Saturday, July 30, 2011

The Writing on the Wall

One of the things I am asked most often about my dad’s illness is if he had any symptoms prior to the day of his fateful run.

As I’ve written in previous entries and as anyone who knew him was aware, Dad was a long-time competitive athlete who thrived on pushing himself to the limit (and sometimes beyond).  He had a very high threshold for pain, which sometimes did not serve him well as he did not always know when to call it quits.  

Dad, getting medical attention after running his fastest-ever time in a marathon
One thing about him I haven’t mentioned, though, and something about himself that he readily admitted was that he was fairly uncoordinated, a fact that was especially surprising considering he was such a talented athlete.  Maybe it was because of this clumsiness or because he was often in a hurry to get somewhere (he hated to be late!), or maybe it was because the amount of time he spent on the road on his bike or running upped his odds statistically of having accidents and mishaps, but either way it wasn’t that unusual for him to have a scraped-up knee or a bloody elbow from a spill that he had taken. 

Dad did have a wreck on his bicycle about a week before he was diagnosed that resulted in some pretty impressive Road Rash on his left knee, shoulder, and arm.  He had taken a spill with the bike tipping to the left side, which frustrated him so much that he had taken his bicycle to the shop the next day to get them to check it to see if it was out of balance.  As we found out a short while later, it was actually Dad who was out of balance; he had left-sided weakness due to the tumor in his brain.  However, at the time, he chalked up the wreck to something being wrong with his bike or to the usual stuff with him, not paying attention to what he was doing, being in a rush, being a bit of a klutz, and/or heat and fatigue due to a very intense training regiment.

Dad, taking an ice-pack break during an ultra-marathon (Note the supplies on the table.)
 Dad had entered three shorter distance triathlons last summer as part of his preparation for the Ironman Triathlon for which he was registered in November, and in all three he did not feel well at the finish, which a doctor who checked him out in between races attributed to heat exhaustion and dehydration.
He finished the last tune-up race in mid-August by staggering over the last mile of the run portion and then falling across the finish line, at which point Mom took him over to the first aid tent where he got some fluids and a stern lecture from the medics there about the dangers of dehydration.  They told him he absolutely had to drink at least 10 cups of water daily in the days leading up to a big race when the temperature and humidity were as high as they had been.  Apparently, after drinking some Gatorade in the tent, Dad perked up enough to jokingly ask one of the medics if beer counts as a fluid, which they did not find funny.  And, as was typical for him, despite the finish line drama, he won his age division in this race, too, which he felt was a good indicator that he was right on target in his training program to get ready for the Ironman.

Dad, after again pushing himself to the limit
 Even though Dad was bald-headed for decades, in personality he oftentimes functioned like a Dizzy Blond.  He had been known to pull up in a parking lot or driveway, put the car in park, get out, and come into the house or his office, all without noticing that he hadn’t turned off the engine of the car!  So, if he was doing things like entering the house without closing the front door behind him or losing his wallet, it wasn’t really something we noticed as a Red Flag because of his past actions.

In late August, my dad went to visit his mother, who was ill and living in a nursing home near my parents’ house.  Not long after he got back home, the telephone rang, and it was one of the nurses at the nursing home letting him know that he had left one of his shoes there.  Evidently, he walked out of it in the hallway of the nursing home and, without noticing, walked to his car in the parking lot and drove home.  Again, we chalked it up to Dad just being Dad, not paying attention and being in a hurry to get somewhere.

A few weeks later, Dad drove my mom and one of my sisters to a restaurant near my parents’ house.  It was pouring down rain, and so, after Dad parked the car in the parking lot, they ran from the car to the door of the restaurant.  Once they got inside, Mom noticed that Dad didn’t have a shoe on his left foot.  She pointed it out to him, and he ran back to the car and found his shoe there.  Again, something that might have been alarming for someone else, but not that out of character for Dad. 

According to the resources we were given on brain tumors, the first symptoms are usually things like headaches, blurred vision, memory loss, behavioral changes, or seizures, all of which can be attributed to increased pressure within the brain.  Other symptoms (depending on the location and size of the tumor) can be nausea, drowsiness, weakness or impairment in sensation on one side of the body, or language impairment.

Even with the 20/20 hindsight that we had once the diagnosis was made, of these, the only symptom that Dad had before the day his tumor was diagnosed was impaired sensation on the left side of his body.

Out on his run that day, he got disoriented and had trouble finding the words he needed to respond to questions he was being asked by people around him.  He was taken by ambulance to a local hospital, where a CT scan revealed a “large mass in his brain.”  He was then transferred by ambulance to a large teaching medical center with a Neuro-ICU, and, en route, he had his first seizure.  The paramedics stabilized him and got him to the second hospital, where the medical staff quickly took him to get an MRI; however, during the test he suffered a second seizure, stopped breathing, and had to be resuscitated and put on a ventilator to help him breathe.

Even once the diagnosis had been made and we had read all about the Warning Signs, we still weren’t able to see The Writing on the Wall; even looking back with 20/20 hindsight, we still couldn’t identify what went wrong and when it had begun. 

No headaches, vision changes, etc.  He was still functioning at his 100%, which was equivalent to most other people's 150%.  We later found a To-Do List in his home office and noticed a slight difference in the legibility of his handwriting, which might have been related to the tumor since he was left-handed.  His typical writing style was of the Chicken Scratch variety, though, and so, as much as the falls and forgetting of the shoe were hard to definitively identify as a symptom, it was even harder to connect those dots, even given what we knew.  Literally, there really was no discernible Writing on the Wall.

We were told by several of Dad’s doctors that the type of brain cancer he had is extremely fast-growing; in fact, this type of tumor usually doubles in size about every three weeks.  The doctors said that the tumor very likely started to grow just a few months before the diagnosis.

And, while it seems like it would be somewhat comforting for us to know that there was no chance for prophecy, there wasn’t something there that we missed, and there was essentially no opportunity for early detection, it really isn’t comforting, because nothing is.  The only thing I see written on the wall is that it sucks and it isn’t right or fair, and I want my dad back!

1 comment:

  1. Steph, my uncle also died with a brain tumor. He had no s/s until the day he too became disoriented and unable to express himself. However, my mother's presented more like a stroke. She commented for days prior that she had headaches and weakness on the left side. I was seeig her every week and still didn't put the two together. like you said, "Hindsight is 20/20." I guess we are too close to the situation to see it, but the signs were there. Thank you for writing this. It has really helped me to stop and think about both my uncle and mother's situations in a different light. You know, if you hadn't been and OT, you'd have made a pretty good writer! LOL! Love ya! Missy