Posted by: wrmcnutt | August 14, 2009

The “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 subject.  He has three options:

1) Surgery.  This is normally the recommended treatment for lung cancer.  If you can excise the tumor, the cancer can actually be cured.  Unfortunately, Dad’s got severe emphysema.  The pulmonologist believes that this will kill him outright, or, at best, leave him bedridden for whatever time he has left.

2) Chemo/radio therapy.  This can halt the grown of the cancer indefinitely, and sometimes even bring on a remission.  But it kicks your ass.  Severely.  Basically, the drugs are toxic. The idea is that the drugs and radiation kill the cancer slightly faster then they kill YOU.  In addition to the emphysema, Dad’s got advanced COPD, diabetes, high-blood pressure, and a severe case of old guy.  The oncologist doesn’t think he can stand the treatment.

3) No treatment.  If he goes with this option, he will most likely live 6  – 18 months.  In the first half of this period he will very likely enjoy his current quality of life.  About halfway through, it will start to suck, and continue to suck worse until he dies.

I’ve been over this before, but I keep turning it over in my mind, so you get to read it again.

Options 1 & 2 will immediately turn his quality of life to 100% suck.  Option 1 is his only chance of recovery, but that chance is so small you can’t see it with an electron microscope.  Option 3 is the only one that offers him any quality of life.

We got a couple of new facts/opinions at this visit.

First, there may be problems with the lymph nodes on the cancerous lung.  Removing the cancerous lobe might not be enough.  They may have to take the entire lung.  And he just can’t spare it.

Second, the pulmonologist finally gave us a long term prognosis.

Untreated,  he has three to nine months left in the sun. Without treating the cancer, he will be able to maintain hsi quality of life for from three to nine months. Then maybe three to nine months more in the shadows.  His ability to live alone and see to his own daily needs in any comfort will begin to decrease between four and nine months from now.  He will begin to spiral down toward the end. And finally darkness.  In nine to eighteen months.

All the other stuff has just taken all his reserves.  He’s got nothing left with which to fight the cancer. I can’t focus.  Nothing seems important.  It hits me at odd times.  I was watering my garden last night, and realized that my tomatoes may out live my father.

After we got done at the doctor’s office, I took the rest of the day off, and Dad and I drove up to Walland.  Walland’s an odd sort of place, if you’re from the city or the suburbs.  Leave Knoxville headed toward Alcoa.  Go through Alcoa, Maryville, the Middle of Nowhere, and then turn left.  About 15 minutes up that left turn is the little, unincorporated village/town/place of Walland.  There, on a creek with no name, is the tiny plot of my Ancestral Land.  In his boyhood, my Dad spent every summer there, in Aunt Betty’s cabin.  Running wild on the ridge, swimming in the swimming hole, and in general acting like a little boy, and, later, a teenage one.  The cabin was pulled down long before I was born.  It had become a health/safety hazard.  The plan was always to put up a bridge over the creek, and then a new cabin.  But something else was always more important.  Anyway, I took him up there yesterday, to see it again.  The creek was up too high for him to cross it over to the old cabin foundation, but he was glad we went, and so am I.

I’m going to talk to him tomorrow and see what decisions he’s made.

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  1. Bill.
    I just don’t even know what to say. Other than this: Please know that we are thinking about you and praying for you.

    • Prayers don’t hurt either. Thank you.

  2. Thinking of you and your Dad. Hugs –

    • Thanks. Extra hugs are always good. Then again, are there ever really ANY extra hugs?

  3. I am sorry to hear about your dad. As a former hospice nurse though, I truly understand what you are going through. Its not an easy journey to say the least. I can send out love, light and comforting energies. If he does opt for no treatment, I highly recommend hospice care. It will help you and him prepare for his transition. Death is not a bad thing. It is merely a transition from one state to the next. Part of a journey that truly never ends. Love continues onward in its light even when the physical is no longer there. The spirit and love always remain. Free and beautiful with transition. For now, focus on the now. Enjoy the moment. Know that no matter what happens, it will still be okay. Many blessings and love to you

    • Thanks, Krista. Tell me, how do I find out about hospice care? I don’t know how long it will be before he needs it. I suspect he’s going to pass on the surgery now that push has come to shove.

      • All you have to do is have his doctor send or call in a referral to Covenant Hospice. Phone number is 374-0600. I can tell you quite a bit about it. Also you are welcome to call and talk with Deb Speelman or Mylil Ramey, they are both the hospice supervisors. And, it is never to early to get onto hospice care. They will offer lots of support for you and your family. We have a Nurse, social worker and chaplain support system. We also have Telehealth monitoring and telephone triage to check and see how symptoms and the like are being managed. Plus there is a nurse on call 24/7. So you always have a way to reach someone in case a need arises. Under Medicare it is covered at 100% no out of pocket costs. Hospice picks up the cost of comfort meds and equipment like oxygen, hospital beds..things like that. If you have any questions, please feel free to call me.

      • Also, if he has decided for no treatment, I highly recommend signing up now so he can benefit from hospice services. Because I know the pain meds are expensive that they use for cancer patients. A box of duragesic patches is nearly 700.00 dollars. With hospice..they are free…You get a two week supply at a time of the hospice covered meds, you goto the pharmacy, pick them up at no charge. Its awesome, plus they would pick up the cost of his oxygen too. Just a thought. And like I said..if you have any questions just give me a buzz.

      • Thanks – he wants to get through the surgery before we worry about hospice. I’m doing some research, though, to be ready in case he needs it after the surgery.

  4. May he, and you, and all of yours, receive strength and peace, as you walk this road. Let the blessings of each day and week and month outweigh the suck that is, and certainly will come.

    Know, good friend you are in my thoughts.

    • Thanks, Drix. That means a lot: really. I recall your own Dad’s passing a few years back. I spoke to him on the phone a couple of times, but we never did get to meet.

    • Thanks. It means a lot.

  5. WEll, at some fammily reunions, I find myself with more hugs than I need….

    ..but in this case – nope there are no extra hugs. you can use all you can get. Hugs from Mississippi. (big and small)

  6. Master Wil,
    Losing or looking at losing a parent is so hard, I know because I have. You loose your history, and then are put in the unlikely position as living head of the family.
    But, from that experince I also know that you never really loose them, and some time they are a close as a though. There are times that I notice thoughs running through my head that I know are not mine, and I know that my mother or grand mother are trying to get my attention. I have a strong faith in an afterlife, and personally have had too many coincidences to not believe.
    Hospice is a good plan, Bill (my hubby) and I went through that with a friend that had skin cancer that spread, and he passed on the only night Bill did not stay with him for his last two weeks with us. Start checking into what kind of hospice care his insurance will cover and for how long, and contact or interview companies now.
    With your permission and that of your fathers, I will be happy to include you all on my list of prays and candle lighting. At the very least, you are in my thoughts.
    Many Blessings,
    Gellis/ Ginger

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