Chemo taking its toll...

We were able to get in to visit with Anne Marie today.  Derek, Eli, and Henry spent most of the evening with her and her new roommate.  I'm very grateful that her roommate didn't seem to mind having the boys make themselves at home in their room.  Although they are very good - most of the time - they're still energetic little boys!  Evidently they gave great amusement to those working at oncology.

Meanwhile, Ella and I spent most of our time waiting at emergency.  Ella's been having an on-again-off-again fever and pains in her lower abdomen.  We never did get in to see the doctor as by 8:00pm the boys were beginning to get sleepy and therefore cranky.  We'll be going back in tomorrow.  We were able to rule out a bladder infection before leaving.  Tomorrow the wait will continue.  My only real concern is appendicitis as my family has a history of bizarre appendix episodes.

For the few minutes that I got to see and talk to Anne Marie it was clear that the chemo is taking its toll.  She feels really sick and I doubt she got much enjoyment out of Henry and Eli's antics.  Pray for her ability to cope and to deal with her fears.  She's on less pain medication, which improves her comprehension and makes her much less likely to have to deal with paranoia, confusion, and even the occasional hallucination, but it also means that she's not able to lose herself in sleepy oblivion.  Thankfully, she's not in any pain despite the reduction of meds.

Pray for Derek and me as well, please.  We're both dealing with exhaustion brought on in part by the busyness of the Christmas season and in part by stress.  I have to regularly deal with insomnia at the best of times, but it has become worse in the past couple weeks.  Derek (lucky dog!) has no issues getting to sleep, but he has more difficulty dealing with the details of illness and hospitalization.  I've had a lot more experience with the ins-and-outs of hospital life, both as a patient and as a patient's relative, so I know better what to expect, what questions to ask, and how the system works.

Keep in mind that I've set up this blog so that relatives can post here whenever they want to add their own updates.  That way if someone's been talking to Anne Marie and has something to share (provided it's okay by her, of course) they can feel free.  Happy Christmas!

~Alisha

Painful Blessings

Christmas is almost "officially" over.  According to my husband it was about at this time that Doran Melanson, his grandfather, would say, "Well, Christmas is further away now than ever."

Today Anne Marie gave us a bit more detail on the cancer.  It is in only one lung and has not, to the best of the doctors' knowledge, spread to any other organs.  It has been caught relatively early, which is quite remarkable as small-cell lung cancer tends to remain asymptomatic until it is very far advanced.

So, although the question of why she has been dealing with so much pain is as yet unanswered, it could simply be that that pain is a blessing from God - it got her into the hospital so they could find and begin to fight this cancer!  It is so important to count our blessings, even when they come in disguise.

Happy Christmas!

Decision to Proceed

Merry Christmas!

Yesterday Anne Marie told Derek (on the phone as we couldn't get in - we had a lot to do to prepare for our Christmas Eve service) that she has decided to go ahead with therapy.  She begins chemotherapy on Monday or Tuesday.  She will have it for three days straight and then have three weeks off.  Then the cycle will continue to repeat for a period of three months.  When she begins chemo she will also begin radiation therapy.  That will be five days per week.

Today we will be visiting her in her new room in the oncology unit: 5AS.  She was able to get a bed by a window, which is good for her SADS.

She will also be beginning physiotherapy in order to strengthen her muscles and help her toward increasing independence.

May God bless you this Christmas, and please pray that Anne Marie would enjoy her Christmas as well, despite circumstances.

What is Small-Cell Lung Cancer?

Today Anne Marie was diagnosed with small-cell lung cancer. There are two basic forms of lung cancer: small-cell and non-small-cell. Here is some information from Cancer Supportive Care Programs about what Anne Marie (and we) are dealing with:

Small cell lung cancer accounts for about a 20% of all lung cancer cases. Also called oat cell carcinoma of the lung, it has the most rapid clinical course of any type of lung cancer, with average survival time of only several months without treatment. Compared with other types of lung cancer, small cell carcinoma has a greater tendency to have spread widely by the time of diagnosis and the majority of diagnosed patients also have metastases (spread of tumor to other organs/sites).

Because of its rapid growth, it tends to be more responsive to treatment with chemotherapy and radiation than are the other types of lung cancer.

Types There are several types of small cell lung cancer, defined by the tumor's appearance under the microscope. These include small cell, mixed small cell/large cell and combined small cell. It is unclear whether these types of tumor have different prognoses.

This tumor arises from neuroendocrine cells which produce hormones; under the electron microscope, hormone producing granules can be seen. These tumors, therefore, can produce an abnormal abundance of hormones which leads to their respective adverse effects.

How It Spreads Small cell lung cancer can spread via lymphatic vessels to the lymph nodes in the center of the lung, the center of the chest, in the neck and above the collarbone, and in the abdominal cavity. It is likely to spread through the bloodstream to the liver, lungs, brain and bone. Classically, small cell lung cancer presents with small primary tumors in the lung and enlarged lymph nodes.

Risk Factors

• Cigarette smokers.
• Exposure to industrial substances such as asbestos, nickel, chromium, cadmium, uranium, radon compounds and chloromethyl ether, and/or air pollutants.

Staging The detailed staging techniques and classifications used for non-small cell lung cancer are not commonly used for small cell lung cancer. Instead, the staging system focuses on whether disease is limited or extensive. The stage of the tumor (limited versus extensive) will determine the prognosis and may affect the choice of treatment.

Stage	Signs and Symptoms	Diagnostic Tests	Treatments	Survival
Limited Tumor is small and confined to the chest including mediastinum and supraclavicular lymph nodes. There is no pleural effusion (fluid around the lung).	New or changing cough, sometimes with blood Recurrent lung infections Hoarseness Shortness of breath Increased sputum Weight loss Swelling of face or arms Fatigue	Lung cancer is difficult to diagnose at an early stage; only 1/3 of patients with small cell are identified early on Blood tests: chemistry profile; examination of sputum or fluid from chest for presence of malignant cells Imaging: chest x-ray; CT scan, MRI; spiral CT scanning has been developed to identify early stage lung cancer in at risk populations Biopsy: of mediastimum, lymph nodes, chest lining Microscopy: once cells are collected, pathologists can use this to accurately diagnose small cell lung cancer	Combination chemotherapy: multiple drugs are much more effective than single-agent Radiation therapy: given at the same time as chemotherapy, this may improve survival rate Surgery: A small % of patients with very early stage disease may benefit	2 year: 20%
Extensive Tumor is wide-spread and cannot be confined to the chest	The above signs and symptoms. If tumor has metastasized, these can include: Severe headaches Double vision Weight loss Pain in bones chest, abdomen or neck	The above exams plus those to evaluate presence of metastases Scans: CT of abdomen; MRI or CT of brain; PET scans of mediastinum; bone scan Endoscopy/biopsy: fiber-optic bronchoscopy with brushings or biopsy; biopsy of bone, lymph nodes or liver	Combination chemotherapy: Different combinations may be more effective than others Radiation therapy: this may help relieve symptoms or with metastatic disease (brain, bone) but it is not necessary to the chest	2 year: 5%
Recurrent If small cell lung cancer recurs, the prognosis is very poor regardless of stage or treatment	Any of the above plus others	The above	Palliative therapy: pain relief and orthopedic aids Investigational drugs/ clinical trials	2-3 months

Supportive Therapy The importance of supportive therapy in the treatment of lung cancer cannot be overemphasized.

Quite clearly, malnutrition results in a bad outcome in patients with lung cancer. Patients must be served a palatable meal and attempts must be made to work with patients to determine food likes and dislikes.
Pain control is of critical importance, and the tools to achieve control are available even for the most advanced cases. These include the use of pain-relieving (analgesic) drugs such as non-steroidal anti-inflammatory agents, mild narcotics, strong narcotics, continuous narcotics and narcotics delivered into the spinal canal (epidural). Pain control can generally be achieved without interfering with mental competence. Nausea can be controlled with a variety of drugs
Physical therapy will help maintain muscle strength to keep life as normal as possible.

As you can see we are facing a tough battle. Anne Marie will have to decide in the next couple of days whether or not she will be undergoing treatment. Please pray for wisdom and peace.
~Alisha