Roller Coaster

My recent hospitalization was the longest and most volatile, resembling that of a roller coaster ride at an amusement park. What started with a fever prompting our arrival at Memorial Sloan-Kettering Cancer Center’s (MSKCC’s) urgent care facility in New York last Thursday evening ended up escalating to a brief visit to the intensive care unit (ICU) as detailed in my prior post.

The isolated cardiac event appears managed by medication (metoprolol) and hasn’t reappeared. However, despite numerous blood cultures, chest x-rays, CT scans, and other diagnostics, the cause of my fever – the original reason for my hospital visit – remains a mystery.

After an infectious disease consult, bacterial infection was ruled out as the likely source of the fever and I was taken off the broad-spectrum antibiotics that were being delivered via intravenous infusion. Some of the cultures take time to process, so there is always a chance that something will materialize in the coming days.

One silver lining amidst the tight turns, steep slopes, and inversions on my roller coaster ride was the fact that my left lung appeared much improved in terms of fluid accumulation. This coincided with almost zero drainage from my two chest tubes over the past week or so and it was determined that removing both of them was in my best interest since they weren’t serving any functional purpose and there is always a risk of infection in having two foreign objects in the body.

Insertion of the two chest tubes (one while at the National Institutes of Health and the other at MSKCC) was done under twilight anesthesia, where I was awake but sedated. This is accomplished via administration of a concoction of agents including a benzodiazepine (midazolam) and the narcotic fentanyl. For both procedures, I had little if any discomfort.

Naturally, I expected that removal of the chest tubes would also be done under twilight anesthesia. Much to my chagrin, I was informed that the extraction procedure is normally done bedside and without anesthesia. Two medical professionals arrived at my room at MSKCC and provided a reasonable explanation for the lack of lidocaine or other local anesthesia (the injections would hurt more than the extraction, several would be needed to cover the entire area, and risk that the tubes could be punctured via the needles).

Ever since their initial placement, I’ve been anxious when cleaning or touching the plastic tubes that protruded from the front of my left chest. There was just something unnerving about seeing the foreign tubes that looked like they would be better suited on a Borg, a fictional alien group that appeared in the Star Trek franchise.

Michael Becker having two chest tubes removed at bedside.

As such, you can imagine my surprise as one of the medical professionals from interventional radiology wrapped the first tube around her hand and proceeded to yank it with the same intensity as trying to start a lawn mower by pulling the cord. To be fair, the pain wasn’t terrible and this was one of those situations where speed was definitely better than dragging it out. Nonetheless, I was shocked by the experience and now had an idea what extraction of the second tube would be like.

 

The first tube was easy by comparison, as it was only placed a short while ago. The second extraction was more difficult as that tube was in place for 4-months and had grown quite attached to me. The first attempt yielded little, if any, movement from the tube. Fortunately, the second try was successful and I am now “tube free.” The tips of both tubes were cut and sent to be cultured in case either was the source of infection that was causing my fevers.

There are plenty of other possibilities to explain my fevers, including the tumors, blood clots, and others. For now, the plan is to carefully monitor my temperature and hope that it continues to respond to Tylenol®. If not, we’ll be back at the hospital.

In view of the current situation, my medical oncologist (Dr. Pfister) appropriately held back on this week’s cycle of chemotherapy to be safe. Encouragingly, the CT scan used to look for pneumonia and other potential reasons for the fever provided a sneak peek of how the tumors responded to the first three weeks of chemotherapy and almost all of them showed decreases in size. This is definitely better than having the tumors grow or stay the same size, but likely doesn’t change the “terminal” nature of my disease. It does, however, hopefully buy me some more time.

It’s great to be back home and I cannot wait to see my daughters and the petting zoo…especially Humphrey! And words cannot begin to express our family’s gratitude for all of the many people that helped out while we were at MSKCC the past 5-days.

 

Snake Eyes

It seems as though each time I make an optimistic blog post, something goes wrong. Since my last post was titled “Lucky Seven,” it seemed appropriate to keep with the gambling theme and title this one “Snake Eyes.” For those unfamiliar with the term, a throw of two ones with a pair of dice results in the lowest possible score, and by extension the term is also used to reference bad luck¹.

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Snake Eyes

Today was supposed to be the start of my final round of chemotherapy, with the second and final day on Tuesday. Sunday night, however, I started running a temperature of 102 degrees Fahrenheit that prompted my second trip to the urgent care center at MSKCC over the weekend. The obvious concerns being influenza, bacterial infection, etc. that would delay receiving chemotherapy.

After a variety of tests, influenza and infection were ruled out. While it is possible to run a low grade temperature from daily radiation, a high temperature such as mine is unexpected. This left all of us wondering what was causing my fever and why it was so high. Since there was no immediate cause for concern, they decided not to admit me overnight and said that I could use Tylenol for the fever. They acknowledged that it was unlikely I’d be receiving chemotherapy on Monday.

The next day (Monday) I saw Nicole – the nurse practitioner. I could tell she was on the fence proceeding with chemotherapy that day given that my temperature was again above 100 degree Fahrenheit. She conferred with Dr. David Pfister my medical oncologist and they opted to be cautious and postpone chemotherapy by one day. The only good news is that this shouldn’t change my final day of chemoradiation therapy which is this Friday.

Around the time of my daily radiation treatment, my temperature had dropped to low grade and I’m hopeful that we can continue with chemotherapy tomorrow morning. Separate from having cancer or receiving treatment, my lower back pain continues to be a problem so they switched me to some stronger opioid medications. I’m not talking minor pain or discomfort – but rather debilitating pain making it tough to get out of bed or getting up from a sitting position. I’ve experienced lower back pain issues in the past, but they usually only last a day or two and aren’t this severe.

It’s the final stretch and I “should” be done with therapy this Friday, so I’m trying not to complain. Hopefully these are just minor speed bumps on the road to Friday and then recovery. Until then, keep those thoughts, prayers, and good vibes coming!

¹ http://wordsmith.org/words/snake_eyes.html

 

That Escalated Quickly…

Truth be told, all this week I felt worse than I had originally expected. I was told the “tougher” part of therapy would be around week three or four, so it was disheartening that I felt so awful after only the first round of chemoradiation.

Moments after my brief victory lap for completing the first week of treatment, I started running a fever and felt rundown. A quick call to my oncologist and I was instructed to head over to the urgent care facility Friday night. Fortunately Lorie and Rosie were already in town to spend the weekend with me (Megan was sick and stayed back in Pennsylvania with a friend).

Michael Becker at Urgent Care Center at Memorial Sloan-Kettering

The snow storm hadn’t hit NYC yet, but the hospital lobby was fairly crowded. When I was seen, they took a nasal swab to test for the flu. Everything was fine until the blood test. During the blood draw, I felt lightheaded and nauseous (which never happens to me…). Immediately afterward the room started getting dark and the next thing I knew I was in another room with nurses standing around me suctioning vomit from my mouth. I had what is called a vasovagal response, which caused me to pass out and vomit.

Long story short, and despite getting the flu shot this season, the nasal swab came back positive for the flu. The flu effects are magnified in patients undergoing chemoradiation, which is why I felt so crappy this first week. The good news is that they started me on an antiviral agent (tamiflu) and hopefully I’ll be feeling much better during week two of therapy.

I was put in isolation so as not to get other fragile cancer patients sick, hence the mask and outfit shown in the accompanying image. I need to stay in the hospital for the full weekend to get IV fluids and rest, but will move forward with starting week two of radiation therapy on Monday with no interruption.

Never a dull moment!