The Year from Hell

August 15, 2017

 Over the years we have encountered many bumps and potholes, but 2016 was without doubt the most medically challenging of Jim's fifteen year cancer journey. He had been on Tarceva-- with typical side effects (diarrhea and rash)--since his eighth lung cancer recurrence in November of 2014. But in February, 2016, the trouble began. He spiked a temp with severe pain on a Friday night, of course, which landed us in the E.R.--an always  frustrating and usually futile venture. (I've yet to find an ER physician who can decipher Jim's complicated medical history.) After a course of antibiotics and failed attempts at pain management, the doctors (oncologist, cardiologist, pulmonologist, surgeon) reached a diagnosis of pericarditis. In March, the thoracic surgeon put in a pericardial window requiring a week-long hospitalization.

Over the next few months--although the pericarditis problem was resolved--Jim continued to suffer from a myriad of problems: weight loss, muscle wasting, fatigue, unrelenting bouts (12 hour duration) of hiccups, and a Tarceva rash--unlike anything he had experienced before.

A PET scan in April showed a very slight progression of disease, an indication that Tarceva might no longer be working. After much deliberation among the oncologists, we started Keytruda (one of the highly touted immunotherapy drugs) along with boosters of Azacitadine. The immunotherapy drugs generally have fewer side effects than chemotherapeutic agents, but, unfortunately, this wasn't the case for Jim. He was miserable during June and July with unmanageable pain, low platelets, fatigue, cough, loss of appetite, edema, and nausea. 

It was as if the Keytruda had triggered an inflammatory response throughout his entire body. The cough and pain made it impossible to lie flat making it necessary to sleep (or attempt to sleep) in a recliner. In early August, they suspended cancer treatment but problems continued. Inexplicably his health continued to deteriorate. The pain was persistent, the cough unrelenting. At night, while sleeping in the recliner in our bedroom, he coughed every thirty seconds. (Yes, I counted.) He was taking oxycodone, Gabapentin (neurontin), lasix, testosterone injections (for muscle wasting), cough medicine, Spiriva, and a corticosteroid inhaler. We started seeing the pain management physician at the cancer center. 

     

On August 30, Jim was hospitalized  suffering from dehydration and edema. His creatinine skyrocketed, reaching a dangerous level 8, nearly requiring dialysis. After a week, he was released under the care of a nephrologist, but his pain level continued to climb. (To be continued in tomorrow's post: How a seventy-five-year-old procedure saved his life)