We have reached the 6 month mark post-surgery. Our dad, while thankfully cancer-free, still feels the enormity of his diagnosis, as well as the unalterably excruciating physical change. On his lastest round of oncology checkups, he expresses, again, the discomfort in the area of his large incision, and an additionally questionable left shoulder pain. Dr. Treisman examines our dad, and this time, instead of speculating on muscular-skeletal pain post-surgery, decides our dad should undergo a series of scans to be certain no further disease is present. Our dad undergoes a shoulder xray, chest CT, and bone scan. He (and we) endures the difficult week-long wait before learning, with much relief, that all images show no disease process.
With disease ruled-out, our dad visits his thoracic surgeon, Dr. Krishnan, again. Dr. Krishnan and our dad discuss the acute pain our dad experiences with regular arm-shoulder movement. Because of the chest wall involvement in our dad's lung tumor growth, in addition to the removal of his upper left lobe, Dr. Krishnan removed portions of four ribs that could, too, have had cancerous cell growth. With the absence of these upper ribs, and the presence of his remaining ribs, he has experienced extremely painful "catching" of his scapula within these lower ribs. From time to time, the scapula falls within the lower rib cavity, rubs against them, and our dad must, by raising his shoulder pull the scapula up and out from within this cavity. The pain is unbearable, he says. In his visit with Dr. Krishnan, he is told he could undergo another surgery where Dr. Krishnan would shave off a portion of his scapula so that it would not "catch" within the ribcage. He additionally suggests adding a "screen" of sorts to the area where the ribs were removed. The caveat for this procedure, Dr. Krishnan explains, is the fact that our dad would have to drop himself out of the clinical trial for a period of almost 2 months, based on the nature of the drug being researched in his lung cancer study.
Our dad, at first, does not want to endure the pain of an additional surgery. However, the severity of the pain from these periodic episodes is incredibly great for him. He decides, that on his next oncology MD visit, he is going to ask to remove himself from the study for a period so that he may have the surgery. I am, personally, very opposed to the idea. I do not share my feelings, but as I listen to my dad explain to the oncology nurse practitioner, Kelly, the pain he feels, and I cannot help but understand his desire to do anything to "fix" what is ultimately a now life condition. Kelly explains that while oncologists would prefer and recommend his continued participation in the E1505 Study, she recognizes the importance of Quality of Life. She further expresses that his decision must be a personal one and both she and Dr. Treisman would agree that his personal assessment on what he can bear as he continues to lead his life is what will determine his final decision.
I suggest to our dad that we make another visit to Dr. Krishnan so that we may ask clarifying questions before he drops out of the E1505 Study. I really, really do not want to see him leave the Study. The drug being tested on our dad is a drug that is currently approved for patients with later staged disease in a variety of cancers, and has been determined to have varying degrees of promise, depending up on the cancer. It is my own personal feeling that abating the cancer is our number one priority, in spite of the physical pain he is experiencing and the difficulty of the physical recovery. I know my view is somewhat detached and very selfish. I am not the person suffering daily.
Dr. Krishnan and his nurse both explain to our dad that the issues he is facing, both with chronic post-surgical pain and the acute pain from the scapula-rib "catching" problem, are the realities of his post-surgical life. The chronic pain from the thoracotomy is enormous: he has lost bone, muscle, tissue, and organ. His incision extends the entire upper portion of his left back and crosses the midline side up to his chest. The amount of scar tissue alone that has developed from such an incision is incredibly great. The added acute pain from the loss of ribs just compounds his troubles. Dr. Krishnan explains that the surgery he had recently suggested would only address the acute pain, not the chronic day-to-day suffering. He recommends additional physical therapy. While our dad has already participated in both general physical and occupational therapy at St. Luke's, Dr. Krishnan suggests our dad see a new physical therapist--one who specializes in treatment and rehabilitation of patients with cancer. He recommends Leslie Watke, and helps to schedule his appointment with her that same week.
Our dad meets Leslie and undergoes his consultation and evaluation a few days later. Leslie has quite an impressive presence. She is professional, strong, interested, compassionate, and solid...my own personal impression within the 5 minutes I had from meeting her myself. I can tell my dad immediately likes her. She tells our dad that he has so much scar tissue buildup it is no surprise whatsoever that he is miserable...miserable. She touches his incision and moves her fingers across his scar and explains the enormity of it as well as the complete comprosition of mobility from the area that had been touched. Yet she follows this with a confidence that compels both my dad and I in believing in her. She tells our dad that she will work with him to work out the bulk from his scar tissue buildup, and will help him to feel "at minimum 75% improvement overall." As a result of our dad's meeting Leslie, he decides to postpone his desire for surgery and proceed with physical therapy. I cannot feel more grateful to Dr. Krishnan for his recommending Leslie. I quietly wonder why, in all of this time, the Oncology doctor has no such logical and sensible recommendations for our dad...
I strongly believe that Leslie is an angel: a sturdy, confident, believable new presence in our dad's life. I see her as a small but essential element to helping to make him feel alive-useful-present in his own life once again. He continues his participation in the E1505 Study, which I hope with all of my being is beneficial for him. An added bonus: we, his family, get to reap the benefits of our dad having hope once again.
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