News About Joan's Recovery from Lung Cancer

13 February 2010

For anybody who has been looking, sorry I haven't posted in almost two months. Its been a busy two months, with the end of one semester, the beginning of another, and (at least for me), a nearly month long trip to China with the Brooklyn College Study Abroad program (I was teaching). Monday will be the eleven month anniversary of Joan's diagnosis with lung cancer, and she's now living a pretty normal life. She hasn't restarted playing the cello yet, but she's walking long distances at a reasonable pace, playing the piano, and doing pretty much everything else she was doing last year at this time. She visits Sloan about once a month now as a subject in a stage 1 clinical trial for a vaccine that, it is hoped, will help to prevent cancers like the ones she had in the future, so there is lots of follow up, but she is doing extremely well. She starts volunteering at Chamber Music Society again this month and is starting to talk about traveling a little late this year. Thanks again for all your support over the last eleven months. I really appreciated it. Davis

15 December 2009

Sunday was the nine month anniversary of Joan's diagnosis with lung cancer. It was also a coming out party of sorts. She took two long walks in horrible rainy weather. The first took her up to 78th and Riverside for a tree party associated with some friends in her book club. She got back a little before four. Then we went to Alice Tully Hall for the Chamber Music Society's annual Brandenburg Concerto concert and party, her first CMS concert since before the first surgery. It was a wonderful welcome home party for her. All her friends from CMS gave her warm greetings. She was given flowers in the patron lounge during the intermission. She learned of the inspiration she has given others during the post-concert party. We walked home in the glow of friendships and her most energetic day yet. Tomorrow night (Wednesday) we go to another concert. We'd love to see you there. If you are interested, ask Joan about it.

7 December 2009

Another benchmark of sorts tonight. Joan had a crowd over (her book club). The event seemed to go well. I stayed hidden away in the back rooms and then helped clean up afterwards. The real test is on Wednesday, however. She had her first post-chemo scans on Saturday. Tomorrow we find out what they have to say. Here's hoping for a clean report.

27 November 2009

Yesterday was Tnanksgiving. Joan took her first long ride in a car since the first surgery. We visited my sister Alice for Thanksgiving. It was a small gathering. Two of her children were off at the homes of the families of their significant others for the day, so it was just six of us (a good number at this point. With Traffic it was about a two hour ride going and an hour and a half ride coming back. The turkey was great. Joan had her second glass of wine since the treatments started, and we all had a great time. We particularly enjoyed the movie "Up", which Joan and I hadn't seen. Hope you had a great thanksgiving too.

21 November 2009

Now that the treatment is over Joan seems to be improving fairly rapidly. Last night we went to the City Opera again (Don Giovanni). She was walking more quickly than last week. Tomorrow we drive up to a concert in Westchester. Real progress.

18 November 2009

Today was Joan's last chemo treatment. Chemo treatments generally take hours, even when they are small and relatively easy treatments, as today's was supposed to be. There is a reason for that. In some ways all chemo is a race within a race. The larger race is the chemo versus the cancer. If the chemo wins, the cancer is destroyed, but often with side effects. The second race is chemo and cancer versus your body. Both actively destroy your body (in different ways) and a part of every chemo treatment is doing bloodwork that determines the amount of damage that has been done and allows informed guesses to be made about how much damage would be done by another treatment. Eight treatments ago the bloodwork suggested a risk of kidney damage and they backed off of a heavy chemo session in favor of a light one. Today her white blood cell count and red blood cell counts were low, suggesting a diminished ability to fight off infections. Based on that, the last chemo was canceled in favor of a transfusion that should help her red blood cell counts. In any case, this course of chemo treatment is now complete. I'm now looking forward to watching Joan regain her strength over the next few months and to a clean scan in December.

15 November 2009

Joan went to a Coffee Concert this morning ... all by herself! I teach on Sunday mornings this semester and couldn't help. She enjoyed talking with Peter and Billy, who were also there, and took a nap after she got home.

14 November 2009

This weekend represented something of a milestone in Joan's treatment. The chemotherapy isn't quite over (one more light treatment), but last night was the first time we had gone to a performance since her cancer treatment started. We attended a City Opera performance of "Esther", an American opera (in English) that debuted with City Opera over 15 years ago. It was not a pleasant evening. It was cold, windy, and was raining lightly, but we left the apartment at a little after seven, walked slowly over the the newly renovated and renamed Koch (pronounced Coke) Theatre, talked to friends while we waited to go in, and sat through the entire performance. Rob was playing in the pit (sitting next to our friend Betsy). The music was fairly atypical for modern opera: atonal composition that never "resolves", but the music is appropriate to the story, the performances were outstanding, the acoustics of the theater are much improved, and the lighting-dominated sets were beautiful and often haunting. Hence, despite the weather, it was a good night. Joan is clearly recovering. Just one treatment to go.

24 October 2009

Joan completed her third round of chemo this week. The first two treatments of each round are the hard ones, and they seem to get worse with each round. The second two treatments are the easy ones, but the effects of the first two rounds linger, and it isn't until the end of a round that we can judge how well she is improving. The overall improvement has been remarkable, but Joan started the first round still using Oxygen, so its easy to be doing better. The best measures of her improvement are her appetite, her overall energy levels, and tolerance of my marginal domestic skills. The appetite is great now. She loves to send me out to pick up liver and bacon from O'Neils, and she often finishes it all at one sitting. The energy levels are improving too, and she has managed to complete all sorts of knitting projects. Finally, her tolerance of my procrastinating approach to housework is going down. The good news is that the higher energy levels are allowing her to pick up some of the slack. All good news, I think. Our best to all. Davis

9 October 2009

This is Joan ... Davis has been busy. Only 6 more chemo treatments, 2 long nasties at most. The first cisplatin dose was skipped for the 3rd cycle, but the second was delivered on Wednesday. The sticking point is kidney function so we'll see what happens next time. Meanwhile I am doing OK, tired, bloated, but all is tolerable.

28 September 2009

A minor milestone. Joan went out for lunch for the first time since just before the second surgery. The restaurant was close, the menu was limited, and the restaurant was quiet, but these are all good things right now. The next big chemo is on Wednesday.

26 September 2009

Joan is now halfway through her chemo treatments. Eight down. Eight to go. She continues to show improvement in important ways. The heavier chemo treatments (like the one she'll have on Wednesday) sap her energy. It becomes hard to take walks, hard to stay awake, and difficult to eat well. The lighter treatments, like the one she just completed, deprive her of her sense of taste (everything seems to taste like cardboard), but allow for improvement. During the last two rounds of lighter treatments she was able to go off Oxygen, take longish walks outside, play the piano, and work late into the night on reading and knitting. Fighting cancer is hard work, but Joan is, as I'm sure you know, a fighter. Its working.

24 August 2009 3:00pm

Joan had her fourth chemo treatment this morning. It is one of the easy treatments and it went fine. Indeed, it marked something of a milestone. Today was the first day she's gone out of the apartment without her Oxygen generator. We just didn't bring it with us. She did great. She has been improving on this all week. For the last several days she has only used the Oxygen (as recommended) while sleeping. All of her exercise, piano playing (she's doing a lot more) and other activities were under the power of her own Oxygen generaqting capacity. This is real progress, but there is a long way to go: 12 move Chemo treatments, and we go back to hard ones on Monday.

15 August 2009 1:00am

Joan's chemo this week (this past Monday) went fine. The hardest part about this chemo, as with the last one, is that Joan has to drink huge amounts of liquid to wash the chemo out of her system. She winds up not feeling hungry as a result, so we have to work to get enough calories into her. In the end, the aftereffects, especially bloating, cramping, etc, are very uncomfortable, but she continues to read, knit, talk to friends on the phone, and, increasingly, do some of her own cooking. This week, for the first time in months, she has started to play the piano when she is feeling better. The pictures from my nephew Noah's wedding that she received from my sister Sarah were a real high point. The next two weeks should be easier, as the feature easier (and fairly quick) chemotherapy treatments. She has a busy first week in September, with appointments with a cardiologist, her surgeon, and a return to more intensive chemotherapy treatments. Otherwise, all is well.

8 August 2009 11:30am

Joan came home from the hospital yesterday. The results of the tests were all optimisitic. Nothing seems to be wrong. The conclusion is basically that she just needs to relax and change her diet somewhat. Rich and hard to digest foods are out. Plainer easy to digest foods are in. The next chemo is still scheduled for Monday.

5 August 2009 5:15pm

It probably shouldn't be surprising, given yesterday's descriptions, that I'm writing this from Sloan Kettering, where Joan is likely to spend the next two days. The day started off well enough. Joan got up early for a shower and I made her breakfast before heading out to teach. When her physical therapist came by late morning, however, her pulse was very high and she was experiencing for herself the meaning of the words "heart palpations". Tony came by with lunch a little after noon, and they soon decided to skip lunch and get checked out at Sloan Urgent care. They haven't found anything wrong. Indeed, her hemoglobin is up. Still, they feel its time to find out what is going on, so she'll be doing some testing for the next day or two (bet on two). As I write this, she's more or less incommunicado except for e-mail. Shell be moving back to the 14th floor shortly, however, and her cell phone should start working again. For what its worth, this is a very normal kind of event for people doing chemo. More when I know more.

4 August 2009 11:45pm

Today was Joan's birthday. It was also a very difficult day that didn't feel at all festive to her. Some of the effects of chemotherapy are more or less immediate. Other more difficult effects take several days to emerge. There was no one difficult symptom today. There were several, starting with general tiredness and a persistently high pulse rate and ending with the need to make the difficult choice between exercising and eating. The choice is an unfortunate one, as she needs the exercise to fully recover and, well, eating is kind of obvious. It remains that if she exercises she is too tired to eat and if she eats the effort of digesting pushes her pulse up above her target range. The problem isn't breathing and oxygen. Its having enough hemoglobin in her blood. That was in decline before the chemo started, and chemo only makes such things worse. Things will get better, but its a lot of work for her right now. Thanks to all of you who called to wish her a happy birthday. Chemo doesn't allow for many visitors, but she loved receiving the calls.

30 July 2009 11:55pm

The first round of chemotherapy is complete. To all appearances it went well, but the effects of chemotherapy accumulate over time and across multiple treatments, so the truth is that all we know at this point is that she seemed to tolerate the chemotherapy reasonably well. Chemo is basically a hurry up and wait process. Wait for blood tests. Wait for the chemo to be mixed and the required amount of liquid to push through your mody. Wait for the chemo itself to drip into your body. We were at Sloan for a little over 10 hours, but this round is done. We'll have some sense of the effects between now and the next round of chemo a week from Monday. If there is anything to report in between I'll let you know.

29 July 2009 5:00pm

The surgery was successful. Dr. Rusch called me (from the operating room) at about 5:15pm as she was finishing the surgery to ask a question. Everything had gone smoothly. I was called up to see Joan at about 6:30. We we arrived back at home at about 8:00pm last night. The first chemo session is tomorrow morning. We meet with the oncologist at 8:30am. I'll probably have something more to say tomorrow morning.

28 July 2009 5:00pm

Joan is in surgery again today, this time for the insertion of a "mediport" through which her chemotherapy can be injected. The procedure shouldn't be very long. Indeed, its probably over as I write this. I'll know more eventually. This begins at least 16 weeks of chemo. The first session is Thursday.

24 July 2009 5:00pm

Recovery from the surgery isn't entirely over at this point, but chemotherapy starts next week and Joan is steadily improving. She is now able to go for long periods of time without supplemental oxygen. She still uses it at night and when she takes longer walks, and when she feels she needs it. Her walks are not, in general, particularly long as yet. The longest she's done at once since coming home from the hospital is about a third of a mile. She has been doing a huge amount of reading, however, and her knitting speed is coming back. On this coming Tuesday Dr. Rusch will surgically install a mediport for the chemotherapy. The first chemotherapy will be this coming Thursday. That will begin 16 weeks of chemo in a 4 week rotation of different drugs.

12 July 2009 11:45pm

Joan is making slow progress increasing her level of exercise and improving her breathing. She sees her surgeon for a post surgical follow up and the oncologist about chemotherapy a week from Monday. Unless things improve substantially, it may be a while before they start chemo.

7 July 2009 10:45pm

Joan has been recovering more slowly from this round of surgery, but the pneumonia created greater challenges to overcome. We don't appreciate how important breathing is to our metabolism and overall energy levels until breathing is a challenge, but Joan has been working steadily to meet this challenge and shows improvement everyday. She is measuring her progress by the ease with which she can do things. Reading, it turns out, is easier than listening because you can take breaks and not miss anything. She has found that listening is easier than knitting, perhaps because knitting requires you to keep track of more than one thing at a time (the pattern, counting knits and rows, moving the needles the right way). Two days ago she found it very difficult to knit. Today she finished several rows on a pair of socks. She is learning to breath deeply and has made major progress in her inspiration spirometer exercises. She is, in short, breathing better, walking farther, and able to handle more and more complex activities. Progress is being made.

3 July 2009 11:00am

Right now we are meeting with a nurse from the Visiting Nurse Service, who is taking a thorough history, sorting out the kinds of assistance they can provide and providing good advice on what Joan should do to recover. She has settled in pretty well at home and we're working out the rhythms of living with oxygen. So far so good.

2 July 2009 4:30pm

Joan has been home for about three hours now. She's now asleep, which gives me my first opportunity in many hours to update here.

1 July 2009 10:30PM

15 laps today. Home tomorrow. Joan had a good visit from Betsy. I'm working hard to have everything ready for tomorrow.

1 July 2009 1:30pm

The last day of Joan's stay at Sloan is all about preparing to send her home tomorrow. This afternoon they will be assessing Joan's oxygen needs. An oxygen unit has been delivered to her room. It will come home with us tomorrow. In the meantime, Joan's primary roommate from her last visit at Sloan, Angela, became her roommate again today. They both had surgery last Tuesday.

30 June 2009 7:30pm

Joan did seven laps this evening (four before Dr. Rusch came and another three after). That brings her total on the day to 16 laps (more than a mile!!!). Another sign that she's recovering well.

30 June 2009 7:00pm

Dr. Rusch just made it official. Joan is recovering from the pneumonia. So long as there is oxygen at home, Joan goes home on Thursday. That means I'll probably spend most of the day at home on Wednesday, so it will be a good day to visit if you are interested. Contact Joan if you are.

30 June 2009 5:30pm

Joan has already walked nine laps today. Her longest walk today is also her longest walk of this stay at Sloan: 6 laps. If she does 5 more laps this evening she will have done a mile today. Could easily happen.

30 June 2009 12:45pm

After an uneventful morning of tests, Joan is looking forward to taking her visitors for a walk.

29 June 2009 10:30pm

Joan and I finished doing some laps a short time ago and she just finished her latest resperitory treatment. Talking is an effort for Joan right now except just after resperatory treatments, so she just made some of her longest statements of my visit this evening. Today was a big day for walking. She got up to 10 laps altogether; double her total from yesterday. Thursday looks like her most likely exit day right now.

29 June 2009 10:30am

Dr. Rusch dropped by this morning. The latest chest x-ray is showing improvement (finally). She now estimates that Joan will come home on Wednesday or Thursday.

28 June 2009 9:45pm

Just returned from doing another lap with Joan. We did three laps earlier (at about 6:30, so that brings her up for 5 laps for the day (another record for this visit). The goal is fourteen laps in a day, so she's a third of the way there. I'll be going home soon, so there probably won't be any more news until tomorrow, when we hope to hear about Joan's pathology report from the surgery.

28 June 2009 6:15pm

Joan is sitting at the window reading a book while she waits for an antibiotic drip to complete. When its done, we'll take her second walk of the day. I have my folding bike in the room, having taken a bike ride up in Dutchess County this afternoon (not by choice, but it was very pretty and enjoyable). Joan continues to show improvement. She is now able to push her incentive spirometer to about double the level she could a couple of days ago, which means her breathing is improving. She still needs supplemental oxygen, however, and will likely need some for a few weeks after she returns home (that's official now; they'll have a social worker start work on setting that up starting tomorrow). Don't assume that means an early exit, however. It appears that Joan will be here through the end of this week (Friday would be the optimistic estimate for her exit; that's official too). Overall, she is looking much better, but the benchmark for leaving will be a confirmation that her lungs are clear of the pneumonia on the chest x-ray, and that indicator åtends to lag actual recovery. Well, time for a walk.

28 June 2009 10:45am

Talked to Joan at midnight and again a few minutes ago. She's working hard at recovery and is expecting to see Manny and Karen this afternoon. I'll see her at around 4:30pm and stay for the evening. More later.

27 June 2009 11:00pm

After working out the mechanics of attaching Joan to the portable oxygen, Joan and I did three laps of the floor. That sets two records for this visit to Sloan. She did a total of four laps today, which brings sets a one day record for this visit, and did three in a row, which marks her longest single walk so far. Its hard work right now, but this walk was very successful. Her Oxygen levels were hight at the end of the walk and her cough is good and strong. Joan is expecting a visit from her Uncle Manny and Karen tomorrow afternoon, and I fully expect she will double the today's total laps tomorrow. Progress is being made.

27 June 2009 8:00pm

Joan had several visitors today. Louise came by and brought a small stuffed bear to keep her company. Linda Keene and Jon Brezin stopped by for while. Rob came by with a box of chocolates and stayed with Joan for a long while. He's leaving for Summer Trios tomorrow and misses havng Joan around the apartment. Joan continues to recover at the hospital. The foley and intravenous pain killer were removed today. She is obviously feeling better and feeling more comfortable talking. Her cough is now strong and effective. Even a short walk to the bathroom is a challenge without her Oxygen, however, and she still needs to make progress walking. There is still work to do before she can come home. Thanks again for all your support.

27 June 2009 8:30am

I received a call from Joan early this morning. She is sounding great. The chest x-ray isn't showing improvement yet, but the cat-scan was clear and Joan has been told that both her foley catheter and the epidural pain management system will be removed today. That means she'll move to oral pain medication and that she'll be a lot more mobile, which should help her to get walking more. She is still using Oxygen. That requires that her lungs clear a good bit more than they have already. The treatments to help her clear her lungs on her own seem to be working. Her cough gets stronger every day, and she is now coughing up a lot of stuff (a good thing). The goal right now is to get her off oxygen, and home, so walking will probably be a major priority for her today. Joan will be taking a small number of visitors today (for the most part they already know who they are). I'll be driving my car up to the home of a friend in Massachusetts so that I won't have to worry about driving it for a bit, but expect to be back at Sloan sometime after mid-afternoon. Thanks again for your caring and good wishes.

26 June 2009 9:00pm

Joan still seems to be doing quite well. She is currently reading, but had a good day. She had her first visitors today. Mimi stopped in for a while and Mark and Karen Putterman stayed for several hours. I expect that we'll be opening up a bit for visits over the weekend. Joan is doing her e-mail, so that's probably the best path to enquire if you are interested.

26 June 2009 5:40pm

Joan is being wheeled out for her cat scan and chest x-ray. With the drain tubes pulled and the recent treatments, she appears to be doing the best she's done since surgery. Who knows, perhaps things will speed up now (in a good way).

26 June 2009 4:15pm

On the good news front, they just removed Joan's drain tubes, which means that regardless of what else may be happening, the lung is healing fairly well. This isn't really a surprise given the generally mild air discharges she's had. There will be a follow up chest x-ray and cat scan later today, but this is an important bit of progress.

26 June 2009 3:00pm

Sorry for posting so late today. I've had trouble maintaining reliable internet connectivity both at Sloan and at home. Joan's breathing problems are related to a pneumonia in her right lung (the one that was operated on). This is not, according to Dr. Rusch, an uncommon side effect of a surgery for lung cancer, and it is complicated by the prior surgery, which reduces her overall lung capacity. She walked two laps this morning (a good thing), but they performed another broncoscopy today, which is only good to the extent that it helps to clear her lung and helps her breathe better. We've seen Dr. Rusch twice since I last posted. The general consensus seems to be that her cough is getting stronger (which is important because coughing helps to clear the lungs), so things are moving in the right direction, but steroids have been added to the antibiotic treatment and she is doing fairly regular chest x-rays now.

25 June 2009 7:30pm

Joan is looking a lot better now. She is breathing better and managed to do a lap of the floor about an hour ago. Things are looking better.

25 June 2009 5:00pm

It has been a slow afternoon. They'd like to get Joan walking, but between medications and other caregiving activities, there really hasn't been time, I would guess that five days is optimistic at this point.

25 June 2009 2:30pm

My apologies for not updating things sooner. I had a great deal of difficulty finding a new parking space for my car this morning (NYC alternate side of the parking), couldn't come over until I was parked, and couldn't reach her or anyone at Sloan while I was working at it. That was really unfortunate, because Joan did not have a good morning. The only problem I've been reporting so far has been breathing. That seemed to be getting better yesterday. It got worse last night, starting just after the walk we took to close the day. The problem, apparently, is that the drains are not doing their job in terms of clearing her lungs entirely and she hasn't been successfully coughing up what remains. She had a bronchoscopy this morning as they attempted to clear her lung. She is back on oxygen. The nurses are strongly discouraging visitors today as she rests and recovers. On the plus side, you have been very generous with get well items once again. A balloon bouquet arrived from Dave and Laurie Evens yesterday. An assortment of white flowers arrived from Carl and Riva Tait today. That pretty much fills available shelf space, so more flowers probably aren't needed now. Your good wishes are, as always, appreciated.

24 June 2009 8:30pm

Today was a bit of a banner day for the move that Joan and I made at the beginning of the year. I moved the last items out of storage today. Joan and I just did another lap around the floor. She is finding aspects of walking rather frustrating right now. She's off oxygen now but seems uncomfortable with her periodic wheezing. She is also feeling a little cold in the air conditioning here. The medical staff seems pleased with her progress however. Indeed they are considering removing her tubes as early as tomorrow. There is some occasional air leakage, but not much.

24 June 2009 1:15m

When I arrived this morning, Joan had just finished breakfast. She's now eating lunch in her new room. She hasn't met her roommate yet, but I do know that the roommate also had surgery yesterday. Things seem to have gone pretty well so far, but this mornings attempt to ween her off of oxygen didn't work. Her blood pressure has remained low since the surgery (that's one explanation) and her breathing is a bit shallow (her inspirometer readings are rather low and they've added a new exercise that involves breathing steam rich air through a "peace pipe" (that's what they call it)). She'll need to take a longer walk or two later today, but for the most part she's just resting and recovering. I'm going out for a bit this afternoon but will return this evening. I'm sure I'll have something to add then.

24 June 2009 11:45am

Joan just took her first walk since the surgery (one lap of the floor) and is about to move to a new room.

24 June 2009 10:45am

Joan moved to a room at 4am. She's in the same room she started in when she was last here, but hopes to move to another room later today. She is looking very good.

23 June 2009 9:00pm

Visited Joan in the recovery area of Sloan from about 7:15pm to about 8:00pm. She is looking great (something nearly everyone who comes by seems to comment on) and is already drinking (she had a liquid dinner tonight). Its a bit like old home week there. One of her roommates from the last visit had her surgery for lung cancer today. Staff who remember her from last time have been stopping by. The really good news, at the moment, is that she doesn't seem to be leaking any air in the aftermath of the operation. That could change as she starts to move around, but if the trend holds she'll probably be home fairly quickly. It is expected that she'll move to a room early in the morning tomorrow (perhaps as early as 6am. I'll probably have something to say again after she moves.

23 June 2009 4:45pm

I just talked to the nurse who is tracking Joan in post-op. She is now resting comfortably (which basically means that she has some pretty good pain meds going now) and drifting back and forth between sleep and awareness. I'll be going to visit her soon.

23 June 2009 2:30pm

I was able to visit Joan for a few minutes around 1:15pm in post-op. She is (predictably) in a fair amount of pain after the surgery, but she looks healthy and seems to be doing well. She'll be in post-op, more or less incommunicado, overnight. I only get one more visit today, so I'll be going over again sometime after 5pm. Right now I'm at home, where I plan to catch up on a bit of the sleep I didn't get last night. I expect to post again after that visit.

23 June 2009 12:00 noon

I just talked with Dr. Rusch. The operation was fairly routine and proceeded as expected. Preliminary biopies show no lymph node involvement (a good thing). The tumor was, as expected, very small. They were able to remove just a small part of the right lung (a segment). There wasn't much to report except that the operation was a success. The only complicating factor was the complexity of Joan's lungs. Most people have a strong separation between the lobes in each lung. The lobes of Joan's lungs twist around, which complicates removal. There will be chemotherapy later in the summer, but the doctor is optimistic that they got it all. I should be able to see Joan at around 1:00pm in the recovery room. That visit should be short. I'll have more to say after that.

23 June 2009 11:15am

I just had a call from the nurse liaison. The operation is nearing completion now. They are closing up and I can expect to meet the doctor in about a half hour.

23 June 2009 9:30am

Just had a visit from the nurse liaison. The operation actually commenced at about 8:15am. So far so good, but nothing has been taken out yet

23 June 2009 7:30am

Joan was just rolled into surgery. She was in good spirits as she left. It will probably be a couple of hours before I know anything more.

22 June 2009 9:00pm

I'm back from St. Louis. Joan's surgery is first thing in the morning. Indeed, we'll be up at about 3am to do our last preparations and get over to Sloan Kettering at 5am. It will be a long day, I'm sure, but she's the first surgery scheduled tomorrow, so it should be over by early afternoon at the latest. I will post here as I learn things worth knowing through the day. At this point, however, its too late to call Joan before the operation. Thank you all for caring enough to follow this account. If you have questions tomorrow, please e-mail me at davisfoulger at yahoo.com.

18 June 2009

Joan wrote the last entry. With her next surgery coming up on Tuesday, I thought I'd add something of my own. Joan is very well healed now. She can still feel a bit of pain from the first surgery, but it will probably subside (or at least be overwhelmed) in the wake of the next surgery, which should shift the pain locus to the other side of the body. She is having no trouble walking several miles at a time now, so she's pretty much back to normal. Right now she is enjoying a bit of a break while I'm away presenting a paper at a conference in St. Louis. I'll be back in New York on Monday and will provide updates as information is available on Tuesday and during her stay at Sloan. Thanks for all your good wishes and support.

8 June 2009 11pm

A change in Dr. Rusch's schedule allowed her to reset the surgery date. It's now Tuesday the 23rd, one week earlier.

3 June 2009 4:45pm

We met with Dr. Rusch about an hour ago. Everything looks good from the first surgery. There was really no new information except for the date of the next surgery, which will be Tuesday, June 30, She'll be doing her preadmission testing (good for a month) in a few minutes. A Cat Scan has been scheduled for June 26. Bottom line, the next surgery won't happen for another 27 days from now, which will give Joan lots of time to finish her recovery before the next surgery.

29 May 2009 11:00pm

Joan has lately been healing well. One of the drains appears to be closing up completely, and the long scar from the surgery may not show much of a scar when it is fully healed. She's managed to fit in at least a mile of exercise (the prescribed minimum) every day for 10 days now, and today our walk (over to Central Park and up to 81rst Street) was at least two and a half miles. In other words, everything is looking good for her next appointment with Dr. Rusch on Wednesday, and I'm hopeful that they will schedule the surgery quickly. Thanks again for all your warm wishes.

22 May 2009 11:00pm

Joan has done a good job getting her exercise for three days now. She's been doing a mile on one of the building's treadmills and then taking a walk outside. The weather has been beautiful, and while Joan still needs her pain medication, she has started to look more comfortable. Her appointment with Dr. Rusch is on June 3, but her pre-admission testing is scheduled the same day, so we expect she'll be moving into surgery fairly quickly after that. Have a wonderful Memorial Day weekend.

19 May 2009 11:45pm

Joan has been home for six days now. Her follow up doctors appointment is scheduled two weeks from now. We expect the second surgery to follow soon after. She's sleeping a lot, exercising regularly (but less than I'd like to see), and seeing friends most every day. Staying out of crowds seems like a good idea right now, so it was a good thing that she missed my Choral Arts Society concerts this weekend (I'm sure she'll enjoy the recording).

14 May 2009 11:45pm

Joan seems to be managing well today. Linda came over to visit in the late afternoon. A balloon bouquet arrived in the late morning. She needs to be getting more exercise, but seemed to have a good day. She is currently scheduled for an appointment with Dr. Rusch in three weeks. I expect the appointment will be moved forward by a week.

13 May 2009 7:45pm

Joan is home from the hospital and is currently resting, to her great joy, in her own bed. Its probably best not to call right now, as she's sleeping, but she has enjoyed exchanging e-mail from many of you today.

13 May 2009 1:30pm

It appears that Joan is coming home this afternoon. Its not a certainty, but I expect to be bringing her home sometime after 4:00 this afternoon. I credit this to what I call "The Liberace Effect". She played the piano on Monday. Her air leakage converted from hubba bubbles to champagne bubbles on Tuesday, and the drain tube was pulled out today. Playing the piano is an aid to recovery, at least for Joan. I'll let you know when she actually is home. At that point the countdown begins to the next surgery.

11 May 2009 11:15pm

I'm sitting with Joan at Sloan. She just woke up. I had already been here for a bit after teaching at Brooklyn College tonight. The plan now seems to be to slowly withdraw the drainage tube, even though she is still leaking air, and a slow rate (about a centimeter a day. The expectation is that the air leak will stop as this occurs. We have chatted about the day. Joan played piano for a while this afternoon. There were visits from Louise, Alice from Joan's book club, and Uncle Manny. Flowers arrived at the apartment today (from Claire for Mothers Day. I'll be bringing them by the hospital tomorrow.

11 May 2009 10am

Joan's just back from x-ray. A rumor has been jokingly spreading around the floor that Joan is still here because she's good or the morale of the staff and she's feeling well enough that she's started to edit some of my entries here. Bottom line. She's doing very well. She just won't be able to leave until at least Wednesday.

11 May 2009 8:15am

I'm sitting with Joan at the moment. The doctors have been through this morning. Air flow is reduced, but not gone. They will be pull the remaining drain out a little today in an attempt to help the healing. Joan is currently waiting for her "Daily Ray" (morning x-ray), but there were no major decisions made this morning. Looks like Joan will be here for Dr. Rusch's next rounds on Wednesday.

10 May 2009 9:20pm

Another mild bit of progress today. There had been two tubes draining the site of the surgery. One was removed today. Air flow seems to be reduced to my eye. If it stops overnight, Joan might be able to leave as early as Tuesday. If it doesn't, there will probably be some additional treatment. Decision time for this is probably tomorrow morning. Joan had visits from Mark and Karen as well as Sharon of Chamber Music Society.

10 May 2009 11:00am

Talked to Joan again at about 10:30am. She has been moved to a new (and newly refurbished) room and, of course, a new phone number. If you need the phone number, let me know.

10 May 2009 9:00am

Talked to Joan at about 7:45am. The air leakage has lessened, but hasn't stopped. The next step will be up to Dr. Rusch, and she isn't back until Wednesday, so there's still time for the healing to finish, but they are talking about another basting, this time with a different compound, and the possibility of a Heimlich valve. The key is that she needs to recover for the next surgery. Her lung has to be working for that to happen, and she needs to come home with it working. At this point it looks like she won't be home before Wednesday or Thursday, and that, of course, has downstream implications for the next surgery, which won't occur until she's been home for at least two weeks.

9 May 2009 5:30pm

Talked to Joan again. She hasn't attempted to play the piano again, and may not this weekend, as she feels the patient area is busier with visitors on the weekend. One of the fellows came around this afternoon, however, and indicated that this mornings x-ray looked very good: that the remaining lobe appears to have adhered properly to its lining and that the air leak should repair soon. She also indicated that the pathology report was back and showed no surprises (good news). What was news is that they actually found the malignant lymph node before they found the cancer. Indeed, the lymph node provided guidance that helped them find the cancer. I'll be seeing Joan again soon today, but she had a visit from Susan and Dennis, good friends we met through Summer Trios. All best.

9 May 2009 8:45am

Dr. Rusch's fellows visited this morning. The air leakage continues to reduce, but it isn't gone, and it now looks unlikely she'll leave on Monday. On the other hand, her recovery is going well by every other measure. Dropped off some piano music that she can play on the patient's rec room piano. I imagine she'll try to play the piano today.

8 May 2009 7:30pm

Joan is eating dinner now. Uncle Manny left a little while ago, Mimi and Louise visited earlier. Joan is generally doing 8 laps at a time now, and is moving very quickly by the standards of the floor. When Manny and I walked with her we lapped other patients several times. Some doctors were through a little while ago. Her air discharge continues to diminish. Its only there when she coughs, but its still present. A Monday discharge appears to be very likely at this point, but that depends on the air discharge stopping by Sunday. I teach on Monday evenings, but Joan has arranged for Mark and Karen to bring her home from the hospital if she's discharged too late in the day. Best to you all.

8 May 2009 9:00am

Talked to Joan early this morning. She's back off suction and has already been out walking the floor. The fellows from her medical team had come by and observed that the air leakage was reduced, but not gone. With the epidural out she was able to wash and dress herself today. Her walking speed is up. She told me about an encounter with someone fresh from surgery who was out taking her first walk who commented to Joan on how fast she was moving. At this point it really is just a matter of the air leakage sealing up. I fully expect she'll be home Monday and into her next surgery on or about May 25.

7 May 2009 11:45pm

Visited Joan earlier after my chorus rehearsal. She was still awake, but working on going to sleep. A number of people had visited during the day, including Kathy, Jackie and Steve, Rob (who brought some fresh flowers that replaced some in one of the vases), Linda, and Marilyn. She was back on suction for the night. A number of friends asked about Joan at Chorus and asked me to pass on their best wishes. Barbara Dana asked me to give her a copy of her new book, "A Voice of Her Own: Becoming Emily Dickenson". I delivered it. Joan was very pleased.

7 May 2009 10:50am

I just talked to Joan. A couple of things changed overnight. The epidural pain medication has been removed in favor of other forms of medication (earlier than we expected, but the suction is back on, as its important to the process of adhering the remaining left lung to its sac. I'll be visiting later today, but Joan has a series of visitors lined up today, so I get a chance to do a little work from home.

6 May 2009 6:45pm

Joan is taking a nap now after a pleasant visit by Susan Lushing, who accompanied Joan and I on a half mile walk. The big progress today is that they took Joan off of vital signs monitoring, but there are still important hurdles to leap before Joan will get to go home. As I wrote this entry, she cross another one, as she was taken off suction.

6 May 2009 12:45pm

Joan was just visited by Dr. Rusch, who projected that Joan would probably be released over the weekend. The continuing problem is air discharge from the space where the lung was removed. That seemed to increase somewhat after yesterday's procedure (a pleurodesis). Pleurodesis acts to adhere membrances in the lung by irritating the membranes around the lung, so its somewhat painful (not in the administration, but as it does its work afterwards). I'm heading over the hospital for the day now, but she's doing fine ... just not making the progress she needs to come home this week. Later.

5 May 2009 9:30pm

Joan is going to sleep now. I'm getting ready to leave for the night. Today's procedure (we jokingly called it "basting", and the needle they used to put the "adhesive" into her drain was about the size of a turkey baster) was, if nothing else, entertaining. We certainly hope it works. At this point our best hope for leaving the hospital is Thursday or Friday, but progress continues to be made. Thanks for all your good wishes.

5 May 2009 6:30pm

Concern about the partial lung deflation turned out to be justified. The remaining left lung had partially detached from the surrounding sac, so there was nothing to hold the lung up. The solution to this is to glue the them together, and as I write this Joan is finishing the remarkably low tech procedure, which involved putting an "adhesive" into her drain, putting the bag up high so it drains back in, and then rolling from side to side every fifteen minutes for two hours. She just did the last turn. The good news that emerged during the procedure is that I haven't seen any sign of air drainage, so one hopes that, once the lung appears to have adheared, that shell be on a fast track to return home.

4 May 2009 11:05pm

I'm visiting Joan late after teaching tonight. Joan has been moved to another room. She has a little more room now, so things fit better around the bed. She also has a new phone number, so don't use the old one anymore. I have the new number if you feel you need it. Joan is back on suction because of they are concerned that . The remaining left lung is slightly deflated. we'll know more tomorrow, but there doesn't seem to be much concern about it, so its probably a minor deal. She walked a total of two miles today, which is clear progress. The big thing right now is that she gets both the rest and the exercise she needs in order to fully recover, so while Joan loves company, if you are visiting and it looks like she needs a nap, please encourage her to take it.

4 May 2009 12:45pm

Joan is already over a mile and a half today. She did her first continuous mile today after the doctors visited to check her progress. Good news on that front as well. In Joan's words: "rusch's fellow came by to say that, for the first time since she'd been around (this weekend) the amt of air bubbling thru the chest drain tube is lessened!" That's consistent with what I thought I was seeing last night. This is exciting news, as the airflow is the primary gate to her leaving the hospital right now. Joan joked that she might actually get out of here "this month". I riposted "twice". She laughed, but in an ideal world she'll have the second surgery and be recovered enough to come home by Memorial Day. (Well, we can dream).

4 May 2009 1:15am

Before I left at about 10:00pm Joan had completed several more laps, bringing her total mileage for the day up over one and a half miles. Progress.

3 May 2009 8:45pm

I've been visiting with Joan for a couple of hours today, but she had lots of visitors during the day. Louise came first. She was joined by Manny and Karen, then Carl, and finally by Mimi. Joan took walks with all of them in various combinations and is up over a mile and a quarter now. Carl brought chocolate covered marzipan, a favorite of Joan's, and others brought books. I brought the Sunday Times, so Joan has plenty of entertainment. She has lots to do, however, just working on recovering, The medication they are using to reduce her retained water was given much earlier today (at six rather than midnight), so its likely she'll get a good nights sleep tonight. Right now Tuesday is the earliest she can leave, and sleep is probably the most important thing she needs to do to recover. Progress is being made, but this is a big surgery and it takes a while.

3 May 2009 3:30pm

Joan called at 9am. She had a difficulty overnight with a rapid heart beat, but they brought it under control. As Joan explained it, there is a complex interaction of medications right now such that she's been retaining water. They are trying to help the water lose with another medication, but that medication pushed her heart rate up. It doesn't seem serious. Its just a part of the process of recovering. Joan also called at 2am, while I was on the bus back to New York, but I was asleep and missed the call.

2 May 2009 10:50pm

Talked to Joan from a Boston subway at about 9:45pm. She was in excellent spirits. Tony visited during the afternoon and walked 5 laps of the floor with her. A mile is 14 laps and Joan did 5 more after Tony left, giving her a total of 20 laps (almost a mile and a half) on the day. She also fit in naps and hourly breathing exercises.

2 May 2009 12:30am

Am visiting Joan now. Jamie, the wife of Burt, an old friend from back when Joan was teaching, is visiting right now. She brought Joan's latest flower arrangement, a beautiful photo of a lotus he took in the New York botanical garden. Joan has already walked close to 3/4 mile today and appears to be doing well and is in excellent spirits.

2 May 2009 9:20am

The doctors have already been around this morning. Joan continues to improve, but the key factor that gates leaving the hospital is the presence of air in the drain from the area where the lobe was removed. This is completely normal after such surgery (lots of plumbing carries air into the lungs, and one lobe isn't there to receive it any more). Air will leak until the remaining lung repairs itself enough to control it. The flow of air has slowed, but it hasn't stopped, and they'll want to keep Joan in the hospital for several days after it stops. As of today, she won't go home until Tuesday. I'll be going over to visit shortly, and will then be away for most of the day. If there is something to post this evening I will. If not, I may not post until Sunday morning.

1 May 2009 7:00pm

Today's benchmarks. Joan has walked a lot today, which is important to her timely recovery (and, as Joan put it today, the ironic goal of returning to the hospital). Today she took her first walk off the floor, going to the patients lounge, where she talked with Mark, Karen, and I for a while. Dr. Rusch visited today and provided some benchmark goals. The current expectation is that Joan will leave the hospital on Monday and meet with Dr. Rusch again two weeks later for a follow up examination. If she is doing well enough, she'll be scheduled for the second surgery (which can apparently happen fairly quickly).

1 May 2009 6:30pm

I've been visiting with Joan this afternoon. A few other visitors have come through, including Louise, who Joan shares knitting and book clubs with, and Mark and Karen Putterman. There are now five bouquets here and we're probably approaching the limits of how many floral displays can be displayed and viewed in the room. Two more floral arraingements arrived on Wednesday. One, from Sarah and Russ Hoffman (my sister and brother in law), is a colorful arraingement of roses. The other, from Carl (a close friend from IBM) and his wife Riva, is a colorful assortment of flowers. A bouquet from the Chamber Music Society of Lincoln Center, where Joan frequently volunteers, arrived yesterday. It features a contrast of large deep red flowers (there is divergent opinion whether they are peonies or dahlias) and smaller clusters of many small white and green flowers in a large frosted vase. It' quite spectacular (Joan says "amazing"). Today a vase of multi-colored arrangement of flowers (tulips and a small purple flower) arrived from Joan's book club. The array has become something of a floor entertainment, with nurses coming through just to talk about them and guess at what the flowers are. Keep in mind, however, that there isn't a lot of room here, so you shouldn't feel compelled to send more,

1 May 2009 1:00pm

Talked to Joan this morning. She had a good nights sleep and had already taken a good walk. I'm about to go over and see her (having finished painting some shelves for the new apartment) and will probably have more to say from there.

30 April 2009 11:45pm

Talked to Joan at about 9:30pm. Tired triumphed after I left, and she napped until about 7pm. She then had a pleasant visit with Manny and Karen. She sounded very good. I will comment briefly on one thing we talked about today. I am gratified that so many of you have found value in this treatment log, but I've slowed my posts rather purposely. These wasn't a lot to share on the day of the surgery, but a lot of people who cared wanted to know what was happening, and I was glad to try to relieve the tension a bit. There isn't so much to know now, and there will be days over the next few weeks when nothing will happen that is really worth posting. I'm sure there will be a lot to say in three weeks or so when the next surgery happens, but please don't read anything into the slowed rate of posting. I'll share news as I have it, and I'll be happy to post interesting observations you have after you've talked to, visited, or exchanged e-mail with Joan (e-mail them to me at davisfoulger at yahoo.com), but I'm not tired; there just isn't all that much to share right now and I do have other work to do here before Joan comes home.

30 April 2009 5:10pm

Just visited Joan. She walked another half mile this afternoon, most of it with visitors Jon and Linda. The suction from last night has been removed, so her voice sounds normal again. She says she feels tired, but looks very awake. They have reduced the dose of pain medication by half. The first flowers, from Dave Evans, a colleague from IBM, have arrived: a colorful bouquet in a pretty glass vase. I'll be heading off to my Thursday night chorus rehearsal shortly (we perform twice in about two weeks now), but Joan will be visited by her Uncle Manny and his partner Karen tonight. She's making noises about taking another walk (which will put her well over the 1 mile goal her nurse set for her). I talk to her again around 8:30 or 9 and will probably make one more post today sometime after 11pm.

30 April 2009 2:30pm

The good news. Joan walked a half mile this morning. The bad news. There was a problem with the drain on her lung (things are actively repairing and reconfiguring for the loss of the lobe in the operation) last night that kept her from getting much sleep and has required the addition of some active suction to keep the area where the lobe was clear. That's changed her voice, at least for a little while, and has her napping more today. Overall she still seems to be doing better than one might expect just two days after this surgery. Davis

29 April 2009 7:30pm

Joan took her first walk (3.5 laps of the floor) a little while ago. We were told that they would make her take a walk and she'd hate them for it. She made them take her for a walk ... and did an extra half lap.

29 April 2009 6:05pm

Here's a sign of how well Joan is feeling. She's making her first phone call.

29 April 2009 5:00pm

Joan looks great. She has a big smile and is moderately active. She got out of bed this morning and sat in a chair for a long time, ate two breakfasts, a liquid one and then a regular one, and had crab cakes for lunch. Karen Putterman was here when Dr. Rusch came through at about 10am. The doctor was (like everyone else) pleased and surprised by how well Joan is doing, but didn't offer much in the way of new information. She expects Joan to be here (the hospital) for 5 days to a week. After that she anticipates that Joan will need about two weeks of recuperation at home before the next surgery. They haven't asked Joan to walk yet (probably because she has been so long getting to a room), but it sounds like Joan is almost ready to push the issue herself. As I say, she is doing very well.

29 April 2009 4:30pm

Joan is now in a room. She only arrived a few minutes ago and the nurses here are still collecting information. She doesn't have a phone yet, but she has started to look at her e-mail

29 April 2009 1:15pm

Talked to Mark Putterman at the hospital. He tells me that Joan is looking great; that she's in pain but that she's 100% her normal self. The nurse caring for her also said she was doing great and said that she ate a normal breakfast and that she had ordered lunch (which was expected to arrive soon). Dr. Rusch came by about 9:00, apparently with her fellows in tow. According to Mark there was no news, but Joan and Karen may know more. I'm heading over to the hospital now, so there may be something more to add in a little while.

29 April 2009 8:45am

The nurse called from the recovery room at about 7am. Joan is awake and sitting up. I couldn't talk to her because there really isn't a phone available in the recovery room. There isn't a room available to move her into yet, so I won't be able to talk to her for a bit, and I have to be in the apartment for a electrical inspection this morning, so I can't go over to the hospital either. Mark and Karen Putterman will be visiting her this morning. Whatever gets posted next will probably be based on what they learn. I expect I'll be pruning much of what I posted here yesterday later in the day, but I'm at the apartment until at least 1pm, so feel free to give me a call if you have any questions or information you want me to pass on to Joan this afternoon.

28 April 2009 10,30pm

I've just been kicked out of the recovery room (they want to keep visits there short). Joan will be spending the night there and won't be moved to a regular room until sometime tomorrow morning. She is awake, aware of the outcome of the surgery, and struggling a bit with the aftereffects of the anesthesia, which provokes a bit of a shivering response. She looks pretty good for a person who has just done six hours of surgery, but she's very tired and, at least for now, pretty much out of touch. I've passed on your warm wishes and will post more here when there is more to post. Take care and thanks for all your love and support. Davis

28 April 2009 9,20pm

It turns out that the thoracotomy (the open procedure wasn't related to seeing anything problematic, but rather to not being able to see the target. The tumor, which was very small, was just very hard to find. After that, the length of the surgery reflected testing a lot of lymph nodes. They ultimately found a malignant lymph node, which changed things yet again. They had anticipated, going in, that the surgery would involve removing a section or wedge of the left lung, but the malignant lymph node closed the case on doing a lobectomy and removing an entire lobe. That has downstream implications for the next surgery (planned as a lobectomy because of the size of the tumor) and for chemotherapy, which is now a given, but probably not until after the second surgery. I'm told I'll see Joan in about an hour now. I'll probably post once more tonight, and then more slowly as Joan recovers and we approach the second surgery.

28 April 2009 8,45pm

Things appear to be moving rapidly to a close. I've just been called into a conference room, that the doctor will be talking to me in a few minutes, and that I should be seeing Joan in about an hour and a half. The minimally invasive video assisted procedure changed to an open procedure about 45 minutes into the operation, which probably means that the doctor saw something she didn't like in the hylum cluster lymph nodes. That's just a guess, however. I'll know more when I see the doctor, probably in the next 15 minutes or so.

28 April 2009 8,40pm

Joan is still in surgery. I expect, based on the information just provided by the nurse liaison, that the surgery won't be completed for another half hour or more. I'm told they are near the end and that I am likely to talk to the doctor in an hour or so. I am also told that the operation is largely complete; that the business of the surgical team has turned to making sure that they've gotten everything and closing up. More when I know more.

28 April 2009 8,05pm

Joan is still in the operating room. I don't know that there is any news at this point, but I have been called upstairs to the surgical floor waiting room. I'll probably know more shortly. The nurse liason who has been providing information just indicated that she would be going into the operating room in a few minutes and would find me afterward. That's not much in the way of news, but it does confirm my expectation that the surgery would still be underway when I got my 8:00pm update. More soon, I expect.

28 April 2009 7,45pm

There is no news right now, but I wasn't expecting any, and at this point in the process, no news is good news. I would guess that the lymph nodes inside the left lung have been examined at this point, that decisions have been made about how much lung needs to be removed, and that they are actively executing the plans. I'm sure I would have heard if there were any serious issues, so I assume there aren't any, and that the progress report I'll get sometime in the next half hour will indicate that the surgery is nearly over. That may be optimistic, but I suspect we're on the home stretch now. It has been a very long day for the surgical team.

28 April 2009 6,15pm

I just had a visit from the nurse who passes around information every two hours. Good news. All of the biopsies from the mediasteinoscopy were benign. They started the thoroscopy (a minimally invasive surgery to remove examine and remove a portion of the left lung) at 5:50pm. This procedure is unlikely to be short, as the lymph nodes near the cancer need to be examined before they decide how much tissue to remove (a wedge or a section). My guess is that the next round of information I get will be during the normal information rotation at about 8:00pm, but that the operation will be completed not long after that. I've been told that the operation will take longer than might be expected normally, but that Joan is doing great in the operating room.

28 April 2009 6,10pm

I expect to get some routine information about the progress of the surgery in the next 20 minutes or so, but it is reasonable to presume, given that I haven't heard anything in the last hour and a half, that the surgery didn't stop at the mediasteinography. That may be an optimistic interpretation, but an hour and a half should have been plenty of time to have results from the biopsies on the lymph nodes, so I am optimistic that things are proceeding well.

28 April 2009 4,35pm

The surgery started with a brochoscopy at about 3:25. I've just learned that they've moved on to the mediasteinography. The biopsy results from these early parts of the surgery are the major decision point. If the surgery ends soon, the next step is chemotherapy and this surgery is completed weeks or months from now. It it goes on for a while, the surgery on the left lung should complete tonight. I don't expect to know anything more until sometime after 6pm, and its probably good news if I don't hear anything before then.

28 April 2009 3,15pm

Joan was wheeled into surgery at about 3:10pm. With multiple procedures scheduled, and biopsy testing gating the operation

27 April 2008 11:00am

We received the first of two calls from Sloan we are expecting today. This one was a review of what she needs to do to get ready for surgery, so it was largely a review of medications and eating habits. The biggest surprise to Joan seemed to be that she needs to stop drinking coffee (anything dehydrating) for the rest of the day. We're still waiting to hear on the scheduling of the surgery tomorrow.

27 April 2008 9:30am

Joan is now preparing for surgery. That means going off of several of the medications she takes and altering her diet in anticipation of surgery. She has been overwhelmed by all of your support, but is nearly burned out on phone calls. Right now she is focusing on making sure the apartment is ready for her return home in a week or so.

26 April 2008

This page has been created to keep friend's updated on Joan's treatment. Other pages may be created as needed, but check here for the up to date news, especially during periods of treatment. Expect that updates on Joan's surgery on April 28 will be posted here as soon as Davis knows anything.

Some history

13 March 2008

We learn that Joan has a lung cancer based on a guided needle biopsy that had been performed on March 10th.

20 March 2008

We meet with Dr. Connery, head of thoracic medicine at Roosevelt Hospital. He shows us the results of a March 18th Pet Scan, interprets the results we have so far, and outlines a probable course of treatment. There is a mix of good news and bad news. The good news is that the cancer is very early stage and a type that tends to grow very slowly without spreading to other places. The bad news is that there is evidence that another cancer is active in the other lung. While its extremely early stage (very small and barely active), its badly placed, near a bundle of blood vessals and lymph nodes deep in the lungs. A bit of good news, however, is that Dr. Connery feels certain its another type of cancer (which would mean that the first cancer isn't spreading), but it was showing activity in the pet scan. It will need to be biopsied too.

24 March 2009

Meet with Dr. Cohen, an oncologist at Roosevelt Hospital. No chemotherapy or radiation is currently anticipated (the team at Roosevelt feels that things are early enough that it can be handled surgically).

30 March 2009

We meet with Dr. Rusch at Sloan Kettering Memorial Hospital. Sloan specializes in cancer and Dr. Rusch, the head of thoracic medicine there, seems to generally acknowledged as the doctor of choice for lung cancer. Her interpretation of the results is very similar to that of Dr. Connery. She notes, as he did, that the occurance of two primary cancers at the same time is increasingly common in cases of lung cancer. She recommends a course that entails two surgeries. The first would be a lobectomy (removal of one entire lobe of her right lung) via a minimally invasive procedure followed by a partial removal of tissue in the left lung via an open surgery. She seems certain that there has been no spread from the smaller cancer on the left side.

1 April 2009

The second biopsy. I note this primarily because transport at Roosevelt causes an hour and a half delay in the procedure (they never show up). This is a critical miss, as it becomes a deciding factor in whether the surgery will be done at Roosevelt, which is only a few blocks from where we live, and Sloan. Its not just the doctor that treats you. Its the hospital.

8 April 2009

We meet with Dr. Connery at Roosevelt Hospital for the second time. He confirms that the results of the second biopsy are an active cancer of a different type. The good news is that it isn't one of the more aggressive cancers. The bad news is that its more aggressive than the first cancer, and is particularly likely to spread to lymph nodes. Given the location of the cancer near a cluster of lymph nodes, he recommends doing a biopsy of the lymph nodes in that cluster, as activity there would suggest some initial chemotherapy as a better first step. I'm impressed with Dr. Connery as a diagnostician. He is very good, and does a good job building and working with teams. The decision to have the treatment performed by Dr. Rusch at Sloan Kettering has been made, however.

20 April 2009

Second meeting with Dr. Rusch. It is no surprise that the second biopsy leads to an altered recommendation. She plans to operate on the left lung first in a serial operation that has three components. It will start with a brocoscopy and a mediascopscopy. Both of these procedures will examine lymph nodes (the first in the throat; the second between the lungs) for signs of spread. It is not expected that any cancer will be found during these procedures, but this is a cancer that spreads, so it has be done. I there is any sign of cancer during these procedures, the operation will stop and Joan will do Chemo before the surgical treatment resumes (some weeks or months down the road). If there is no sign that the cancer has spread, Dr. Rusch will continue on to the lung surgery on the left side, where she expects to remove a part of the lung. The decision on whether it is a wedge (smaller) or a section (larger) will be made during the surgery. The operation is scheduled for April 28.