64

Mama with Ed

Ed turned 64 this past Sunday. He had a 'fair' day. He slept a lot, waking up for a few minutes ever so often. He woke to people who love him. People who were waiting to see his eyes open to wish him Happy Birthday and to kiss him and hold his hand and just love him. The Lortab he takes for the head pain makes him sleepy and loopy.

He had visitors through out the day...there was cake, cupcakes, and pie. He got a bite of most of them. 

His family and friends praise God for another birthday for Ed.

March: A Time of Change

                (Ed getting kisses from pet dog, Charlie)

March has brought change. The time has changed...it now stays daylight until bedtime. The weather has changed...we have actually seen signs of spring with warmer days and clusters of blooming daffodils. Edward's health has changed...he is in decline.

The second week of March brought a rather dramatic change in his health. Several mornings in a row, he became nauseated and vomited. This is something he never did with radiation or the two different types of chemo therapies he took. He began having episodes of coughing to expel mucous; coughing that lasted many minutes and left him gasping for breath and red in the face. But after the mucus was expelled, he could breath better and stopped coughing. He began having difficulty with chewing and swallowing meat and some other foods.His urine and sweat had a strong, distinctive odor. For the first time since this all began in November, 2008, Ed asked for pain medication.

Me and other family members began talking about hospice, in and out of his hearing distance. He and Mama were still resisting.

After two weeks of these changes, and after a particularly bad weekend, Mama finally called me last Tuesday morning and said it's time. I immediately hanged up the phone and dialed the number for the hospice center we had discussed using. After just a few minutes of discussion with a lady at Odyssey Hospice, the wheels were set in motion.

First, his oncologist had to provide Edward's medical records and give his consent that Ed was in a situation of 'end of life' illness. This was completed within hours. Then we set up an appointment for two representatives from Odyssey to come out to complete paperwork and give Ed a health assessment. They came the next day, Wednesday, at 1:00pm and the paperwork and assessment were complete by 6:30pm.

During this visit, it was explained to Mama, his primary caregiver, what Hospice is, what it does, what it won't do, and what to expect. There was a mountain of paperwork to fill out (by the RN) and be signed (by Mama). She was nice, pleasant lady, age 71, and she was methodical in her method. After all the paperwork was finished, she checked out the patient as he lay in his electric bed.

She said Ed's pulse was good, his temperature normal, his blood pressure slightly elevated, his heart rate good,  his breathing rate fine and his lungs clear (which surprised me). She measured the circumference of his right arm and asked him a few questions. She checked the place on his right ankle and confirmed what we already knew, that it was a bedsore. She treated and wrapped the bedsore and was on her way.

Hospice services began the next day, Thursday. His nurse, Deirdre, came and checked him out and a man delivered some supplies and a rolling tray and oxygen machines (for later use if needed) and a new mattress that helps prevent bed sores. Later in the afternoon an aid came and bathed him as he lay in bed.

This was all good, but the two things that Mama needed help with most was not being done...getting him to the toilet to have a bowel movement, and first thing in the morning his clothes and bed needed to be changed due to the excessive urination that happens during the night. The RN had told us she didn't really have a solution for these two problems. She thought it would be best if my brother continued to come in the evenings and get him on the toilet, but that was part of the reason we called in Hospice is because my brother is breaking his back picking up our Dad. As for Ed waking up in a pool of urine and sweat - the RN said the aids could only come as their schedules allow. All they could really tell Mama was that they would be there before noon, or after. 

Mama asked if the nurse could put in a catheter for Ed, so he would cease to urinate on himself all during the night (even with her assisting him two or three times during the night) and the nurse agreed that was a good idea. Praise God, it does seem to have helped with the problem of him waking up in the morning drenched head to toe. Now it is okay if the aid who comes to bathe him is running late and perhaps not there until later in the day.

My brother is still putting our Dad on the toilet most every day to try to help him toilet. Mama has tried to convince Ed to just go in his 'pull ups', but he is having a hard time with that, and I can't say I blame him.

As the new week began, and Hospice began, Ed begin feeling better. He stopped having nausea and vomiting, and resumed eating. Granted, Mama has cut out most meats and other foods that he easily gets choked on, but he is still eating well considering. He drinks anywhere between 3 and 5 bottles of Ensure a day. He became more alert and back to 'his old self', as he was a few weeks ago. 

I feel like the biggest change that has occurred in the past week is the level of pain we feel Ed is experiencing. We knew he sometimes had headaches and there are places on his body that hurt if there is too much pulling and tugging or pressure is applied. But now, we find that he will grimace in pain. He still will not call out, or even ask for pain meds. But if we ask him if he is in pain, he will sometimes admit it. And if we ask him if he wants a pain pill, he will sometimes say yes. Hospice gave us a chart to use, to judge his level of pain, and for the most part it is helpful in determining if he needs medication.

Edward hates being 'zonked out' on the pain meds, but sometimes we feel the pain is greater than he will admit, and so far have been able to ease him with half a Lortab. He has also taken half a 30mg Morphine tablet at two different times, which really 'knock him out'. He doesn't like sleeping all day and missing out on life, so Mama only gives it to him when he appears to be in real pain. (signs...grimacing, squeezing his fist, rigid body, sweating). Mostly, so far we have only seen the grimaces, and sometimes some sweating.

He continues to have seizures. They come approximately 1 week apart. Sometimes so mild that mostly there is just a bit of tremor like jerking and eye blinking. Sometimes a bit longer, a bit more jerking, and either eye blinking or staring. I witnessed one today, and it did not seem as violent or whole-body-encompassing as they have in the past. His eyes stayed open wide and staring. He did not lose consciousness and seemed aware that we were talking to him. I cried. Not because I was scared, but just saddened. When the seizure, which lasted between one and two minutes, he came to himself rather quickly and seemed okay. Note to self: His left side, the side which is not completely paralyzed, was involved in the seizure...jerking of the leg and clenching and spasms in the hand. But his paralzyed right side did not appear to be involved in the seizure. Hmmm.

Ed has exceeded, once again, the life expectancy that his doctors predicted. He has lived nearly two weeks past his last expected 'expiration date', if you will. As always, his will to live far exceeds the doctors idea of when his body should shut down and stop. 

But, it is apparent that his body is tired, his organs, perhaps, slowing shutting down. No one lives forever on this earth, and the inevitable is, well, inevitable. But at least Mama has finally convinced him and herself to bring in help to get to the end with help. A nurse comes in and checks his vitals and makes notes in a book for us to review. An aide comes and bathes him and changes his sheets to make his body and bed clean and fresh. Equipment and supplies are brought and eventually, when the medication on hand runs out, they will provide more, and the manufacturers who make his seizure medications have agreed to continue providing those medications at no cost. Hospice will also provide a minister when and if needed or desired. 

March is a time of change. Some good. Some not so good. But as the saying goes, the one thing that remains constant, is change. 

End of February Update

Hoyer Lift

Ed is still hanging in there, but NOT hanging in there .  (You will understand after reading this entire entry).

He has been pretty much the same since his last doctor visit in January. His health remains about the same. 

• He remains mostly immobile. He still has use of the left side of his body. But since the right side does not work for the most part, the left side can only do so much. He shaves with an electric razor, eats, uses the controls for his bed, etc., with his left hand.
• He must remain in bed until someone takes him out and puts him in his wheelchair or recliner.
• His weight appears to remain the same. He eats pretty much anything.
• He doesn't like Gatorade as much as he has in the past, he drinks more Ensure.
• Except for a few words, he remains without speech ability.
• He still loves to watch Westerns on TV.

A few days ago, a friend of the family had a Hoyer Lift delivered. The first day it was delivered and demonstrated, my mother was very pleased with it. I knew that would be short lived. After a couple of days, Mama decided it was more trouble than it is worth. It doesn't help that my brother won't use it. Mama was able to operate it, but said it is too big and bulky and hard to move around to make it a useful item. If you haven't figured it out yet on your own, we have some really stubborn people in our family.

Members of the family and friends still continue to help when and where they can by bringing food, care items, and visiting to try to lift Ed's spirits, and Mamas.

Ed's former oncologist, Dr. Splichal, must have instructed his staff that as a former patient, Edward can no longer receive any type services, for I have placed three calls asking for advise or assistance of some sort, and my calls were not returned. I can understand not receiving any type of service or product, but advise or guidance I would think would be provided at least until a new doctor could be secured.  We must find a general practitioner or family medicine type doctor to treat Ed for things such as high blood pressure, cholesterol, colds, etc. My sister-in-law finally got someone at the oncologists' office to speak to her. She explained that yes, Dr. Splichal has released Ed as a patient, and he is not receiving treatment for his GBM brain tumor anymore, but he is still alive and needs his blood pressure medicine, would they please give him one more refill until a new doctor can be found. 

I was extremely pleased with the care and treatment Edward and myself received while he was a patient of North Georgia Cancer Center in Athens, Georgia. The nurses, technicians, office personel, and doctor were very caring and helpful. We were always greeted warmly, and Ed was treated with respect, compassion and given good care. We were given advise, medical treatment, and patient assistance as needed, and almost always with a smile. But when Dr. S said he is released as his patient, he wasn't kidding.

I myself, would opt for Hospice care now, if it were my decision to make. But Mama (and probably Ed also), are not ready for that. They still do not want strangers in the house. Ed may have a brain tumor, but he is still aware and I think does not want a strange person undressing him, bathing him, or cleaning him after using the toilet.

Ed still does not qualify for Medicare or Medicade or any home health care, except Hospice. He does get Low Income Assistance through the hospital in Athens. This covers emergency room visits, hospital stays and tests. But not doctor visits for colds and aches and stuff like that. He also receives help with his two most expensive (very expensive) medications, Lyrica and Dilantin, which he takes to control his seizures.

Yes, he still has seizures. They come approximately every two weeks. Sometimes just small little ones, but sometimes bigger, more severe ones. But thankfully, he still does not lose consciousness nor do they last more than a few minutes. 

The Hoyer lift is on the front porch, 'out of the way'. Mama says she can move Ed better without it. Therefore, he is NOT still 'hanging in there'.

All we can do is take one day at a time.

He keeps on tickin'...

...like a Timex watch!

Three weeks ago Ed had his last visit with Dr. Splichal, his oncologist. At that appointment, Ed was told the tumor in the left side of his brain had not shrank from the last round of chemo, but instead, had grown. According to the MRI done just the day before, it had grown enough to shift his brain one half inch off center.

All chemotherapy has been halted. Ed had already decided to opt out of his last two chemo treatments of the Avastin/Irinotrican cocktail. Dr. S also stopped the blood thinner, coumidin, stating he was in more danger of bleeding to death (in the event of a cut/hemorrhage) than of dieing from a blood clot. Dr. S increased Ed's dosage of the steroid from 1mg a day to 16mg a day to help with the swelling of his brain, which according to the MRI, is significant.

Other drugs, both prescription and over-the-counter, Ed currently takes are Lyrica (for seizures), Dylantin (for seizures), a high blood pressure medication, a cholesterol lowering drug, a stool softener, a Centrum 50+ multi-vitamin, and Prevacid (for stomach acid). There are other drugs he takes on an as needed basis...two different types of inhalers for his emphysema (wheezing), Tylenol for headaches/aches & pains, Lortab if he needs something stronger, and Morphine tablets in case it gets really bad, Mucinex and Benedryl as needed for runny nose, nausea and anxiety medications are on hand 'just in case'.

Ed's day begins early, usually sometime between 6:30am to 7:30am, when Mama gets him up and changes him and washes him. She then cleans and changes his bed. He sits in his wheelchair while she makes breakfast, perhaps taking his pills (twelve in the a.m.) while she prepares. Breakfast usually consists of sausage and biscuits and scrambled eggs, but sometimes there are smoke-links (hot-links), bacon or ham, gravy, grits or oatmeal, and sometimes pancakes.

Most mornings, my uncle Mert (Mama's brother) comes to get a biscuit and bring Mama the newspaper. Mama will go out and feed the cats and dogs and let them out of their pens for the day. The day is spent watching TV, reading, visiting if anyone drops by, quilting, lunching and napping. Ed loves westerns, and Mama loves court TV, so those are the two most watched things each day.

In the evenings, Mama makes dinner and sometimes has to wake Ed from his nap to get him ready for dinner. He can sometimes feed himself with his left hand (he is right handed, but his right hand is almost totally without use now), but sometimes she has to feed him, especially if he opts to stay in bed to eat. Usually an hour after dinner he takes the p.m. pills; all ten of them. The rest of the night is spent either visiting with friends or family who have come by, or watching country music shows, or Repo, Cops, or a reality TV show about living in Alaska.

Mama usually has the job of moving Ed from the bed to his wheelchair, from wheelchair to recliner or toilet, and back to the wheelchair or bed, by herself. She is pretty tough to be 72 years old, but Ed is heavy at 185+ pounds and he is unable to help as all the strength and use is gone from his legs. Most of the time, she does okay with him, but at times he gets off balance and sinks to the floor. At those times, she tries to get him up on her own, but often has to call my brother (who lives about three miles away) or a neighbor (about a half mile away) to come assist her on getting him up.

We have asked Mama to let Hospice come in and help, but she is not ready for that. The word 'Hospice' invokes such fear in the minds of the sick or the caregivers/loved ones of the sick. When you hear the word 'Hospice', you think 'death', 'morphine induced coma', and 'bossy nurses' who come in and take over. Mama (and Ed too, honestly), don't like the idea of a stranger coming into their homes. I know Ed does not want a stranger feeding him, bathing him, seeing him naked, or handling him. I know as long as Mama is physically and emotionally able to do it herself, she will.

Our friends and family have rallied around to help as much as we can and as much as they let us. When people get older, the one thing they are afraid of losing (other than their spouse), is their independence. Older people dread the day they are no longer able (or allowed) to work, drive, or live alone. The longer they can delay the end of these things, the better they feel. Me, my brothers, sister-in-laws, aunts and uncles, cousins, and Mama and Ed's friends do what we can do to keep them as independent as possible. But shopping, cooking, cleaning can only go so far. Mama really needs someone to come in and help with bathing, lifting, changing, but she isn't giving in to it just yet. They have no insurance for a home health care nurse, and Ed does not qualify for Medicare/Medicaid yet (he is on disability - 14 months down, 10 months to go) and will not qualify for Medicare/Medicaid until disability changes over to regular social security benefits. The best (only) choice is Hospice.

Ed still has his mind. He does get things mixed up...he might say yes, when he means no, or vice-a-versa. But he still tries to communicate with words and hand motions. He will still let you know if he likes or dislikes something. He still smiles and laughs when someone tells a joke or funny story. He loves to 'join in' when everyone is talking by nodding his head or just following along and smiling (or not!) when appropriate.

Ed tried to answer Dr. S question, what is your quality of life like these days, he shrugged and said well...but since he cannot speak well, and Dr S is a busy man, he never got to finish that question. Sometimes, if I let my mind wander, I imagine that Dr S feels like the life Ed has, is not worth the trouble. I beg to differ, and I think Ed would too, if he could speak. Maybe I am wrong.

Dr. S told us three weeks ago that Ed has between two weeks and two months to live according to his calculations (based on past experience with cancer patients and the 'signs'.) But Dr. S has been wrong before. We hope he is wrong again. Once again, we go back to that old familiar word that I have referred to since this journey began over a year ago...HOPE. We still have hope. Maybe we are hoping for something different now...maybe we are being more realistic about what we are hoping for. Instead of a cure, or a miraculous healing, maybe that hope now is for a good quality of life for what life there is left... filled with love, care and gentleness.

The diagnosis of a GBM brain tumor gives a man (or woman) a hard row to hoe. But maybe there is hope for a small spade to gently turn that dirt. Maybe instead of a crash landing, we can hope for a slow and soft descent.

This is the First Day...

...of the rest of your life.

I know you have heard that saying before. I think the phrase was made quite popular years ago in a cereal commercial - maybe Total cereal?

(Picture: Ed resting in bed with cat Longlegs resting on top of him!)

Ed had an MRI of his brain on Monday, January 18, 2010. My office was closed for Martin Luther King Day, and I was able to help my brother get Ed to the Physician's Imaging Center in Athens, Georgia. He is now unable to walk and unable to stand unassisted and unsupported. The imaging center was unequipped to handle someone as disabled as he is, so me and my brother had to put him onto the MRI table and assist the technician in getting him situated to be able to have the test done. She told us that he would initially be inside the machine for 20 minutes, she would then bring him out of the machine to start an IV to inject dye, and he would go back into the machine for another five minutes. I determined he would be in there about a half hour. After 40 minutes I was beginning to get nervous. But she came to get us soon after that.

Of course, you do not get any type of results at the time of the MRI. Even if the technician does see something, or knows something, they are not allowed to discuss the readings in any form or fashion.

With today's technology, we are able to get these results so much sooner than ever before. The next afternoon me and my brother again loaded Ed into the car to head to see Dr. Splichal, Ed's oncologist, to get the results of the MRI. I think I prayed all the way to his office, as I'd been praying all the days before. Please God, let Ed get good news.

Ed had already decided to take his break from chemo, two chemo treatments earlier than planned, due to the overwhelming toll the drugs were taking on his body. He has become so weakened by the chemo, that his right side is almost totally useless. He cannot lift his right arm some days, and the hand does not cooperate either. If you place your hand in his right hand, he can squeeze your hand, and quite hard. But it is not helpful in such tasks as holding on to anything to lend support or in feeding, bathing, etc. His speech has worsened to the point that there are few words he can say that can be understood. Thank God, his left hand is still functioning.

We did not have to wait long to see Dr. Splichal. He came in and greeted us as usual. And then he just said it. The tumor has grown.

He explained that the tumor had grown enough to once again push the mid-line of the brain a half inch off center. He said that Edward had outlived his expectations for him, that they never believed he would live beyond six months after the surgery to remove the tumor. He stated that additional chemo would only worsen Ed's weakness and he felt like it would not help him anyways. He then told us that due to the aggressiveness of Ed's tumor and the size of it now, and the deteriation of his body, that he expected Ed to succumb to the brain cancer/tumor anytime between two weeks and two months. He said to stop giving him coumidin, that he was in more danger of bleeding to death than of a blood clot. He also said to up his steroids from 1 mg a day to 16 mg a day to reduce swelling in the brain.

I know me and my brother were momentarily stunned, and sat in silence. Then my brother asked him something, and Dr. S repeated his prediction. Then he told Ed he had fought hard and good and shook his hand. Ed was smiling up at him. Then Dr S shook my brothers hand and I hugged Dr S and thanked him for trying so hard to help Ed.

Before he walked out of the examining room, Dr. S told us there would be no follow up visits, but of course to feel free to make an appointment if we needed to come back to him. That seemed so final.

We held it together until we got in the car. Then I had to bury my head in the back seat to try to cover up my sobs. My brother put on his sun glasses to try to hide the tears coming down his face. I don't know if Ed knew we were crying. He was quiet all the way home.

Once home, we got Ed out and took him inside, greeted by Mama who wanted to hear the 'good news'. But the news was not good and she did not take it well. Her crying and questions really brought it home and finally, Ed cried too. I am not even sure he was totally aware of what was going on until we got home and we were all crying.

As usual, Ed was trying to console us; trying to make us feel better and feel like it was all going to be okay.

So. How do you think you would feel if a doctor gave you an estimate of how much longer you were going to live, and it really wasn't that long? I don't know how I would feel. Do you think to yourself, 'Today is the first day of the rest of my life'?

Taking a Break

Edward was scheduled for chemo yesterday, Wednesday, January 13, 2010. However, he was so weak he decided to take his 'chemo-break' early. He was scheduled to have two more chemo treatments including this one, and then Dr. S was going to put him on a chemo break for awhile to allow his body to detox and build up strength again.

Unfortunately, Ed's body decided he needed that break sooner. He is so weak he is almost completely back to using the wheelchair for mobility, is sleeping a large part of the day, and can barely assist in getting himself in and out of bed, to the bathroom, etc.

Of course, like always, he goes back and forth in his degrees of weakness and abilities. Some days are better. Some days are worse.

My mother, his primary caregiver, who is 71 (72 later this month), is suffering from physical and mental exhaustion and depression. She's always been a physically strong person. I have seen her move furniture from one room of the house to another, but if you have never tried to move a person at dead weight, you cannot imagine how hard that is. My Granny weighed less than 90 lbs when she died, but I could barely move her from her wheelchair to the bed. Ed weighs 180-185 lbs.

Mama has barely left the house since Ed became ill. She stopped going to his doctor's appointments after the second visit because she doesn't understand medical jargon and when the doctor talked about hospice and dieing and such, she became very angry. I would rather she did not go to these visits. We have tried to coax her out of the house, tempting her with shopping trips, eating out, (which she has never liked or done very much), or even just to go out driving and looking around, but she won't leave the house.

She has kidney disease and had a stent put in an artery year before last, and I feel she doesn't go to the doctor like she should or take care of herself like she should, but she is not a child and I cannot force her to do things, especially leave the house. The only break she gets from Ed and caring for him is when some of us take him to the doctor for chemo or tests, or the once a month trip he takes to the bank with my uncle Mert. Everyone needs a break from care giving, no matter how much you love that person or how dedicated you are.

But back to Ed. His speech is down from 100% at the time of tumor discovery to about 5% usage. He can answer yes or no and sometimes you can make out a few other words. He is beginning to more and more confuse words. Sometimes he points to an object but that is not what he wants or is talking about at all. Sometimes he uses the wrong words for things. He sleeps a very large part of the day. His right arm (controlled by the left side of the brain, where the tumor is located) loses more and more use.

The doctor, Ed, and all of us, are hoping taking a break from chemo will allow his body time to detox, heal and grow stronger. He will be having an MRI of his brain on Monday, January 18, at Athens Regional Hospital. We will visit Dr Splichal the following day to get results. I ask for your prayers, that the tumor will be smaller than it was two-three months ago, when, if you recall, it had grown ever so slightly from the previous time.

My daughter sent me a devotional regarding the big 'C', cancer. The devotional says though we hate the cancer, we are scared of it, we don't understand it, and don't understand why God lets us suffer from cancer, we have to try to remember that all things are for the Glory of God. Though we don't like it, we hate it, it makes us sad, we are afraid of it...it too, has it's purpose. Here is an excerpt from that devotional:

'We go through suffering for reasons bigger than we can ever understand. We go through suffering so that ultimately God will receive the Glory'.

It is hard to understand, but we just have to keep the faith. In the meantime, please pray for Ed to have a good break from chemo, a healing and strengthening time. Please pray for my mama that she will seek help from friends, family, doctors and God. Thanks to everyone!

Happy New Year! (2010)

Happy New Year Blog Readers!

I hope everyone is having a wonderful and happy day and is looking forward to much love, joy, good health and wealth in 2010! It sounds good doesn't it???

This year is Ed's second year as a brain tumor patient/survivor. He has survived one year and a month and half since the discovery of his GBM (glioblastoma multiforme brain tumor). His doctors predicted he would live about six months. He has doubled that time and working on more!

We hope this year will bring him an improvement in his quality of life. Yes, his life has been extended through and by the miracles of modern science and medicine, but he is weak, unable to speak, and pretty much dependent on others for a lot of his day to day life experiences.

Praise God, he is still able to get himself to the bathroom (be it ever so slowly!), wash himself, dress himself, feed and himself.

But he has fallen a couple of times, he falls asleep easily, he has great difficulty in expressing himself as most of his speech is completely gone. But it is evident he still has his mental capacities otherwise.

He still gives me directions to get places (by pointing), enjoys t.v., reads his Bible, and tries his best to participate in conversations, even if it is only with yes, no's, nods and hand gestures. He loves to watch westerns and don't think for a minute he can't still have an 'argument' with my Mom!

Our prayers for you, readers, is to have a Wonderful Life in 2010! Please pray we do too!