12 Days at MD Anderson

What started out as a trip to MD Anderson for an outpatient surgery to place the Port A Cath and ended up as a 12 day hospitalization. The Port A Cath placement went well but Marc's BP went sky high after the procedure was completed. Because of that Marc was kept overnight for observation. Complicating matters the abdominal pain worsened and became unbearable for Marc.The blood pressure improved slightly overnight but the abdominal pain worsened. So when he was discharged in the morning from the outpatient surgery center, I took him directly to MD Anderson's Emergency Center.

After multiple tests in the Emergency Center, Marc was admitted for further testing to determine the cause of the abdominal pain and to get the blood pressure under control. While talking to the neuro-oncolcgist I mentioned that I had thought for a long time that the cause of Marc's abdominal pain was the IVC filter because the pain had started about a week after the filter was inserted and progressively worsened. The pain had become so severe that Marc was using a Fentanyl patch and taking morphine sulfate every 6 hours which failed to help the pain. Note that I had told every Dr. we had seen since the palcement of the filter that I wondered if the cause of his abdominal pain might be the IVC filter and was told that would be very unlikely . Well I finally found a Dr. that listened to me - he left the room and read the possible complications of IVC filters and returned saying "You are right, I am positive that is the cause of the pain". But complicating the diagnosis the gastroenterologist who examined Marc felt the cause was GI related due to the high steroid doses and the Avastin (the chemotherapy that Marc is now on). Marc was then seen by an interventional radiologist who felt that it was unlikely the pain was from the IVC filter and agreed that a GI workup should be completed before considering the removal of the filter. First of all he felt it unlikely that the filter was still retreivable because of the lenght of time it had been in place; secondly he felt an EGD (endoscopic evaluation of the esophogus, stomach and duodenum) should be completed before attempting the retreival because it was much lower risk. They (the Drs.) went round and round about which procedure should be done first.It was initially decided that the EGD be done first, to the dismay of the neuro-oncologist.

Then it was cancelled because Marc's BP was elevated and anesthesia refused to assist with the procedure. The EGD was scheduled for a week ago last Thursday. Marc was not allowed food or drink (NPO) after Midnight on Wednesday. The procedure was scheduled for 3 pm that day. Well at 5 pm, the procedure was unexplectedly canceled. The EGD was rescheduled for 3 pm the next day and wouldn't you know the procedure was canceled because Marc's BP was elevated and anesthesia refused to assist with the procedure. This was Friday and again Marc had been NPO since midnight the night before. Marc was furious and his BP went up even more. That meant staying in the hospital through the weekend.

Because the BP was so elevated an internal medicine specialist was consulted and felt like Marc needed to add 3 different BP medicines to keep the BP under control. More labs were done. By Monday Marc was so debilitated that he could hardly get out of bed, his oxygen saturation was low and his blood gasses showed a very low oxygen level. Marc was placed on oxygen and his oxygen levels were monitored continuously. His condition seemed to deteriorate more each day. I was able to take him to the lobby on Sunday to visit with Steve, Julie, Brayden, Annie and Abbie. Annie later told her Mom that she wanted to be a nurse when she grew up so that she could work at this hospital and take care of her Papa.

Finally the decision was made to proceed with attempting the IVC filter removal and that procedure was scheduled for 1pm on Monday. When we got to the holding area to prepare for the procedure the interventional radiologist came in (a different Dr. from before) and said he did not feel comfortable doing the procedure until GI complications were ruled out. Since the EGD was already scheduled for 3 pm that day he recommended that Marc go ahead and have the EGD and the IVC filter retrieval be scheduled for Tuesday. Well by the time we got back up on the floor the EGD had been canceled by the schedulers and rescheduled for Wednesday afternoon. So now Marc still had the filter removal scheduled prior to the EGD. After many phone calls to different physicians, Marc's nurse contacted the patient advocate who miraculously go the EGD scheduled for 5 pm that evening. We waited in the holding area for almost 2 hours before they took Marc back for the procedure. Marc was back out within 15 minutes with a report of no GI problems found. We finally got back to his room about 8:30.

The next day the IVC filter retrieval was scheduled for 3pm. And for the second day in a row Marc was kept NPO after midnight.Transportation showed up at about noon to take him down for the procedure. We waited in the holding area until about 3 pm before Marc was taken back for the procedure. Marc was already agitated because of the long wait. He was in the procedure room for over an hour and the Dr. explained that he was unable to remove the filter. He said that at one time during the procedure he actually thought he was going to get it out but then got to a point that he felt would injure the vena cava if he forced the removal. So we thought the procedure was in vain. I don't know what Marc was given for anesthesia but he was extremely agitated after the procedure. One of the nurses tried to force him to do something (I don't remember what) and he slapped at her and yelled "no". It didn't take them 5 minutes to release him to his room. That night was a nightmare! Marc was agitated all night. He kept trying to get out of bed (he had to lie flat for 4 hours after the procedure was completed) and didn't want to listen to anything I said. Finally about 4 am I got him up in the chair and he seemed to fall asleep and started to snore. I lay on the bed reading and must have dosed off and was awakened about 4:30 by Marc trying to get out of the chair. He was so weak he could hardly stand. By the time I got to him he was nearly in the bathroom (only a couple of steps from the recliner) hanging onto the door jam. I couldn't hold him up with him in the position he was in so I let him gently down to the floor. He got on his hands and knees and crawled into the bathroom. I am not sure how I got him back up but I eventually got him back in the chair. By then it was nearly 5 am and there was no going back to sleep. Marc was exhausted and so was I!

The next day all Marc couldn't get up without assistance from 2 people. His urine output had increased so much the endroconologists were consulted. They decided that he might have diabetes insipidus as a result of the removal of the pituitary macroadenoma last November and said the condition could occur up to a year after the procedure. So again more testing was done. His urine output was monitored closely. He also had an elevated serum sodium level and low potassium and magnesium levels. His IV fluids were changed and he was stared on potassium and magnesium by IV infusion. His oxygen saturation remained low and he was on continuous monitoring of his vital signs. The only good thing was that he no longer complained of abdominal pain.

Julie graciously offered to spend the night to help me with Marc. I fell asleep in the chair and don't remember anything until morning. Julie asked me the next morning if I remembered telling Marc to "sit down and shut up". I have no memory of that or of the nurse asking me which medication she should give him to help settle him down so he could rest. Julie says I answered her but I don't remember. I felt more rested the next day than I had felt in a long, long time.

That afternoon, Marc attempted to get out of the chair. I was just across the room on my laptop when I heard a thud. I found him on his knees in front of the chair. It took a nurse, 2 aides and myself to get him up and back in the chair. The nursing supervisor decided that for Marc's safety they needed to get a sitter to stay the night. He wasn't much of a sitter, more of a talker and just kept telling Marc all night that he needed to stay still. About 3 am I woke up hearing the sitter tell the RN that "he just wouldn't stay still, I told him he was going to pull out his IV". At that time I realized that Marc had in fact fulled out his IV. The IV team had to be called to replace the needle in the port. I dreaded seeing what the daytime sitter would be like! I am not sure that we needed her because Marc was scheduled for an MRI under sedation at 10 am.

The MRI was scheduled to evaluate for new tumor growth and to assess the pituitary for abnormalities as Marc had developed some new right sided weakness during the time he was so debilitated. I was concerned that there might be some changes in the tumor due to the new symptoms. The most refreshing news I have had in a long time were delivered by the neuro-oncologist just as Marc was being taken back to his room. He said that he saw no new tumor growth and saw no abnormalities in the pituitary. The dictated report had not been completed yet by the radiologist but should be done in the morning. We - Marc, Julie and myself, cried some tears of joy upon hearing the news.

Julie is again spending the night and Steve is home with the kids. He is suffering from a sinusitis and I told him he couldn't see his Dad until he had been on antibiotics for 24 hours. Marc even called him tonight and talked to both Steve and Annie. We have had some laughs tonight as you can see from the picture above. Marc got a kick out of telling the sitter he wanted pillows until he was covered in pillows and linens. It is so good to hear his laughter and see him smile.

We are looking forward to being discharged to home tomorrow. I pray that the smiles and laughter continue. It is wonderful to see Marc pain free. The doctor tells us he should be in "Medical Miracles". I don't care about that but I pray that his recovery continues. He was able to get his third dose of Avastin today (the current chemotherapy) and is scheduled to get it again in two weeks. He will have followup labs this week and next and we will have another MRI on 9/28 and see the neuro-oncologist again on 9/29.

Another day at MD Anderson

8/10/09
Marc had his second round of IV chemotherapy today at MD Anderson. We had to be there early to have lab drawn and the chemo wasn't scheduled until 3:30 this afternoon. All went well until about an hour after we checked in for the chemo. The clerk came out and told us that Marc would have to come back tomorrow for the chemo because it had only been 13 days since his last dose. I told her that I wanted the Dr. called because if his blood work came back OK there was no reason to wait another day. She paged our oncologist's nurse. When she called back I told her the same thing, that I saw no reason that Marc could not have the chemo today; especially since she had told me his labs were entirely normal. She said that the oncologist and is nurse practitioner were both on vacation and she would have to contact the covering physician. About an hour later the nurse called me back stating that the covering physician agreed that it was OK to have the chemotherapy. Everything just seems like such an ordeal, nothing is simple.

When we got back to the treatment room, Marc tried to lie down on the bed (actually a modified cot). His feet hung at least a foot over the end of the bed! When he elevated the head of the bed, it bent at mid chest position instead of at the waist. He just couldn't handle it as any position made his abdominal discomfort worse and there was no way to get comfortable. While trying to change positions he pulled out the IV and it had to be restarted. Fortunately they got it in. I finally got him up in the chair and he was more comfortable. Of course being in such pain, his blood pressure rose. As elevated BP is normal with the Avastin, the nurse was hesitant to continue the infusion. I had brought extra BP medication with us as the same thing happened the last time, and gave Marc the medication. The nurse called our oncologist who told her to go ahead and complete the infusion, that I knew what to do and it would be OK. So the infusion continued and went well until about 15 minutes before it was to be complete. Marc started having more abdominal pain and insisted walking would help. So with the nurses blessing we walked. His BP was still high but Marc was doing OK so we completed the infusion. We got home had a late dinner and now Marc is resting now and we are hoping that the future chemo treatments are less eventful.

8/11/09
Marc had a little better night last night and then a dentist appointment this am. Of course his BP was up again after he sat there waiting on them to start his cleaning (they checked it after performing all of the X-rays). I again gave him some BP med and he rested while I got my teeth cleaned. By the time I was done and they got ready to start on Marc again, he was so uncomfortable that we had to reschedule the cleaning. We're home again now and he is resting. I am going to check his BP again soon and hopefully it will have gone down.

We are scheduled to go back to MD Anderson for his pre-placement consult for the portacath on 8/21. We still don't know when they will do the insertion. They have added anesthesia consults to the appointment lists so I suppose they will have to coordinate the insertion between anesthesia and surgery. Again, can't anything be simple anymore???

The care we get at MD Anderson is wonderful and we are very appreciative that we have the means to afford his treatment there. Had we stayed with the original oncologist, Marc would have been on the standard treatment with less chance for survival. This way we feel we have the best chance to "Beat the Beast".

Thanks to all who have given us the support and prayers, they are appreciated beyond words. I will try to post again next week.

Some good days, some bad but hanging in there!

It's been awhile since I posted anything so I will try to review the last 2 weeks now.

We went to MD Anderson for Marc's chemotherapy as scheduled but when we got there Marc was having such severe abdominal pain that they sent us to the emergency room for evaluation. After 24 hours there with lab, X-ray and CT scans they decided that Marc's problem was severe constipation. I know, we always knew he was full of it but now we have proof! The repeat CT scan did not even mention the umbilical hernia! While in ER it took 2 doses of IV dilaudid (a powerful pain medication) to relieve his pain. They discharged us at 9:30 the next morning and scheduled Marc to get chemo that afternoon at 5pm. They also gave Marc a prescription for morphine tablets to help with the pain. When they got ready to start the chemo, Marc's blood pressure was extremely high. Because the one of the side effects of the chemo is elevated blood pressure, they would not start the chemo until his BP was down. They had to call the nurse practitioner to come up to see him and gave him medication to bring down the BP. After 2 hours his BP had gone down enough to start the chemo. He tolerated the chemotherapy well and finished up a little after 10pm. So after leaving at 6pm on Sunday for an early Monday morning dose of chemotherapy we finally got home at midnight on Tuesday morning. We were both exhausted to say the least.

After we got home we started aggressively working on resolving the problem with constipation. It has not been pleasant for Marc and he is still having episodes of severe pain. But the episodes are getting fewer and further apart and less severe. They no longer bring him to tears but he still gets very uncomfortable. He has been a trooper through it all. The morphine was not controlling the pain so the Dr. prescribed a fentanyl patch which he changes every 72 hours and he takes the morphine for breakthrough pain.

The good news is that his speech has improved a little since getting the chemo. We were told that the chemo would decrease the inflammation in his brain and the improved speech is proof that this is happening. We are also starting to reduce his steroid dosage and hope to get down to 4mg of dexamethasone a day as a maintenance dose. I've now got him down to 8mg a day now with no troublesome side effects. That is very encouraging.

We return for the second dose of chemotherapy this Monday and are hoping that this trip to MD Anderson will be uneventful. Marc is now scheduled for his consult for the insertion of the portacath on August 21. They also scheduled him to have lab drawn that day so I don't know if they will do the procedure when we are there or schedule us to go back at a later date for the insertion. I am hoping that they can get everything done while we are there.

As you can see from the pictures, Marc still has his wonderful since of humor. He loves life and loves his family and we love him dearly. It is so difficult to see him suffer and we pray every day that the suffering will stop and he will heal.

I have returned to work 2 1/2 days a week now and have hired a home caregiver to stay with Marc while I am gone. They are very expensive so Steve is staying with Marc one day a week to give me a break in the expense. He is able to work from home so he works while he is here. Marc isn't thrilled about the home caregiver but does enjoy spending the time with Steve.

I will try to post more later this week after Marc's chemo is completed. I apologize to not posting regularly and will try to do better in the future.

MRI results lead to new treatment plan

We finally got the MRI results. Overall, compared to the last MRI done at MD Anderson, the MRI shows a little improvement, the area they have been watching is slightly smaller. That said, Marc's oncologist wants Marc to start IV chemotherapy. He will receive the chemo every two weeks. Because the MRI cannot rule out new tumor growth (the only way to do that is surgery which is not an option at this point) and there are new areas of inflammation the oncologist wants to start Marc on the 'Big Gun" treatment protocol. The drug used is called Avastin. It is used for many other types of tumor but has shown some success with glioblastoma. The major side effects of the drug are bleeding and/or clotting, and the other listed side effects include but are not limited to: dry mouth, cough, voice changes, loss of appetite, diarrhea, vomiting, constipation, mouth sores, nausea and headache. I just hope that Marc is able to tolerate the medication without any significant problems.

Marc will need a portacath insertion for the chemotherapy administration, however there is a waiting list for this procedure so we don't know when he will have that done. In the meantime, the dosage will be given through a regular IV. I just hope the IV team is as good as everything else at MDA is.

The good thing with the Avastin, it decreases inflammation so we will be able to decrease the steroid dosage some. Due to the severe problems that Marc has had each time the steroids were discontinued I am going to insist that we find the lowest possible dose to keep Marc on and not discontinue them. Decreasing the steroids should help some with the insomnia. I am praying it does because neither Marc, or me for that matter, just don't function well on 1 to 3 hours of sleep a night. I am going to try to start back to work again the first part of August and need to have adequate rest to perform my job duties. My work has been so good to me but I just cannot continue to be off work. I have put my coworkers in a bind by not being able to be at work when scheduled and it is not fair to them. I have contacted a home care agency and contracted with them to have a companion come to the house to stay with Marc while I am working. The problem is that it is very expensive, so I can't afford full-time home care. Steve is going to stay one day a week with Marc as he can work at home and can do his work from our home.

Marc continues to have the diffuse abdominal pain. His primary provider wants him to have a surgical consult but doesn't think surgery is a good option. The other problem is that with the new chemotherapy, surgical procedures are contraindicated for 28 days after receiving the Avastin.

I will continue to update the bog and let you all know how Marc tolerates the new treatment. Please continue to keep Marc in your prayers.

Test results . . .

We did get about a half inch of rain after I posted the last blog. We are in need of much more but do appreciate what we got!

Marc had a restless weekend. The effects of the steroids are beginning to appear again and take their toll. He doesn't sleep much at all now, maybe an hour or two here and there. He has taken to walking around the cul-de-sac in the middle of the night, sometimes two or three times between 10 and 5. So far tonight we have been out 3 times and it's only 2:30! He is using the walker when he takes these journeys but is a little unsteady in his gait so I join him. His lower legs and feet are beginning to swell some but not yet to the extent they have in the past. The only good thing is that his appetite has improved some. He seems to be in limbo with his speech and there has been little or no improvement since his discharge from the hospital. He still gets speech therapy twice a week as well as occupational and physical therapy.

The abdominal pain has not improved but he is managing to cope, only if he takes the pain medication regularly and even then it seems to only numb the pain a bit. The CT scan results were normal with an "incidental finding of a fat containing umbilical hernia". His PCP wants him to see a surgeon. I am afraid that a surgery at this time might be too much for him but Marc told me that it needed to "get fixed". At this point he is so ready to be pain free he will do just about anything to obtain relief. It is so difficult to see him suffer. It just breaks my heart to watch him try to get through the day, but he just keeps on going. He is such a fighter. I think there is no braver person in the world.

The MRI results are still pending. I called first thing this morning but haven't heard anything yet. We are both anxious to get the results. I will post something as soon as we hear something. Marc has another appointment with the oncologist next Tuesday, I just hope we hear something before then.

Status Update

As some of you know, for the last 2 months or so Marc has been plagued with intermittent, diffuse abdominal pain. It was difficult to assess as Marc couldn't verbalize the nature of the pain but just draw a line with his hand around his waist and back when asked to pinpoint the pain. The pain became more severe the last few days and I was finally able to get him in to the Dr. when he was having the pain. Always before I would tell the Drs. about it but when evaluated he wasn't having pain so they just chucked it up to gas, constipation, diet, etc. The last time he was hospitalized he even had an X-ray of his abdomen with negative results. When he was evaluated yesterday, the Dr. found a good sized umbilical hernia and recommended a CT scan of the abdomen to rule out any other pathology. He needed labs first to evaluate his kidney function before the radiologists would do the CT scan. Because we already had an appointment for a MRI at MD Anderson the next day (today) and he would have lab drawn there prior to the MRI the Dr. thought it was acceptable to wait and use the labs from there and do the CT early next week. Anyway, that was the plan when we left the Drs. office yesterday afternoon.

Well last evening and night the pain became more severe and constant. I put in a call the the nurse practitioner at MD Anderson early this morning to see if the CT scan could be done when he was there for the MRI. It was late in the morning before she got back to me. In the meantime I called his Dr. and was told to take Marc to the ER for evaluation. I agreed and by the time I got dressed and ready to go Marc had made up his mind that he was not going to the ER because he did not want to miss the MRI. I called the Drs. office back and they were able to schedule a CT to be done at 1pm today. We jumped in the car and went directly to Conroe where the CT was scheduled as a prep must be done 2 hours before the CT.

Marc was so uncomfortable, even with pain medication and a sedative that he asked that I be allowed to stay in the room with him while the CT was done. Once he was settled on the table we did some relaxation breathing and he was able to make it through the exam. After the exam we waited for 30 minutes for them to run a CD of the procedure so that if we had to go to the ER over the weekend I would have the disc and the test would not need to be repeated. We were cutting it pretty short because our appointment at MD Anderson was scheduled for 3pm. At 2:30 the clerk told me the system rebooted and they had to start the process of transferring the images again and it would be at least an hour before the disc would be ready. I made arrangements for Julie to pick up the disc later today and we headed to the Medical Center.

Poor Marc was miserable. We stopped by the house and got him a pain pill for the trip into Houston and he settled in for the ride. Our first stop at MD Anderson is always the lab, fortunately their phleblotomists are excellent as Marc has no veins left. Then it was time to give Marc more sedative so that he could make it through the MRI. He never used to be claustrophobic, but the frequent MRIs have done him in. By the time they got his IV started he was more relaxed and the pain had decreased a little. He again requested that I go in with him for the MRI. What an experience. I had never had an MRI nor been present in the room when one was being done. The opening in the machine is just big enough to squeeze Marc in. His arms are up on his chest and they place thin rubber pads on his sides so the arms are held up and don't rub on the sides. Ear plugs are placed in his ears (I am also given a set to use). A mask is placed over his face and the table he is lying on moves into the circular opening. There is just enough room for him to breathe without his chest and abdomen rubbing on the opening. Then the MRI starts - the noise is unbelievably loud, rumbling and pounding. The table even seems to vibrate from the sound. The test lasts about 25 minutes and he is expected to lie perfectly still the entire time. I now understand why he gets so anxious.

We are home now and will not have any results until Monday or Tuesday on either test. Marc is still very uncomfortable, he tried going to bed but was not able to get comfortable. He is now in his recliner and just started snoring. I am praying that he is able to sleep through the night and that we can manage the pain over the weekend; if not we will go to the ER .

I will post an update after we get the results of the tests. In the meantime, the weatherman gave us a 60% chance of rain tomorrow and we are hoping that he is right. I never thought I would wish for a rainy weekend but it has been so dry for so long we really need the rain. We wish you all a wonderful weekend.

In Limbo again!!!

A lot has happened since the last post. I have been so wrapped up in caring for Marc and arranging appointments and therapy I just haven't gotten to posting on Marc's progress.

After the last post Marc just started going down hill. He had more right sided weakness and had more difficulty participating in physical, speech and occupational therapy at the rehab facility. He didn't want to do anything but stay in bed. He wasn't eating. He became dehydrated and was given IV fluids. He seemed to perk up a little on Saturday when his sister and youngest brother came from Kansas for a visit but later that afternoon he got back into bed. His breathing became labored and is color changed to a dusky gray. He would not respond to me at all, even to painful stimuli. I was afraid that he was dying.

He was promptly transferred back to Memorial Hermann The Woodlands by ambulance. He was again evaluated and admitted.The first 2 days there he was in bed and didn't want to eat or drink. His brother and wife from Canyon Lake came to visit, so all of Marc's sibling with the exception of his oldest brother were here visiting him. I am a little foggy about everything that happened the next couple of days. Long story short, after multiple tests his EEG was "slow overall", the neurologist thought it might be from a postictal state from the seizure he had had the day before. His MRI was read as showing new tumor growth and an order was written for a neurosurgery consult. The neurosurgeon came in wanting to schedule surgery. I told him no, that I wanted to consult with Marc's oncologist at MD Anderson before anything was done. He promptly wrote an order discharging Marc from his service stating the family prefers treatment at MD Anderson. MD Anderson had no available beds at that time so we stayed where we were.

Marc seemed to perk up and was up walking in the hall the next day. He was doing so well that I asked that he be discharged to home and told them that I would make arrangements to see Marc's oncologist. The admitting Dr. agreed and wrote orders for discharge and home health evaluation in order to continue the therapy at home. He was discharged on Tuesday.

I scheduled an appointment for Tuesday, July 7 at MD Anderson. The oncologist pulled up the last 2 MRIs and reviewed the differences. The latest MRI showed some inflammation or tumor growth around the cavity of the original tumor and a small amount of growth on the area that they had been watching. He started telling us the options, one being a repeat surgery. I asked if they would insert more glial wafers if surgery is necessary. It was as if the light bulb turned on! The oncologist said that the inflammation surrounding the original cavity very well may be caused from the effects of the wafers and not from new tumor growth. He went on to say that they do not use the wafers at MD Anderson because the swelling that they cause makes it difficult to tell if the tumor has returned. He recommended a specialized MRI using the necrosis protocol which could help tell if the area was new tumor, dead tissue or just inflammation. He also recommended that Marc see the neurosurgeon just to discuss the possibility of surgery. He also said that he would probably change Marc's chemotherapy if we opted not to have the surgery. There are 2 options for chemo, the first is the 'big gun', is IV and given every 2 weeks. He said it works 70% of the time but that if the tumor does grow back the tumor is usually much more aggressive. The other chemo is a combination of 2 different drugs taken orally and daily. These drugs were used prior to Temador being used for first line treatment.

We saw the neurosurgeon on Thursday. He started the conversation stating that he wasn't going to recommend surgery at this time but wanted us to be aware of the possible complications if surgery was necessary. The most concerning complication is that the tumor is in the area that controls motor function and surgery could possibly cause paralysis. He stated that he was in agreement that the MRI be done before we determine the method of treatment.

I got a call last evening from the oncologist's nurse who said that the MRI had to be approved by radiology and that the radiologist who read the last MRI didn't feel that there was enough change to warrant the specialized MRI. He recommended a repeat MRI in 4 weeks. So now we are waiting again as the oncologist and neurosurgeon are discussing Marc's case and trying to determine what they think the best option is.

This whole process is trying our patience and is very frustrating. I work in the system and knew that there were always many roadblocks for patients to get through but did not realize the extent of the issues that must be dealt with. I certainly don't know the answers but there must be a better way!

For now Marc is doing well at home. I am staying home with him for now but must return to work soon. I will be working in the Conroe RMCHP seeing same day family planning patients once I go back. That will put me closer to home and will alleviate the issue of having to reschedule patients if I need to be out with Marc. I don't feel comfortable with him staying home alone because he cannot call for help if needed. Marc is furious that I will not leave him alone but I see no options at this point. I am trying to work out something that will satisfy both Marc and I.

Please continue to keep Marc in your prayers and I will post again once we figure out what is happening.