CT Scan of Liver

Grandma went for a CT Scan of her liver. Since my mom was at a workshop, a friend came over to provide transportation. After the test, Grandma had to drink ten cups of fluids. When my mom arrived home, Grandma stated she drank so much that she was almost nauseated. She didn't really want any supper. My mom waited till later and fried her an egg. Grandma ate the egg, toast and soup.

Grandma is really not comfortable with bothering others. She told my mom how long the test took thinking that my mom will pay our friend by the hour. My mom told Grandma that our friend helped us out of love. She didn't do it for money.

Best Behavior

My mom attended an all day workshop to learn about creating a good life for me and planning for my future. Since nobody was available to support me at home for the day, I got to tag along. I was in my best behavior the whole time and my mom is very proud of me. I got quite a few compliments from other participants.

My mom brought along a few flyers and catalogues, pen and paper, scissors, and my iPod for keeping me busy. We walked into the room and my attention was totally captured by the nicely decorated Christmas tree with flashing lights. I started off looking at the flyers and catalogues. This is a great time of the year for me. I enjoyed the pictures of colorful Christmas trees and decorations. Then I started drawing and scribbling. My mom whispered to me from time to time. She took turns with me drawing and coloring when I needed some attention. As my demand for attention increased, she pulled out my iPod. There is new music on my iPod! She must have figured out that I got tired of the music I had on it previously. I bounced with the rhythm and occasionally I hummed along. When I smiled and appeared to be enjoying the music, my mom got curious and took one of my earphones to listen in to find out what was amusing to me. We need to get something to allow both of us to listen to the music at the same time, so that she does not have to snatch my earphone.

Half way through the afternoon, the music went dead. I handed the iPod back to my mom. She figured the battery must be dead. I resumed my drawing and scribbling on the flyers. I was behaving so well that my mom didn't need to employ alternative strategies, such as scissors.

Radiation Therapy

Grandma attended her pre-treatment appointment at the WW Cross Cancer Institute this morning. She has become the first person in our family to have "tattoos". They are permanent on her chest to mark the area for radiation.

There is a waiting period of about 3 weeks, so treatments won't start till around Christmas. My mom wants to be present for at least the first few treatments, so she told them about our Disneyworld trip from December 25 to January 5. If the treatment cannot start on December 22, it will be postponed to after we return to Edmonton.

Social Activities

Since the drains were removed, Grandma feels more comfortable in resuming some of her usual social activities. She went to church on Sunday and she is attending the senior's fellowship this morning. She will go out for lunch with her friends before coming home. It is good for Grandma to get back to some kind of normalcy before she starts her radiation treatments.

Grandma has a pre-treatment appointment at the WW Cross Cancer Institute tomorrow morning. She will be measured and the radiation dosage will be calculated. We do not know when the radiation treatments will commence. We only know that it will be 20 treatments. The radiation department closes on weekends and holidays. Even if the treatments can start on December 1, her course of treatment will span over the Christmas holidays.

Emily and Peter are going to take me and my mom to Disneyworld leaving on December 25. That means we won't be home when Grandma gets her last few treatments. My mom will have to make arrangements for someone else to transport her to and from the cancer hospital.

Dance Dance Revolution

It is so nice to have Emily and Peter home this week. They brought the Wii and a new game - Dance Dance Revolution (DDR). I love the game as it has music, flashing lights, and spinning images. I ask for it by saying, "tap, tap".

I have been reluctant to visit my mom for some time lately. Now that there is the DDR at mom's home, I keep coming to the door and knock on it.

Emily and Peter will be going back to Vancouver tomorrow. We are going to miss them a lot.

Tamoxifen

Grandma starts taking Tamoxifen today. The pharmacist gave her a list of natural health products to avoid. Grandma does not go to health stores to buy supplements. However, the list contains foods that Grandma eats. My mom searched the net to make sure she knows all the listed items and was glad she did. She didn't know anise is the spice we sometimes use in our cooking. She knows the Chinese name but not its English name. Wild yam is on the list and it is a relief to find out that it is not the yam and sweet potato we eat as foods. Grandma loves sweet potatoes.

The following are foods that Grandma should avoid:

* alfalfa
* anise (八角)
* bitter melon (苦瓜)
* dong quai (當歸)
* all types of ginseng (參)
* flaxseed
* licorice
* milk thistle

Oncology Consultation

Grandma saw the oncologist (a fancy name for cancer specialist) this morning at the WW Cross Cancer Institute. The doctor recommended a course of radiation (20 treatments) plus Tamoxifen for five years. Grandma's immediate response was she would not take the radiation treatments. My mom asked for more time to make a decision. The doctor was going to call us in a week and she explained that the sooner the radiation treatments start after surgery the better.

After my mom talked it over with Grandma, she indicated that she did not want to bother others in terms of transportation daily for four weeks. My mom told her that not wanting to inconvenient others is not a good enough reason to refuse radiation. Eventually Grandma agreed to the radiation treatments. She has an appointment to go back on November 26 to do the preparation work for radiation.

Removal of Drain

Grandma's drains were removed today. She dreaded the moment because she had been told by a friend that the procedure is VERY painful. It did hurt, but not as much as she anticipated.

Doctor's Appointment

Grandma will see Dr. Yakimets this afternoon and the cancer specialist at the WW Cross Cancer Institute tomorrow morning.

Drain #1 is ready for removal. Drainage from Drain #2 remains at 38 ml. for the last few days. We do not know whether the doctor will remove the drains or not.

Grandma and my mom are really excited about Emily and Peter coming home tonight. My mom talks about Emily, but I don't understand what she is trying to tell me. I say "mai-mai" (little sister) once in a while. My mom is not sure if I miss her or not.

I feel sorry for Emily because she will not be able to sleep in tomorrow morning. They have to be at WW Cross by 8:15 am. Traffic is bad at that time of the day, so they will have to leave home early.

Soups

Grandma decided not to go to church today because of the discomforts and inconvenience associated with the drainage tubes sticking out of her chest. Drain #2 is still draining 35 - 40 ml. a day. Hopefully, when she sees the surgeon on Tuesday, the drains will be ready (under 30 ml.) for removal. Please pray specifically for this as we anticipate that Grandma will be more comfortable without the drains.

My mom brought home four different kinds of soup for Grandma. We are touched by the love and support of family and friends. Thank you!

Graduation

Emily will be coming home next week for her convocation or graduation ceremony. For her and many others, graduation is an accomplishment and a happy event to be celebrated. For me, when I "graduated" half a decade ago, it was because I reached the age that the school system could kick me out.

Today, my mom attended a workshop called "Beyond Graduation", which explores what a "good life" looks like for people with disabilities after graduation and how they can use their strengths to contribute to the community. Even though my "graduation" was years ago, my mom decided to sign up for this workshop because my days are not meaningful enough. I have a good life and I am well cared for by my support workers. My mom knows that it is possible to make my life better by supporting me to be a contributing member of society. She cannot do this all by herself, so she is working on building a circle of friends for me. Due to my lack of social skills, this has been a slow process.

Beyond Graduation is a project of PLAN Institute for Caring Citizenship. In partnership with Taking IT Global, a website has been created for families and youth to connect and to access information/resources. The website is in its early stage of development. They welcome feedback and suggestions so that they can improve it.

Upcoming Appointments

Grandma's drainage from Drain #2 is gradually reducing. Hopefully both drains can be removed on Tuesday (November 18) when she see Dr. Yakimets.

Grandma will be seeing the cancer specialist at the WW Cross Cancer Institute next Wednesday (November 19) morning. My mom has been able to find someone to cover for her at the Chinatown footcare clinics so that she can accompany Grandma to this appointment. Emily will come home Tuesday night so that she can also be there.

Grandma's CT scan of liver is scheduled for the morning of November 27 at the Misericordia Hospital. My mom has registered for a whole day workshop on that same day to learn about planning for my future. Now my mom is feeling torn between the needs of Grandma and me. She thought about not attending the workshop, but will try to find someone to take Grandma to the test.

Breast Cancer Risk

Grandma has her bone scan done this afternoon. It required two visits to the lab. The first one was for the injection of a dye and the scan was 2 1/2 hours later.

Grandma's road to recovery is not a steady continual improvement. How she feels fluctuates from day to day. Yesterday, she had a good day and today it is not that great. Most of her discomforts are related to the nerves. The following is what my mom has read from a book called "The Intelligent Patient Guide to Breast Cancer":

"Many nerves pass through the breast to the skin and to the nipple. In addition, the intercostal-brachial nerves come from the area between the ribs, through the armpit (axilla) and reach to the underside or back of the upper arm. These nerves are often stretched or cut during surgery in the armpit which leads to an unpleasant tingling, burning, numb or 'thick' sensation on the back or underside of the upper arm. These sensations usually fade partly or completely over several months after surgery, but some numbness is often permanent."

The book also explains about breast cancer risk. The risk for breast cancer increases with age. Women over the age of 70 are four times more at risk than someone who is 40 years old. For three-quarters of the women diagnosed with breast cancer, age is the only identifiable risk factor. The lifetime risk for certain ages is:

* by age 25 - less than 1 in 1,000
* by age 50 - 1 in 63
* by age 75 - 1 in 15
* by age 90 - 1 in 9

At age 80, Grandma's risk is naturally high. Now that Grandma has breast cancer, what are the risks for my mom and Emily? The book says:

"A family history of breast cancer in a close relative such as your mother, sister or daughter contributes to your risk. However, breast cancer in only one distant relative such as an aunt or grandmother has little or no impact on your risk."

Healing Connections

Grandma attended the Healing Connections program this afternoon. There were education sessions led by nursing, PT and OT. The physiotherapist measured the range of motions of Grandma's shoulders. She pointed out how to do the exercises correctly. For example, when Grandma raises her arms above her head, she should be using her shoulders and not arching her back to get her arms up.

One of the sessions was in a support group format. Each woman had a chance to share their stories. Most of the participants were newly diagnosed and had surgery within the last few weeks. The two facilitators were Breast Cancer survivors. There were tears as well as laughters.

A lady there had her surgery one week earlier than Grandma. Her drains are still in. She asked if it is normal for her drains to be in for so long. The nurse stated that it is and that some women have theirs in for as long as 6 - 8 weeks. I certainly hope that Grandma's drains do not have to stay in that long. Grandma is more comfortable today and thinks that the removal of the steri-strips has made a difference. Just imagine how much the removal of her drains will help in enhancing her comfort level.

Incision

Grandma experiences more general discomforts that is affecting her sleep and rest. She takes one to two tablets of Extra Strength Tylenol as needed. This morning, my mom removed the steri-strips on her incision to improve her comfort level. My mom knows that Grandma's discomforts are related to the nerve, not the incision. But she wants to try anything that can make Grandma more comfortable.

The incision line is clean and dry. Due to the irritation of the drains, the area around the drain sites are red. My mom cleaned it and applied a light dressing over it. Drainage from Drain #1 is minimal. Drainage from Drain #2 is gradually reducing from 100 ml./day a week ago to 45 ml. yesterday. Grandma will see Dr. Yakimets next Tuesday (a week from today). Hopefully the drains can be removed then.

One way of managing the edema is to do exercises. Grandma has a whole list of exercises that she does everyday. Tomorrow, she will attend an education and support program at the Misericordia Hospital. The program is called Healing Connections. The multidisciplinary team consists of nursing, physiotherapy (PT), occupational therapy (OT), clinical nutrition and support visitors. PT will provide information and exercise sessions. The topic areas covered by OT include management of lymphedema and energy conservation techniques. These will all be helpful to Grandma.

Flu Shot

I got my flu shot during the night after I fell asleep. I should have known that whenever my mom sleeps over in my room, she is up to something - generally not good for me.

Grandma starts to get more visitors and that gives me a lot of opportunities to sneak over to spend time with mom. I am not going to write daily about Grandma as nothing exciting is happening.

Follow-up Appointment

Grandma saw Dr. Yakimets this afternoon. To her disappointment, the drains cannot be removed yet. The doctor would like the total drainage per day to be less than 30 ml. Drain #1 was at a total of 35 ml. yesterday, and Drain #2 was at 55 ml. yesterday and 100 ml. the day before. The next follow-up appointment will be on November 18.

The drainage from Drain #2 increased after Grandma noticed the swelling in her right upper chest wall. The swelling is still present, so removal of the drains may lead to more swelling.

It is not the wound or the incision that is bothering Grandma. She experiences pain in her shoulder and upper arm. Dr. Yakimets explained that during surgery, the nerve under her arm could be injured causing pain, discomforts or altered sensations. The nerve can take up to 6 months to heal.

Dr. Yakimets stated that fourteen lymph nodes were removed and two of them have cancer cells. It is best if none of the lymph nodes are affected. Two is not good, but could have been worse because we knew from the biopsy that at least one node has cancer.

Grandma will have a bone scan done on November 13 and a CT scan of liver is being booked to rule out spread of cancer to these areas.

Pain Management

My mom has told Grandma that she does not have to stoically endure pain and not to wait till she is too painful before she takes her pain medication. She left it up to Grandma to decide when to take Tylenol. After not taking anything for a couple of days, she was becoming more uncomfortable.

Last evening, one of my aunties called Grandma to find out how she was doing. She encouraged Grandma to take her pain medication. So she did and slept well last night. She took Tylenol again today and it helped her to be more comfortable.

The drainage from one drain has reduced, while the other one has increased. My mom suspects that the increase may be related to the edema. She is not sure what the surgeon will do when Grandma sees him tomorrow afternoon.

Drains

Grandma is looking forward to seeing the surgeon this coming Thursday with the anticipation that he will remove her drains. She knows she will feel more comfortable without those tubes hanging out of her chest.

This afternoon, a nurse called to check on Grandma. She stated that the doctor will only remove the drains if her drainage has stopped. Today, one of her drains collected 40 ml. this morning and another 30 ml. this afternoon. Hopefully, the drainage will reduce over the next couple of days. Please pray for the readiness of drain removal on Thursday.

Lymphedema

Grandma has her lymph nodes under her arm removed and this can contribute to lymphedema, a swelling of tissue caused by an abnormal build-up of fluid.

Grandma's right upper chest wall is swollen. My mom examines her and takes note of the extent of swelling so that she can monitor its progression or improvement. There is no redness or sign of infection.

Management is exercises, so Grandma is now on the mat exercising. One of the exercises is to move her arms up and down while holding onto a cane. Grandma's cane has sharp ice-picks at the end. It is kind of dangerous to wave her canes around. Peter's mom gave me a gift from Australia. It is a long wooden musical instrument - perfect length/weight and it is easy to grip. Grandma is using that instead of her cane.

Grandma does not have any heartburn today.

Heartburn

Grandma was tired yesterday. She has another night of good sleep and feels stronger today. With fewer phone calls and no visitor, Grandma is having a more relaxed day.

Grandma experiences some heartburn. This is a pre-existing condition that she has taken medicine for many years. My mom has different snacks and a pot of soup handy so that Grandma can eat small, frequent meals to see if it can help.

Laughter is the Best Medicine

Praise the Lord that Grandma is recovering well. As her condition stabilizes, writing about her becomes mundane. However, it is good to stay this way, as I certainly don't want to report any exciting (or nerve wrecking) news.

At bedtime, my mom reads to wind down from her hectic day. She is currently reading the book called Chicken Soup for the Nurse's Soul. The title of one of the stories captured her attention - This is the way we brush our teeth.

I don't like getting my teeth brushed. Since I love music, a song was created for me using the tune of "The wheels of the bus go up and down". The song goes like this - This is the way we brush our teeth, brush our teeth, brush our teeth, this is the way we brush our teeth . . . . .

I hate the song, but I like the story:

Long, long ago, as first-year students, we were on the floor for a short time each day. Our duties were limited to refilling water pitchers, changing flower water, dusting th room, and taking vital signs.

On one of my early mornings on the ward I was asked to clean the dentures of all the patients before breakfast. Delighted with the important assignment, I went to each room with a tray, gathered the denture cups on the night stands of the sleeping residents, and proceeded to the workroom to fulfill my duty. I diligently cleaned the teeth under running water with a special brush and denture cleaner, then placed them all on the counter in a neat row. As I started to put the dentures back into each cup I suddenly froze. Although I have done a superb job of cleaning them, I now saw a dilemma, which held me suddenly suspended. I didn't know to whom the dentures belonged!

Nervously, I went to the charge nurse and confessed my problem. After she wiped tears from her eyes from her laughter, she helped me sort some that she recognized, then we set about the arduous task of fitting the remaining dentures to the appropriate residents.

Room by room, we fit and refit teeth until, hours later each resident was smiling a gleaming smile and anticipating chomping down on breakfast.

The next day when I returned to the floor, the charge nurse began laughing again as soon as she saw me.

"Mrs. Smith's son came in last night wondering who was responsible for his mother's new teeth!"

My heart stopped. Expulsion from nursing school whirled in my mind.

"He said, 'They fit for the first time in fifteen years! We cannot thank you enough!'"

A good night

My mom was happy that Grandma had a good night last night. I had a good night too. I was so tired last night that I didn't even ask for music. I fell asleep shortly after I was tucked in. I snored the whole night through and thank God for an extra hour of sleep.

My mom cleaned Grandma's wound yesterday afternoon. It is clean and dry. She reapplied a light dressing for Grandma's comfort, as the drain site is somewhat irritating.

Sleep

I have guessed wrong. Last night, Grandma was tired but was wide awake till 1 am. She got up at 5 am. to make coffee. Other than not feeling rested, Grandma is generally well. She is up and about doing her exercises, walking around the house and watching TV.

Her ears have been ringing since after the surgery. It does not affect her hearing, but Grandma finds it annoying. My mom does not know what might have caused it, or how to resolve the problem. If it does not go away by Monday, she can call and consult Grandma's nurse.