The Elusive Biopsy Results

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…

Surrender

2017 Reflections…

The first of July, Ken, our son-in-love, and I were in Costa Rica to help Howard move back to the U.S. Howard had been working hard to liquidate our “stuff”, 2 cars, furniture, kitchen equipment, bedding. You all know, the usual “stuff”. This was our 2nd time around at downsizing. We were pros after our May 2012 move.

I had already moved back to Colorado in October 2016. In this same month, Howard was playing tennis with a friend, and fell while trying to make a lateral move. We didn’t think it was serious enough for me to turn around and return to Atenas. After his fall, Howard traveled to Colorado to enjoy Christmas with family. He even felt good enough, so we vacationed in Estes Park with Chevy. Haunted hotel and all. As the holidays progressed, it was evident Howard’s pain was increasing. But he pushed through the pain, and we had a nice family Christmas.

Upon returning to Atenas in December, he learned he needed hip surgery, but not a total hip replacement. The doctor repaired the labrum tear in January 2017. I flew down to assist him, because he was required to be on crutches for 6 weeks. In March, he made his decision to return to the U.S. The necessary downsizing in Costa Rica seemed like an easy thing to do.

… Regressing back to 2012-2013

We had already accomplished the big downsizing in 2012, the year we moved to CR. We/he were pros at it. We, in a sense, became minimalists, except for our 2 vehicles. An SUV that seated 7, and a small Nissan sedan. In 2012, we thought we “needed” the 7-seater, so our entire family could go on adventures. It seems like another lifetime ago, 2012, when Martine, Ken, Chevy, Jai, Howard Storm, Cloud and I moved to this little enchanted, foreign country. Costa Rica, as we learned, was not so easy or a sustainable lifestyle for the younger generation. The kids stayed a little over a year. They left the summer of 2013. Oh, how my heart broke when I watched their Delta jet heading north to return to the U.S. (From our hillside pool, we could watch most flights coming and going, San Jose Airport.)

Martine and family returned to Colorado, and Jai moved to Maui. Right before Jai moved, we lost my 18-year old cat, Storm, in a vicious encounter with an unknown, unseen, animal late one night. Storm was returning to our main house, from a sleepover with Jai, who at the time was living in our casita. How can one person, I, move forward, in a positive fashion, with so much loss that occurred within 2 months? These setbacks were deeper and darker than I had ever experienced. Love, friends, yoga, swimming, and my new best friend, Surrender, got me through it all. Deep down I wanted to grieve gracefully, and grace seemed much easier with my new best friend, Surrender, by my side.

… Back to this year

Howard’s biggest hurdle in the downsizing department were the 2 cars. He advertised on local forums. After many bites, and a money scam where we lost a couple thousand dollars, he still had 2 vehicles to sell. A bit discouraged, feeling victimized by another gringo, and embarrassed by the money scam, he remained motivated to return to Colorado to be with family. By May 2017, his health and recovery were not where we thought it should be. We rationalized it by saying we don’t heal as fast as we age. He pushed through the pain, and remained focused to be back in Colorado by August. As June approached, with 2 vehicles still parked in his yard and very minimal furnishings in his house, I was adjusting to the idea that his August return vision was no longer realistic. “Hi, Surrender. It’s nice to see you again.”

The end of June, Howard had a sneezing attack. As a result, he was in severe pain from, what he later learned was, a hernia. He pushed through it that day. That evening, he lowered himself into bed, but it was more of like a flop. The flop brought on more pain. He was literally paralyzed in bed for hours, writhing in pain that was a 10.

His phone was out of reach. His 5-inch thick doors were locked and bolted. There had been a rash of burglaries in his neighborhood, so he thought it would be best to lock the gate, lock and bolt all doors. As he laid in bed with his 10, he remembered the double bolted doors. He panicked. No one would be able to get to him.

He went into shock and was able to swing his legs to the side of the bed, raise himself up, and as he lifted himself from his low-lying bed, he fell to the floor and caught his fall with his left hand. Can one’s pain level go higher than a 10? Miraculously, he was able to get himself to the bathroom, take a pain reliever, unbolt the doors and find his phone. He called a friend.

Every pothole and movement of the car was excruciating as his friend drove him to CIMA, the world class hospital in Escazu. The orthopedic surgeon visited him and, after X-rays, it was concluded he had a hernia and broken thumb. Both surgeries occurred that night. One room, 2 surgeons working on him simultaneously.

I asked him if he wanted me to get on the next plane. “Not yet”, he said. “Let’s wait and see.” The next day, lying in his hospital bed, he was resting after the surgeries and the previous night’s ordeal. But something was not right. Had he injured his left hip during the fall, the one where he had the labrum tear repair? The orthopedic surgeon ordered more tests. Another MRI showed a broken hip. He went back to the operating room for a total hip replacement. 3 surgeries within 24 hours.

From the MRI and during surgery, it was discovered something was wrong. Very wrong. His recently repaired hip bone was, as the doctor described, like Swiss cheese. How could this be? They were just “in there” in January. Howard didn’t wait for me to ask. He called me to say, “come quick”. I want you here. I may have cancer.

I was on the plane the next day. My “angel neighbor” took me to the airport for my 6:00 AM flight. As you can imagine, that was the longest, hardest flight in my life. It just didn’t move fast enough. I landed in San Jose, and took a red taxi to the Courtyard Avenida Escazu, an easy walk to the hospital. After re-familiarizing myself with the area and climate, I felt empowered. I can do this! I made it to Escazu and walked to the hospital. For many reasons, the rest of that day is a blur.

Cancer was confirmed. More tests. The result, Stage IV adenocarcinoma, non-smoker lung cancer. I remember thinking, this is a living, fully awake, nightmare! “Hello again, Surrender.”

I don’t know how, or if, we could have accomplished everything that needed to be accomplished with lightening speed without Ken and friends. And, Howard’s physical therapist, Andres. Andres advertised our vehicles on a local Tico site. The smaller vehicle sold within days. We sorted, gave away more “stuff”. We hired our lawyer to help with bank accounts and gave him the authority to sell our SUV on our behalf. We made our flight arrangements for Howard and me. We returned the last week of July. Ken would remain there by himself for complete closure. As it turned out, Andres and Ken sold the SUV within a day of Ken’s return. Ken returned the first week in August.

We have the best son-in-love, friends and family in the whole wide world.

During our 5 years in Costa Rica, we created many long stories that I hope to share in the future. Upon our return, the next adventure started taking shape. The initiation into the Rocky Mountain Cancer Center pipeline was not for the faint of heart.

With Grace and Surrender, here we are. I wish for you and us the happiest of New Years. I love you. And I am grateful for your Love and support. Until next time, I picture you in my mind, with Love, Light and Peace.

Hope, Love

Good morning, from Manitou Springs. On Wednesday, Howard had his PET and CT scans. Thursday afternoon, we met with our oncologist, Dr. Matei. We took in the information. Sometimes, it feels like we are drinking from a fire hose. On Friday, HP and I stored the information and met a friend for lunch. Friday evening was quiet, and we were content as we continued to process the doctor’s newest recommendations.

After combing through pages of physician’s comments, with an ample amount of confusing clinical terminology, we jumped to the summary for each scan. For the most part, the cancer’s progression is in a holding pattern. The lung tumor is a tad smaller, yet active, and she said it isn’t time to let our guards down. No new bone or soft tissue metastases. The current bone lesions are shrinking.

During next week’s trek, Howard will have another chemo cocktail, but with 2 drugs instead of 4. To date, the chemo side effects have been tolerable. Let’s hope that next week’s treatment, with only 2 drugs instead of 4, gives him minimal side effects. Zero side effects would be even better. May we ask for zero side effects? Sure we can!

Also, next week, HP will meet with a new doctor, a lung doctor, to discuss taking a biopsy of his lung tumor. We were hoping to bypass this step, but the sample taken from his right hip in Costa Rica didn’t survive the trip back. Therefore, it didn’t provide the markers needed. Basically, the sample deteriorated with the time it took us to get back here and established in our new medical routine. If he is a candidate for this new biopsy procedure, Dr. Matei is hoping to get more markers to determine the next “cocktail” recipe and/or design a maintenance plan. It seems we aren’t at base camp yet, but we are doing okay on our hike. We are strong. We have incredible support every step of the way.

And, more important than anything else, we have each other. We have YOU, our loving family and incredible friends around the world. We have an awesome medical team by our side – traditional and alternative. We have an abundance of love in our lives. We are grateful.

Merry Christmas

Happy Holidays

May we all experience amazing family times and times with friends. (Jai, we will miss being with you. Yet I know our energies are strongly connected over the miles.).

Much love and gratitude ❤️😘❤️. Judi

Hope Beats Not Knowing

In my last post, I mentioned HP will be getting a CT scan to assess the progress in shrinking his lung tumor. The doctor was emphatic about not ordering a PET scan due to the amount of radiation.

Yesterday was that day. True to form, the Unplanned Journey continues. The doctor ordered CT and PET scans, along with a blood test. I mentioned to the staff that the doctor’s wishes were to skip the PET scan to which she replied, “no, Howard will complete both tests.” I’m convinced that the pecking order goes like this at the cancer center. Top dog is Scheduling. Next in line is staff. And, third, is the doctor. 🙃

Today is the day we meet with the oncologist to discuss the results and to hear her recommended course of action. Since his last chemo cocktail on November 30 (Zometa, carboplatin, alimta, keytruda, anti-nausea and steroids, and the occasional B12), I have been in this strange tug of war between fear and love. Fear of not knowing. Love of hope. It puts my mind at ease when I compartmentalize, so in my mind, the feeling of Love and Hope resides in the present moment and the feeling of fear and Not Knowing resides outside of the present moment.

What a beautiful, gigantic life lesson this Unplanned Journey is providing through what seems to be a never-ending supply of examples. I suspect these examples will keep coming up as often as needed, because it is my desire to ace the test on Present Moment Living.

What I know for sure is that Howard didn’t experience all the bad side effects that were expected with this prescribed cocktail. He still has hair. Nausea fluctuates in duration and intensity, but has been manageable. Energy ebbs and flows, but he has been able to keep up with family and friends’ activities. He continues to be on the miracle man path.

What does the future hold? Who knows? No one knows.

To be continued after today’s appointment…

The Summit

In a few hours, we will be at the summit. It has been a 6-treatment journey that began on August 15. Back in late June, when HP got the diagnosis, I was on a plane to CR the next day. Early July, we began processing the diagnosis for HP and planning our next steps. The remaining time in Costa Rica was a flurry of activities, including 10 radiation treatments on his right hip. We got to work, with the help of Ken, our son-in-love (who always loved living in CR), getting Howard ready to move back to the U.S. with me.

Some of the most fabulous friends in Atenas, CR, came to our rescue. Every day, I hope to be able to serve others as we have been served by friends and family. Sometimes it is not easy to ask for help. But this medical event was big and one we never, ever thought would be ours to handle.

As we processed more and more, the 6th treatment seemed like a lifetime away. But, here we are. It went pretty fast. Easy for me to say, right? I think HP would agree as he has made this journey, this trek, look so darned easy. He has been an awesome example for me, family and friends. A true inspiration. His strength has been fueled by a positive attitude and optimistic outlook.

Today, I thought we would wake up feeling lighter and celebratory. Maybe we will tonight. Yet, as we flowed through our morning routines, our energy seemed heavier than I had anticipated. We talked about it, and we were both thinking the same thing which took us into the future. Every time we leave the Now moment, heaviness settles in. With a lot of practice over the last 2 years, I/we have learned to recognize heavier energy, and are getting pretty good at flipping the switch to return to the Present Moment where peace and light live.

When we allowed ourselves to go into the future, for only a few minutes, we agreed our thoughts went to the next test, a test yet to be scheduled. The doctor will order a CT scan to help her decide on the maintenance plan, and then we will meet with her mid-December. After talking, we quickly recognized that the test is just another stop on our descent. We will take it in stride and with grace.

That’s another day, and today is today.

Today, we will stand at 29,028 feet and enjoy the view from the top, stronger in every way than we were just a mere 158 days ago when HP first got the word. Our undying love for each other and from all of you will give us the light, peace and strength that we need to see the way. For this, we are eternally grateful.

Gratitude and Happy Tears

As the Thanksgiving weekend comes to a close today, I hope you all had a very memorable, loving Thanksgiving holiday. And, for those of you who got out and shopped, I hope you survived and scored on some good deals. I’ve never witnessed Black Friday, firsthand, but what I have seen on TV, it looks quite interesting and memorable.

On Thursday, our family and friends sat down around Martine and Ken’s dining room table and held hands. Martine began the gratitude chain, and the tears quietly rolled down our cheeks as we tried to encapsulate all the things we are grateful for into 1 minute. One minute was not enough time to express it all, but what rose to the top were the highlights that we hold in our hearts every day.

From my heart, I expressed my gratitude for family and friends and, especially, for HP being “home” with his family to celebrate Thanksgiving 2017. A holiday that he and I have celebrated together since 1974, with the exception of one year.

Yesterday was a special day, too. HP and I went to our storage unit to see what Christmas decorations survived our 2012 downsizing. Prior to moving to Costa Rica, we sold our house and furnishings, our condo in Keystone and furnishings, and most of our stuff was gifted, tossed or sold. The stuff that survived (and has been in storage since 2012) was photos, pictures painted by our kids, favorite Christmas decorations, record albums (HP), spiritual relics (JP), reference manuals (HP and I were preppers way back when), ski stuff, winter stuff, business papers and our kids’ excess stuff that hasn’t followed them into their new lives.

Last year, when HP and I were living in 2 separate houses in 2 different countries, we talked about our storage unit and the best time to empty and release it. It was ridiculous to pay their ever-rising storage fees now that I was back in the U.S. The path of least resistance never materialized. I found the perfect little nest for me in October 2016 and was able to move some of my stuff from the storage unit to my nest. But so much stuff remained.

As our Unplanned Journey unfolded this year, HP moved back to the U.S. a little sooner than “planned”. We are embracing what was once my little nest in Manitou Springs and making it a nest for the both of us. It has been perfect for us in terms of location. We have quick access to his medical team, stores and services. The setting is peaceful. A true fairy setting. We are in nature, walking distance to Manitou Springs (and back, if we are being ambitious), and 20 minutes to Penrose Hospital where HP gets his treatments. We love our neighbors who have become friends, and the drive to Guffey to see family and friends is a beautiful road trip.

Yesterday, HP and I made great memories while decorating for Christmas. It was a beautiful Thanksgiving holiday and weekend. Gratefully, we shall store all the blessings and memories in our hearts.

Being Grateful

Happy Thanksgiving 2017

On Facebook this morning, a memory popped up from 5 years ago. I thought it was appropriate for many reasons. Tis the season. It ties our new Costa Rican adventure in with our present Thanksgiving. It’s the gap between 2012 and 2017 that is so very interesting for us and our family.

Facebook memory, “Happy Thanksgiving 2012, friends and family. I love you all. Making my first apple strudel with filo. Fingers are crossed. We are so fortunate to have Jai, Martine, Ken and Chevy all here in Costa Rica. When I reflect on this, it is almost unbelievable. A lot of faith, commitment and hard work made it happen.”

HP and I were thinking about this a couple of days ago. If our memories serve us well, this year is his first Thanksgiving with family since 2012. Wow! I am over-the-top grateful that he is here, and we are able to celebrate Thanksgiving together in our beloved state of Colorado. (We miss having you with us, Jai, and I hope you are doing something special in Michigan.)

Today, I remember the importance of remaining grateful. Perhaps, in the past, I selectively practiced gratefulness. Especially, when there were special moments/times to be grateful for. It was easy to be grateful when everything went well. What I had not learned yet was to be grateful during the darker times. To living in the Now. Just like gratefulness, it was easier to appreciate the Now moments with a gentle reminder from Eckhart, or Wayne, or Og (a special guru from many many years ago). But what I had not learned yet, through life experiences, was that being fully present in the Now moment was an actual place to reside. It has become my sanctuary.

Yesterday, HP and I went to see his oncologist. (Prior to treatment #5, she wanted to see him to discuss the next steps. She hinted that she may move him to a maintenance plan after #5, because he is doing so well, determined by his PET scan in October. As her words went through our personal filters, we both heard, “chances are very good that #5 is your last chemo treatment, and you will go onto maintenance”). So, with light hearts, we expected to get confirmation from her. But, that is not what happened, which is often the case with our fabricated expectations.

Yesterday, she said, “I will schedule treatment #6 for November 28, and then we will meet again after a CT scan to see what maintenance options will work best.” From that point on, all our other questions evaporated from our minds. Our hearts became heavier. But why did this news hit us harder than what we expected?After our appointment, we stopped at a nearby restaurant to grab something to eat. (HP’s appetite or taste for good food has never waned through his 5 treatments.) We were both quiet as we processed what had just happened.

Our conclusion is that our hearts became heavier for one reason only. It wasn’t because we heard bad news. There had not been any new test results to drive her decision down this “new” path. In reality, the path was not new at all. It had always been discussed, 6 treatments 21 days apart. She simply stayed the course. I can’t help but believe the one reason our hearts went from light to heavy in a matter of minutes was because our expectation bubble was popped.

The gap between 2012 and 2017 has taught us some very valuable life lessons. Even if there is a dark time, be more Grateful than ever. The Now moment is where peace lives. And, for heaven’s sake, try hard to not fabricate expectations. When the bubble pops, the pop can be very loud. HP and I talked about still being able to Dream and Hope, but at the same time Flow. When we are totally in the flow, there are no loud pops. Yesterday, we experienced some sadness. And I am so grateful for the sadness, because it was a great reminder of what is important in our lives… Family + Friends + Love + Gratefulness + Now + Flow + Dreams + Hope = Life. I’m confident this Unplanned Journey will shine a bright light on other life lessons, and I say,

“I am grateful for what I have learned along the way and for what is to come. Happy Thanksgiving to you all and your loved ones.”