Sunday 28 September 2014

Catch 22

There are many things with this hospital stay that are the same or similar to last time and there are many things that are different.  Plus we forget about how things were when he was in hospital for 15 days last time.  Today was day 10 this time and I am absolutely exhausted and want Rob home so badly.  I will go back a few days and tell you about our week.


Since the surgery wasn't as complicated this time and we were not dealing with a tracheostomy and a skin graft (praise the Lord!) there were many days that almost nothing happened and we did lots of just waiting around.  Maybe that is why this stay feels harder.  On Wednesday morning the drain that was removing fluid around the lymph nodes was removed!  This is the tube Isaac refers to as the rainbow tube and it doesn't hurt but is uncomfortable so Rob was very pleased to get it out.  The doctors would come and check on him each day but for the most part they would say things are going well but be patient and then be on their way.  We knew Friday would be a big day because Speech Language Pathology (SLP) was coming to assess Rob's swallowing.  I made sure I was there as early as I could be on Friday but no one came all morning, or afternoon.  Once 3pm hit I went to the nurses and said that they needed to get someone from SLP here because we were not waiting until Monday to start this process.  About 10 minutes later Desmond showed up to do the swallowing assessment.  I explained our experience with and NG tube and swallowing problems.  We really felt we were going to have to do some convincing that we knew what we were talking about.  From last time we knew that Rob cannot swallow with the NG tube in however normally they do not remove that tube until you can swallow....you see the problem here!!  Desmond got Rob to try swallowing some thickened juice and as we knew would be the case he was not able to swallow it properly.  He said he wanted to do a Fluoroscopy (like they did in May) so that he able to see how things are working on Monday and for the weekend we would leave the tube in and have nothing by mouth.  He left the room and I burst into tears.  I was frustrated that we weren't heard and needed things to keep moving forward.  Rob was the strong one and told me that we had to keep trusting God and that He was watching out for us.  No more then 10 minutes later Desmond comes back into the room and said he talked to Dr.Pathak and he said to pull the NG tube and let Rob swallow.  And just like the NG tube was gone!!!!  Praise the Lord.  We could have both done a dance we were so excited.  After the tube was removed Rob's swallowing was assessed again.  He did much better but there is still fear he is aspirating some into his lungs.  Basically over the weekend Rob was put on a thickened clear fluid diet.  The only problem with that is the hospital does not have many options on this diet and having apple, orange or cranberry juice and tea or coffee is not enough calories for Rob so I asked if he could have Ensure.  The last few days have been spent practicing swallowing and meals take quite awhile.  Please pray that Rob is able to get back to where he was with swallowing and he no longer aspirates.  It feels like we took about 10 steps backward but we know Rob can get back to where he was.  On Monday he will see SLP again and hopefully they are pleased with his progress and give the ok to go home. 


On Saturday morning half of the staples were removed.  It is normal for them to do every other  and wait a day to make sure nothing opens up.  Tomorrow he should be able to get the rest out as it is looking really good. 


Without having an NG tube it meant that Rob's IV could be closed off temporarily and he could leave without his IV pole.  This weekend we were able to go for lots of walks and went across the street to the little park.  We were even able to take Isaac to the playground and Rob pushed him on the swings! 


So we go into a new week hoping that as soon as possible Rob can come home.  At this point I think he would do better at home and any care he needs I can help him with. Pray that we are both patient, that Rob comes home on Monday,  that the doctors listen and that Rob can gain strength in his swallowing. 


We continue to place our hope in the only one who can give us hope.  God continues to show us his love and encourage us.  We still have times of discouragement but then God leaves a little encouragement for us to keep us going and trusting in Him.
Love Karen

Tuesday 23 September 2014

4 nights down...

 Tonight I am sitting on the couch by myself while Rob is in the hospital by himself and I would do anything to have him home.  As I prayed with Isaac at bed time I was praying for Daddy and I started crying.  Isaac looked at me and asked why I was crying and I told him it is because I miss Daddy.  He said he missed him too and came to the end of the bed and hugged me.  What a sweet sensitive boy!  Even after spending the day with Rob not having my family all under the same roof feels wrong.  Go give your family hugs and don't take for granted the great things you have!

So last update Rob was still asleep and I am happy to say he is awake now.  On Saturday morning they started to take him off the drug they were using to keep him sedated.  It didn't take long for him to wake up and he started asking the nurse questions right away (the first one was where is my wife?).  I arrived shortly after and was greeted by his groggy smiling face.  I was able to explain to him that it was a day later, why they kept him asleep and how the surgery went.  At 9am the doctors were doing their rounds and the plan was to take out the breathing tube.  So with about 10 people in the room watching they took the breathing tube out of Rob's nose and allowed him to breath.  The concern was there would be too much swelling and his airway would close in but he had no problems at all.  He didn't even need any extra oxygen because his O2 saturations were 100%.  He was told that even though he was able to talk now that he should try not to talk much for about a week.  Within a few hours of getting the tube out they started feeding him through the NG tube and mid afternoon he was moved up to a regular ward.  Rob's short stay in ICU was as good as it could be.  The nurses there are very good at what they do and they treated him so well even when he was sedated.  We are very thankful that the ICU was willing to take care of Rob (his case is not typical care for ICU) because this allowed him to avoid a tracheostomy.

The last few days have been spent settling into the ward.  Rob is in a double room but has the window side so we have enjoyed a few beautiful sunsets in the evening.  His roommate is an older woman which I always find weird but she is lovely and so is her family so we are thankful for that.  We were even able to go to the lounge at the end of the hall on Sunday night and have a "date night" watching the Amazing Race Canada finale....it's the little things like this that make the hospital stay tolerable!

The doctors have been in to see Rob each day and at this point he just needs to let things heal.  They need to make sure everything is drained out and that there is no risk for infection.  The goal is to get radiation started ASAP and an infection would hold this up so they are being very cautious.  Rob has had a slight fever the last few days and they are just keeping a close eye on it.  At this point speech language pathology will see him Friday and do a swallowing assessment.  After his last surgery he had a hard time swallowing  so we are praying this isn't an issue this time and that he can come home on a pureed diet without the NG tube.  The suture in his mouth is looking good and there is no leakage so after a few more days like this he will be able to try things orally.  We had hoped that maybe he would get to come home before the weekend but it is looking like early next week he will be home.  We have 4 nights done so hopefully by this time next week we will all be under the same roof again.  I have had a lot of people ask me how Rob's pain is and  the answer is he doesn't have much.  From the time they woke him up on Saturday he hasn't needed any pain meds aside from tylenol for a headache.  He is uncomfortable because of the tubes and drain but is not in pain...Praise the Lord!!

Isaac has done very well this time so far.  He asks every day to go to the hospital and see Rob.  I asked him what he like about going to see daddy and he said playing angry birds (his favourite game) but also giving Daddy lots of hugs and kisses.  We have managed to have a little visit with all of us everyday so far and we will continue to do this and enjoy a few minutes together.

Day by day God is walking with us and giving us the strenght we need....we cannot bare this alone so we are thankful He is with us.
Love Karen

Friday 19 September 2014

Another surgery day complete!

Something you don't often hear about is surgery being early but that actually happened today.  We arrived at the hospital at 9:45am for his surgery to start at 11:45am but we got all the paper work done quickly and they were ready early.  After getting all prepped and talking to the doctors I said goodbye to Rob about 10:45am and off he went.  Since there were so many unknowns with this surgery we had no idea how long it would be but I was told anywhere from 2-4 hours.  After I said good bye I wandered downstairs to meet my friend Catherine.  She greeted me with yummy Starbucks and we sat downstairs and chatted.  After having some lunch we headed back upstairs just before 1pm.  I had been told a nurse might come out and give my an update around then so I didn't want to miss it.  About 1:30pm Dr Nason came out and told me they were done and gave me an update. 
Overall the surgery went as planned and went as well as it could.  Some people were praying that the surgery would go so well that even the surgeons were surprised and I feel like that was the case!  They removed 3 lymph nodes that they knew were cancerous.  They also checked another area at the base of the tongue that showed up on the MRI but when pathology looked at it they confirmed it was not tumour related but likely just part of the granulation we have been seeing in the mouth.  The largest tumor was slightly into the muscle at the base of the tongue so when they removed it they had to go in the mouth to re-stitch the flap.  For about a week Rob will have to eat by tube feed again because they need to make sure the flap heals up properly so no food gets through the stitches and cause an infection.  They did not have to do a skin graft which is a huge answer to prayer!!


As you know one of the things that we really wanted to avoid was another tracheostomy and if you have even had one you will understand why.  Knowing this the doctors decided to do things a little different.  The decided to keep him breathing through a tube that is down his nose into his airway.  The only thing about this is he cannot pull it out and therefore has to be kept sedated.  Basically it just looks like he is sleeping and they are keeping him very comfortable.  This also means that he is spending the night in the ICU.  The doctors reassured me that he is not in the ICU because he is really sick but because he needs the one to one care to make sure he is kept asleep.  Even though he was asleep and didn't even know I was there I still wanted to stay with him.  I played his music on the ipod so he could hear it and talk to him lots and held his hand. 


The plan in the morning is to wake him up slowly and I am hoping to be there for that.  Once he is awake they will deflate the little balloon in his throat to see if he can breath and make sure the swelling doesn't close in on his airway.  If he breaths fine they will take out the tube.  If he has a problem then they will have to assess the next step.  The doctors seem optimistic that this will work.  Please pray this is the case and that while he rests tonight the swelling goes down and that there will be no need for a trach.


Many of you have asked about Isaac and he is doing well.  We have told him what is going on with daddy and he seems to be dealing as well as a toddler can.  He spent the day with Grandma and Grandpa and still went to preschool in the afternoon.  Hopefully if all goes well he will get to come and see daddy tomorrow which I know will be good for both of them. 


Overall Rob looked very good when I left him sleeping peacefully.  We still have many hurdles to get over but another one is done and we are thankful it went well.  We are still unsure how long he will be in hospital this time but likely at least a week.  Tomorrow will be a big day and will give us a better picture of how things will look over the next couple of weeks.  I look forward to seeing Rob tomorrow and telling him he slept all of Friday away and that it is Saturday now!!


Thank you for all of the prayers today and please keep praying for a speedy recovery so we can get radiation and chemo started and beat this cancer!
Thank you Jesus for getting us through today.
Love Karen

Thursday 18 September 2014

Tomorrow is surgery day.

This has been a very emotional week for us.  As much as the surgery was booked very quickly and is happening fast it feels like a long week.  The anticipation and all the unknowns cause our heads to spin.  We know that God is incharge and that we have an army praying for us but as humans we let fear slip in sometimes. 


This week was also a tough week because I have been sick.  It is hard for me to complain about a silly cold when Rob is dealing with so much more but it really hit me hard.  Isaac just started preschool and of course came home with a cold within the first week.  I wasn't able to work much this week as they don't want me coughing all over the residents plus I didn't have much energy.  Our biggest fear with the cold is that Rob would catch it.  We are doing tons of hand washing and staying away from Rob.  Rob is also sporting a very lovely mask when he is playing with Isaac.  It looks funny but if it does the trick who cares!  I am starting to feel better and was finally able to get out of the house today.  Pray Rob continues to be healthy and that he doesn't catch this cold. 


Last night we had our pastors and council members come over to pray over Rob and anoint him with oil.  This is something the bible teaches us about in James 5:14 and it was a very powerful time.  We know many of you were praying with us during that time from your homes and we felt God's presence.  We know that God can heal Rob but that does not mean it will happen without suffering.  So we journey on trusting our big God will heal Rob and gives us the strength and peace to get through the months ahead.


Tomorrow is surgery day and we were told on Monday that the time has been changed.  It will now be at 11:45am and they are estimating 4 hours long although many things could change that.  We are praying that they are able to remove the lymph nodes with no complications,  that the tongue does not swell up and there is no need for a tracheostomy, that the blood supply to the flap is not affected and no damage is done to the flap.  Doing a second surgery in the same area means they are dealing with scar tissue and it makes it hard to know what they are up against until they are in there.  We are praying for the best possible outcome and that Rob will not have to stay in the hospital too long.  At this time we were told 10 days but it could be a few less or a few more.  If you have time tomorrow we asked that you would pray whenever you can so the whole day is covered in prayers. 


I have saved the best news for last this time.  This morning Rob had his MRI and his chest CT to check and see if any cancer had spread to his lungs and chest.  If this was the case then his treatment would have changed drastically.  Around 1pm Pam, our nurse, called and said his chest was all clear.  I could barely believe what I heard!  Praise the Lord!!!  We still have a tough road to beat this but knowing that it has not spread is amazing.  After being told bad news a few weeks ago it felt so incredible to hear good news and to know that God is hearing and answering our prayers. 


Thank you for caring for our family.
Love Karen







Friday 12 September 2014

Time for more surgery

Yesterday was a long day and we were told a lot of information.  In the morning before we arrived the team of professionals that work with head and neck cancer patients met to discuss the cases.  This gives them a chance to see the big picture and to make a treatment plan together.  We met with Dr.Nason after the conference was done and he gave us all the details.  The lump on Rob's chin is actually cancerous lymph nodes and there are possibly more than just one.  He explained that we all have 150-300 lymph nodes in our necks.  During Rob's initial surgery they took out about 30 to test. They decide which ones to take based on previous experience with other patients and anatomically how it would naturally spread.  The 30 lymph nodes they tested of Rob's were all clear and showed no abnormalities.  In most cases there is a 10% chance that after having the lymph nodes testing clear that you will have one with cancer later....unfortunately Rob is in that 10%.  It isn't that they missed the lymph nodes before, it is just that it would have been so microscopic that they didn't see it.  Having the cancer in the lymph nodes is better surgically speaking however the lymphatic system goes through the whole body and is a way that cancer can easily spread.  The team decided that right now surgery is the best option.  Dr.Nason and Dr.Pathak will perform the surgery to remove the lymph nodes that are showing abnormalities.  We need a lot of prayer for the surgery because a second surgery in the same area is not as predictable and there is the chance for many complications.  Best case is they remove the lymph nodes with no problems and stitch him back together.  However, there could be problems with interrupting the blood supply to the flap (the new tongue), causing the flap to have to be re done, not being able to remove the lymph nodes, complications if it is too close to the jaw and even if they have to remove skin from his chin that he would need another skin graft.  The surgery will be happening next Friday September 19th and we ask that you would cover it with prayer.  Rob has gone through so much already and it would be a huge answer to our prayers if the surgery wasn't full of complications. 


Before the surgery they will be doing another MRI to get a better picture of the tissue for the surgery.  We are basically on call 24/7 right now and they will call when they have a cancellation or no show and we will have very little time to get there.  They are also going to do a CT scan of the chest to make sure nothing has spread.  The lymph nodes would spread to the lungs and chest first so they want to check before surgery.


To be sure nothing is missed again this time Rob will also be having radiation and chemo.  This will begin about 4 weeks after surgery and last for just less then 2 months.  We have been told some details and side effects with that but we are focusing on surgery right now and will look more into that when the time comes. 


Rob will be off work for approximately another 6-9 months recovering.  Every person responds differently so exact timing is hard to say but we know that he will be extremely tired and he will need time to get back on his feet. 


Yesterday afternoon after we left cancer care we just needed to do something fun and forget about everything.  Sometimes all we are dealing with feels much too heavy to bare and it is easier to forget about.  Isaac was well cared for with Grandma and Grandpa so we were able to spend the afternoon together.  We had a nice lunch out and then did some shopping and errands.  Around dinner time we headed to get Isaac and had supper with Rob's parents.  It was really nice to have a nice home cooked meal and to not have to think about preparing it myself. 


As we left Rob's parents place there were some dark clouds in the sky and even some rain but also the sun was shining.  For those who know me you know that the thing in nature that I love the most that God created is a rainbow.  As we came around the corner we saw the biggest most beautiful rainbow.  We could see the entire thing end to end and it was amazing!!  It felt like God put it there just for us to remind us that he will never forget about us and that he cares for his children.  In Genesis God sends a rainbow as a reminder of the promise that he will never completely destroy us.  In that moment, and after the tough days, weeks, months that we have had it was a reminder that God is good and he hears our prayers.  Even thinking about that rainbow makes me smile and I am so thankful it. 


Here are the things we need specific prayers for...
-Surgery on Friday- that they remove the lymph nodes they need to with no problems, that there would be no further complications and that Rob would heal quickly
-That Rob would get a scheduled MRI appointment before surgery
-CT of chest is totally clear and shows no signs of spreading
-For our family to have some good time together this week while Rob is still feeling good
-For peace and strength....we need a lot of it!


Thank you for all the prayers.
Love Karen

Thursday 4 September 2014

Not good news.

When I woke up yesterday I had no idea what was in store for our day and it is a day I wish I could rewind and make different.  Before 8:30am we got a call from Pam, Dr Nason's nurse, she said that Dr Nason needed to see Rob that morning and we should come as soon as we could.  So we had been planning for Rob to start work with the students that day but instead we headed straight to Cancar Care.  We were brought right through to a room and waited for a few minutes.  Dr Nason came in shortly after and told us what we had feared and didn't want to hear.  He had received the results from the needle biopsy the evening before and he didn't like what it said.  Basically the cells were atypical, meaning they were abnormal.  Dr Nason looked more into the report and feels that the type of cells he saw are tumour cells.  He also looked again at Rob's pathology from the surgery and the whole tumour had been removed and all the lymph nodes were clear, so it appears this is another tumour.  He said he doesn't like what he sees and something needs to be done immediately.  At this point he is thinking that the team will agree that radiation alongside oral chemotherapy will be the way to go.  Surgery is not out of the question but it is not a first choice based on where it is located.  Today Rob had a CT scan done which will give the team a better picture of the size and location.  Next Thursday his case will be discussed at the Head and Neck Consult and we will meet with Dr Nason afterwards to talk about what the team thinks is the best option.  Dr Nason is 90% sure that they will agree on radiation and chemo but we will know more next week.

As you can imagine we are shocked and scared.  It felt like we were just going to be getting back to "normal" and now it feels like we are starting all over again.  Rob is now not going to be able to go back to work.  Within a few weeks of treatment he will be too exhausted to work and will likely be off for at least 3 more months.

Please pray for Rob and I as well as Isaac as we process the news and deal with more unknowns.  Pray the CT Scan shows that the cells are not cancerous.  We know God can heal Rob and that he can even change what the tests results showed so pray with us in Jesus name that there is no more cancer in Rob's body.  Pray for complete healing for Rob. Pray for peace for all of us and that God would be real to us.
Love Karen