Summer 2017, after a series of injuries and surgeries in Costa Rica, the doctors told Howard, “you have stage IV non-smoker lung cancer, adenocarcinoma”. This was confirmed during hip replacement surgery, when they took a biopsy of cells from his hip bone. Just in case further testing was needed, they prepared a bloque de parafina biopsia (paraffin block biopsy).
Howard was in the process of downsizing our stuff in Costa Rica to move back to Colorado. But this news accelerated his relocation timeline, the need to get back to Colorado as soon as possible, and establish a cancer treatment schedule. When the oncologist at CIMA hospital told me we should take this biopsy block with us to the U.S., the sense of urgency was intensified. How long will the block last? What will TSA say? Do we need to buy a cooler to keep it refrigerated during the flight?
The thing that caused me the most concern when moving to Costa Rica was the comfort of my cats during the flight. We took a non-stop, red-eye, flight from Denver to San Jose on Frontier Airline so Storm and Cloud would be in their carriers for the shortest amount of time. Prior to flying with them, I put them in their carriers for brief periods just to get them used to their space. I did practice runs with their pills for sedation. I timed everything. How long before I saw signs of sedation? How long did sedation last? Would Storm and Cloud react to the meds in the same way? Did they appear relaxed or distressed? How long can they go without water, because the sedation may dehydrate them? It was my concern for my fur kids that kept me awake, the middle of many nights. Howard and I would be fine with our move. It was our decision, and we would roll with the punches. But Storm and Cloud had no say in this new adventure. I was 100% responsible for their safety, comfort and happiness.
Five years later, the cats would not be joining us for our “re-pat” flight. My only live travel companions would be Howard and the biopsy block. I knew Howard was determined and had a strong will to return, so he would be fine. It was the block I worried about. I didn’t have enough information, so I phoned a friend, our health insurance agent, Mauricio. He was by our sides every step of the way at CIMA Hospital. He stayed with us as long as we needed for him to translate forms, conversations, and to get authorizations from Best Doctors, Howard’s insurance provider. “Mauricio, I’m so nervous about this biopsy block. I know how important this is, and I don’t want to mess anything up. Will you go with me to the pathology department and help me get the biopsy block?” He did, of course. With his help, my anxiety dissolved. The block was small enough to fit in my purse. No refrigeration needed.
Upon arrival, back in Colorado, Martine and I hand-delivered the biopsy block to Penrose Hospital pathology. Our mission was to get pathology to agree to a rapid turnaround of biopsy results. We needed more markers to determine the characteristics of Howard’s adenocarcinoma. These additional characteristics could guide oncology in prescribing Howard’s chemo cocktail. In the meantime, the oncologist ordered the standard cocktail of Alimta, Carboplatin and Zometa. After a week or so, Penrose pathology concluded the cell samples didn’t survive the trip and provided no additional markers. Oncology made the decision to continue with the standard cocktail and go for more biopsies after the 6-treatment cycles. We worked fast and hard to get the biopsy block to Colorado and into the right hands, so we were disappointed to hear the results were inconclusive, to say the least.
After his 6 rounds of treatment, oncology referred us to a lung doctor. The pulmonologist would attempt to go through Howard’s mouth, down through his bronchial tube and then up and over into the lung. There were no guarantees for getting the sample cells needed for a new biopsy. But if successful, additional details could provide guidance for Howard’s maintenance treatments. On December 27, six months after the hip replacement and first bone biopsy, Howard went in for the bronchoscopy. We would hopefully gain more details and markers for his type of cancer.
On January 9, we met with the pulmonologist. From the biopsies taken, pathology was unable to give us any additional details. The biopsy produced only a few amount of cancer cells, not enough to provide additional markers. This means, at this time, a more customized maintenance treatment plan is on hold.
Treatment #8 was yesterday. The cocktail was simple, Alimta and anti-nausea. Howard is feeling fine this morning. I am grateful for his continued stamina and successes. He is a strong climber. We are still on Mt. Everest, so to speak. Been to the summit and are taking our time on the descent.
Next week, we will meet with oncology to get her read on the reports from the latest pathology results. We have compiled a few questions. In summary, we have traveled a lot of ground in the last 6 months. Time has flown by. Some of it has been a blur. Some of it has been with great clarity. Most of the time has been filled with hope. And surrender. Our moments of fear have strengthened our resolve to live in the Now.
We are not sure why these important biopsy results remain elusive. For now, we find comfort in saying, “it is what it is.” Until we know more…