We Are Not Finished Yet...

We have had a pretty eventful week.  I have held off blogging for a few days while I tried to wrap my brain around everything that we have been through and what we still have ahead of us.  

Tuesday we headed down to SLC for an early appointment for a Pulmonary Function Test.  Trent had to do all this breathing while they monitored and measured everything on a computer.  It looked awful.  I was trying to do some of the breathing requirements with him to see how hard it was.  It was dang hard and I have full lung capacity!  He was a  trooper though and while his breathing is decreased, it is what they expected to see.

We met with Dr. Carr to discuss our options.  He proposed an extra pleural pneuomonectomy.  It is the same surgery we were scheduled to have in Boston but without the interoperative chemotherapy.  They also do not think that photodynamic therapy (which is what we would have had in Philly) is the best option for Trent.  So, Dr. Friedberg from the U of Penn has agreed to fly to SLC to do the surgery with Dr. Carr.  They will remove the entire left lung, the pleural lining, possibly some of the pericardial sac, and possibly some of the diaphragm.   The plan is to follow up with a few more rounds of chemo and about six weeks of high dose radiation to the empty chest cavity.  During surgery Dr. Carr will go straight for the pericardium and if there is a tumor there, they will back out.  There will be nothing left to do for Trent if that is the case.  Yeah, that was a lot to swallow.

We talked about the test results of the previous days.  The CT scan showed the big tumor is still shrinking but only by about a centimeter each direction.  We did not see the scan but they said the tumor looks like a big doughnut, all dead in the middle.  Yay!  The PET scan was also good.  No cancer anywhere except the lung.  However, they can't see cancer in the heart with a PET scan because the heart is already lit up.  The last PET showed Trent's activity number to be 31.  Normal is 2.  The places that read activity are your brain, heart, and kidneys.  Anything else is likely cancer.  This time his number was 6!  Can I get a 'Hallelujah'?!  That was great to hear.  That most likely means that the majority of his tumor is dead, or at least has very decreased reproduction.  The tests on his heart all came back normal, but we still haven't heard the results of the Cardiac MRI.

Dr. Carr told Trent that he would likely been on oxygen the rest of his life.  Any time anyone is sick, Trent would need to wear a mask and really protect his other lung.  Mentally it will take a little bit to get to the point of acceptance of being on oxygen forever.  I really don't think Trent will have to be on oxygen.  Dr. Carr pointed out that we don't really know what Trent will do...he has already blasted through every odd that was put before him.  So, it would surprise no one if he came out of this better off than he is now.  While Dr. Carr was talking I was scribbling notes and trying to stay calm.  Eventually I had the calmest feeling come over me.  At that moment Trent was saying to Dr. Carr that while this was a ton of information, and obviously a risky surgery, he was calm and felt like we should do it.

Dr. Carr said that for the longest time we have been seeing the light at the end of tunnel but were not really sure if that light was a train.  He has hope and believes there is a possibility that it is not.  So do we!  Dr. Carr admitted that he was nervous and  a little scared about this surgery.  I actually think that might be a good thing.  He is going to be meticulous!  He already is...with all the tests he has requested it is clear that he is crossing every 't' and dotting every 'i' before opening Trent's chest.

We left Dr. Carr's office and went back to the 'U' for a meeting with a cardiologist.  We had a newbie who had to be about 25 come talk to us first.  When I told him the procedure Trent would be having he had to break the words apart to figure out what it was.  Several medical professionals have had to do the same thing.  Finally the cardiologist came in.  He looked 14 but said he was older than Trent.  He said Trent is a 'low risk on an intermediately risky surgery' as far as his heart is concerned.  He did note that Trent's heart rate was about 118 and suggested that he begin taking a medicine to slow his heart rate, Metoprolol. I am not sure that he really needs it, I think he was just a little anxious because of everything he had just learned from Dr. Carr.  Dr. Mitchell, the cardiologist recommended having a stress test done the following morning.

Then we went back to the Hunstman to have a pre-op meeting with the anesthesiologist.  I am not sure why since surgery is not scheduled until April 23.  Anyway, while we were there Trent's heart rate was still a little high at 118 but the blood pressure cuff was not working so the nurse went to go get another machine.  While she was gone I asked Trent to humor me and sniff the peppermint for a bit.  In the two minutes it took the nurse to get the machine Trent's heart rate dropped to 103 by smelling the peppermint.  Hmmmm....I sure do like that stuff!

By the time we got home that night we were both exhausted.  Neither one of us made it past the living room.  Trent crashed on the couch on I slept on the recliner.  Unfortunately we were up even earlier the next day for more testing and chemo.

Wednesday Trent had to do a stress test, chemically, not on the treadmill.  We decided that with his leg issue it would be too hard for him to walk quickly on an incline so they gave him Dobutamine to speed up his heart so they could take pictures of it under stress.  They told him that in men it often makes them feel as though they have to use the bathroom but they really don't and the feeling passes after a while.  Sometimes men even beg for a urinal.  A few minutes into it Trent loudly announced, "I just urinated!"  That about sent everyone into a panic until he admitted he was kidding.  Sheesh!  As the medicine continued to raise his heart rate it got worse and worse.  It was awful to watch.  He was shaking and breathing really shallow, he was anxious and really wanted to get up.  All during this his blood pressure was dropping like a rock.  Then he got nauseous.  I ended up massaging his head while holding the peppermint under his nose.  They gave him some fluids and Metoprolol to bring his heart rate back down and raise his blood pressure.  By the time he was finished he looked pretty beat up.  Not the most fun morning...and he still had chemo to look forward to!

Trent-Stress Test

By the time we got to the Huntsman Trent was feeling horrible.  When I checked us in I requested a bed for him.  He was really feeling sick so they gave him an Ativan which he promptly threw up, along with the small bit of juice and water he had just had.  The nurse started his pre-meds and we monitored his low blood pressure for a bit while we were waiting for his labs to begin chemo.  Within about two hours he was feeling much better and was able to get up to the bathroom and have a little lunch.  He looked much better and his vitals were fine.  Too bad the poison being pumped into his veins would change all of that just a few short hours later.  Poor guy!  He really took a beating that day!

We are now in the grips of Round 26.  We had a rough morning and I will blame the Neupogen shot for that.  I hate this day in chemo.  It is "crazy day".  Trent usually gets really emotional and is sure he is taking his last breaths.  He says things like, "Make sure the kids know that I love them," and wants to make sure his funeral plans are in order.  Then it is my job to talk him down from all of that and reassure him he is not going anywhere yet.  Man, I hate this day.

Luckily, there is a new day waiting for us.  We feel very blessed that Trent has this chance for surgery and that the doctors are willing to do it for him.  We are anxious.  We are scared.  Yet we are at peace.  I know that the feeling we both felt while visiting with Dr. Carr is a confirmation that this is the right decision.  When we are scared or nervous we can remember that feeling and remind ourselves that it was reassurance from the Lord.  Whatever the outcome is, it was what the Lord wanted for us at this time.  That brings great peace to my trembling heart.