This continuation document, covering 01-01-02 to 09-01-02 has been added by his son, David R. Posh.
On January 2, 2002, Dad called his Primary Physician to see what could be done about him feeling week and out of breath. After a CBC with a low red blood cell count, the doctor admitted him to the hospital for a blood transfusion (3 units). After the transfusion he felt marginally better, but he didn't feel like dancing as some of the nurses suggested he might.
On January 31st, before getting another transfusion, the Primary Physician wanted to check the condition of his heart and its ability to handle the increased volume. A sonogram of the heart showed his heart to be in good shape for a man of 77 years.
On February 6th, after another low CBC, Dad went in for another transfusion of 3 units. On Febuary 13th, his CBC showed an increased RBC count to 11.8.
On February 18th, Dad had an appointment with the head Medical Oncologist at the Clinic. At the end of the office visit, the head Medical Oncologist said that there was nothing else he could do, and that he was going to set my Dad up with Austin Hospice. He said that he would let Dad consult with the Radiation Oncologist at the Clinic. Dad was very upset, saying that the head Medical Oncologist was "putting another nail in his coffin".
We left the head Medical Oncologist and went downstairs to visit with the Radiation Oncologist, Dr. Nuesch. After Dad described his condition and location/severity of his pain, Dr. Nuesch said there were still some things that he could do to help Dad with the pain. He cancelled the appt. with Austin Hospice, and scheduled CT imaging the following day.
These are screen shots of the CT imaging the the doctor used to plan
the radiation treatment.
From February 21st to March 14th, Dad received radiation treatments which seemed to successfully eliminate the hip and back pain he was experiencing. However, he was still having general bone pain, in his legs and arms, but nothing that could be pinpointed and treated with radiation. During January and part of February, Dad was using hydrocodone for his pain management. In February, he switched to Duragesic patches (first 25mg, then 50mg, then 75mg) that delivered a more constant pain medication, and only used the hydrocodone for breakthru pain.
On March 18th, after visiting his Primary Physician, Dad had another blood transfusion in response to a low red blood cell count on his CBC.
Because Dad was unhappy with his current Medical Oncologist who wanted to wash his hands of his case, he obtained a referral to a different Medical Oncologist at another clinic nearby. On April 2nd, we had our first visit with the new Medical Oncologist, Dr. Costanzi. After hearing Dad's medical history, one of the first things the doctor did was to eliminate his Casodex treatment. Dad had been taking Casodex for about 6 years. The doctor said that sometimes the cancer cells, after that much time, learn to thrive on Casodex.
Another part of the treatment was to start on weekly Procrit injections to maximize Dad's production of blood cells (with what little bone marrow he had remaining after all of his radiation treatments). Finally, the third item in his treatment would be infusions of Zometa to increase his bone density. The main purpose of Zometa (or Aridea) is to increase bone density to reduce the chance of getting broken bones. However, the doctor said that it may also help reduce the cancer (by crowding it out of the bones(?)).
On April 22nd, while shopping at Walmart's with Mom, Dad had an episode of dizziness, loss of balance, nausea and vomiting. The following day, Dr. Costanzi scheduled an MRI of the brain, which didn't show anything unusual. The doctor had Dad try Dimetab Extendtabs, and that seemed to help the problem. It seems like inner-ear congestion was causing the problem.
On April 24th, Dr. Costanzi had scheduled a bonescan for Dad. Upon viewing the results of this scan along with that of Nov 5, 2001, both the radiation technician and the doctor made the comment that the bonescan looked like it was of a different person. It loooked like 95% of the cancer that had metastizied into the bones had disappeared.
Here is the bonescan from April 24th. Compare it to the one from Nov 5, 2001. It looks like the Samarium 153 that Dad had on 11/15/2001 has made a significant reduction to the metastizied cancer in the bones.
On May 2nd, because of low red blood cell count, Dad had another blood tranfusion (3 units).
On May 13th, Dr. Costanzi changed the Zometa treatment to Aridea. Zometa had just been approved a few months earlier, and it's infusion can be done over a shorter time than Aridea. But due to the side effects that Dad was experiencing (increased pain after infusion), the doctor decided to switch to Aridea, which doesn't have the same side effects, but takes a little longer for the infusion.
On May 29th, Dad had another blood transfusion to bring up his RBC count.
The Duragesic patches and the hydrocodone haven't been able to alleviate the general bone pain that Dad hs been experiencing, so Dr. Costanzi set up an appointment with a radiation oncologist. On June 5th, Dad received an injection of Strontium 89, which is similar to Samarium 153. The Strontium however has a much longer half-life (50.4 days instead of 46.3 hours) but seemed to be less intense radiation (with the Samarium, Dad couldn't leave the office until it was confirmed with a Geyger counter that his urine was radioactive; with the Strontium there weren't those same concerns.
Since the beginning of the year, Dad had spent much of his time in bed, trying to manage the bone pain with Duragesic patches and hydrocodone pills. He had also been loosing weight regularily since the beginning of the year. I had just seen a new television series "The Dead Zone" where a fellow comes out of six years of coma and needs physical therapy to begin to use his muscles again. I thought the same might apply to Dad, after being in bed for most of 6 months. The doctor agreed that it might be good and we set up visits to his home three times a week, for what turned out to be about six weeks. The first visit was July 1st.
On July 10th, during one of Dad's visits to the doctor's office for his Procrit shot and Aridea infusion, I noted that his weight on the balance beam scale was 137 lbs. Two weeks later, in for another Procrit shot and Aridea infusion, but his weight was now 139 lbs (first time this year that it was increasing). His CBC was low (8.42 RBC and 25.2 platelets) and he went in for a transfusion of 3 units on the following day, July 25th. After the transfusion, it was 12.1 RBC and 35.0 platelets.
After three weeks of physical therapy, the therapist said that Dad had trippled his strength and trippled his endurance. And on July 30th we set up a visit by a dietician, to see if there was anything else we could do to make sure Dad was getting the nutrition he needed when restoring his muscle mass.
On August 5th, again on the balance beam scale at the doctor's office, his weight now was 143.
Up to this point, Dad had been on the Duragesic patches and hydrocodone pills. Recently, he hadn't been needing the hydrocodone pills as much. So we decided to start reducing the Duragesic patches (slowly so he wouldn't have the withdrawl symptons like he had last December). In the first or second week of August, he had reduced the pain medication, and wasn't having much bone pain in his legs, as he had previous months.
However, he was feeling weeker, more tired. He wasn't wanting to do his physical therapy exercises like he previously had. We also noticed that his speech was slightly slurred, and his mouth didn't look simetrical. What I was thinking was depression, turned out to be something else...
On August 20th we visited his Primary Physician. Upon examination, it was determined that he had pnemonia in his lower right lung lobe. He went into the hospital for IV treatment of pnemonia that day.
On August 21st, at the hospital, he had a CT scan done of his head. On August 22nd, we got the results from his Primary Physician, it was multiple metastices in the brain. Dr. Surapaneni said that since it was multiple metasticies, it couldn't be easily treated with radiation and that a palliative approach would probably be appropiate.
On August 23rd, Dad switched onto hospice and came back home.
During the conversation with Dr. Surapaneni at the hospital on August 22nd, she mentioned consulting with Dad's oncologist, Dr. Costanzi, and that his first reaction was a curative type approach. When she mentioned the palliative approach to him, he did say that a steroid might be helpful for the swelling in the brain. However, since we didn't talk directly to Dr. Costanzi, both myself and my brother, Larry, set up an appointment with him for August 27th to see what his curative thoughts were; what the chances of cure were, how much pain would Dad go thru, etc. On August 26th and the morning of August 27th, when I mentioned to Dad what we were doing, he was still a little hopeful. On August 26th, I took this picture of Dad, saying "wave to Dr. Costanzi", so I could show the doctor how Dad was doing. During the visit with Dr. Costanzi, he said basically what Dr. Surapaneni said, that there wasn't much hope for curing multiple brain mestastises and that the palliative approach was probably best. When we got home and told Dad, he was disappointed and said something like "oh, shit".
The black and blue on his face was from a fall when he tried to get out of his bed at the hospital the night of August 22nd. During the four days Dad was in the hospital, he had fallen down five times (by his accounts). The first night at the hospital I had spent the night with him and was awakened about 3-4am with a loud thunk sound. Dad had tried to get to the bathroom without help and had fallen down. He didn't want to be at the hospital, he wanted to be home, in fact, he removed his IV a couple times without help from the nurses.
Dad was home from August 23rd until September 1st. On August 23rd, my brother Larry and his family drove in from Houston, and Patricia, my Mom's sister, flew in from Michigan. We were all with Dad during his last ten days. He was somewhat talkative and communicative the first half of that time, less so the last half.
We were all with him on the morning of September 1st, when he stopped
breathing at 9:56am. We will all miss him greatly.