Happy Encounters

Last week little Will’s grandpa got to meet his first grandchild, who is almost five months old.

When Ralph arrived from Germany, he also got to be reunited with his wife Astrid, his daughter Ann Sophie, and his son-in-law Nelson. It’s difficult to understand what’s happening in the little apartment in Rochester, Minnesota, from 4300 miles away in Europe.

But now Ralph has adjusted to the medically-oriented lives of his loved ones and how things work at the Mayo Clinic. Like the rest of us, he’s learning that by the process of elimination, doctors figure out what something isn’t, before they determine what it is. And this process can be frustrating for all of us.

Last week, Nelson’s vomiting and diarrhea had increased to epic proportions. Doctors thought it might be a response to trace remnants of the chemotherapy drugs mixing with the new immunotherapy drugs. Or it might have been Nelson’s reaction to the new immunotherapy as his system tried to switch from chemo to that.

They drew blood again (almost a daily occurrence) and finally discovered he had a bacterial infection of his digestive track, which was evidencing itself in the vomiting and diarrhea. Several days after he began antibiotics, though, the vomiting and diarrhea began decreasing—much to everyone’s relief, especially Nelson’s.

Throughout this time, he’s been taking the two pills daily that make up the targeted immunotherapy, and yesterday he spent time with the head oncologist on his case and another doctor. They were both pleased about where he is with the new therapy but will keep it at a half-dose for a while longer.

In meeting with pulmonology, they learned that about 150 milliliters of fluid are still “caught” in pockets at the bottom of his right lung. Though they tried to drain it out, the regular suction method failed. They may try to get it with a needle.

If they succeed, then they’ll also remove the catheter on that side and close up the wound. The left lung still needs draining daily, and Ann Sophie does that with excellence. It remains a mystery why the right lung had initially produced lots of fluid and now has dried up, while the left lung, which hadn’t produced much for many weeks, now has more.

But that’s the way it is in the world of medicine. One issue gets sorted, but then another one appears. But we have faith in the doctors we’ve worked with thus far and have seen their expertise and determination in action. Their goal is to resolve Nelson’s cancer symptoms and the side effects from drugs until the immunotherapy and his own immune system can overwhelm the cancer. And what a happy day that will be!

“My Child, never forget the things I (the Lord) have taught you. Store my commands in your heart. If you do this, you will live many years, and your life will be satisfying.” (Proverbs 3:1-2)

Moving Forward

It’s been a busy medical week for Nelson and Ann Sophie with multiple appointments at the Mayo Clinic. Today is day #10 of Nelson’s targeted immunotherapy treatment, and like everything else, there’s an upside and a downside.

The upside is that it’s (hopefully) targeting the cancer cells in Nelson’s body, teaching his own immune system to fight back. The downside is that in these last days, after having had only mild nausea on the immunotherapy, now he’s vomiting again with greater intensity. Though Nelson had been off of all nausea medicine, not needing it, now the strongest of three med choices still isn’t helping.

In addition, his legs have become more swollen than ever (he called them tree trunks), so one appointment this week was to alleviate that. He received an IV combination of albumin (protein) and a diuretic to drain some of the fluid, which is leeching out of his veins and settling in the tissues—thanks to the cancer. The IV infusion lasted about an hour.

Since the IV, Nelson has lost eight pounds of fluid, which helped his swollen legs some. He’ll receive a second IV diuretic along with more albumin on Monday. If fluid continues to drain from his legs, bringing them closer to normal size, Mayo’s will custom-make compression stockings for him, which should help in the future.

Nelson’s left arm is also swollen, but for a different reason. A sizable blood clot is inhibiting the circulation in his arm by clogging three veins near the shoulder. (See picture.) But we learned something phenomenal about the human body today.

The doctor said that in two-thirds of people who have blood clots, the clots never resolve, even with blood thinners. In those cases, then, the body gradually begins to reroute the blood to nearby veins, expanding their use enough to move blood around the clotted area. (See the doctor’s pencil lines on picture.)

Nelson and Ann Sophie actually got to see these new veins in imaging tests today. To prevent additional clots, Nelson has learned that he’ll be on blood thinners for the rest of his life.

His medical team began the immunotherapy with a half-dose ten days ago, waiting to see if his system could tolerate it. The plan was to move to a full-dose regimen this week, but because of all the vomiting, that strategy is on hold for now. He takes one pill every morning exactly two hours after eating, and another every evening in the same way, putting the pills 12 hours apart. Ann Sophie has become a clock-watching cook and follows medical instructions perfectly.

Nelson says Ann Sophie could be an official member of the palliative care team with her expertise in administering meds and caring for Nelson’s every need, making him as comfortable as possible. She is still expertly draining his left lung daily, as well as managing their extensive home pharmacy of pill bottles. And she’s his strongest cheerleader throughout every day, without fail. We are all deeply gratef for her.

“May the God of hope fill you with all joy and peace in believing, so that by the power of the Holy Spirit you may abound in hope.” (Romans 15:13)

Cancer–Plus and Minus

Fighting cancer can be a full time job, and it’s not just the many doctor appointments and tests. It’s also the drain of committing to battle the disease. A cancer patient can fight and fight some more, yet still lose ground. Determining to continue, then, can wear a person down till there’s no fight left.

Nelson has had his highs and lows during his war against lung cancer and was pulled into another low just yesterday. Without an end-date to the cancer, it can seem like it’ll go on forever.

He and Ann Sophie were tempted to cancel a doctor appointment with a new oncologist yesterday afternoon, hoping to take a little time away from thinking about cancer, but the staff persuaded them to attend.

As it turned out, it was God’s rescue from the low. Ann Sophie said, “The doctor was very positive and filled us with hope.” He told them that Nelson had lots of reasons to be stressed but that he was handling it well, better than most in his position. This was uplifting to hear.

Ann Sophie said the doctor looked a lot like Santa Claus and made her wish they could stay and have him read stories to them all afternoon. Looking back on the day, it was clear that just when they’d needed a strong boost, God brought Dr. Santa Claus into their day.

It turned out that Nelson’s albumin level was extremely low, causing him to feel worse than usual. The doctor recommended he take in as much protein as he can eat or drink, and then as time passes, his levels will slowly rise, making him feel much better.

Dr. Santa also schooled them in how to take the first immunotherapy drugs, which Nelson did last night. The two pills, which had arrived via FedEx (one needing refrigeration) were to be taken exactly 12 hours apart, two hours after eating. So Ann Sophie went to work on making a chart to help keep things well regulated. What a blessing she is!

Dr. Santa said Nelson should be feeling a little better even at the end of the first week—more encouraging news. And it’s no small gift that the nausea of chemotherapy is now in the rear view mirror. Nelson takes no anti-nausea meds now, after having needed them daily. This, indeed, is progress!

“Better is the end of a thing than its beginning.” (Ecclesiastes 7:9)