3/22-3/24: Day 4, 5 & 6, Cycle 1: Chemo, ER and ICU

We’ve had a busy couple of days pass. I myself was able to catch up on some sleep Thursday night only to deplete my reserved shut eye the following day with an all-nighter in the ER... I’ll get to that in a minute.

I recently received some advice from someone about living with cancer and treatment. It was never so real and true as it became these past few days. I was attempting to plan a time we could meet and catch up. He stopped me from thinking of a good time to meet. A man who lost his first wife to cancer and whose second wife is in recent remission from a brain tumor, he said, “Ryan, don’t worry about this. You’re going to be living day to day. There will always be some new surprise popping up that you didn't anticipate.”

Well surprises have certainly popped up lately.

On Thursday (Kristine’s final day of chemotherapy) we had just about finished in the cancer center. Kristine had dropped about 4lbs of the fluid she was retaining, which made the center's staff more comfortable with her condition. She started to feel a sudden shortness of breath and increasing pressure on her chest. We notified our oncology nurse and a wave of 5 other nurses rushed into check Kristine’s vital signs. Her “pulse-ox” reading (the percentage calculation of oxygen levels in the blood) had fallen into the 80s when it should be greater than 90%. The nurses administered oxygen and monitored her for a little while.

Dr. Staddon discussed the situation with us after Kristine’s oxygen levels had stabilized. There was discussion among the nursing staff of taking precaution and admitting her to the hospital. However, Dr. Staddon felt that Kristine quick recovery was a good sign and that she would be better off in a familiar comfortable surrounding at home. He felt that the risk of increased exposure to hospital grade infections outweighed the benefits of close observation. (Remember that chemotherapy lowers the white blood cell count – the basic structure of the immune system that helps fight infection and disease – thus increasing the chance of potentially dangerous infection).

The remainder of Thursday was fine. Kristine, her mom, her dad and I all got a decent night’s sleep. On Friday, Kristine’s good friend J.J. arrived from Chicago for a weekend visit. Kristine was feeling restless and anxious that morning. She was more lucid and aware without the stream of new medication she had been receiving the previous few days. But her awareness left her feeling more discomfort. She had trouble catching her breath and maintaining an adequate resting position. The shortness of breath seemed to worsen as the day continued. She complained of increasing pressure in her chest despite having lost a few more pounds of fluid. Around 9:00pm the chest pressure had become more uncomfortable and her temperature had increased to around 99.7 (we were warned that 100.5 was the tipping point where we needed to seek medical attention). The on call oncology physician wanted to be conservative and recommended that we bring her into the ER for a careful inspection. She underwent a new CT scan and EKG. After several hours the attending physician spoke to us about the medical team’s concerns. When compared to the CT scan from 7 days prior, the new scan revealed 2 additional clots in the vein where the original clot developed.

It's not yet clear whether these are newly formed clots resulting from tumor compression of the vein or embolus—fragments of clot that have broken off and traveled through the blood. The primary concern at this point is pulmonary embolism. This is where a fragment of the clot, or embolus, travels to the lung and blocks oxygenation of the blood. The doctors addressed this concern by adjusting the blood thinning medication that Kristine had been taking. At around 4:00am on Saturday morning Kristine was admited to the intensive care unit (ICU) for close observation until at least Monday. At which time we will review recommendations and next steps with our oncology team. Oh, and by the way, in case you thought that you read the above times incorrectly you didn't. Thanks to hospital and insurance beuracracy we were in the ER from 10pm-4am or 6hrs.

As for today (Saturday), Kristine is in excellent spirits. She’s the most alert she has been all week. She is very weak from the chemo, but hopefully that means it’s doing its job. So until Monday, it’s rest for Kristine’s weary support team and milkshakes and smoothies on demand for our brave fighter.

Ryan