A Visit to the Emergency Room - 9/20/11

I consider myself a reasonable woman. I seldom go off the deep end. I evaluate the situation, make a rational decision, and hope for the best. So when I started having inexplicable chest pains that radiated into my back on Thursday night as I drove to Cleveland, OH for the North Coast 24-Hour, I pulled into a rest area, took a couple of Advils, and fell asleep for about six hours. I woke up Friday morning refreshed with no chest pains and ready to finish up the drive. Some where between Cincinnati and Columbus, the chest and back pains came back. Again, I pulled into a rest area, took more Advil, and took another nap. For a second time, I woke up with no pain. This was not normal. I was not real sure what was going on.

I finally arrived in Cleveland, got some really good take-out food at a Thai restaurant, and went to the Motel 6. However, I wasn't able to finish the food. The chest and back pains were returning, and now I was just nauseous. So, I took more Advil and went to bed early. At least with all of this sleep, I thought, I should manage to stay awake for the entire 24 hours and get some good mileage. But what if the pain continued?

On Saturday morning, I drove to the race location at Edgewater Park that sat on Lake Erie. It's a beautiful park, and we were having a wonderful day, slightly overcast and just cool enough. I quickly found my running buddies. Fred (OH) had a large yellow tent that was set up on the outskirts of the running path, along with dozens of other tent set-ups. He would share his space with Rosemary (KY), Karen (TX), and me. Nancy (OH) was going to crew for Fred, and his mom was going to spectate and cheer him on. Since it's the USATF 24-hour national championships, he wanted to have a good showing. He ran 93.02 miles for 3rd place in his age group. I'd say that he had a great day. Karen and Rosemary also ran great races, finishing 1st and 2nd, respectively, in their age group.

I managed 45.94 miles, far less than I was planning. The chest and back pains started early, and it was difficult to even walk. I got into the routine of running/walking until the pain occurred, and then taking Advil and relaxing with Nancy and Fred's mom until the pain subsided. I would then get back on the 0.90075 mile asphalt loop for a few more laps. During the night for one of the pain breaks, I decided to take a nap, which, of course, turned into a six-hour sleep. Once the sun was up and it wasn't so cold, I went back out onto the loop for more mileage. The chest and back pains had not subsided during the night, but I could still walk slowly enough until time was called.

The return trip home on Sunday was the same as the drive to Cleveland. I would drive until pain stopped me, pull into a rest area, take the Advil, sleep until I felt better, and then continue driving. At this point, I was thinking that I should just get home and get to the emergency room. But when I got home, I felt better. I took a shower, got into bed, and on Monday morning, I was back at work. But now I had a head cold. I guess that cool breeze coming off Lake Erie during the race may have pushed me over the edge. Chest and back pains were still coming and going. I had a fever, and I couldn't seem to get warm. That night in bed, my entire body hurt, and no amount of pain killers seemed to help. Before I knew it, I had started crying, the covers on the bed engulfing me in a ball. My cell phone rang and, desperate for a distraction, I answered it.

"Are you crying?" he asked. I said "yes" as I burst into another wave of sobs.

"What's wrong?" he asked. "I am so tired of hurting. I am so tired of the pain," I told him.

"It will get better," he said. "Not if it keeps progressing," I whined.

We silently sat on the phone. He listened to me sob, and eventually the tears stopped. We began to talk, and he made sure that I laughed before we got off of the phone. I can't remember if it was something about his dog, his mom, or his son. I just remember laughing a little through the pain before we said good night.

On Tuesday, the pains were worse. After I got enough pain killers in me, I finally made it to work. I only stayed an hour before I finally decided that I was going to the emergency room. On Wednesday, I had to do all of my preliminary scans for the new chemotherapy regiment that I will start at the end of month, and I would have preferred to wait until I saw my oncologist, but now I was thinking that I could be having a heart attack or maybe there were blood clots in my lung. I was hospitalized for five days in 2003 because of blood clots in my left lung. The blood clots had occurred from over exposure to the five weeks of radiation treatment that I was having at the time. I also knew that blood clots could occur during chemotherapy, so it was worth it to get the situation checked out.

When you fill out the paper work in the emergency room and you say that you are having chest pains, you are immediately moved up on the list. They did an EKG that showed that I was not having a heart attack. They then did a CT Scan that showed that I did not have any blood clots in the left lung. The emergency room doctor said that, from the CT Scan, it appeared that I had metastasis on my sternum. I have metastasis in a lot of areas, but the sternum is not one of the locations that my oncologist and I have discussed. I was simply told to go home, take the pain medications, and follow up with my oncologist. Before I left, they gave me liquid potassium for good measure. That stuff really tastes yucky!

On Wednesday, I went in to have the dye injected into my veins for the bone scan that I would have three hours later. In the meantime, I went to have the CT Scan. I drank my two tall cups of yummy lemonade contrast (that would later give me diarrhea for the remainder of the day) before they called me back into the scan area. I told them about the CT Scan of my chest at the emergency room the day before, so they called my oncologist's office to see if that CT Scan was sufficient. She told them that it was fine and to just do the CT Scan of the pelvis and abdomen. After the scan, I went to Subway for brunch, a six-inch veggie sandwich. It was going to be a long day and who knew when I would get a chance to eat.

After brunch, I went back to the hospital for the bone scan. It took over an hour. We had to take a break in the middle because the contrast from the CT Scan was doing a number on my stomach. Afterwards, I headed to the oncologist's office. In addition to weight, temperature, and blood pressure, the lab nurse had 10 tubes ready to collect blood. Since the technicians had exhausted my veins for the bone scan, the CT technicians had to access my port for the radioactive contrast, and they left the tube in for the visit to the oncologist's office. My lab nurse for the day is a good vein finder and sticker. Although I really wished she had used the port, she insisted on finding a vein in my now bruised and swollen arm. She found one she liked, poked the needle right in, and began filling the tubes. At least she got it on the first stick.

A patient and her lab nurse were next to us, and we hear the patient say that she is feeling light-headed and that she feels like she's going to pass out. And she did! Her eyes rolled back into her head. She was sweating and mumbling. Other lab nurses were fanning her, putting cold compresses on her head and neck, and calling her name. And my lab nurse is still drawing blood from my vein, as she scooted her rolling stool closer to me to avoid getting hit in the head by the now flailing patient and the onset of nurses and doctors coming to the rescue. "Don't you pass out on me," she said jokingly. "We have a good vein. I'm not stopping until we fill up all ten tubes." My lab nurse and I were hysterical. We felt bad for the other patient, but what could we do? We had those tubes to fill before that poor vein blew.

Finally, I was handed a urine cup to fill, and then I was taken into a room for my visit with the research nurse and my oncologist. The research nurse hooked me up to the EKG machine while she listened to the story of my life for the past week. When my oncologist came in, I had to retell the story while she examined me. "You know the hospital is now going to think I can't control my patients' pain," she joked. Yeah, but I didn't want people asking, did she die from the cancer? No. Did she die from the treatment? No. She died because she refused to go to the hospital and have a blood clot checked out that broke off from her lung and went into her brain. It wasn't funny, but we all nervously laughed at my reasoning.

My oncologist and I have had the pain management discussion before, but this time, I'm going to really try and play by the rules. I tend to wait until I can't tolerate the pain before I take pain medication, and then I'll take Advil. If I won't take the prescription pain killers, then my oncologist has always wanted me to take Aleve instead. Aleve does not work for me. Hydrocodone does not work. Oxycodone is the break through pain killer that I have been prescribed to go along with the Oxycontin for regular dosing. One of them makes me nauseous, but at least I'm pain free for two hours. "Take the meds," she said, "at least until we get your tumors under control."

It turns out that the emergency room doctor misread my CT Scan. I do not have metastasis on my sternum. I have several new tumors in my left lung. With the tumor flare, my lung became inflamed, pressing against the sternum, which caused the pain in my chest and back. What the emergency room doctor saw on the scan was a bruised sternum. My goodness! In a month, my lung had gone from two stable tumors to several tumors (there's a cluster in the lining of the lung) that had inflamed the lung so much that it had tried to break out of the chest bone. This cancer is trying to kill me.

The research nurse brought in three more tubes. She said that she would ask my oncology nurse to take the blood from my port. They also gave me a 30-minute IV bag of steroids to get rid of the inflammation and to calm down all of the heightened nerves. Wednesday night was the best night of sleep that I've had in two months.

It's hard for me to take pain medication if I'm handling the pain. But it's best to keep some pain medication in my system so that I'm not starting from ground zero. I realize that and hopefully, I won't get in another emergency room situation any time soon. I've been alternating the Oxycodone and the Advil, holding off the Oxycontin. I feel like I'm taking drugs all day long, but I'm really only averaging about every 3-4 hours. Regardless if I'm in pain or not, I take something. I'll get it under control. Next week I'll start Xeloda. I'm already thinking that I may have to invest in some adult diapers for the diarrhea that may come with that chemotherapy regiment.

It's Friday, and I didn't think I would be able to go to the Georgia Jewel 50 Mile in Dalton, GA this weekend. But I'm going. There's a 30 hour cut-off, the head cold is gone, I have pain meds, and the trail shoes are packed. I'm ready!