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The Cancer Blog

Update
Diehl Martin passed away in October 2007. If you need to contact someone, please contact Monica Martin.

Notes

I was diagnosed with pancreatic cancer in September of 2004. There was a Whipple procedure surgery in October of 2004, radiation and chemo every weekday from the end of December 2004 to February 2005, two more rounds of chemo through the winter and spring of 2005, another hospitalization in the spring of 2006, and more chemo from June through November 2006. For much of this time, it has been assumed that I would not survive very long, but would be called Home within a matter of weeks. Since then, we have had a major miracle. The Lord has blessed me in every possible way. During November of 2006, there was a complete and total turnaround. I was back to the energy level I had before this cancer was diagnosed in September of 2004. The pain was gone, the tumor marker was back down into the normal range. For someone with Stage IV pancreatic adenocarcinoma, this was very unusual. Since then things have been up and down quite a bit. I trust the Lord fully, and am not worried about the ultimate outcome.

In order to potentially help others through similar situations, I decided to post this cancer blog. As a Christian, I am not worried about my future. I have no doubt of being Heaven-bound. So I smile my way through life here, hoping to bring a few more along to meet Jesus.

Resources

What is involved in a Whipple procedure? Here is a page which describes it from the patient's perspective: http://diehlmartin.com/whipple.html

I have assembled a web page which shows what a typical chemotherapy infusion involves, from start to finish. This page shows how simple it is once the patient has a port installed: http://diehlmartin.com/infusion/

What do the scars look like from a Whipple procedure? What scars are there from having a "port" installed? This page shows that it isn't all that bad: http://diehlmartin.com/scars.html

Some of us cancer patients get nasty skin infections, due to our weakened immune systems. Here is a page on what I had to do to get control of mine: http://diehlmartin.com/sores.html

What are the side-effects of the pain killers that cancer patients take? Here is an extremely frank discussion of some of the side effects and issues involved: http://diehlmartin.com/painkillers.html

I have had requests for a link to our wedding pictures, which were mentioned in the Sept 19, 2006 posting. Look here: http://diehlmartin.com/wedding/

What am I praying about during this cancer incndent? The answer may surprise you. Here is an explanation of what I pray for, and why: http://diehlmartin.com/prayer.html

So, you or someone you know has been diagnosed with pancreatic cancer. Besides the medical treatment, there are some more things which really need to be taken care of. Please, take care of the legal paperwork quickly: http://diehlmartin.com/legal.html

There are so may pills to take! Why am I taking this one or that? Well, now you will know, since I have listed them all, and linked to sources as to what they all do. The list is here: http://diehlmartin.com/pills.html

My time is rapidly running out. Here are my thoughts concerning my own end:
http://diehlmartin.com/testamony.html

As a fully committed Christian, I have a few thoughts on living the Christian Life. Since Jesus has been so very good to me, I simply must share this:
http://diehlmartin.com/testamony2.html


Oct 27, 2007

Diehl Martin passed away this morning at about 5:00, very quickly, in his beloved Monica's arms.

UPDATE

Funeral services will be held at 1:00 PM Sunday, November 4 at the First Baptist Church of Guntersville, 1000 Gunter Avenue, Guntersville, AL.

Memorial contributions may be made to
Diehl Martin Memorial Fund, First Baptist Church, Guntersville, or
The Gideons International, or
Hospice of Marshall County.

Oct 25, 2007

I cannot recall ever being this tired. Over the weekend, the bottom simply fell out of all my energy. My lungs heave, but I am not getting the oxygen I need. Standing up and walking three steps results in falling down immediately. Without direct, immediate assistance, I almost cannot move at all.

For the sequence of events through which I have come, I am amazed to still be here. In August of 2004 we had just been through one of the most awful real estate transactions imaginable. We had been cheated so badly in the deal, that we ended up having to bring very large amounts of money to sell the Huntsville house. It hurt very badly, but then again it was the right thing to do. I would so much rather arrive Home having forgiven everyone everything, trusting my Savior for everything, than to bear a single grudge against anyone or anything. So as of the end of August 2004, that matter was fully taken care of. It was done, forgiven, and no longer of concern. While we had been seriously cheated, yet we made sure to treat our buyer right. It is the proper, Christian thing to do. So this put us in a seriously hard financial position from which to recover.

It was a major shock, then the next month, during September 2004 to be diagnosed with Pancreatic Adenocarcinoma. Dr. Stuart Foley (Lakeside Clinic, Guntersille) noticed my jaundiced eyes with no other pain, and referred me first to Dr. Winter Wilson (Marshall Medical Center North) and then on to Dr. Mo Eloubeidi (UAB Hospital, Birmingham, Alabama) who used visual and ultrasound endoscopes to inspect the area for tumor growth, They found enough evidence, both through imaging and biopsies to refer me to Dr. Selwyn Vickers (UAB Hospital, Birmingham, Alabama) for a major surgery called a “Whipple Procedure,” on October 21, 2004, wherein they removed all of my gall bladder, the head of the pancreas, including the bile duct, part of my stomach, part of my intestine, every lymph node they could reach, and anything else that looked even slightly suspicious. They sewed me back up a very different person, with much less digestive tract. As soon as the skin healed up a bit, the next treatments began. There were 28 days of radiation treatment combined with Xeloda, which is a systemic chemo drug, and then there was 28 days more of Xeloda by itself.

This sequence of treatments seemed to help for a while. There were no new visible issues until pain developed in February 2006. From that time on, it became obvious that the cancer had metastasized, and that there would have to be a broadside-systemic approach to fighting it. At this point, Dr. James Posey (UAB Comprehensive Cancer Center, Birmingham, Alabama) was brought on as lead doctor, and as the oncologist. From Spring to 2006 then there were a series of tests (CT scan and PET scan of abdomen, chest, and pelvis, MRI of my head, bone scan) and from that information I was started on a whole series of chemotherapy agents.

The first chemo agent was Gemzar. I had a port-a-cath installed to make the infusions work better, and the Gemzar seemed to keep everything at bay for six months or so. After that though. the tumor marker they watch (called CA19-9) started to climb, and so the decision was made to try two other chemo drugs simultaneously, these being Tarceva and Oxaliplatin. What awful stuff those are, and furthermore, beyond being impossibly expensive, they had no positive effect, so that has been cancelled along with all other cancer treatment, and I am now in the care of Hospice.

My writing has slowed a bit, because the end-of-life drugs are meant to relieve the considerable amount of pain. My staying lucid is a secondary consideration now. Yes, when I cannot breathe, and the panic attack begins, I do not feel badly about taking the concentrated morphine sulfate. I am dying now, it is over. The Lord could call me Home today, and I will joyfully go. I want to be found faithful to the end, and for me the end is very near.

So, in some form this is a bit of a a farewell message. My hands are so numb that typing this much took me several hours. I will continue to work as long as I can function, but that is not guaranteed past ten minutes from now. May My God most seriously bless all of those who have walked with me in this way, and held my hands up that I may continue beyond all rational time.

May Jesus bless you mightily.

Diehl Martin
Guntersville, Alabama,
Oct 25, 2007


Oct 23, 2007

Once again, the Lord allowed me make It through the night. I have a definite list of things to do today, and so there is a reason to get going, showered, shaved, and look at least moderately normal.

We had multiple hospice nurse visits yesterday, and there have been several minor decisions made. The first decision is that my blood pressure has been too low (96/64) and that I should stop taking the lisinopril for now. In my case lower blood pressure is definitely not better, as it tends to weaken me even further. The second decision is to delay further treatment with the warfarin (Coumadin) until at least the weekend, as the amount blood I am coughing up, passing, and otherwise losing continuously is excessive. It is interesting to me to get this level of medical attention near end-of-life. There is no reason whatsoever for complaint.

So my first order statement is that hospice care is not a thing to fear. I have no doubt that they vary quite a bit, but that the folks at Hospsice of Marshall County (Alabama) know what they are doing, and can deal very well with the sickest of us out here.

Update

In order to reduce that acute anxiety attacks, a pill called Lorazpam was precsribed last night. It may well work but it causes a real mental problem. I took one pill right before bedtime and was out past 8 a.m. Now I am tryng my hardest to get my engineering work done yet I know that mentally there is a big hole where my brain normally is. Maybe tonight I will take the Lorazpam, and skip it in the morning.

Oct 22, 2007

I am alive today. This morning was very difficult, coughing up lots of blood, and I had a panic attack because the breathing was nearly impossible. That was treated with concentrated morphine sulfate. That acts to open the bronchial airways a bit, and reduces the stress level for an hour or two, but it also says how far things have gone. Not being able to breathe is very frightening.

My beloved Monica and I talked about the situation last night. She is so very wonderful and supportive through this, the hardest of times. On Saturday, she finished putting together our wedding album (we had slides and negatives from our March 27, 1971 wedding, but this is the first time that there is a real album with printed out pictures and everything.) It is gorgeous, and it reminds us just how far we have come. We were so very young back then, and made this life-long commitment. The most notable thing is that although we had no idea the challenges we would face, and although we had a little inexpensive wedding with all of about 75 guests, we are just as married as if we had a really big wedding. We promised “until death do us part” and that is exactly where we have come. I have known Monica for more than 40 years, now, and have been married to her for 36-1/2 years, and I cannot imagine a more wonderful life partner.


Hymn Time!

One of our good friends (Emily Patrick, a fellow professional photographer) suggested this hymn to me for today, and it is indeed both highly applicable as well as being one of my favorites. I do not believe I have ever sung this one in church, but I have it on a recording featuring Tennessee Ernie Ford, and it speaks very well to where I am today.

Precious Lord, take my hand,
Lead me on, let me stand,
I am tired, I am weak, I am worn;
Through the storm, through the night,
Lead me on to the light:
Take my hand, precious Lord,
Lead me home.

When my way grows drear,
Precious Lord, linger near,
When my life is almost gone,
Hear my cry, hear my call,
Hold my hand lest I fall:
Take my hand, precious Lord,
Lead me home.

When the darkness appears
And the night draws near,
And the day is past and gone,
At the river I stand,
Guide my feet, hold my hand:
Take my hand, precious Lord,
Lead me home.

For more about this hymn, check out the Cyber Hymnal.


Oct 21, 2007

Today is Sunday. Normally I would be getting ready for Sunday school and church now. However, my energy level is so low that just making it from the recliner to the bathroom, and then to the kitchen, has been just barely possible. The physical weakness is totally overwhelming.

Yesterday evening, Carrie the night nurse from hospice came by, and talked us through some of what is going on bodily, to help me know better why I feel as I do, and what it means. So this sequence of events is not at all unusual, and indicates that my time here really is short. She brought up several things of interest. One is that the continued swelling of my legs is due to fluid retention, but that the fluid retention is due to the heart not being able to keep up. So the loop diuretic may help some by helping me get rid of excess water, but the heart issue is not going away. My heart rate is up from its usual 60 to well past 90 most of the time, and much higher if I actually stand up. With low oxygen, the heart malfunctions as well, explaining the irregular heartbeat. This apparently only gets worse,

The biggest apparent risk is still that the blood clots are moving around, as the blood thinner (Coumadin) lets them loosen up. All it takes is one in the wrong spot, and I go Home Right Now. So far, the clots in the lungs (pulmonary embolism) are what is causing the intense weakness all the time. My oxygenation percentage has not been measured since I got out of UAB hospital six weeks ago, but then it was less than 85% without supplemental oxygen, and my guess is that I am seeing excursions way below that now even with oxygen. I can cough for ten seconds, and be left totally unconscious for several minutes thereafter. My lungs are failing. Because of the tumors in the lungs and lymph nodes/ducts around the lungs, there is no prospect of recovery from this. Now remember that this is pancreatic cancer doing this, and has spread all over, and continues to grow rapidly. Cancer treatment is over.

So what is there to be done now? I am simply awaiting my time to go Home. Jesus is carrying me now, as I simply cannot go one step further. I am ready to go Home, Lord. I am ready, not because of what I have done, but rather because You have done it all for me, and have shown Your love and care for me throughout my whole life. What I could not do, You did for me. Thank you, Jesus!


Oct 20, 2007

Prayer partners: I need your prayers right now. The breathing difficulties reached a desperate level last night and this morning, to the point where I was in shock. It took most of the night to come back out of it. We are not sure quite what happened, but not too long after supper I simply could not breathe at all. Monica turned the oxygen concentrator all the way up as far as it would go, and spoke with the hospice night nurse about the situation. After another nebulizer treatment, more Levsin and Mucinex, things calmed down a bit, but not much until 3 a.m. or so. So sweet Monica has been up most of the night trying to keep me going, and by now at 5 a.m. she is asleep while I prop myself up in front of the computer, able to breathe a bit better now, but totally unable to sleep.

OK, now there were other symptoms also. Besides the breathing difficulties, there was a really exciting irregular heartbeat sequence that went on for an hour or so. Then there were visual migrane disturbances, with big bright sparkly light shows. So this was more than the ordinary little incident.

So what happened exactly? I can only make a couple of guesses. One possibility is that I ate too much, or the wrong thing, and that this was simply my body telling me to not do that. Another possibility is that the sudden recent change in medications is more than I could deal with quickly. It could also be those blood clots in the lungs moving around as the blood thinner (Coumadin) works them out. Well, this is stage IV cancer, and anything could have happened quite frankly.

So, please pray about this. The Lord hears all of our prayers, and is faithful to answer. I am willing to go Home when He calls me, but until that point, it would really help to be able to breathe.

Update

Yes, I can breathe. No, there is not a congestion problem today. The drug combination seems to have solved the congestion for now. The problem seems to be that the oxygen transpiration is very low, and though I am inhaling 5 liters/minute of concentrated oxygen, it just isn't getting into the blood stream like it should. With very great effort, my beloved Monica got me up, washed and dressed so that I look normal, other than being a lovely shade of gray/blue. If I sit here and do not move, I can get some computer work done, but I cannot even talk on the phone because it takes too much energy, and cuts into the oxygen supply.

Quite frankly, the way things are going, I have to wonder if I will last the week.


Oct 19, 2007

Over the last day or two the breathing issues have intensified. We called hospice and Daniel came back out to see what could be done, and it was decided that I should do several things. First is to increase the frequency of taking the hyoscyamine (Levsin) to four times a day, and the guaifenesin (Mucinex) to six times a day, to try to get the increasing amount of very sticky phlegm both dried up some and also out of the lungs. Also, they prescribed four times per day treatment with 0.5 mg ipratropium bromide and 3.0 mg albuterol sulfate, administered with a nebulizer. This is supposed to help open up the airways some. Those drugs are commonly found in thee pocked-sized treatment sprayers for athsma, only in this case the dose is larger, and the administration requires the nebulizer (it looks like funny plastic peace pipe) and an air compressor. So we shall see if that helps.


Oct 18, 2007

Happy Thursday evening. I am still here. The breathing difficulties are getting yet worse, and I am nearly drowning again. Daniel from Hospice suggested that I might want to increase the dose of the Hyoscyamine (Levsin) and take more Mucinex in order to help the drying process. Well, it is worth a try. Right now there is so much phlegm to get up that it takes so much coughing that now I am coughing up blood as well. This takes a whole lot of energy. But at least it comes up and then I can breathe again. One breath at a time is all I get anyway, right?

Really, things are going very well, all-considered. Let's face it – for a guy on severely borrowed time, I am glad just to be here and able to sit up in front of my laptop computer and continue being even a quarter normal, some of the time. I receive emails from caregivers every week about some other pancreatic cancer patient who lasted a couple of weeks or months, and went straight downhill immediately. Well, my initial diagnosis was in September of 2004, and while Dr. Foley gave me less than three months to live at that time, after three years I am still here. So, has the Lord been good to me or what? Every additional day is a gift, and I gladly accept whatever He presents me for the day.

Hymn Time!

This is one of those wonder