Tyler's Heart

Pictures - Pictures from Houston.
LVAD Video - A YouTube video about living with an LVAD.
HeartMate II Video Clip - Short video clip about the pump Tyler has.

Another good blog to read is from our friend Bill. Cozumel Part 1 - This Might Be Habit Forming.

Friday, September 30, 2011

A Reprieve


Tyler had an oncology appointment today to discuss the results of his PET and CT scan done this week.  Both test came back negative for signs of cancer.  Yeah!

What this means is that there is no evidence of cancer at this time.  He will continue to have CT Scans (next one in three months).  There is always the possibility that there is cancer floating around that is to small to be picked up by the scans at this time, but at this time the appendectomy may have removed the cancer he had.

Since regular scans are being performed we should be able to catch signs of cancer early.
If a scan picks up signs of cancer, it could be localized or spread around a large area.  If localized there still could be the possibility of surgery to remove what is found.  If spread around, then adjunctive chemo could be implemented to prolong life but it wouldn't "cure" the cancer at that point.

So, a reprieve for now.  My attitude is to take this as a good sign and move forward.   Tyler has some possibilities of interior design clients and no signs of cancer.  My business is doing better and better and I'm still cancer free.   The animals are doing well..... life is good in this moment.

Wednesday, August 31, 2011

Try, try until you get the answer you want

Where we are now......
The abscess has now been reduced/corrected.  The stints that were placed in his colon to help drain the abscess came out on their own, so the procedure to remove them went really fast!

But that still left us with the "what to do about the cancer" debate.   We were hearing from the oncologists that Tyler needed to have a right hemicolectomy (removal of about 1/3 of his colon) and 6 months of chemo.   The removal of part of the colon (and some lymph nodes) was to determine the existence and stage of the cancer.   Obviously Tyler wasn't really into this after all that has gone on.

I was chatting with a friend of mine who reminded me that she had been diagnosed with the same cancer.  They didn't do a hemicolectomy and were just monitoring her with scans and blood work.  So we got an appointment with her oncologist.   Fingers were crossed that Tyler could just be monitored also.

We drove up to Ft. Collins, CO (about 60 miles north of Denver) for the appointment.  The doctor's opinion was that Tyler should just go the monitoring route also.   He would have recommended the hemicolectomy if Tyler didn't have his other issues going on.   He also could have seen doing chemo although it is now a bit to late to be as effective in relation to the risks posed.   He felt there was a better than even chance the cancer has not spread to the lymph nodes based on Tyler's records (previous scans and blood work).  The cancer may have been removed along with the appendix.   Tyler's tumor was a T3 which means it had invaded the muscle of the appendix, but had not advanced outside of the appendix.  Also, during the pathology of the appendix there were no tumor cells at the margins (where the appendix was cut away from the colon).  Also, the chemo that was going to be given was for colon cancer since the appendix cancer is rare and there appears not to be a chemo regimen specifically for that type of cancer.   The new plan is to do a PET scan and blood work towards the end of September and go from there.

So, it is kinda like asking Dad for permission and then trying Mom!   Keep asking until you get the answer you want.   Does this mean Tyler doesn't have cancer?  No.  Does this mean Tyler does have cancer? No.   It just means that in Tyler's situation the risks of surgery and chemo outweigh the benefits that may or may not happen.

So there is a chance Tyler is over this latest challenge, but it also may mean that the cancer is still active and may reappear other places.   But for now, the challenge is that he still has blood in his urine (only seen through a microscope) and tomorrow will be having a cystoscopy procedure to see what is going on in his bladder.

Thursday, July 28, 2011

Another Procedure

Tyler had to go through another procedure and 3 nights in the hospital last week.   He had been in pain since the appendix surgery and they found an internal abscess/hematoma behind his bladder.
Below is Tyler's posting:
Surgery Again

Yes, another surgery, I don't know how much more my body can take.

Since my appendectomy, I have had severe abdominal pain.  Initially, I thought it was just recovery from the surgery and then I thought it might be a urinary tract infection.  I consulted my surgical office numerous times but no one seemed to take it seriously.  

Finally, through the persistance of my cardiologist, I had a CTScan and they found an abssess and it had to be immediately removed.

I was only in the hospital for 4 days but enough already.

As far as the cancer surgery goes, we have decided to wait for a while and get a second opinion.  Removal of the colon, although some what common is a major surgery.  And with the LVAD it is even more precarious.

After what we went through with the appendectomy and the complications of the appendectomy we think it is wise to get a second opinion and to make the right decision.

I also think my body needs to recovery fully before yet another surgery.

Thursday, July 14, 2011

And then Cancer

Yep, I said it.  Cancer.
Tyler went for his appendix surgical follow-up on June 22nd.   The hospital had done a pathology on his appendix and found cancer.   It is an Appendix cancer and is very rare.  Found in about 1 percent of removed appendix.   The cancer was found all along the length of the appendix and may have been the cause of the appendicitis.  It is an Adenocarcinoma with Goblet cells.

Tyler called me while I was at a business lunch and said there was no easy way to tell me this, but "I have cancer".   Then he laughed a little.   Of course I said ... "Not funny."   He said what else could he do at this point but laugh.  The surgeon told him the treatment would be removal of the portion of his colon that had the cancer.

I didn't write about this in the blog sooner because we really didn't know what was about to happen.  What kind of cancer?  Had it spread?  What was the treatment?   How much of the colon would be removed?   Colostomy bag?  Why do we get to have all the fun!?

Tyler then started doing tests; Colonoscopy, some PET scan like thing, urine tests, blood tests, etc.   The colonoscopy came back normal, the scan came back normal, the other tests came back normal.  So a doctor called Tyler and let him know the good news was that they would just remove half his colon.  Tyler's response:  "Doesn't sound like good news to me!"

So we spent about three weeks saying "What?".   And we also spent three weeks going to dark places in our minds.   Does he really still have cancer?   Is it treatable?  Will he have yet another "bag" to carry around?   Do we prepare for the worst?

We decided this was enough of a "push" to get our paperwork in order.  Living wills, Advance directives, power of attorney's, Last Will and Testament.   Oh the fun of it all.  His parents unfortunately went on "alert" again.   Again, we decided to spread the word only so much since we didn't really understand what was about to happen.

On July 13, we went to see a surgical oncologist.  Please, oh please, explain this.   The doctor first came in and said when he first saw Tyler's case it was a "no-brainer".   Observation only.   Then he took it upon himself to contact Tyler's other doctors at the hospital to further discuss his case.  At that point he changed his mind.   Even though Tyler has an LVAD, his other doctors said he was very strong and should be able to handle surgery..... again.   So the doctor now was advising going ahead with the surgery.

The surgery would be a right hemicolectomy.  It would remove about 1/3 to 1/4 of his right colon.  If everything goes well there would be about 5 to 7 days in the hospital, no colostomy bag, and about two to four months recovery.  This is a preventative measure.   So at first, we thought  "forget it.... observation only."  The problem is that by the time a scan or other tests indicated the cancer had spread it would almost be to late to handle the problem.   We made another appointment with the doctor in about three weeks while we way the options.

The other issue is that with a cancer diagnosis, more than likely Tyler wouldn't be allowed on the heart transplant list.  Tyler and his cardiologist had already discussed waiting a while to see where technology went with heart pumps, so this wasn't as dire as the doctor thought it would be.  

At first Tyler thought he would just go the observation route.  But then after a little while he thought that would just delay the inevitable possibly and any pain he had he would think it was cancer.

So while a final decision hasn't been made yet, I believe we are leaning towards surgery.  Even though they want to treat it as an aggressive form of cancer, it appears we have a little time to think this through and schedule surgery.   Possibly beginning of September.

We are exhausted physically and mentally.   The doctor wants Tyler to fully recover from the appendix surgery (hence the three weeks before the next appointment).   One doctor commented that his colon was "pristine" and one of the blood tumor markers was elevated but not by much.  So it looks like we have a chance to catch our breath before the next surgery.

Wednesday, June 8, 2011

We have to go to the Hospital.


Obviously it has been quite a while since October 2010.   Things have been going relatively smoothly since then.   There have been on again, off again issues with blood pressure and his INR (blood-clotting) levels.

Two days ago Tyler started complaining about a stomach ache.   You would think this would trigger something inside of me since it was in Cozumel that he started complaining about pain.   But we didn't know if it was something he ate, muscle strain, etc.

At 5am the next morning, Tyler woke me up and said "We have to go to the hospital now."  My reaction was simply to get up, get dressed, and go.   Okay, I did brew a cup of coffee.  Being panicked just doesn't happen anymore.  

At the ER, they started running test and put him on morphine and diloted for the pain.   His white blood cell count was up and they though it might be an infection.   I was worried that his drive line might have become infected.  Once Kathy, the LVAD nurse came, I went back to the house to take care of some things.   Then I got a call and he had appendicitis.  Man, Tyler's luck is something else!

Once I got back to the hospital (the Houston flashbacks were really starting to kick-in!), they were loading him up on Vitamin K to get his blood thicker.   Of course they took his INR in the morning and it was 2.2.  Finally got it to the right level and immediately they had to start reducing the level so he could go into surgery.

He went into surgery at about 4:40 pm and  I got to wait in the waiting room.   More flashbacks.  But, I had a good book to read.   I was asked later how I could concentrate on reading, but at this point I was just taking things in stride.   Nothing I could do at this point.

Surgery was over at about 6pm.  The appendix had not ruptured, but was seeping.   The surgeons were able to get the appendix out and clean the area up, and felt good about the surgery.  They had to do the old-fashion type of surgery (cutting instead of laparoscopy) due to not wanting to expose the LVAD to infection.   I saw Tyler in ICU and he was in immense pain.   I was told he wouldn't remember anything last evening, so I got out of there quick!   He was in good hands and I needed to get home.  Yeah!  I could actually go to my house this time!

Tyler has apologized to me for "messing-up" another celebration.   When we were in Cozumel, we were celebrating the end of my cancer.   This weekend we were going to celebrate my birthday.  Oh, well.   I more than fine with him being okay.  I talked with his mother and she asked me what I wanted for my birthday....if I had anything specific I may want.  My response was, "..in no particular order, a heart, appendix, or testicle would be just fine!".

Not sure how long he will have to stay in the hospital this time (hopefully less than 4 days).  Supposedly Tyler is the first LVAD patient to have an appendix removed.  Yeah!  Another milestone!  :-)   Tyler of course had already wooded the staff and some mentioned they couldn't wait to talk to him after surgery.  I warned them to temper their expectations.  Sure enough, right after surgery Tyler was trying to sit up, wanted to go walking, and informed the staff that the oxygen he was being given wasn't doing him any good!  I was asked if I could calm him down after relating a story about Houston in which I was called by an ICU nurse to come and calm him down.   I figured the only thing that would calm him down this time was pain meds!

He is doing well so far this morning and I think he will be fine.   He is very strong and should recover well.