for.  I am Praying hard for those I know who are having a tough go of it.  

And Now We Wait

Overall, I had a very good day yesterday with little nausea and trying foods that I haven’t had in 6 months. I am alternating between total fatigue and insomnia and slowly I think that will settle itself out. Right now I am emotionally overwhelmed that the chemo treatments are over.  I think the trauma has finally hit and I am dealing with it.  We are hoping to get a earlier consultation with Dr. Russo so that I can have the surgery as soon as I am ready.  I so want this behind me.

I plan to start making things for my classroom and working on a baby sweater for our sleepy-head.  His Mama is ready and he is also getting there but not quite.

Jan has business travels next week and wanted me to go with him but I feel safer here in NY until the blood situation is stabilized and I do want to be here for Rea.  Shira is also coming home so we can have some time together.  

For today, I am here in sunny NYC with the expectation of a few guests and grateful that I am awake and ready to  have my morning visit with my higher power.  So much to be grateful for.

THE SCAN RESULTS

And so we spent the morning at Sloan going over the scans with our doctor and to get an idea of where this disease stands.  I am sure, technically, Jan could explain it better, but from a patient’s point of view is what I can share.

The scans show that the cancer has shrunk significantly in the kidney and the shoulder.  It is no longer in the affected lymph node nor showing up anywhere else in the body.  Therefore, the chemo did its job. Now that the cancer cells are confined to those two areas the plan is as follows:  NO MORE CHEMO.  Thank God.

On September 5th. I will meet with Dr. Russo to plan for the removal of the Kidney.  I need these next few weeks to get my blood system and body back in order to be able to safely handle the surgery.  We assume the surgery should take place the second week in September.  I will also meet with Dr. Healy (orthopedist) to discuss the removal of the bone or radiation of the small area left in the bone.  With each of these procedures, I get a little closer to having this disease under control.

There are no guarantees, however, that the cancer will never return or that I that I don’t develop another type of cancer.  But those are the same odds for anyone walking on this earth.  We just don’t know where it comes from.

I am a very grateful person.  It was a fluke that this cancer was found at all and at a stage where it is workable.  For so many things that have gone so right from something so wrong I am so indebted to my doctors and the staff at Sloan.  It is amazing how I survived these last 5 months and now the trauma has finally hit me.   Chemo is not for the meek that is for sure.  There were times I just never thought I would make it.  But I am here still and am taking a step at a time to wellness.  But the tears just will not stop.

I don’t know what I would have done without all of your prayers, notes in the wall in Israel, stones, cards, daily calls, e-mails, visits, food, and overall energy that you have continually sent my way.  I am one very fortunate soul and I do not take any of you for granted.  Know that I pray for and send my energy back to each of you all the time.

PS: I am now allowed to eat whatever I want.  The first thing…………Sushi!