Mom's Wellness, 04/09/2002
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Mom's sickness (read below) may have knocked her down for a while, but not a long while! She's back at home (I hear), as of last Saturday. I tried calling her last night but she was out celebrating because her latest xray showed ... no cancer! Looks like the chemotheraphy treatments did their job all right.

I'll try to get hold of her tonight, but isn't that terrific news! Let's keep praying!

    -- Dean

Mom's Illness, 02/19/2002
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Below is taken primarily from emails I've distributed describing mom's condition when she was first hosptialized with hyponatremia, and the subsequent discovery of a tumor in her lung, that was later found to be a small cell cancer. Since undergoing her first chemotheraphy treatment, she's doing much better, and while still early, my own "prognosis" is that she'll be her old self in a short while.

    -- Dean Cashen, 02/17/02

Well, let me just start by saying I'm trying a distribution list
I've cobbled together of people who I think will want to know how
mom's doing. I'm writing this as much for me as for you, to be honest. Here goes...

Today's Monday, Feb 4th. Some background on mom:

• She was taken to her doctor on Jan 21st by her sisters Bonni and
  Sue because of fatigue and instability (she'd fallen down). Subsequently
  they found her blood electrolytes were off, particularly her sodium
  level which was 106 (~140 is normal, 125 or below is a "medical emergency").
  For this she was later taken, by Ed, to the ER where she was then
  hospitalized because of the low sodium. This, by the way, is known
  as "hyponatremia," and her's was the "chronic" version, meaning it
  had been dropping for quite a while (The other version, "acute hyponatremia" is when sodium drops over a short period of time, i.e., < 72hrs. An example
  of acute hyponatremia can be seen in marathon runners who lose a
  lot of salt through sweat and replenish only with water which, quite
  simply, dilutes the salt in their blood).
• She remained in the hospital while they gave her low levels of
  sodium via a saline drip (those bags of water you always see hanging
  over someone in bed, the fluid is injected, "dripped", into their
  bloodstream). Now, it's important with chronic hyponatremia that
  sodium is introduced slowly, the brain can be injured if too much
  is given too soon (for acute it's the opposite, you want to bring
  the sodium level back up quickly). This is because the brain has adapted to the lower sodium levels over time, and raising blood sodium levels too quickly can cause swelling in the brain. Since the cranium presents a limited containment volume, brain swelling causes pressure that can injure the brain.
• The effects of low sodium are: Mental confusion, imbalance, instability,
  and so on. Mom, with so low a level, fit all these symptoms, and
  it's assumed now that her sodium's been low since Christmas, or before.
• I came out that Wednesday, and the Gods were smiling because, even
  with the snowstorm the NW has gotten, the mountain overpass was clear
  for my trip. Can't say I like the drive, at night, with random lanes
  closed, black skies, trucks, and rain along Hood River, though.
• After a few days in the hospital, mom's sodium level came up: 112,
  118, 124, 136. On the day it was measured at 124, mom was pretty
  far back to normal, she was walking (albeit slowly and carefully
  -- she had fallen a second time at home before she came in and hurt
  her left arm, so she wasn't taking any chances now), and she was
  talking and thinking lucidly. And, her progress was such that by
  Monday, Jan 28th, she was released from the hospital. I took her
  home, and since she was still recovering, we set up a "bedroom" downstairs
  for her; she wasn't ready to tackle the stairs just yet. Mom was
  taking three medications for her sickness, one an "antibiotic," the
  real purpose of which was to keep her sodium level up. She also
  was taking an steroid to clear her lungs and breathing, and also
  taking a second antibiotic to clear up some mild bronchitis they
  found. She was taken off her previous long-term meds to keep her
  blood pressure under control, the doctors though these might have
  caused or contributed to the sodium crisis.
• Now, while she was in the hospital, they wanted to better understand
  WHY she'd gotten sick. Chronic hyponatremia is a symptom of something
  else gone wrong. One thing they investigated were her lungs, disease
  or infection in a person's lungs can cause a hormonal shift that drops
  sodium. A chest xray found some "spots," and they followed up with
  a CT scan ("CAT scan"). The CT showed a tumor in her lung, fairly
  large (6 cm, just over 2" in size). They believed it was cancer,
  and did a biopsy that we had to wait, agonizingly, through the weekend
  for the results. They also did an MRI on her brain to see if,
  should it be cancer in her lungs, it had spread to the brain;
  apparently lung cancers tend to "metastize" (spread) readily to the brain,
  especially advanced ones. When mom heard this she became scared,
  and at points was ready to throw in the towel. HOWEVER, the MRI
  was analyzed quickly and on, oh, Sat or Sun in the hospital we were
  told her brain had NO evidence of cancer! That led to the hope that,
  no spread of cancer, no cancer whatsoever!
• As I said, mom was released on Monday, and the gating factor was
  that we wanted to get the results of the biopsy, and on Monday the
  lung-specialist came in and pronounced the biopsy as "non-diagnostic.
  " What that means is, while it showed no cancer, they believe they
  simply didn't get a good sample of the tumor, and recommended, and
  scheduled, a second procedure to try to get another, better, sample through a different, and more invasive procedure. The doctor's believe it's unlikely the tumors are benign, hence the desire to get a biopsy that will show what we need to battle.
• Mom's progress was extraordinary, so when she got home on Monday
  she was "pretty good." She still had a lot of fatigue, and as I mentioned
  she wasn't very stable in walking and so didn't want to go up the
  stairs. She took a lot of pleasure in watching "her shows" that
  we'd taped while she was in the hospital (Soap Operas, and "West
  Wing"). But she had trouble with many things, she had no interest
  in reading, and couldn't do the crossword puzzles she did every morning
  before she became ill (although, while in hospital she did do one
  on Sat or Sun). She couldn't work the TV remote, it just didn't
  make sense to her now. But, as her sodium continued to rise, and
  as her brain had time to "soak it in," we expected her to return
  to normal soon (the brain, apparently, protects itself from drastic
  electrolyte changes, so the lag between her blood sodium level and
  her brain's adoption of it was said to be about two-to-three days).
• It didn't work out that way, however. By Tuesday (Jan 29th) she
  was becoming less able to walk, more sleepy, and showing signs of
  confusion (She thought she'd been back from the hospital for "months
  and months," even though she'd come back the night before). She
  wasn't eating much at all, and drinking nearly nothing at all. Everything
  tasted bad to her, even the various bottled waters I got for her
  to try. She was sometimes nauseous, and started complaing of headaches.
  So, throughout the week we spent time either calling doctors, going
  to doctors, or going to the hospital as her condition worsened.
  She had a blood workup on Wed, and her sodium was 141, which was
  fine. Sodium wasn't the problem, and the doctor's thought it was
  probably related to the meds she was taking, so we alternately substituted
  some for others, or she stopped taking them entirely.
• On a personal note, by Thursday I was having difficulty managing
  this all, and called Alexas mom who, thank God, scooped up Alexa and
  flew out on Friday to help out. When they got here Friday afternoon
  it was a homecoming I'll never forget!
• By Friday mom was in very poor shape, and I took her to her doctor
  and he halved the only med she was now taking, "Declomycin", that
  she was prescribed to bring her sodium up. We were sent home, but
  by this time I was ... suspicious ... given the trend I saw in mom. However
  the doctor was confident the reduction in her meds would bring results.
  Doctor's seem confident a lot.
• By Saturday night she was in terrible shape, and hadn't eaten to
  any real extent, was very very confused and unable to walk, sit,
  etc. She was also suffering from greater and deeper hallucinations,
  some quite disturbing, and some just "silly" (She thought she was
  a "Princess" who was given billions of dollars by the Prince. She
  asked me if I got my $600M. Wish I had, but I think I'd have noticed
  if I did).
• I called her doctor, got his standby, and explained what mom was
  going through. He suggested taking her to the ER, and I did. (By
  the way, as most of you know, mom is hardly a fan of doctors and
  hospitals. These trips to/from were something she always fought
  against, but we eventually got her to comply). She was dehydrated,
  and her sodium was 148 -- now it was getting high. They gave her
  a saline drip again, and I pressed on the ER physician that something
  more needs to be done. He was (I'll say) "supremely confident" that
  this would both flush her system (her "BUN" count in her blood was
  high, essentially a measure of toxins in the blood) and get her back
  on her way. He estimated she'd feel "50% better" by the time she
  got home that night, "50% better" in the morning, and by Monday she'd
  be "pretty much back to normal." Reluctantly, I took her home.
  I say "relunctantly" because I just didn't feel right about it, based,
  of course, on the trend the past week, and all the failed attempts
  by doctors to get her back to normal, failed despite their expressed
  optimism.
• Early Sunday morning Alexas mom got up before me and found mom had
  fallen in the hallway. Mom was fighting to be left alone (she was
  saying we'd all be hurt if we stayed near her, not by her, but by
  "something," the thing she believed was after her and that had brought
  about this disease). It's hard to pick up someone who doesn't want
  to be picked up, but we managed and got her into bed. I called the
  standby doc again, got a callback, and described mom's condition.
  I also told him I wasn't about to subject her to a "visit" to "try"
  something this time; mom needed focused care. He cleared the way
  through ER and I took her into the hospital where she was given a
  room yesterday morning (Sunday). Her condition was horrible, to
  be frank, and they prescribed another saline drip for her continued
  dehydration, and bloodwork now showed her sodium was at 155. This,
  surprisingly, was "critically high," (known now as "Hypernotremia"). So the Declomycin was working, too well, and probably contributed or caused her decline in the past week. And as a result of the dehydration her kidneys, which
  had previously been great, were starting to shut down. That shouldn't
  be cause for any panic since (I'm told) it's normal given in cases
  of dehydration, and the saline infusion should clear it up.
• I spent the entire day with her, leaving late in the evening and
  got something to eat (The "Pedro" burrito and enchilada at "The Ram"
  close to the hospital. Now here's a tip: The Ram's good for burgers
  and such; if you want Mexican food, go to a Mexican restaurant.
  The ale was great, though). The hospital staff had, in fact, asked
  me to stay to help; mom wasn't cooperating with them and I was able
  to, sometimes, get her to. You should realize that poor mom's system
  and brain, by this time, had been subjected to a wild "cocktail"
  of toxins, low and high electrolyte levels, and it plays havoc with
  a person's cognitive capabilities. Mom simply wasn't herself, and
  until her system is stabilized, she won't be. The doctors now wanted
  to keep her under evaluation and care in the hospital until they
  can get her back to normal. That certainly wasn't happening at home,
  to everyone's surprise. She was supposed to get better.
• I spoke with her doctor ("Dr. Foulke") this morning (Monday) and
  her sodium, measured last night, was now 156 -- essentially the same,
  but a new measurment will be made this morning. He expects it to
  drop. He also expects that now she's under monitoring and care that
  she'll snap back to normal/near-normal. I could be wrong, but this
  prognosis sounds familiar.... No timeframe as of yet, but assuming
  this time it's true, well, that's great news!
• The fundamental problem still remains, the tumors in her lungs
  and what to do about them. Until mom's current condition improves,
  treatment for that is on hold. It certainly won't do to perform
  a second biopsy when she's as weak as she is. We're planning/hoping
  for her to recover quickly, and as soon as I send this I'm heading
  to the hospital (you sure can get tired of hospitals and doctors
  Real Quick -- I can only imagine how tired of it all Mom must be).
  When I know more, I'll let you all know.

Hopefully this (I know, too-long!) letter sheds some light on how
mom's doing, and what's been happening.

Thanks to all who've helped out, called, or sent their wishes.

From a subsequent email 02/12/2002:

Subject: Update on Eve (02-12-2002)

Hello:

Well, some good things to update you all on regarding mom. First,
she's come around mentally, to the point that today she more-or-
less acknowledged that she did, indeed, have cancer. But most important,
she agreed to start chemotheraphy, and did last night (and, keeping
in form, the hospital made sure it took all day to start, in fact,
she didn't begin chemo until 9:30 last night). She was scared,
frankly, not knowing what would happen, and mostly, I believe, scared
at admitting to herself that the cancer was for real. I stayed with
her through the night, and everything went great! She didn't have
any side-effects, slept through the night as well as you can in a
hospital (tough to sleep much when people are coming in at all hours
to take blood, check your vitals, so on). She woke up around 5:30,
chatting away and feeling good (although, she was a bit confused
about some things, but nothing like the past weeks).

I don't yet know the chemo schedule, or how long mom'll have to stay
in the hospital. It won't be much longer, though. The doctor, whom
I didn't get to speak to yesterday (he called in the treatment to
the nurses, I'm convinced the first rule of doctoring is to avoid
hospitals and the afflicted at all cost) had said last week that
the schedule was along the lines of 3 days of chemo, once every 3
weeks, for 3 months. That would then be followed up by radiation
theraphy. The treatments can be handled on an out-patient basis.
But I may have that schedule wrong. I also don't know -- no one
does -- what kind of care mom will need when she leaves. Obviously
we all hope she can take care of herself just like she's done the
past 70 years, but it's too early to tell. I spoke to her about
getting some help in, and she's somewhat agreeable to that, so we'll
play it by ear based on how she progresses. As it stands now, with
the way she is, she'll need someone to help her out, or more reasonably,
she'll need to be in a place where they can give her 24 hr care.

However, the doctor's universally agree that the chemo will treat
her cancer (a cure is less likely, only about a 10% chance), and
give her a "good" year or so, maybe more. And, the confusion she's
feeling should go away once the cancer's suppressed; as it stands
now, it's still playing with her electrolyte balance, and will continue
to cause her problems until the balance becomes stable and normal.
In short, everyone expects the treatments to bring her back to
her old self, for a time.

Subject: Update on Eve, 02-17-2002

Date: Sunday, 17 February 2002 14:06:18 -0700

Hello:

Well, a lot's gone on in the past days, sorry for not updating sooner.

First, mom's out of the hospital, and has been for about four days.
Following her first chemotheraphy treatment, the next morning they
decided she was ready to leave the hospital, and we agreed, bringing
her home that afternoon. Mom couldn't wait!

She's improved since leaving, and has another chemo treatment scheduled
for next wednesday. However, she's not well enough to take care
of herself yet, and she agreed to stay in an "Assisted Living" home
until she gets stronger. She moved into "Lancaster Village" yesterday
afternoon, here's her address:

 Eve Cashen
 AL13
 4138 Market Street, NE
 Salem, Oregon
 97301

It's really a nice place, and it's less than 10 minutes from mom's
house, so she's in the same area. They take care of the basics such
as food, entertainment, general care, laundry, etc. Mom's at the
"base" level of care, meaning the minimal amount they offer. As
she gets stronger we'll see about moving back home. It depends,
of course, on the effects of the chemo and how mom continues to improve
because of it. So far, the only side-effects of the treatments seem
to be some nauseau, and she seems a bit sleepier that before. But
she's walking, often but not always with a walker, and her spirits
are great!

Sandy and Tom, and of course myself, are still here, staying at mom's.
I plan to wait through her next chemo treatment, and in the meantime
I'll attend to details to get her settled in her apartment (mail forwarding, move her phone, so on).

I'll post some photos of mom that I think you'd like to see on our
website, and give you the link. (I'd mail them but the mail program
I'm using here is kinda limited and I'd have to send them one at
a time. However, I'll attach one for now).

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