Friday, September 25, 2015

Grandpa's Struggle with Lung Cancer

Dad or as I affectionately like to call him - Grandpa Neal - first learned of his lung cancer in October, 2014, when he was only 72 years old. He had a cough that would not go away and he went to see his Kaiser Permanente doctor. After doing a chest x-ray, he discovered that he had a tumor in one of his lungs. He was very surprised to hear this - as he had only smoked one year during his early youth and was in excellent shape (having run multiple marathons and half-marathons). He was overall in excellent health, and this diagnosis came as a severe shock.

He still wanted to continue to dance Zumba and to play his accordion. Cancer treatment would slow him down too much.

We had multiple discussions with Grandpa on his medical treatment. Inna and I felt that he should undergo a surgery immediately, to remove the tumor, before it had a chance to spread to other organs. However, this would involve some risk and would necessitate a long-recover. Removing the tumorous piece of his lung would reduce his lung capacity and would require significant rehabilitation. Despite many attempts to try to convince him, Grandpa refused to undergo surgery (as he had never had surgery in his life).

In November 2015, Grandpa tried to explore other possible lung cancer treatments, including positronic radiation on his tumorous lung. However, when an MRI was done, it showed that the tumor was touching nearby arteries and the doctor felt that there was too much risk in doing radiation.

In late December of 2015, Granda started to cough blood and decided finally, after many conversations with us, to undergo the surgery on his tumorous lung. However, after doing an MRI and a X-ray, it was found that the cancer has spread to other organs and the surgeon refuse to operate. Once cancer spreads to other organs, removing it from just one organ is no longer sufficient. Since all Kaiser's doctor was offering was standard chemotherapy, we decided to look for more promising therapies.

In reading Wall Street Journal, I learned that a new drug called "nivolumab" was found to work on cancer patients with melanoma and lung cancer. It was approved for melanoma but still experimental for lung cancer. It worked on cancer patients with a specific genetic defect and I wanted Grandpa to try this new wonder drug. After looking at ongoing drug trials, we found one nivolumab trial ongoing at Stanford University's hospital.

Enrolling in Stanford's drug trials was a large hassle. We first had to get approval from Kaiser Permanente (Grandpa's current medical provider), so that Stanford would manage all of Grandpa's cancer treatment and would bill Medicare directly. At first, Kaiser refused to grant Grandpa this ability and Stanford would not allow Grandpa into the drug trial without Kaiser's permission. Finally, after writing multiple letters to Kaiser, Grandpa was allowed to enroll in Stanford's drug trial.

Stanford's facilities were much superior to Kaiser's. Stanford's doctors did not trust any of Kaiser's tests, so Grandpa had to do all of the blood tests, X-rays, and MRI's all over - prior to initiating the nivolumab drug trial. We met with Dr. Heather Wakelee - Stanford's oncologist - and her many assistants and discussed the trial. It would be a blind test trial - we would not know whether Grandpa would get selected to take nivolumab or one of the other chemotherapy drugs.

After some waiting, we were delighted to hear that Grandpa was chosen to get nivolumab every two weeks.The trials started sometime in March, 2016, and I was surprised to learn that Grandpa did not experience any side effects at all. Given all we have read about possible side effects, it was very positive news.

After a month of nivolumab shots, Grandpa had to do a series of blood tests and x-ray's, to determine how the cancer was reacting to being treated by nivolumab. We learned that Grandpa's lung cancer was not growing - but it was not shrinking either. However, there was a concern that he had a small cancer growth on his liver.

After a couple of months of treatment with "nivolumab", Grandpa started to complain about pains in his legs. He thought it was some muscle cramps, but we eventually discovered that there was a tumor in his bones. For some reason, the Stanford doctors failed to notice the cancer growth in his leg, even though it was clearly visible in the x-rays (such incompetence!).  Grandpa was extremely angry at Stanford's physicians - how could they miss such an obvious problem - especially since he as complaining about his legs pains to them often.

Grandpa went back to Kaiser and the doctor there suggested that he get radiation therapy to kill the cancer in his leg. Doing so required stopping all "nivolumab" treatment. By then, he decided to stop "nivolumab" all together because he thought that it did not work. I think that this was a huge mistake because "nivolumab" did help to keep the lung tumor in check.

After completing radiation therapy on his leg, Grandpa discovered that he also had a pain in his ribs. Another cancer there was discovered, and again treated with radiation therapy. However, this second treatment really weakened Grandpa. He lost a lot of his energy and vitality and did not have the energy he used to have to dance Zumba or play his accordion.

His health started to decline rapidly after this second treatment of radiation. We had to take him to an emergency room, because he passed out in his apartment, while talking to us about getting additional in-home support services.

We noticed that he started to get confused easily, and all normal activities took much longer for him to do (like making a meal) or washing dishes.

On Friday, September 4th, Inna planned to take Grandpa to Kaiser for a blood transfusion - because Grandpa's iron level was low, and the doctors felt that he could benefit from additional iron. When she got to his apartment, she found that Grandpa has hurt himself (falling) and he could no longer walk. She called 911 and the emergency team brought him to Kaiser's emergency room. Since Grandpa's left arm and leg (and face) seemed paralyzed, the physicians thought that he had experienced a stroke. We later learned that it was not a stroke but a cancer that has spread into the left lobe of his brain that was disabling his activities.

Since Grandpa was so weak, he could not receive chemotherapy. Grandpa's Kaiser doctor - Dr. Myron Kwong - said that his best best was to go to a Nursing home, where he could get 24-hour care. We found a bed in Mission Skilled Nursing facility and he was transported there.

Grandpa was initially a bit confused a how he got there, and he hated the fact that he could no longer move his left arm at all. His vision rapidly declined  (because of the cancer) and he could no longer see very well. He still liked listening to music  and could see us when we were close. His mind was still fine and active and he made many calls to his friends and relatives.

The food at Mission Skilled Nursing is very processed (for patients who are toothless) and looks and tastes horrible. Grandpa refused to eat it, so we brought him fresh Borscht and other Russian delicacies from home. He really enjoyed eating them, instead of the horrible food provided.

I got the dreaded call at 5:30am on Wednesday, September 30, and I rushed to Mission Skilled Nursing. Grandpa died at 5:38am on Wednesday, September 30, 2015. Unfortunately, I did not make it in time to see him. I was told by the nurse that was there that his breathing slowed down and then stopped.

It was a very sad moment for me.

September of Changes

Wow, this  has been a months of many changes. In short, I sold my lovely 2009 Mini Cooper "S" convertible, affectionately named "Chili", my trusty Canon 5D Mark III camera, my MSI GTX 970 graphics card, and my GoPro Hero 3 Black action cam.

After a few weeks of trying to sell my 2009 Mini Cooper "S" on Craigslist, I decided to try website.

Previously, I tried selling my Mini Cooper "S" convertible on Ebay, but never had any luck. Craigslist was even worse - as none of the potential buyers seemed serious. Since my Mini had a 6-speed manual gearbox, I had to be sure with all callers that they could actually drive a manual transmission.

 Many Americans no longer know or want to drive a manual-geared car. I really like driving manual transmissions, and bought this Mini originally with this very purpose. Potential buyers on Craigslist were all offering low bids, in the hope that I was in a hurry. It seems to me that Craigslist is not a good place to sell cars (though I previously sold my Lexus RX300 and my two motorcycles on Craigslist with no problems). Eventually, I did find two serious buyers - all on! The first buyer was very serious, until the last minute when his wife decided she would rather have a Porsche convertible. The second buyer liked the car and purchased it the same day. I hope he enjoys the car as much as I did.

I hope to replace the car with a nice dual-sport bike that I can take to dirt trails, especially in nearby Metcalf or Hollister. As much as I like cars, I like motorcycles a whole lot more. I will be taking the two-day "Intro to Dirt" class from Brian Garrahan in Hollister. I hope to learn how to handle a dirt bike on actual dirt trails, before purchasing one. The bike I am considering is he Yamaha WR250R, which is a 4-stroke dirt bike that is light enough to ride on the street and on serious dirt roads. To tow the bike on my Toyota Sienna minivan, I considering adding a trailer hitch, so that I can attach a bike carrier.

As far as photography, I sold my Canon 5D Mark III camera on Ebay and replaced it with a Canon 5DS that my Dad purchased for my birthday from an outfit called BuyItDigital (eBay). I expected to get a gray imported Canon 5DS body (imported from Europe and without U.S. warranty). Because of the exchange rate, camera bodies purchased in Europe can be cheaper than in the U.S. After placing an order, he got a call from Albert who offered to upgrade me to a U.S. version for $227 extra. I agreed and patiently waited for the order. A week later, I received the Canon 5DS but it was the European model as it came with a European charger and without a U.S. warranty card. I am still resolving issues with ButItDigital. The Canon 5DS works fine, but I can see that it is slower than 5D Mark III, due to the large 50 megabyte files coming from its 50 mega pixel sensor. I am looking forward to shooting with this new camera.

I also replaced by old and trusty Bogen Manfrotto Digi 725B tripod with a MeFoto Globetrotter Carbon fiber tripod. This is a much sturdier, lighter tripod with a nice ballhead for shooting nature and still photos. I look forward to using it in the field. It came with a nice carry on bag and packs very compactly.

My CanoScan Lide210 scanner died suddenly, and I needed to replace it with a newer version. I looked at many alternatives but eventually chose a CanoScan Lide 220 - a newer version of the same scanner. It was inexpensive and well-rated. I had good experience with Lide210, so I thought to give Canon another chance.

The GoPro Hero4 Silver is smaller than my Hero3 "Black" and has an lcd in the back. This is very helpful in reviewing past footage. However, I am still concerned that battery life is still terrible, though batteries are easier to replace.