Phew...

To say it's been a long bunch of weeks is truly the understatement of my life. Where to start? About 4 weeks ago, I started to feel something that I have never felt before. It had been about two weeks since my Cyberknife procedure and lung biopsy but I wasn't feeling anything out of the norm the two weeks after the procedure, so all in all, it was pretty odd. After a bad night sleep, all of sudden, I started having trouble breathing. I woke up with a kink in my back that prevented me from taking a deep breath. I thought that maybe I had just slept wrong and the kink would just go away in due time. That was not the case, and it got progressively worse. I couldn't walk up our stairs without buckling over. I knew something wasn't right, but I still thought that it would just go away. Long story short, it didn't. So on Saturday, October 29th we checked into the ER at Swedish Hospital in Seattle. After a series of tests that ruled out the most serious things, it was determined that my lungs were filled with fluid, and what I had experienced was a pleural effusion. Before completely understanding what caused the effusion, we had to get the fluid out of the lungs so that I could breathe more comfortably. Fortunately, it wasn't "mission critical" to get the fluid out immediately, and so we decided we could wait until Monday to have a specialist remove the fluid. So on Halloween morning, I had 1.5 litres of fluid removed from my lungs by a great Interventional Radiologist, Dr. Fergusson. The procedure itself was very trippy. After numbing my back with Novocain, Dr. Fergusson stuck a needle through my back and into my lung and started sucking out the fluid. I started to gurgle and heave, and then voila........we were done. Almost immediately, I could feel some relief. I had some pain at the needle sight, but I felt my lung re-expanding and my breathing capacity enhanced.

OK, so immediate crisis averted. Now where do we go from here? What is a pleural effusion? What caused this? How serious is this? What do we do about it? So many questions. First mistake we made. Reading the internet stuff. I knew this was a bad idea, I have often counseled against this, but here I was, reading all of the worst case scenarios, etc, etc. I really didn't have a choice, I really didn't know what was going on, and most importantly didn't know what it all meant. The week of October 31 was "bunker down" week and Jen and I sprung into action. After a day or so of feeling sorry for ourselves and fearing the worst, we decided to do what we do best..........dive in, kick butt, and take names. Team Dougherty, led by my unbelievable, amazing, remarkable wife Jennie got on the horn. By Wednesday, we had connected with our UCSF Thoracic team, Dr. Dormady, and had an appointment with the best Thoracic Surgeon in the state of Washington. We also lined up a call with Doc Renneker. Doc was great as usual in helping us understand what was going on, and was able to put it all in context for us. After our conversation we were re-assured that this wasn't a game changer necessarily, and could be categorized as just a bump in the road on our journey to survival. We needed a lot more information before we could really determine things. After a good cry, and squeeze of my girls, I felt my first sense of relief since the ordeal began. The most crucial things we needed to know were, number 1 was the fluid that was pulled from my lungs malignant (full of cancer cells) and how quickly (if at all) was the fluid going to come back into my lungs? Well, today we got a better understanding of those questions.

We met with Dr. Eric Vallieres at Swedish Hospital. He came highly, highly, highly (is that enough highly's?) recommended by both Dr. Mann and Dr. Jablons at UCSF. Not only was he respected for his work, but both Dr's called him a close friend as well. I immediately loved him. He cut the tension in the room right away with his confidence, sense of calm, and total command of the situation. After a series of questions trying to establish my history a little bit to determine what might have caused this, he very quickly let slip out that the fluid in my lungs came back without any cancer cells. He did caution that we would need to test additional fluid to be certain, but the initial negative was indeed a good thing. Nice way to start a meeting. We talked about what might be causing this. He feels that is most likely one of the tumors pushing against the lining of the lung and essentially creating a leak for the fluid to enter. This is certainly not abnormal. As the disease progresses, and the tumors get more frequent and larger, eventually they get in the way and cause effusions. So in a way, our main goal and objective has not changed, we need to get rid of these tumors. Dr. Vallieres also talked about things he can do surgically to prevent effusions from recurring. There are really two types of things he can do. One would be to essentially put in a drain that I could tap myself as fluid started to build up, and the other would be to put a more permanent fix in place by sealing the walls of the lungs with talcum powder in a procedure called a pluerodesis. As we listened intently to which one he would recommend, he gave his reasoning for each. He explained that he only does a pluerodesis on someone that is "going to be around for awhile", and that I was clearly in that camp. I can't tell you how great and relieved that made me feel. I didn't push him for his definition of "around for awhile", but I'll take it nonetheless. We then talked about how quickly the fluid might or might not come back. He took a listen, and didn't think he could hear any buildup, but we needed to do an ultrasound to be sure. He summoned his colleague, Dr. Gordon, to do the exam. Within two seconds Dr. Gordon said "absolutely no fluid in here". This is a very good thing. It doesn't mean it's not coming back, it just means it's not coming back rapidly. I am scheduled to see Dr. Gordon again on Monday to test the fluid level, but if I don't feel the shortness of breath, I don't even need to go in. Finally we talked about the importance of my lung re-inflating after we drained the fluid, which it did, again very important. By no means are we out of the woods, but we definitely are back in control after feeling totally helpless and confused for 3 weeks. The fluid can and most likely will come back, and more than likely we will do a pluerodesis which is a lung surgery and a 3 day hospital stay, yada, yada, yada. Just a blip on the road of life. No biggie. So now what?

Next Wednesday I have an appointment with Dr. Dormady in Mountain View. We got the results back from the tumor testing we did, and the good news is that it looks like there are many types of drugs that might work on me based on molecular profiling. So Dr. Dormady and I are going to become mixocologists with chemo and try and cook up the right combination. We will continue to monitor the effusion and possible fluid accumulation, and determine if and when to do the pluerodesis. But for now, life goes on. I can barely describe how much better I feel than I did before the tap. I am able to go for my walks again without curling over, and each day it seems to get a little better. Jennie's mom came out to help last week, and is going to stay through Thanksgiving, which is wonderful. We are getting very excited for Thanksgiving around these parts, as the whole Dougherty/Bartlett clan is making the trek North to be with us. We are going to have a full house!! And Charlotte has already figured out the sleeping arrangements (not sure everyone is going to agree). We can't wait, we have always hosted a big Thanksgiving, and to be able to do it again this year is truly a blessing.

And finally, I need to tell you about my partner and love of my life once again. I know I sound like a broken record when I describe what an amazing person she is, but she continues to reach unprecedented levels of amazingness with each hurdle we face. I know it's hard to put yourself in someone else's shoes, but imagine what this has been like for her? This truly hit us out of the blue, and we had no idea this was coming. We had just spent 4 wonderful days with the Beckmans from Concord and then all of sudden I can't breathe. Jennie immediately put the wheels in motion. We had our UCSF Thoracic team on the case within 24 hours. She tracked down Dr. Mann who was in China on personal business, and he immediately hooked us up with Dr. Valleries (I couldn't fly in my condition, so I had to have someone local). Oh and by the way, we have a 4 year old that needs constant attention and mothering, and she runs the apparel business at Amazon. The day I was tapped was Halloween (a very important holiday for a 4 year old), we didn't miss a beat. Charlotte's two best buddies from school came over for some trick or treating and had the time of their lives. Later in the week, Jen presented her entire rollout and marketing plan to the Number two guy at Amazon. He of course absolutely loved it, and allocated all of the resources she asked for. To see the relief on her face and feel it in her hands yesterday was magic. I'm not here without her, plain and simple. Thank you god for Jennie.

So that's about it for now. I will update things more frequently if necessary. But for now, remember to savor every day with your family and friends. Hug your kids, spouses, significant others, parents, etc. Tell them you love them. Don't put off something today for tomorrow. Life is too short. Take it one day at a time, and make it last a loooooong time. What's the hurry?

xoxo,
The Dougherty's