Cyberknife #2 Complete

I could have sworn that we were told that Cyberknife would take approximately 45 minutes. Now granted, it supposedly stops when the patient moves and starts up again when they are still. If that's the reason for the delay, E. must be one wiggly fellow because it is taking at least double the estimated time.

Today's Cyberknife session wasn't nearly as painful for E. He said it was still uncomfortable to lay on that back incision but it didn't cause the same pain as yesterday. He also didn't complain of the same splitting headache afterwards. He remarked that at some time during the treatment he could smell something burning. We sarcastically joked that maybe it was his brain.

We met with the radiation oncologist and were finally able to see pictures of E.'s latest MRI. The areas where the two tumors had been looked like gobstoppers with circles of colors all around them. When the Tumor Board was reviewing E.'s case for the possibility of Cyberknife, we had been told that they would be looking at the size of the cavities left behind after the tumors were removed. We knew that the original tumors were too large for Cyberknife, but were told that once they were removed, the cavities would shrink in the healing process. The cavities we saw on that MRI were still BIG! Like really big! The radiation oncologist explained that the cavities fill with fluid and the some of it may eventually be reabsorbed into the brain, but we were left with the impression that they would pretty much remain there forever. On a positive note, there was "nothing new" from the original MRI when E. first went to the emergency room (meaning no new cancer and no new suspicious spots).

When we first discussed Cyberknife, we were told that the typical course of treatment for patients with brain metastases consists of between three and five sessions. Today we found out that E. only needs three treatments. That means that tomorrow will be his third and final Cyberknife treatment. We also discussed the need for steroids or other medications. The radiation oncologist explained that frequently patients have side effects from the radiation or Cyberknife that require steroids and/or other medication. Many of the side effects are the direct result of swelling in the brain ... headaches, dizziness, fatigue, nausea, seizures. If E. can manage to avoid all these side effects, he won't have to take the steroids or any additional medications. We'll be keeping an eye out though, because as is the case with most radiation patients, the side effects are cumulative and usually show up after treatment is all said and done.

As of right now, he's still feeling good. Woohoo!

Trained

I'm trained and ready to go. I now know how to flush an IV. I now know how to give IV anti-biotics. We've got a whole bag of supplies ... tubing, caps, sleeves, alcohol wipes, gloves, 4 X 4's, saline syringes and of course, bags of anti-biotics. Thankfully, I don't actually have to insert the IV needle, but I suppose at this point if I had to learn to do that, I would cowboy up and do that too. E. just has a peripheral IV (no PICC line) and it should last for about four days. He has to go back on Monday for labs, as do all the infusion patients (so they've dubbed it "Bloody Monday") and he'll get a new IV then. He only has 8 to 10 days left of anti-biotics left. We're thinking he got pretty lucky after hearing that most of the infusion patients have IV's for a minimum of 6 weeks. This home IV system is real high-tech too ... we hang the bag from the wall with a push pin/thumb tack. He only gets his IV anti-biotics once a day and they take 30 to 40 minutes to run, so no need to drag an IV pole around for that little bit. This little bump in the road will be over before we know it.

E.'s Home

E.'s first Cyberknife treatment is done. Unfortunately, it wasn't nearly as quick and easy as we thought it would be. Laying on the back of his head really gets to be painful (where that back incision is), especially for extended periods of time. And the Cyberknife took well over an hour today. His head rests on a hard plastic piece which they "pad" with a piece of bubble wrap ... one little sheet of bubble wrap. The hard netting mask holds his head in place in an awkward position and they readjust him occasionally. He was told to keep his eyes shut as there were a series of bright lights. E. didn't actually feel anything in terms of the Cyberknife, just from laying on his head post brain surgery. By the time he was done, he had quite the headache that is just finally easing up now. Supposedly, tomorrow's and Friday's Cyberknife treatments won't be as long as today's so hopefully that is better for E.

E. was also able to get discharged from the hospital! Yay!! Tomorrow morning, he has to go to the infectious disease office for an infusion of anti-biotics. I spoke to the nurse there and it sounds like the insurance company has approved E. to receive the IV anti-biotics at home for the duration of his treatment. There was one little twist that I wasn't aware of ... tomorrow *I* will be trained in flushing E.'s IV line and giving him his IV anti-biotics. No time to be nervous, just gotta do what's gotta be done.

E.'s happy to be home. And we're happy to have him here.

S.

Tidbits of Good News

* The infection has been confirmed as Staphylococcus Epidermis. Of the two Staph infection possibilities, this one sounds like the better one to have.

* The infection originated from E.'s port. The port has been removed so it obviously can't cause him any more trouble.

* E.'s EKG looked good and it doesn't appear that any bacteria made themselves at home in his heart.

* E. is responding well to the anti-biotics and today's cultures were clean.

* There are another 8 to 10 days of IV anti-biotics remaining. The infectious disease doctor indicated she's thinking about discharging E. after his Cyberknife treatment tomorrow, but she is awaiting "insurance approval."

(I am dumbfounded by insurance's involvement in E.'s potential discharge. Being at home has to be less expensive than being in the hospital for another 10 days. But I'm going to focus on the positive and that discharge is being discussed ... I'm crossing my fingers that E. will be in his own bed tomorrow night. Well, his rented hospital bed in his own room anyways.)

Still in the Hospital

E. did in fact get his CT today. He also got his face mask mold made. He is all set to start Cyberknife. Still no word about a possible discharge from the hospital, so as it stands right now, he'll be wheeled over from the hospital to the building next door for his Cyberknife treatments. He's currently on the calendar for three Cyberknife treatments ... Wednesday, Thursday and Friday.

We're really hoping that E. will be discharged from the hospital soon. Other than being a little grumpy and a lot bored, he is feeling good. He does have some cabin fever, or is that "hospital fever?" And he says the hospital food is, ummm, how should I put this? ... not very edible. He wants out of there!

Cyberknife's Still a Go

The radiation oncologist was in this morning already and we were happy to hear that a little ole staph infection isn't going to derail the plans for Cyberknife. They'll wheel E. over today for his scheduled CT, and he'll also get his mold/face mask made. Then, whether he's at home or in the hospital, he should be getting his first Cyberknife treatment on Wednesday just like originally scheduled.

Staph Infection

We've learned so much about esophageal cancer in the last 18 months. And diabetes. And brain metastases. And other things I never thought we'd be learning about.

Now we're learning about infections. It can be a tad bit overwhelming. I think I should have paid a little better attention in biology. (And if I get any of the following information wrong, please forgive me. We are learning as we go.)

The hospitalist explained to us that infections are either "Staphylococcus" or "Streptococcus" infections; E.'s being the "Staph" variety. (But there are over 30 species of Staph and many more sub-species as well.) That much we knew last night. The blood that was drawn on Friday and cultured, already grew something by Saturday morning which tested positive ... that is why we wound up in the emergency room. Each day as the culture grows, they are able to tell more and more about the specific kind of bacteria in E.'s blood. That is important to tailor the right anti-biotics. Right now, E. is on two "high-powered, broad-spectrum IV anti-biotics." Depending on what the cultures show in the days to come, those anti-biotics will be changed to specifically target the bad guys and kill them all dead.

The infectious disease doctor informed us today that they now know that E.'s infection is "coagulase negative" which means that it is a "Non-Staphylococcus Aureus." Because it is not Staphylococcus Aureus, it is Staphylococcus Epidermis which means the infections originated on the skin somewhere. And, using my deductive reasoning skills and a little googling, I deduced that since E. has a NON-Staphylococcus Aureus, he could not possibly have MRSA (Methicillin-Resistant Staphylococcus Aureus) since MRSA is a S. Aureus. I really don't know much about MRSA other than the horror stories I've heard which have effectively scared the bajeebers out of me, so I'm pretty thrilled with this piece of information.

There are potential complications from infections in the blood, including when the infections move into other areas like the spine or the heart. E. did have an EKG done yesterday to see if there were any bacteria camping out in his heart and making themselves at home, but we have yet to receive the results. It sounds like there is pain involved when the bacteria move into other areas (such as back pain when the spine is infected) and E. has not complained of any pain, so that is a relief.

And there was still the issue of E.'s port ... One of the problems with having a foreign object in your body (such as E.'s port!) is that it makes a great little breeding ground for the bad guys. It is very hard to clean and sterilize an object inside your body. So, even if anti-biotics effectively treat the infection, the bad guys hiding out on/in the foreign object (port) could reinfect the body in no time. The easiest answer is to remove the foreign object. Luckily, in E.'s case, he's not currently using his port and there are no plans to use a port in the near future ... so out it came! The good news is that the port is out. The bad news is that removing the port disturbed the bad guys. It riled everyone up in the body and now we have to wait about 24 hours for everyone to settle down (and have a couple of shots of anti-biotics while they're hanging out) until blood can be drawn again. Once that blood is drawn again, we have to wait for the cultures to come back.

I attempted to clarify with infectious disease doctor, "So, they'll draw blood on Monday and if the cultures come back clean on Tuesday, we can make discharge plans then?" The response I got wasn't nearly as encouraging as I had hoped, "Wellllll, cultures can take 24, 48, 72 hourrrrrs." Further identification still needs to be made on the infection. And, the blood cultures need to be negative before they'll discuss discharge. Oh, and the best case scenario at this point is that once he's released, he'll be on IV anti-biotics for a couple of WEEKS yet.

P.S. Room #333 this time around.