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For those of you who are interested, I am including this brief chronology of Barbara's breast cancer. It began just less than two months ago, though it seems much shorter. The medical personal didn't seem particularly excited about this particular cancer, which I guess I should find comforting. It is my intension to continue noting events here as they occur. Barbara died unexpectedly shortly after this account should have ended, and brief details are recorded here. |
| 20 Jan 2020 | Barbara didn't wake up. She is lying on her side, in the same position as when I left her, and has vomited during the night. A call 911 brings deputies and paramedics. Barbara is pronounced dead. |
| 19 Jan 2020 | Around 9 or 10 pm BJH became lethargically sleepy, fells asleep at the table, on the toilet, & standing up (not unusual behavior for her). With difficulty, I got her on the bed in the front bedroom. She slept & snored loudly. |
| 18 Jan 2020 | The night of 18/19 BJH doesn't go to bed or sleep (her statement). |
| 20 Dec 2019 | Barbara receives her last radiation treatment. She and I reviewed all her prescriptions with Dr. Bradley (PCP) and eliminated a few. Reduced morphine from 60 mg SR twice per day to 30 mg SR twice per day. |
| 19 Dec 2019 | Barbara receives radiation treatments. |
| 18 Dec 2019 | Barbara receives radiation treatments. |
| 17 Dec 2019 | Barbara receives radiation treatments. |
| 16 Dec 2019 | Barbara receives radiation treatments, gets Holter Monitor (heart) to wear for a month. |
| 13 Dec 2019 | Barbara receives radiation treatments. |
| 12 Dec 2019 | Barbara receives radiation treatments. |
| 11 Dec 2019 | Barbara receives radiation treatments. |
| 10 Dec 2019 | Barbara receives radiation treatments. |
| 9 Dec 2019 | Barbara receives radiation treatments. |
| 6 Dec 2019 | Barbara receives radiation treatments. |
| 5 Dec 2019 | Barbara receives radiation treatments. |
| 4 Dec 2019 | Barbara receives radiation treatments. |
| 3 Dec 2019 | Barbara receives radiation treatments. |
| 2 Dec 2019 | Barbara receives radiation treatments. |
| 30 Nov 2019: Saturday | MRI rescheduled by Radiology Limited. No reason given. |
| 29 Nov 2019 | Barbara's radiation treatments canceled due to machine malfunction. |
| 28 Nov 2019 | THANKSGIVING DAY HOLIDAY |
| 27 Nov 2019 | Barbara receives radiation treatments. |
| 26 Nov 2019 | Barbara receives radiation treatments. |
| 25 Nov 2019 | Barbara began radiation treatments. |
| 20 Nov 2019 | Reviewed perscriptions with Dr. Bradley (PCP). Reduced night-time morphine from 60 mg SR to 30 mg SR. Replaced lisinopril (allergy) & ranitidine (recalled). ALH begins managing BJH medications. |
| 18 Nov 2019 | MRI appointment rescheduled. BJH was not informed of the necessity to bring her inter-stem device controller. |
| 10 Nov 2019: Sunday | Released from Oro Valley Hospital. |
| 5 November, 2019: Tuesday | When I arose circa 7:15 I found Barbara lying on the kitchen floor with a black eye, talking in random incoherances & unable to get up. Called 911, BJH hospitalized at Oro Valley Hospital where it was found she had no gag reflex. She was sedated and intubated and remained so until Friday afternoon (Nov 8). Missed MRI appointment due to hospitalization. |
| Oct 3, 2019: Wednesday | After a routine appointment, Barbara was found unresponsive on the VA hospital campus. She was transported to the ER, and treated for stroke. She was hospitalized until discharged Saturday afternoon. She was diagnosed as having had stroke, though there was some uncertainty. A confirmatory MRI was scheduled. |
| October 22, 2019 | Simulation appointment with Dr. Gonzales, 3 pm. Marked reference points (tatoo). |
| October15, 2019 | Missed appointment with Dr. Gonzales |
| October 8, 2019 | Based on Barbara's dizzy and fainting episodes (including one in Dr. Hitt's office that Barbara could not remember), as well as nausea, vomiting, and fatigue, Dr. Chalasani recommended that we discontinue chemotherapeutic treatments, and move on to radiation. We are now awaiting a call from the office of Dr. Gonzales. |
| October 5, 2019 | Barbara dizzy and passed out. She recovered consciousness quickly and, after lying down, dizziness passed in about 20 minutes. |
| October 2, 1920 | Barbara marginally incoherent in afternoon and evening |
| October 1, 2019 |
Saw VA Dr. 11:00 Blood draw 12:10 Saw Dr. Chalasani 14:40 Barbara was dizzy, RBC Ok, pulse ox 92 Chemo infusion number 4 postponed for 1 week Daily chemo pills stopped for 1 week Dr. Chalasani on the front page of Tucson Daily Star
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| Septenber 24, 2019 |
Chemo infusion number 3 (Methotrexate and 5-flurouricil administered IV) started at 14:00. Transportation snafu, BJH stood outside for 30 min |
| September 20, 2019 | Talked loudly in her sleep for 1.5 hours |
| September 17, 2019 | Chemo infusion number 2 (Methotrexate and 5-flurouricil administered IV) started at 14:10. Fatigue, nausea started about 5:00 pm. Vomited a small amount. Cyclophosphamide (125 mg) taken daily after evening meal. Generalized malaise lasted through Sept 18. |
| September 10, 2019 | 8:50 Have labs drawn, 10am see Dr Chalasani, then 3 hours chemo, phone 520-694-2873. Out patient procedure. Prior to chemo, BJH was dizzy and sleepy almost to the point of being unable to stand. Methotrexate and 5-flurouricil administered IV (amount unknown). Cyclophosphamide to be taken daily, but had been sent (by the VA Pharmacy) to our mailing address. Identical treatments scheduled every Tuesday for the next 19 weeks. |
| September 9, 2019 | Surgery to install an internal port. Prep, 1 hour, surgery 3 hours, recovery 2 hour. Out patient surgery, but low blood pressure (105/58) and low % oxygen saturation (91) almost mandated an overnight stay. |
| September 4, 2019 |
Dr. Chalasani replied: We will be monitoring her kidney function very closely (with weekly labs) and adjust the dose. Kidney function labs would indicate any potential issues with chemo. Pavani Chalasani MD, MPH |
| September 3, 2019 |
E mailed Dr. Chalasani: Barbara Hatch is worried that chemotherapy will further damage her polycystic kidneys. Is there any evidence for this? Barbara |
| September 3, 2019 | Banner Health surgery scheduler called us and arranged for the installation of a port. We are to call them Friday (Sept 6, 2019) between 2 & 4 pm (520 694-6359) to finalize details. Prep, surgery, and recovery should take about three hours. Scheduled for 9 am. check in @ 7:000 am. No food after midnight. No K, no senna, no miralac. |
| Aug 22, 2019 |
Met with Dr. Pavani Chalasani. Testing of the surgically removed tissue consisted of identifying the alleles present at several (I think she mentioned six) locations on the genome. A numerical value based on each of the identified alleles is entered into a formula (unknown to me) and a final score calculated. A score of 25 or less suggests chemotherapy is not indicated and a score higher than 25 indicated that it is. Barbara scored 39. For people in Barbaras' situation, the recovery rate without chemo is 80% and with chemo is 90%. We decided to undergo chemo, and Dr. Chalasani outlined two possible regimens (shown below). Both are thought to be equally effective.
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| Aug 21, 201 | Dr. Pavani Chalasani (Oncologist) called and reported that the testing results suggest chemotherapy is indicated. We will meet with her tomorrow @ 1:00 to discuss the details and map out a course of action. |
| Aug 1, 2019 | Dr, Jennifer Erdrich completed The request for medical excuse from jury duty and faxed it to 520 866-5313. |
| July 31, 2019 |
We met with Dr. Jennifer Erdrich (Surgeon). She examined the incision and seemed satisfied with the healing process. We are to see her again in 6 months. Also met with Dr. Pavani Chalasani (Oncologist). She opines that chemotherapy is probably unnecessary, but will to run another test on the biopsy material to confirm that impression. She will call us with the results in 2 to 3 weeks. If chemotherapy is indicated, it will commence 5 to 7 weeks post surgery and continue for 4 to 6 weeks. After (or in place of) chemotherapy, radiation therapy will commence and continue for 4 to 6 weeks. At this point the patient is considered cured, but medication that inhibits the synthesis of estrogen and progesterone will be proscribed usque ad mortem. Dr. Chalasani agreed to fill out and fax a Medical Excuse Form to support Barbara's request for jury duty excusal. |
| July 24, 2019 |
Received the following reply:
Good Afternoon, |
| July 17, 2019 |
Received another jury summons, this time for August 19, 2019. Replied as follows: Amanda Stanford |
| July 15, 2019 | BJH lumpectomy began at 1:00, ended at 4:00. Removed tissue about the size of an apricot. Blue dye & a radio tracer applied to suspected cancer sites were noted in two lymph nodes, which were then removed. Pathology report due in one to two weeks, and results will guide further treatment. |
| July 12, 2019 | Rreceived surgery instructions from Banner hospital (520 694 6359) |
| July 12, 2019 | Problems getting cardio stress test results to anesthesiologist. |
| July 9, 2019 | BJH Cardio stress test |
| July 7, 2019 | BJH learns she is released from jury duty. |
| July 3, 2019 | Met with Dr Erdrich, discussed potential outcomes/problems Scheduled surgery for the 12th or 15th of July. |
| July 2, 2019 | Met with Dr. Gonzales, oncology radiation. He recommended post operative radiation of 4-6 weeks (5 days a week) depending on the pathology findings (no chemotherapy recommended at this time). The effect of radiation on people with Ehlers-Donlose is not well enough characterized to be germaine. |
| June 26, 2019 | Received letter from tri-west authorizing procedures. |
| June 24, 2019 | Phone call from Jennifer @ Dr Fitzpatric's office stating that prior authorization from VA had been requested. |
| June 24, 2019 | Phone conversation with Dr Erdrich. She will probably recommend a lumpectomy followed by radiation. Expect call from radilogist. The effect of radiation on people with Ehlers-Danlos is poorly characterized. |
| June 19, 2019 | Met with Dr. Erdrich, oncology surgeon for 2.5 hours. She will confer with Banner cancer board. |
| June 11, 2019 | Learned biopsy results = cancer. The VA doesn't perform breast cancer surgery, so BJH was referred to Banner Health, here in Tucson. |
| June 6, 2019 | Biopsy |
| June 5, 2019 | Mammogram retest, diagnostic equipment |
| May 16, 2019 | Routine yearly Mammogram |