Lisa Bonchek Adams

No news isn’t always good news. A lot has been happening in the last few days. On Tuesday they successfully drained 2 liters from my left pleural space after the unfortunate failed attempt last Friday. There is still about one liter remaining in there (the doctor can only safely remove about 1.5 liters at a time). Think about that: two liters. The size of a soda bottle… a few pounds. From one side. It’s astounding how much space and weight that is. Those are the actual bottles of fluid in the photo.

Everyone kept telling me how great I would feel after the thoracentesis. I did feel like I was breathing easier, but I didn’t feel great. In fact, I had quite a bit of pain. They checked for an air leak by x-ray as they always do after this procedure. There were no visible complications. But there was still tremendous pain starting that day and increasing into the next. It was more than the pain from the reinflation of a lung that had been compressed by half its size. But exactly what it was we weren’t sure.

By Thursday when I had to go back to Sloan-Kettering for my PET scan, echocardiogram, and EKG I was in agony. One of the doctors I met with could see how much pain I was in and prescribed some narcotics. I can’t take anti-inflammatories because I am having a liver biopsy next week and they put patients at risk for bleeding. I am so grateful a doctor seeing me about paperwork reached out to offer assistance and relief.

My father met me in the city. After I completed the required tests he drove me home. I can’t think of anyone better qualified to keep an eye on me than a retired cardiothoracic surgeon. Unfortunately, the pain continued. In all likelihood it is a combination of the cancer causing inflammation in the pleura and some nerve inflammation now that some of that fluid is gone and the lung is reinflated. It’s really all conjecture. We will see if the scans and tests reveal any additional information.

Oxycodone couldn’t keep the pain under control so yesterday I had to combine it with a Fentanyl patch. This duo is definitely helping me more; I’m still in pain but it’s more manageable today (Sunday). Each of these patches lasts for 72 hours and will deliver a constant stream of medication to me. I am pretty much bedridden.

It’s looking like Tuesday (New Year’s Eve) will unfortunately be a tough day. I was already scheduled to have a liver biopsy (This is not to check for malignancies; we already know there are metastases here. This procedure will be for repeated genomic sequencing analysis and other testing to make the best choices about chemotherapy and future clinical trials). Now, given all of the events this week, the team has decided that I need to have a PleurX catheter put in. This is a drainage system that will allow me to remove excess pleural fluid at home rather than having to have it tapped with a needle each time it builds up. The catheter will stay in place only as long as I need it, which will be as soon as treatment starts working and the fluid stops being produced in such copious amounts. I assume this will be at least a few weeks.

Having these two procedures and pain control issues means I will need to stay overnight in the hospital for observation. It’s amazing the lengths some people will go to to be in NYC for New Year’s Eve fireworks, isn’t it? Maybe Anderson Cooper will swing by while I’m recovering.

Once we see the results of all of the tests I’ve had and have these two procedures behind me, we will re-assess the plan to start the second clinical trial on Thursday. The most important immediate tasks at this point are to treat the two symptoms and get my breathing and pain under control. Immediately after that we go to work on the metastases to stop the problems at their source.

Thank you for all of the support I’ve had over the last few days including local friends who have been so kind and some friends who came from quite a distance to keep me company this weekend. I’m just putting one foot in front of the other and doing everything I can to gather all of the information I need to make a decision about what the best next step is.

Of course, as much as I can, I’ll keep you posted. Twitter is always the best way to keep up to date on daily happenings. It’s a lot easier for me to get quick bursts of info out in that medium. So many have asked: I have all of the help that I need and respectfully ask for no visitors or gifts during this time.

I would like to wish you all a happy and healthy 2014 if I don’t post again here before we all ring it in.

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I’ve never forgotten seeing the black and white cow with a window carved into its side. I was in grade school, living outside of Milwaukee, and always loved going to the Wisconsin State Fair each summer.

There was a beautiful cow lazily eating in a pen, indifferent to all of the people milling about.

When I walked around the enclosure to see its opposite side, however, the cow was anything but normal-looking. The cow’s left side had a glass-covered hole in it. The man standing next to it and stroking its head was talking about cows’ digestion. He said the window allowed access to the cow’s stomach for research about nutrition and illnesses. The man then shocked the audience by opening the cover of the hole and reaching inside the cow’s upper stomach to extract a handful of grass that was in the process of being digested. The cow remained aloof.

I have now learned that the cows are  called “cannulated cows” or “rumen-fistulated cows.” I have been able to confirm that my memory of seeing one at the Fair is correct. As I remember it back then, the window looked more like a miniature glass dryer door, one that swung open with a small hinge on one side. I am not sure of that. The photos I see of cannulated cows now have a different look. To learn more about rumen-fistulated cows you can watch this video which is extremely interesting.

I woke up thinking about that black and white windowed cow this morning.

I woke up wanting a window into my body and what is happening inside right now, this very minute. I want to know if the clinical trial I’m participating in is having any effect on my cancer. For now we use other indicators but they are unreliable. Even blood tests for tumor markers lack validity and reliability in many people (why they are not used as screening tools to diagnose breast cancer in the general public).

And so I forge ahead, taking pills, getting injections, wondering if it is doing anything to keep my metastatic breast cancer under control. Side effects vary day by day. Yesterday was a bad day. Terrible back pain, gastro issues, a migraine, and fatigue had me down for most of the day. But today I feel better.

So I focus on today.

I envy the researchers who gain knowledge in real time. I envy the way their information can be analyzed and promptly used to help sick cows.

I wish I had an immediate view inside, an indicator as to what my body is doing. Instead, the image of the black and white cow with the window in its side stays with me.

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