Posted by: wrmcnutt | August 11, 2009

Dad’s Got Lung Cancer

My father has recently been diagnosed with lung cancer. 

He’s had severe emphysema for a while now, and gets a chest x-ray every six months.  About three weeks ago, his lung doctor took one look at his x-ray and sent him to a cancer specialist.  Dad’s got some old TB scarring, but one of the nodules the lung doctor had been “keeping an eye on” exploded into a 4.2 cm tumor since his last chest x-ray.

The prognosis is poor, due to the emphysema.  The man already can barely breathe, and the oncologist is talking about removing 20% of his extant lung capacity via surgery.  The lung doctor is currently riding the brake, hollering, “stop, woah, wait, this is a bad idea.”  But the alternatives provide for an equal amount of suck.

It would appear that, as of right now, Dad has three choices:

Choice #1 – Radical invasive surgery.  The good news about lung cancer is that, as long as it has not already spread to other organs before being detected, you can cut it out, throw it in a bucket, and be cancer free for the rest of your life.  This is the recommended treatment, and Dad’s oncologist is all about it.  The problem is that it reduces your lung capacity.  Dad’s emphysema is so bad that he has trouble walking up a single flight of stairs.  The lung doctor feels that there is a non-trivial chance that they will not be able to wean him off of the lung machine.  Should he survive that process, the lung doctor then feels that Dad’s most likely prognosis is that he will, at best, be able to totter from room to room in his house.  There is also a good possibility that he will become bed-ridden, barely able to make it to the bathroom.  However, this is also the only alternative that gives him any chance at all of becoming cancer-free and returning to his normal life. But it’s a very long longshot.

Choice #2 – Radio/Chemotherapy.  This is a combined program of daily radiation treatments together with injected drugs 2 – 3 times a week for six weeks.  It is likely to halt the growth of the tumor and might reduce it.  There is also a chance that it could go into remission.  But this approach almost always features the cancer returning eventually.  The major problem with this approach is that at this time in his life, Dad has heard from dozens of friends and relatives who have had this course of treatment.  And, frankly, it can take a healthy male athlete in his twenties and kick his ass up and down the street.  Universal side-effects include nausea, diarrhea, loss of appetite, and chest pain from the radiation burns.  Additional side effects likely are temporary numbness in the extremities and permanent neuropathy (numbness) in some cases.  And Dad’s not a healthy athlete in his mid-20’s.  He’s 75 years old and has severe emphysema, COPD, high blood pressure, and diabetes.  And you don’t even know if the radio/chemo is going to work until you try it. To make it a little more complicated, Dad’s already ruled it out.  At 75 years of age, he’s already seen dozens of friends and relations go through chemo, and it sucks rocks.  It sucks rocks for a long time, and he’s not interested in that.

Choice #3 – Palliative care.  That is, don’t treat the cancer, just the symptoms.  Today’s trip to the oncologist was a waste of time.  He didn’t have anything to say to us; he wanted to know what we were going to do.  So since he didn’t have anything to say, I held his feet to the fire on a couple of key questions.  First I got more details on the chemo, as noted above.  Then I asked him about not treating the cancer. Untreated, the tumor will continute to grow until it intereferes with lung function, and the cancer will likely migrate to his other organs, including his lymph nodes, brain, and bones.  Dad’s already survived two strokes.  He can’t take another hit to his brain function.  And I know all about bone cancer.  Nobody wants any of that.  The pain can’t really be treated except with high doses of morphine, which he is allergic to.

With Dad ruling out choice #2, and the consequences of choice #3 being unacceptable, Dad has currently elected to have the surgery, even with the potential consequences.  Thursday we go to the lung doctor, who will try to talk him out of his decision.  Once we have completed that fight, it will be a matter of scheduling.  Cancer moves fast, so whatever happens will be done in a very few weeks.

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  1. Ok – now i won’t ask about *him* I’ll ask about YOU. How are YOU doing?

    • Worried, mostly. HE has to make this decision, but I am in a position of advising him, and I don’t know what to advise him to do.

  2. Will,

    Unfortunately you can’t really advise him, cause your not in his position, you can however share your passions about what you want for and from him.
    Know that there are people that love you and will pray for you to have strength, no matter the outcome strength will be needed. Lean on your family and freinds, that is what they are there for, blessings old friend, may peace find you

  3. I’ll be thinking of you both. If you need to talk, even if it’s just to vent, give me a holler and let her rip.

  4. I am thinking of you.
    We are balancing the “what is best” ideas about Niall’s mom now. Longer life with less joy, shorter life with more joy. What will make HER the most content with the available choices and what can the family best live with. Easy decision when it is flavor of birthday cake – really difficult when it is real people, real life, and real outcomes.
    I am sorry you are having to go through this now. Call if you need to talk. I do understand.

  5. You need to tell him to do what *he* feels will be best for his quality of life. Realize that might mean he goes for palliative care, because he doesn’t want to deal with the surgery and such. Hospice may be in his future.

    And tell him you will be there for him, whatever he decides he wants his ‘normal’ life to be.

    And your friends will be here for you.

  6. I know your dad is the one with the cancer, but I am so sorry that you are going through this.

    We will be praying for all of you.


    • Thank you, Deirdre. The hardest part is making sure I’m giving him the RIGHT advice.

  7. Bill (or is it Bud). sorry I will always think of you as Bud as that is what Shea always calls you. I just got an update from Shea this morning and I am so sorry about this. I believe it has to be his choice. I am going through a lot with my Dad at the moment. He jusst had a new pacemaker and now they have found blocakages in his leg and he wants to have the surgery to put in a stent. With his diabeters, kidney disease, congestive heart failure, and cirrhosis of the liver, I am concerned about surgery for a 85 year old man. but I am going to support him in his decison. Reading the other responses, it sounds as if you have a lot of friends to support you and pray for you. I will keep you and Shea and your Father in my prayers. Life is really hard sometimes. But I know I still thank God that I have had my Father this long. Take care, yvonne

  8. Keeping you and your Dad in my thoughts and prayers. This is tough!

  9. […] “Last Visit” to the Pulmonologist For those of you who are new to the blog, Dad’s got lung cancer.  And the situation is very grim.  There is very little new news since my last post on the […]

  10. […] yesterday, and it did not go at all well, from any point of view.  For the new readers among you, Dad’s got lung cancer.  The surgeon came within a hair of flatly refusing to do the operation.  It was a repeat of the […]

  11. […] Well, today was the needle biopsy.  But I’m getting ahead of myself.  For the newcomer, Dad has lung cancer.  Complicating this is emphysema (COPD).  Essentially, thirty years of two packs of cigarettes a […]

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