Woody's theory

Woody has a theory that Dr. Ginger Holt bought into completely. The theory is that before the melanoma was removed from his temple it got into his system. However, his immune system was strong enough to win all the battles with the melanoma--even though it wasn't strong enough to win the war.

When the bicycle accident happened, his immune system was compromised (through the loss of blood and bone on the road) and spread thin--now having to fight on three fronts: 1)hematoma the size of half a Texas cantaloupe on his left hip, 2)two broken bones and a jagged wound just above his left wrist, and 3)the melanoma, wherever it was.

And, unfortunately, Woody didn't take his pain medicine. After he got home from the hospital he got online and googled "diet broken bones" and found a great site that gave him a list of things to eat: spinach, no-fat yogurt, etc. The article was entitled: "Research on Foods that Help Heal Broken Bones" summarized by Rosemary Fisher. It stated:

"Aspirin And Anti-Inflammatory Drugs Can Retard Bone Healing: When you break or tear a muscle and are on pain medication, you may want to stop taking the pain medication as soon as possible so you do not delay healing. A study in May 1995 issue of The Journal of Orthopedic Trauma shows damaged cells in a fracture release large aounts of chemicals called prostaglandins. These chemicals cause the pain and are blocked by the pain medication. However prostaglandins are also very important in the first stage of tissue repair. So decreasing the use as soon as possible is helpful to the healing process.

"Furthermore a study in the October 1995 issue of the Journal of Rheumatology found that continued use of anti-inflammatory drugs over several months can increase the rate of cartilaginous breakdown in joints of people who have osteoarthritis. The drugs mentioned in the studies include Aspirin, Anaprox, Lodine, Meclomin, Motrin, Naprosin, Pensile, Relafen, Toreador, Tolectin, Indocin and Ibuprofen."

One result from not taking his pain medicine was that he didn't sleep well. And some say that the key to maintaining a strong immune system is getting a good night's sleep.

There has been a major difference in the amount of sleep he's been getting since Dr. Sosman prescribed pain medicine for him on Dec. 26th and he's been taking it. Before he started taking the pain killers he'd typically toss and turn all night and get an hour or two of sleep. Now he's getting 6 or 7 almost every night. Hopefully with the removal of the number one source of the pain (tumor) he'll be sleeping even better.

So one of our major concerns is his immune system and getting a good night's sleep every night. If you want to pray for something specific, pray that he gets a good night's sleep.

And, indeed, when the Interleukin treatments start, it's ultimately the immune system, God's mechanism for healing, that will need to win the battles and win the war. So pray for his immune system to win the battles and ultimately the war. And, may God get all the credit and glory!

Woody's had another good day. He walked to the library this morning. I can definitely see his strength returning. And, he's going to need every ounce of his strength for the Interleukin treatments.

One week ago tonight...

At this time a week ago, Woody was in the recovery room at Vanderbilt...probably giving the nurses a scare. Some of his blood work came back showing that he was having a problem--I'm guessing by what they were doing when I got to the recovery room, that it showed that he was having trouble with his heart. They were ordering potassium and an EKG, etc. But all the while they kept saying that he couldn't be having a problem by looking at his coloring and watching all the little lines on the monitor (the tech who was to do the EKG came in and looked at the monitor and just shook his head and said that Woody didn't need an EKG)...but they had to follow protocol and had to start giving him potassium and do an EKG. At a point a nurse came in and said that they were going to have to take another sample of blood, this time from his arm rather than from his IV lines. They were guessing that the sample that had been taken from his IV line had gotten saline in it. And, that must have been the case, as the second sample came back fine. But he got to stay a bit longer in recovery than he would have without this little scare! Life is never dull!

Anyway, today, a week after surgery, Woody completed our income tax forms, walked to the Post Office to mail them, and stopped along the way to get a hair cut. After he got home he ate a good lunch, took a shower, washed his hair and THEN he slept most of the rest of the afternoon! What a difference a week makes!

Thursday update

We are approaching a week since Woody's surgery. He is doing quite well. He is still having pain, but at this point is experimenting with taking less pain medication. He has tried going longer between doses and has also tried taking one instead of two.

Last night we had a bit of a concern as small blisters had started on either side of his incision. This wouldn't have been as big a concern if he hadn't been fighting a rash since shortly after his surgery after his bicycle accident back in September. It comes and goes and is very bothersome since it is so itchy. Even now he says that at times he is more bothered by being itchy than by being in pain. Dr. Fiala had told him to use hydrocortosone cream on it and that has helped keep it under control. But we seem to get on top of it and think that it is gone and then it is back. I think that he has had four or five or maybe even more bouts with it since September 15. Anyway, the way the rash gets started is with red spots and then these red spots turn into blisters. Last night when we saw the blisters we were hoping that the rash wasn't encroaching on his incision. Woody had me take a digital picture of it and send it by email to Dr. Holt. When I looked really closely at the picture prior to sending it to Dr. Holt, I pretty much decided that it looked to me like an allergic reaction to the bandage that they put on his incision--the blisters are pretty much in a straight line on either side of the incision. And, when Dr. Holt emailed back this morning, she said that the incision looked fine and that she thought it was a reaction to the adhesive or even to the pad that was on the bandage. Aren't digital cameras and email great! In the "olden days" we would have had to get in the car and head to Nashville to have her take a look at it. Dr. Holt had told us that if we had questions that the best way to communicate with her was by email and it certainly worked this time.

The last news that we have to share with you this posting is that Woody has applied for short term disability at work and it looks like it has been approved.

Here's how February is stacking up

Here's what's on our calendar so far for February:

February 5 Dr. Zubkus, Woody's Murfreesboro oncologist, for his first Zometa infusion. Zometa (this is a high powered Fosamax type drug) is given when cancer has spread to the bone. This treatment helps to protect bones and may reduce or delay complications such as bone fracture. He will be having these infusions every 4 weeks. It is given in the oncologist's office and takes about 30 minutes.

February 9 Dr. Holt for follow-up after surgery visit. He will have his staples removed at this visit.

February 10 Dr. Sosman for visit prior to entering Vanderbilt for Interleukin 2 treatments

Except for the date for entering Vanderbilt, the following dates are approximate as it will depend on how many infusions he will be able to tolerate:

February 11-15 Enter Vanderbilt for first round of Interleukin 2 (He is supposed to get infusions of Interleukin 2 every 8 hours with the hopes of having 14 infusions in the 5 day period.)

February 16-22 Home for 7 days

February 23-27 Reenter Vanderbilt for the second round of Interleukin 2

Picture not for the squeamish & medication confusion

Well, this didn't publish as I wanted--I wanted to put the picture toward the end so you could choose to look or not! Sorry! But here is a picture of his incision and ALL the staples! It is such a "clean-cut" wound that it doesn't really bother even my squeamish stomach!

Now to report on Woody's recovery progress. He is really doing very well. His pain is under control now that he is taking the medication according to hospital instructions and not the prescription bottle instructions.

We came home on Sunday and our pharmacy wasn't open. Woody wanted all records to stay at the same pharmacy so he decided to wait to fill the hospital prescription till Monday and use his pre-op pain meds till then. The pre-op prescription handled the pain fairly well, as he was able to pretty much sleep through the night on Sunday. I went first thing Monday to get the post-op prescription filled. They told me at the pharmacy that this prescription was "a step up" in pain medications from what he had been taking. Woody took the new medication at the appropriate time. I left for a little while and when I got home he was obviously in more pain rather than in less. I kept thinking that I was surprised that the prescription directions said to take one--we both knew that he had been taking two at the hospital. And I remembered them telling us at the hospital that he could take one or two. I finally remembered that we had a patient discharge paper with instructions to follow at home. It said to take one or two of these pills every 4-6 hours as needed for pain. The size tablet that was on the discharge instructions was the same as on the prescription bottle, so he immediately took another and very shortly his pain was much less.

Now it is Tuesday and he had another pretty good night. He says that he has pain, but that it is tolerable. He is resting now. He is thinking about taking a walk a little later. So I would say that he is progressing very well in his recovery.

A picture is worth a 1000 words

Here's a picture of an x-ray that shows Woody's arm fixture. The shapes to the left of his arm bone are the buckles to his sling. You can see the plate that was placed on his upper left arm bone and the screws that attach it. The little "rectangles" that you see on the right side of the picture are the staples--those go on up onto his shoulder. He has many staples!

I say that the plate and screws look like a praying mantis with too many legs!

Home Sweet Home!

We left Vanderbilt at noon and pulled up in front of our house around 2pm. It's so good to be home. Woody is happy to have his recliner to rest in and is looking forward to no nurses interrupting at all hours of the day and night. I imagine that we will both take naps! Nights are short at Vanderbilt!

Day after surgery

It has been another busy day in the life of a Vandy hospital patient. Woody has had doctor visits (starting at 6am), physical therapy training, x-rays, meds, vital signs, meals, another doctor visit, etc., etc. And, a good portion of those came all at about the same time. They about ran him ragged this evening starting a little before five till a little after five. You can't imagine what can be packed into just 15-20 short minutes!

Melany came up and spent most of the day with us. She was a very good patient's advocate for her daddy. If he needed something, she made sure that he got it. It seemed that we waited a shorter time to have Woody's needs met when she asked the nursing staff. She and I also snuck off for a little while to get something for us to eat--we even brought a treat back for Woody.

We will be going home in the morning--of course what is deemed "morning" around here will be determined when we actually leave! Melany will be coming to take us home and Woody told her not to get here very early! I don't know what we would do without our kids! Nathan brought us to Vandy early yesterday morning, Melany is taking us home and they have both taken us to doctor appointments. I call it "driving Mr. and Mrs. Daisy."

It has been good for Woody to stay in the hospital today--he just needed this day to get back on his feet.

Dr. Holt brought a very interesting x-ray of her handiwork--I think that Woody may set off the metal detectors at airports--of course that isn't really a problem as he doesn't like to fly! We found out today that the tumor was the size of a small lime or perhaps a golf ball. This afternoon x-rays were ordered of his lower arm near his wrist. I told Dr. Holt that she was just curious to see for herself the damage done to those two bones. She said that she was, but that she also wanted to check and make sure that there wasn't cancer in those bones keeping them from healing.

Hopefully the next blog entry will be from home!

What a looooooooooong day!

The day has sort of become a blur. I took notes, but...they now seem jumbled. I think that his surgery started a little after 3pm and I was called by Dr. Holt a little after 5pm saying that they were finishing up his surgery at that time. He was in the recovery room by 6pm. But we didn't get to a room till 9pm. I almost passed out in the recovery room--but that is another story!

Dr. Holt reported that the biopsy of the tumor showed that it was melanoma and that the tumor had eaten away a lot more bone than they realized from the scans. She removed the tumor and cleaned up the bone and then put in the bone cement and then a plate over that. She said that they were able to "carefully" (she stressed the carefully!) manipulate his shoulder to give him better range of motion. He will start physical therapy in the morning on his shoulder.

At the moment I am thinking that we won't be going home tomorrow, but I guess time will tell. He is having some pain, but the meds seem to be keeping it at bay enough that he is resting peacefully. I have a chair that makes into a bed--they have provided linens and pillows for me--so I am set and, I am pretty sure that I will sleep tonight--no matter what! Sitting in a waiting room for 11+ hours and then another 1 1/2 hours in the recovery room (part of that 1 1/2 hours I was standing--reason that I got a bit woozy--but that got me a chair!)--has definitely made for a loooooooooong day!

I had the best serendipity today in the waiting room--while I was visiting with Linda and Doyle Hasty, the young lady next to us overheard what I was saying about some of Woody's treatments that were ahead for him. It seems that her dad was having an almost identical surgery as Woody's--at about the exact same time--by the same doctor. Her dad has renal cancer and had a tumor on the upper bone of his left arm also. His tumor did prove to be renal cancer. He has gone through Interleukin 2 treatments--so she and her mom shared about what was ahead for us. It was so helpful. God is so good to have sat these two ladies down next to me! They are just two doors down from us in this part of the hospital--so I am sure that we will see each other tomorrow. They also share Dr. Sosman with us. We couldn't believe how our paths had paralleled each other.

Again, thanks for all the thoughts and prayers. They have been felt.

1st "surgery" update

It is now almost 2:30 and Woody's surgery hasn't gotten underway. We were told to be here by 9am--we were here by 8:30. When he was admitted they said that his surgery was scheduled for 1:30 rather than noon...so long wait in the Vandy main waiting room. Woody was so calm...I would not have been!

Woody was finally called back for preop stuff at 12:15. I went back to sit with him around 12:45. They took him to surgery around 2pm. I am supposed to be called when they actually get started with the surgery.

I have tried to send email to several--but so far I haven't gotten email to send--but can receive.

By the way the wrap was a hit--it did draw attention. I think that all who will be with him know about his lower left arm's fragile condition!

It's a wrap!

Here is the "wrap" that I made for Woody's lower left arm. He came up with the wording that would include "Dr. Ginger Holt."

We just hope that all will heed the warning!

Surgery time is set

Woody's surgery is scheduled for noon on Friday (Jan. 23rd) at Vanderbilt. The surgery is supposed to take about three hours. He will come home on Saturday (Jan. 24th) as long as he is doing ok.

Dr. Holt said that Woody will be healed enough by February 11th to be able to start his Interleukin 2 treatments (reason that the surgery got scheduled so quickly). And, by removing this tumor and repairing the bone, there will be one less place (hopefully) for the Interleukin 2 to have to fight the melanoma.

Several have asked about his broken lower left arm--he will still be facing surgery on it on down the road.

I will attempt to update the blog from the hospital on Friday after we get into a room.

Thanks for all your thoughts and prayers!

Expect the unexpected!

We are home from Vanderbilt after seeing Dr. Ginger Holt, an orthopedic oncologist. She showed us a cross section of the CT scan that showed his arm bones. His right upper arm bone is a connected circle--the left isn't. And there is indication of a tumor in that area.

She wants to do surgery (something that we had not expected at this time) to remove the tumor, clean up the bone, repair the bone with bone cement and perhaps a plate. She also plans to unfreeze his shoulder if possible.

Here's the REALLY unexpected...the surgery is scheduled for this Friday (Jan. 23). They will call us tomorrow (Jan.21) with the time.

Let's back up a bit more--1960's to the present

I got to thinking that some of you really don't know the background and are sort of being made to jump into the middle of Woody's story...so let's back up a few years.

When I first met Woody (1967) he had a mole on his forehead. We married in 1969 and lived in Tullahoma. Woody went to work for ARO out in California in 1971 for two years. When we returned to Tullahoma in 1973, one of Woody's co-workers noticed that the mole had grown while we were away and mentioned it to Woody. So Woody made an appt. to have Dr. Harvey remove it (1973). The lab reports came back that it was benign. Over time it started coming back in three small spots. We assumed they were just places that got missed when the mole was removed. When those spots grew back together, the mole was irregularly shaped. So we never thought anything about its shape since it had a reason to be an irregular shape. People mentioned it to him from time to time, but again he would always say--he'd had it removed once and it tested ok--so he was sure that it was still ok. Dr. Chris Dunlap told Woody that if Woody were his dad that he would tell him to have it removed (early 2000's). It was our dentist, Dr. Troy McDonald, who finally convinced Woody to have it removed again. That was 2 1/2 years ago (2006). Woody decided to have Dr. Marvel here in Tullahoma remove it, since it was on his face and Dr. Marvel is a plastic surgeon. Dr. Marvel was pretty sure that it was melanoma so he removed an extra margin around the mole at the time he excised it. The lab report did come back that it was melanoma and the lab report recommended reexcision of the area. Dr. Susan Harlow, our family physician, referred Woody to Dr. Bell, a dermatologist in Murfreesboro. Dr. Bell referred him to Dr. Akins and Dr. Converse--both are surgeons in Murfreesboro. Dr. Akins did the reexcision and Dr. Converse did the sentinel node surgery. These two surgeries were performed on the same day in the hospital in Murfreesboro.

The sentinel node is the first lymph node that the melanoma would spread to from the original site. A radioactive dye is injected close to the original melanoma site and then they wait for it to drain to a lymph node--that first lymph node that the dye drains to is called the sentinel node. If the melanoma hasn't reached the sentinel node then it is assumed that it hasn't gotten into the lymph system.

During the surgeries, Dr. Akins reexcised even more tissue than had been advised and Dr. Converse was able to remove the sentinel node. Everything from those surgeries tested cancer free. So Woody was just to have follow-ups with the dermatologist. And those check-ups he did faithfully.

So we breathed a sigh of relief and got on with our lives...until he found the lump behind his ear in early November this past year (2008).

Due to the fact that the sentinel node was removed and showed that the melanoma hadn't spread, then the melanoma that Woody now has is considered a recurrance.

The fact that it has metastasized to other parts of the body away from the original Melanoma site puts it at Stage 4. The places we know that it has metastasized to in Woody's body are: the bone in the upper left arm, soft tissue mass (lymph nodes) in his upper chest, lymph nodes on his back in the shoulder area, and perhaps in a muscle on his upper chest toward his side. Those are places that have been indicated to us.

He is having some pain and that is from the cancer in the bone in his upper left arm. I guess we will find out more about that when we see the orthopedic oncologist next week on Jan. 20th.

A "Path" has been chosen

We had our appointment with Dr. Jeffrey Sosman at Vanderbilt on Monday (Jan. 12th). Lots of questions were asked and information gathered. Woody has chosen to take Interleukin 2 (IL-2). This will mean a stay of 5 days in the hospital at Vanderbilt, then come home for 7, then back to the hospital for another 5 days. He is scheduled to go into the hospital on February 11th. There is a slight possibility that he will go into the hospital on January 27th if someone cancels out on their treatment. Vanderbilt only schedules three patients at a time for this treatment, as it takes special nursing skills to take care of the IL-2 patients. I will be staying with him at the hospital at the request of the doctors (and of course because I want to!). One of the side effects of taking this drug is that it sometimes causes confusion and they want someone who knows the patient well to be there to let them know when the patient isn't acting like themself. Woody says that he will be sure to tell them when I'm not acting like myself!

Interleukin 2 is one of the few FDA approved treatments for melanoma. It is given by infusion every 8 hours with the hopes of having 14 infusions in a 5 day period. It is such a strong drug that most individuals' bodies aren't able to tolerate all 14 infusions--so the patient ends up having less treatments in the 5 days.

Interleukin 2 is a biologic therapy (recombinent DNA) rather than a chemotherapy. Chemotherapy breaks down the cells. Interleukin 2 builds the immune system with the hope that the immune system will recognize the good cells and destroy the bad cells. Chemotherapy doesn't make that distinction.

This treatment has severe side effects. But the side effects are short lived in comparison to many other treatments such as chemotherapy. Dr. Sosman told Woody that if he had started Interleukin 2 on January 1 that he would be feeling like himself again by mid February.

20%+ of the patients who take Interleukin 2 see a regression in their tumors and a remission at least for a period of time. There is only a 5-10% cure rate. Melanoma is pretty tough to beat to say the least!

Dr. Sosman has a concern about the melanoma that is in the bone in Woody's upper left arm. Next Tuesday (Jan. 20th) Woody will be seeing Dr. Ginger Holt, an orthopedic oncologist at Vandy.

So we are now in what I call "the Vandy loop." One specialist doctor visit leads to another and another and...

I hope that this explains a little about what Woody is facing. It's not going to be easy, but I know that we will get through it--God will see to it! We do appreciate all your thoughts and prayers.

A fork in the road: which way should we turn?

I am beginning this blog so that our family and friends will be able to keep up with us during Woody's melanoma treatments.

Woody found out Monday (Jan. 5) that the bones in his arm haven't healed sufficiently--so he will need further surgery--bone grafts and a plate. His orthopedist and his melanoma doctor conferred and for the time being that surgery will be put on hold so he can get started on his melanoma treatments.

To back up a bit for those who haven't been in on the story from the beginning: Sept. 15th (2008) Woody was in a very bad bicycle accident--he will be the first to tell you that it was caused by a woman driver! He was going along at a pretty fast clip (between 20 and 25 mph). He saw a car approaching so he moved over to the paved shoulder. The driver turned in front of him immediately after passing him. He ended up braking to avoid hitting the car or vice-versa and the pavement broke his fall and he ended up with a compound fracture of both bones in his lower left arm just above the wrist. The orthopedist, Dr. Fiala, attempted to put the bones back together--but lots of bone was left along the side of the road. Dr. Fiala described what was left at the ends of the broken bones as cornflakes! Woody had surgery on Sept. 15th and a bar (external fixture) and pins were placed in his arm and hand to keep the bones in alignment with hopes that the bones would regenerate. So it has been almost 4 months since the accident. The bar and pins were removed Monday, Jan. 5. He now has a soft, half cast on the lower arm to protect it until he can have the surgery.

Early in November, he felt a soft knot behind his ear and immediately called to set up an appointment with his dermatologist. Woody acted swiftly due to the melanoma that he had had removed from his forehead 2 1/2 years ago. The dermatologist told him that he was sure that it wasn't anything, but due to his history he needed to have it surgically removed. It was removed the week before Thanksgiving. We received a call (after 8pm) from the surgeon on the Monday after Thanksgiving telling us that it was melanoma. The surgeon set up an appointment with Dr. John Zubkus, an oncologist in Murfreesboro. At our first visit Dr. Zubkus set up P.E.T. and CT scans. Those scans showed hot spots in several places in his body. Dr. Zubkus got Woody an appointment with Dr. Jeffrey Sosman, the head of melanoma research at Vanderbilt. We found out the results of the scans on Dec. 23 and we were seeing Dr. Sosman on Dec. 26th--so once in a while initial appointments with a doctor can happen quickly! Dr. Sosman has put forth several options that Woody can choose to try--and that is the reason that I call this post "a fork in the road."

Dr. Sosman put things on hold till Woody found out about how his arm was healing at the January 5th orthopedist appointment. The treatments that Woody has to choose from would not aid in bones healing. But now that the bones aren't healing, I imagine that we will be going forth posthaste with melanoma treatments and look at surgery on his arm at a date after he has recovered sufficiently from treatments. We will be returning to Dr. Sosman on Monday, Jan. 12, at which time I am pretty sure decisions will be made about which treatment/s Woody will be taking. None of the options will be any fun. Woody will be in for the fight of his life.

Once Woody chooses which treatment/s, I will explain more about it/them.

We ask that you keep us in your thoughts and prayers.

Lois