"Intrathecal Pain Pump"

St. Paul's Hospital - Vancouver

As I write this post I am a patient in the Palliative Care Unit at St. Paul's Hospital in Vancouver. I was admitted on referral from the BC Cancer Agency earlier in July to be evaluated for the "intrathecal pain pump" which delivers prescribed medication directly to the pain receptors within the spinal canal.

The beauty of this type of system is that it can vastly reduce the amount of "systemic" medication required to achieve pain relief in my case of intractable pain.  Thankfully, the results of the initial studies were positive and I am now equipped with the indwelling portable pump.  The pump lives under my ribs on my lower left abdomen.  A catheter goes from the pump into the spinal canal.  The hope is that I will realize significant gains in quality of life while continuing to live at home with wheelchair mobility.

The pump itself is about the size of a hockey puck and it carries three different medicines in suspension together in the pump reservoir.  These medications can be topped up as required with a visit to the pain clinic back here at St. Paul's Hospital.  While my own personal system is not exactly as that shown, the following illustration gives the general idea of the system and its various parts.

I am just putting this up as a short post for now to let family and friends know about this new direction in my own cancer care journey.  I hope I can post more over the weeks and months ahead as I learn to live with this new piece of hardware and as I am able to reflect further on living well with cancer.

Peace and blessings...  Rob; in Vancouver

Proactive Palliative Care

I have decided to name this new stage of the cancer journey as "proactive palliative care".  This is to differentiate an active approach towards healing and wellbeing from what might be understood as a more passive response to disease progression.

P r o a c t i v e   P a l l i a t i v e   C a r e

  

Under the rubric of "proactive palliative care" I will continue to assertively engage in treatment options which reduce pain, prolong life, and otherwise keep me in good health through this stage, however long it may last!  

Palliative care (from Latin palliare, to cloak) is an area of healthcare that focuses on relieving and preventing the suffering of patients... Palliative medicine utilizes a multidisciplinary approach to patient care, relying on input from physicians, pharmacists, nurses, chaplains, social workers, psychologists, and other allied health professionals in formulating a plan of care to relieve suffering in all areas of a patient's life. This multidisciplinary approach allows the palliative care team to address physical, emotional, spiritual, and social concerns that arise with advanced illness.  Wikipedia 2012

Sacral Cementoplasty

I continue to be awed by the incredible array of technological innovation brought to bear in contemporary cancer care.  The most recent procedure I have undergone while a patient at the BC Cancer Agency Hospital is known as "Sacral Cementoplasty".  This radiological intervention involved the insertion, and radiological guidance, of a needle through the fracture plane of my sacrum beginning at the left sacroiliac joint.  A fast-acting plastic cement was injected through the needle upon its withdrawal to stabilize the fracture and reduce the pain.  

After two weeks I am happy to report that I have been virtually pain-free since the procedure, which is truly awesome!  As a measure of my pain level I am once again able to concentrate enough to read, which I was unable to do since shortly after Christmas.

For all of this, again, I am eternally grateful! 

Peace and blessings... Rob; in Vancouver

I am a Lost One in a Foreign Land...

There is little more to add this week.  I am working with the palliative care team to get the right mix of pain medicine.  This is an ongoing process which seems to be bearing some fruit.  I am, at least, emerging from the fog enough to write a cognizant paragraph or two.  Maybe not!

Companionship:
I am deeply grateful for the gift of companionship that has been shared with me at this time. This gift is given in so many ways.  The very word "companion" has always inspired me.  It's roots suggest a literal sharing of bread, "com - pan" with bread.  Much of the companionship I share these days is indeed "with bread".

I have many colleagues, family, and friends who live deeply with me through these days of my illness.  I am mindful of their presence, their compassion, and their love even though my illness has created this barrier.  Not a real, physical barrier, but one of sleepiness and immobility.

People ask, "Should we call?  Can we visit?  When are your "down times"?.    Well, for now, I still enjoy afternoon visits in the condo and Pam and I enjoy weekend visits, mostly at home.  Email is probably the best way to connect.  If that changes we will let you know.

We are NOT Alone.
I wrote at some point earlier in "A Cancer Journal" of the very "real presence" of those who break bread and walk with us in our times of trial ("We Are Not Alone").  it is equally true that many of those who have shared their lives and since died remain with us divine companionship.

One of my favourite living mentors is Joyce Rupp.  I share this short prayer as a reflection on my own inner geography at this time. It calls for a slow, prayerful reading, if you are lucky enough to find such space in your life.

Divine Companion,

there's an ache in my heart

that stretches like a canyon,

crying out for all the familiar

faces and places of yesterday.

All the tears of my loneliness

gather themselves together quietly;

a hollow sadness rises in my soul

and presses against my every moment.

I am a lost one in a foreign land,

an orphaned one without a home.

I am out of place and unsettled,

yearning for peace that hides from me.

My feet take me through each day

but the rest of me just drags along,

wondering if I will ever feel at home,

doubting if this path is right for me.

Ever-Abiding Life Giver,

be a source of hope for me this day

as I adjust to this great change.

Be a sparkle of joy in my spirit

as I struggle with the pain of farewell.

Be a strong connector of love for me

as I leave many treasured ones behind.

Consoling One of My Heart,

assure me with glimmers of peace

that this transition can be a source of growth.

Grant me hopeful eyes to see beyond today

to the time when joy will tumble freely.

Lift up my heart and comfort me. 

Joyce Rupp

Peace be with you...  Rob; in Vancouver

"Life is short.  And we do not have long to

gladden the hearts of those who walk the way with us.  

So let us be swift to love.  And let us make haste to show kindness." 

Henri Amiel

Bad News!

It is always difficult to be the bearer of bad news about ones own health.  But there you have it!  So here it is… 

A CT scan this past week has confirmed that cancer has returned to my sacrum.  While it comes as no great surprise, given the increasing pain lately, it still comes as a great disappointment.

The recovery I was enjoying over the Summer and early Fall included some of my best periods of health and energy I have enjoyed for the past three years.  Pam and I were even beginning to indulge in something we’ve rarely done over the past eight years, anticipating and planning for the future!  Alas!  Such dreaming is not yet to be.

The situation as it currently stands is that I am able to walk only very short distances. I have a wheelchair in the condo and am able to use it for short local outings (accompanied).  I am also limited in terms of how long I can sit upright.  For the most part my days are bed-ridden unless broken by an appointment of one type or another. 

Treatment Plan:

With the retirement of my Oncologist, Dr. Paul Klimo, from the Lion’s Gate Clinic, we have decided to consolidate my care at the BC Cancer Agency.  The Vancouver Centre of the BCCA is a comprehensive cancer care facility where I will have chemo, radiation, pain management, and palliative care all under one roof.  My new medical oncology team is Drs. Cheung and Albarack.  Pam and I met them on Wednesday and came away with a strong sense that whatever lies ahead, we will be well supported by compassionate and competent medical care.  

Over the next few weeks I will have another scan, a meeting with my radiation oncologist, a meeting with the pain management team and another appointment with Dr. Albarack.  By then we will have a pretty good idea of what sort of treatment options are, or are not, available to me at this stage. 

Visits:

Over the past years I have enjoyed frequent visits from a wide range of family, friends, and colleagues.  These visits have often included scenic walks in Stanley Park or along the Seawall; lunch dates, picnics, or movies; and great conversation.  Unfortunately, many of these activities are now precluded by my mobility and sitting limitations.

I would appreciate weekday visitors but we need to work around the parkade renovations, which currently subject my condo to a relentless 8-hr barrage of jackhammering.  The contractors do usually have a predictable break for about 45 minutes at 2:00pm.  So if you are interested in a short visit and that time slot works for you send me a note.

Wheelchair walks will be a possibility when the weather improves as well.

Peace and blessings... Rob; in Vancouver

"Life is short.  And we do not have long to

gladden the hearts of those who walk the way with us.  

So let us be swift to love.  And let us make haste to show kindness." 

Henri Amiel