Monday, September 5, 2016

Angela's Angels

Thank you Angela's Angels for fighting with us to beat cancer!

Miracle Performed by the Lord---Cancer in Remission!!!

July 1, 2016
Today I witnessed a miracle brought to our family by Angela's Angels. Just a short thirty-two days ago I cried as I watched Angela Bursler being wheeled into the ICU and today she is cancer free. We are humbled by the kindness of our families, friends, medical professionals and folks that just plain old care about their fellow human being. Thank you to all for without you her battle may not have been won. Just for the record the score is now Angela Bursler 2 Cancer 0. We do not want a third fight but the second bout taught us that the strength of many can beat this terrible disease. As has been said many times God is good.

Spring/Summer Hospital Stay Day 21 Comment #2

June 6, 2016

Welcome home mom!!!

Spring/Summer Hospital Stay Day 21

June 6, 2016

Checkin' in but getting ready to check out. Discharge has been authorized. She can now go home after being hospitalized for twenty-one days.

Spring/Summer Hospital Stay Day 20

June 5, 2016

The effect of twenty straight days supporting my wife in the hospital hit me hard today. As I have the last three weeks I awoke this morning with knowledge of where I was going and what I was going to do. There are no decisions or choices for my wife has no choice but to be hospitalized so I have no choice but to be by her side. Bottom line, without sounding too much like a whiner, I'm exhausted.
Apologies out of the way the more important story is that Angela Burslers condition is stabilized to the point where there are rumblings of discharge as early as tomorrow. I'm cautiously optimistic but there are still a few wrinkles that need to be ironed out before it happens. A real quick recap of her condition is as follows:
White blood cell count normal
Neutrophils (specific type of WBC) normal
Blood pressure stable at 130/80+
No headaches
Appetite is semi-restored. She consumed enough food to account for a moderate amount of calories today.
*Hemoglobin (red blood cell count) <7 but given a unit of blood today.
*Still experiencing random fevers--still trying to zero in on source.
*Fluid on the lungs slowly being absorbed by the body.
* Breathing unassisted while in a stationary position. Assisted with a continual flow rate of 2 liters of O2 through the nasal cannula while moving or sleeping.
* Denotes conditions that need resolution before discharge will be approved.
We have high hopes for tomorrow.
A couple of quick shout outs to some folks who actively participated in events today in support of cancer research. Nancy Boman I can't thank you enough for marking the name of my wife on your arm in support of her battle as you successfully battled your way through your first half-marathon.
Michael M. Wascheck congratulations on hitting your $ goal for the Relay for Life in Pennsville, NJ in support of cancer research.
Collectively we will conquer this disease. My wife and I have plans ten years from now that will not be interrupted.

Spring/Summer Hospital Stay Day 19 Kyle Graduates

June 4, 2016

Spring/Summer Hospital Stay Day 19

June 4, 2016

Angela is fine and resting well tonight. It was an emotional day that culiminated in a decision not to attend her son's (my stepson) graduation. There is/was a solid medical basis supporting the decision that was made.
1. Pleural effusions still exist in the chest wall cavity parallel to both lungs that prohibits proper oxygen intake.
2. She is still experiencing unexplained random fevers that result in bouts of fatigue.
3. Mobility is significantly limited.
4. Appetite is suppressed.
Medical basis aside Angela, herself, clearly communicated to the doctor's that she did not feel comfortable leaving the hospital.
The decision to remain in the hospital was not a mandate delivered by the medical team but instead it was made by both Angela and I using the criteria stated above.
This weekend's objective has changed from attending a graduation to working hard to increase her lung capacity and strengthening her muscles. Doctors are hopeful that by increasing activity the excess fluid in the lungs will be absorbed by tissue. Two other methods that were considered to remove the fluid were the use of Lasix and aspiration. Tests indicate significant dehydration in the all other organs except the lungs so the use of Lasix was suspended. Aspiration is invasive and as such could result in infection. Also there is evidence that fluid could quickly return resulting in a higher degree of respiratory problems. The procedure is still a consideration but only as a last resort.
Essentially the ball is completely in our court. If we take a disciplined approach and work hard doctors said she could be released as early as the beginning of next week. Angela is a determined, hardworking individual so I have no doubt that she will give it her all.

Spring/Summer Hospital Stay Day 18 Comment #2

June 3, 2016

After some discussion with the Pulmonary specialist and Angela Burslers primary doctor it was finally confirmed that it would not be safe for her to attend the graduation tomorrow. The basis for the decision was Oxygen deprivation upon movement (hypoxia) and lack of nutrition.
Things are still progressing in the right direction but just not fast enough for her to go tomorrow. The decision is final so there will be no last minute changes.

Spring/Summer Hospital Stay Day 18

June 3, 2016

The word of the day was compromise and the question was do we or don't we. The medical team appears to be hesitant to authorize the release ofAngela Bursler without her consent and Angela is hesitant to agree until she can move freely about without pain.
If I would have told Angela on May 17th, the day she was admitted into the hospital, that she could potentially miss her son's graduation she would have been crushed. Given the circumstances her choice may be to risk her health and attend or remain hospitalized, not attend and realize a complete recovery.
Objectives, targets and goals are good but if progression toward accomplishment is off pace than they could and should be changed. If a runner has a goal to break three hours in a marathon but stumbles late in the race does he or she quit or modify the goal? In end the accomplishment of finishing the race may be not be as satsifying as breaking three hours but it is an accomplishment none the less. The quitter quits and accomplishes nothing. In the case of Angela an objective was set to attend her son's graduation however her recovery has fell off pace so what does she do? Give up, quit, die , fall off the face of the Earth? No, she sacrifices the graduation to realize a full recovery to be better prepared for the next battle which is sure to come.
Cancer is war which consists of many battles of which this is only one. She needs to win this one in order to have an opportunity for the next. Ultimately, when she wins the war, she will be around for college graduations, marriages, grandchildren and every other important event in the lives of her sons. Yes missing one graduation may leave a bad taste in her mouth but when the war is over and she is the victor this one sacrifice may well be what swayed the pendulum in her favor.
Compromise is not a sign of weakness but instead it is a sign that a person is aware, thinking and making wise choices. Risk, on the other hand, if pursued, is a sign of a person who reactively makes decisions without giving thought to the consequences. We will compromise if need be but risk is not a part of our vocabulary. The answer to the opening question is yes we will compromise if recovery is slower than expected because there are bigger fish to be fried than one graduation.
Angela Bursler is a warrior with the heart of a lion who may miss one graduation but she will conquer cancer.
More to come--it isn't over 'til it's over. I still wouldn't be surprised if she found her way to the graduation.

Spring/Summer Hospital Stay Day 17 Comment #2

June 2, 2016

Transfer out of ICU and into the general care unit is complete. Objective #1 has been satisfied.

Spring/Summer Hospital Stay Day 17

June 2, 2016

achieved two major milestones today. First, with the assistance of two very nice physical therapists, she rose up out of bed and went for a brief walk. When asked how she felt afterwards she commented that she experienced moderate pain outward bound but only minor pains on the way back. She was instructed to continue this exercise at least two times a day for the next couple of days.
The second major milestone achieved today occurred this evening when she was able to urinate on her own without the use of a catheter. This may not seem like an important achievement but when urine has been mechanically removed from the body for multiple days it's important to demonstrate the bladder muscles can function on their own without assistance.
Her condition, in general, continues to improve.
1. Rate of respiration is normal with the use of supplemental Oxygen. She has been instructed to take deep breaths into a mechanical device called a spirometer to help strengthen her lungs. Concurrently with this action doctors are slowly reducing the amount of Oxygen being used to supplement her breathing. So far she has responded well to the reduced Oxygen flow.
2. Blood pressure is consistently within her normal range of 135/82
3. Pulse is a bit high ranging in the low to mid 90's but that can be expected from a person who has been in the hospital for an extended period of time.
4. Temperature continues to fluctuate in and out of normal range. (98.6 to 101). Tylenol is being administered routinely to manage this problem. Fevers are most likely a symptom of pneumonia.
5. Headaches have subsided completely.
6. Bouts of nausea are few and far between but when experienced they are quickly treated by administering Zofran.
7. Creatinine value was reported to be 1.5 down from the 2 that was reported yesterday. This improvement is reflective of the kidneys in repair.
8. She has expressed a number of times her urge to eat however she has been slow to act on that urge. In her defense the food served in the hospital is not the right consistency or amount for a person who has not had food in three days. Today's nutrition included a half of a fruit cup and maybe a few bites of yogurt that I bought for her at a local convenience store. In comparison the hospital served a heavy portion of pasta which was generally not appealing to a body that has not digested food in three days.
9. The most recent X-ray of the lungs shows that the antibiotic, Levaquin, is successfully treating the pneumonia.
The targets are:
1. Transition from ICU to the general care unit tomorrow.
2. Complete discharge from the hospital on Saturday just prior our son's graduation.
Hitting these targets is completely dependent on how willing Angela is to work hard. If she takes a disciplined approach to her breathing and walking exercises the door will be wide open if not it will be slammed shut. Having observed how hard Angela has worked to get to this point I have no doubt that her butt will be planted in one of those seats in the Carpenter Center on Saturday.

Spring/Summer Hospital Stay Day 16

June 1, 2016

 vital signs continued to improve today however the progress that has been made has not yet positively impacted how she feels. She is still battling shortness of breath, intermittent fevers and nausea all conditions which have left her exhausted.
The medical staff is still investigating several theories that could potentially be the source of her symptoms. It was revealed to us to day that the new number one contender appears to be a viral pneumonia. Her latest X-ray revealed cloudiness along the top quadrant of the right lung which is indicative of pneumonia. While there are several other possibilities that could explain the shadow the most likely cause is pneumonia. As a result of this finding the team prescribed the antbiotic Levequin and stopped all other antibiotics from being introduced into her system.
A further examination of the lungs revealed that the fluid on her lungs is slowly being eliminated. The course of action going forward will continue to be the use of Lasix to assist with the elimination of the excess fluid.
There was no recognizable difference in kidney function over the last twenty-four hours. Her creatinine value of two and reported protein leakage is indicative of damaged kidneys however doctors believe that this issue could correct itself as functionality of the lungs is restored. This is a serious concern and will continue to be monitored by the Nephrology team.
Her white blood cell count continues to rise with a value of 7.2 reported today up from the 6.2 that was reported yesterday. The increase was realized with no transfusion so the bone marrow is clearly productive. More importantly the neutrophils are now within range changing her status from neutropenic to normal. She is no longer anymore susceptible to disease than the average person.
The best news of the day came around lunch time this afternoon when she was told by her primary doctor that he expects her symptoms to subside in time for her to attend her son (my stepson) high school graduation on Saturday. Immediately following receipt of that news her pulse dropped from the high 90's to the low 80's and her respiration rate dropped to 20 from what was the low 30's. Earlier in the week her pulse was upwards of 110 and her respiration rate fluctuated between 35 to 45.
The final piece of good news delivered by her primary doctor was that her body is ready for solid food.
I find myself tearing up anytime good news is delivered these days and this afternoon was no exception. I'm not the most affectionate guy on the face of the Earth but I had the urge to give the doctor a great big hug.
She has made some giant strides but still has many challenges ahead of her. Her hemoglobin is low (<7) which in combination with excessive fluid build up on her lungs has her in an exhaustive state. She barely has the energy to prop her head up on her pillows. She has been non-responsive to text messages, emails, and phone calls and will remain so until her treatment takes effect.
It was an up and down day because all signs are pointing in the right direction but she still feels very bad. This woman can internalize pain like no one I've ever seen do before. I'm sad when I watch her suffer but I'm amazed at the method she uses to cope.
I'm going to give this day a thumbs up and the round to Angela Bursler, The road to winning this war will be long but cancer just may have picked on the wrong person.

Spring/Summer Hospital Stay Day 15 Comment #3

May 31, 2016

Angela's first meal in three days This should make her feel better.

Spring/Summer Hospital Stay Day 15 Comment #2

May 31, 2016

The doctors report this morning was a bit frustrating. Lots of theories but still no clear understanding as to why the fluid continues to accumulate on her lungs.
The two theories, in particular, that are being discussed are 1. It is a symptom of cancer and 2. The proactive approach of introducing significant amounts of antibiotics to prevent infection may have saturated her organs and tissue. The latter theory is the more likely scenario leading doctors to consider stopping the administration of antibiotics. The risk is obviously infection however multiple blood cultures over the last thirteen days have yielded no positive result. In this case the benefit of eliminating excess fluid from her body outweighs the risk.
The plan of attack has yet to be confirmed but the most likely scenario is that all intravenous fluids will be stopped and tubes will be inserted into the chest wall cavity some time today. The tubes will not only drain the existing fluid but they will also drain additional fluid as it accumulates.
Stopping the administration of antibiotics in combination with the removal of excess fluids should also improve kidney function. The kidneys, though secondary to the lung problem, are still a concern. Creatinine levels increased overnight from 1.9 to 2.0. The change is considered insignificant at the moment but doctors are consistently monitoring.
The lack of nutrition is a concern that I expressed. She has not been given solid food nor has she had nutritional intravenous fluids in three days. At 99 lbs. my concern is that she is being starved. The doctors reassured me that this is a non-issue.
Appearance wise her facial expressions and body movements are indicative of a person in significant pain. When not sleeping she is lucid however our interactions are painfully difficult.
While I have 100% confidence in her level of care I demanded that the staff begin to lay out a firm plan with associated timing so we understand when we can start recognizing visible results. My wife is as tough as nails but the suffering has to stop. #heartofalion

Spring/Summer Hospital Stay Day 15

May 31, 2016

Angela Bursler remains in stable condition tonight. Respiratory rate, blood pressure and pulse continue to improve. She is still, however battling fevers and nausea. Both could be related to the excess fluid on her lungs but doctors have yet to confirm this theory.
The treatment plan includes limiting fluid and food intake to better control fluid build up and nausea. It's heartbreaking when the only thing in the world that the woman I love requests is a glass of iced tea and I can not provide.
I'm hopeful that she has experienced the last of her setbacks and that tomorrow is the day when our prayers are answered.
The battle has reached the next round with the score cards even. Angela Bursler will eventually throw the knockout blow but she is patiently waiting for the right opportunity. That's where we're at, we are patiently waiting for her body to recover. #heartofalion

Sp;ring/Summer Hospital Stay Day 14 Comment #2

May 30, 2016

Angela's sleeping pattern is very disruptive but she is at least resting.
The doctors reported that her respiratory rate has significantly improved and that her creatinine value has dropped from 2.1 to 1.9. These are indicators that fluid removal through the use of Lasix is improving lung capacity and kidney function. If recognizable positive changes continue she will be discharged from ICU and readmitted to the general care unit by tomorrow.
Once breathing rate and kidney function are restored focus can return to white blood cell count . Today it was reported that her WBC is now 6.3 up from the 5.2 that was reported yesterday. This continued progress shows that the bone marrow is actively repairing itself.
This mornings report brought tears to my eyes. #heartofalion is up from the mat and now taking command of this battle.

Spring/Summer Hospital Stay Day 14

May 30, 2016

Angela is still in ICU but her condition improved significantly throughout the day.
Her overall white blood cell count is now at 5.2 which is considered to be within normal range. This is indicative of the body repairing itself.
Respiration is still off (3 breaths for every one breath a healthy person would take) but that is to be expected in a a case of fluid on the lungs.
The primary plan to treat the pleural effusion is to administer Lasix, prohibit fluid intake while measuring urine production and monitor her breathing. Elimination of excess fluid through the use of Lasix should increase lung capacity allowing her to breathe easily.
In the case the primary plan is unsuccessful drainage tubes will be inserted in either side of the chest to allow fluid to drain freely. Fluid accumulation in itself is a symptom of a bigger problem which has yet to be identified. Infection is still high on the list of culprits but pneumonia, kidney damage and general inflammation of the lung are also being considered.
Secondary to her lung problem is what has been identified as signs of kidney damage. Blood tests show high creatine levels and urine tests show protein leakage. These conditions in themselves could be contributing to fluid build up around the lungs. There is no sense of urgency to treat the kidney damage because it could correct itself once the lungs are clear of fluid.
She is still experiencing fevers and her blood pressure is border line high but the headaches have subsided.
She continues to battle tooth and nail against this terrible disease. The scorecards show that she won today's round of this never ending battle.
Thank you so much for the words of encouragement, thoughts and prayers.

Spring/Summer Hospital Stay Day 13 Comment #2

May 29, 2016

Her condition this morning is stable however it is not without assistance.

The doctors are still struggling to identify the source of the problem but are working diligently. It is most likely related to some type of infection but as of this moment that has not been confirmed.

The doctors are in conference as I write this note so I expect the plan for the day to be communicated soon.

Spring/Summer Hospital Stay Day 13

May 29, 2016

And the battle continues. Angela was rushed to ICU tonight due to decreased breathing (<75%) and a temperature of 103. I experienced the first moment of weakness when I broke down in tears as they transported my very disoriented wife to the intensive care unit.
The response by the folks at Penn was amazing. Over a dozen physicians and nurses were mobilized to her bedside within five minutes of the emergency call made by the attending nurse. Her condition was stabilized within two hours of being transported to ICU. One of her first comments to me was that she was scared words which were quickly retracted most likely to protect me. Unfortunately my wife has spent most of her life sacrificing her feelings to protect others. In this post I'm issuing a challenge to everyone in her life to begin thinking about how she feels and consider being that shoulder to lean on in HER times of need.
This is a classic battle between a tough woman and a tough disease. The disease knocked her down with a good punch tonight but she got up before the count of ten. Winning and losing the little battles doesn't count as much as winning the war and when this is over Angela Bursler will be the Victor.#heartofalion

Spring/Summer Hospital Stay Day 12 Comment #2

May 28, 2016

Excess fluid has been removed from the space in between the lung and the chest wall. The volume of fluid removed was a shocking 1.5 liters from one side of the chest only. The medical team will return tomorrow to perform the same pocedure on the other side of her chest.
The effect of the procedure left her with a bit of a cough but overall her ability to breathe has improved dramatically. Removal of the fluid also took stress off of her heart which was reflective in her blood pressure (129/79) a measurement that has consistently been @ 150/90.
She may not have only turned the corner but she just may be on the straight away leading to the finish line.

Spring/Summer Hospital Stay Day 12

May 28, 2016

As a result of yesterday's tranfusion the platelet count is now at 55 which is well above a safe level. Doctors are now working to secure staffing to perform the procedure to remove water from her lungs. In spite of the holiday weekend the lead doctor and his assistant are here working and assured us that they have ways of getting the right folks here today to get the job done.

Spring/Summer Hospital Stay Day 11 Comment #3

May 27, 2016

A unit of matched platelets was transfused this afernoon/evening with some side effects but nothing considered to be serious. Toward the end of the transfusion her temperature and blood pressure spiked but both were immediately controlled by medication.
Angela Bursler overall white blood cell count is still below what is considered to be normal but the neutrophils (specific type of white blood cell that is essential to the immune system) are now up to 1250 which is considered to be a safe state. This measurement was taken before this afternoon's transfusion which makes it an indicator that the bone marrow is repairing itself.
A dose of oxycodone this morning relieved her of her headaches and allowed her to rest. Blood pressure and fever subsided at the same time so there appears to be an obvious correlation between the three symptoms and just plain old rest. The kidney doctor okay'd the use of Lasix which is now being administered. She will feel even better once some of that excess water is removed. (Photo of her elbow is attached)
There were a lot of good signs today leaving us cautiously optimistic that she's turned the corner.
Prayers, thoughts and comments are very motivating. Both Angela and I thank each and every person who is in her corner pulling hard for her to beat this disease. If there is anyone in this world who can win this war it would be Angela. #heartofalion

Spring/Summer Hospital Stay Day 11 Comment #2

May 27, 2016

Here we go platele
ts let's do your thing!!!

Spring/Summer Hospital Stay Day 11

May 27, 2016

High fevers, nausea & vomiting prevented the platelets from being infused last night. Though still very sluggish her condition has improved this morning so the team plans to move forward with the infusion some time today.

Spring/Summer Hospital Stay Day 10 Comment #4

May 26, 2016

In spite of the announced arrival of the matched platelets Angela Burslerexperienced a very tough day today. The quick and short of it is that the three big symptoms fever, headaches and elevated blood pressure returned with a vengeance. Most of the day she was non-responsive and in obvious pain. Doctors were in and out of her room often but none could provide a quick fix to her problems. In fact, at one point, she reached her max dosage of Tylenol so headaches were treated by icing her head and main arteries. Poor woman suffered mightily but never gave in.
Contributing to her pain is the ever deteriorating lung capacity caused by fluid in the lungs resulting in shortness of breath. Mid-day today she was told that if the volume of Oxygen used to assist with her breathing had to be increased consideration would be given to putting her in ICU. She struggled, especially when getting up to urinate, but the Oxygen was never increased and she remained in the general care unit.
She was visited today by the infectious disease and neurologist teams neither of which had solutions to her problems. Tomorrow we expect a visit from the Nephrology team to report on the condition of her kidneys. In preparation for that visit an ultrasound of the kidneys and bladder was done today. Antibiotics and other medicines have reduced kidney functionality below normal so this team has been called to do an exam.
Lots of suffering today but we are hopeful that the infusion tonight of the matched platelets will spark a dramatic improvement. If the platelets have the desired effect than fluid can be removed from her lungs allowing her to breathe freely.
The symptoms are beating her down but she has the heart of a lion and is holding her own.

Spring/Summer Hospital Stay Day 10 Comment #3

May 26, 2016

Matching platelets have been found and will be infused tonight!!! The news brought a magnificent ray of sunshine in to an otherwise cloudy, tough day.
Love you Angela Bursler

Spring/Summer Hospital Stay Day 10 Comment #2

May 26, 2016

Walked in on Angela Bursler in the middle of an emotional breakdown. The doctor just told her that there is a possibility that she may be released for Kyle's graduation only to have to return immediately thereafter. Her only thought is of her in a wheelchair connected to Oxygen which is certainly not the look she wants for either herself or her son. We need to stay focused on best case scenario which is that the HLA matched platelets are found and infused by tomorrow allowing for the water from her lungs to be removed the following day. If it plays out that way than she could possibly be discharged this weekend. A more realistic release date falls somewhere in between best and worst case. The good news is that the platelet count held steady at eight (target is eleven) over the last twenty-four hours which is an indication that the bone marrow is restoring itself.

Spring/Summer Hospital Stay Day #10

May 26, 2016

A day that started out in dramatic fashion turned out to be pretty uneventful. The drama started when the resident physician preliminarily reported that the CAT scan of Angela Bursler head showed what appeared to be a spot on her brain. Unfortunately this information was conveyed to Angela before I arrived at the hospital so she was forced to digest it on her own. Unshaken by the news she went about her way until I arrived. When she told me of the report my jaw dropped to the floor but we both did our best to stay composed. We discussed it a bit but eventually let it go by the wayside. It wasn't long after I arrived that we were told by the doctor that a final analysis of the scan by the radiologist and attending physician indicated that the scan was negative and there were no spots. Big sigh of relief!
After this bit of excitement the rest of the day was calm and as I said before somewhat uneventful.
The majority of her symptoms that prompted her visit to the ER last Tuesday have been successfully treated. i.e. fevers have subsided, blood pressure is controlled and headaches are few and far between. She is, however, still experiencing shortness of breath and bloating caused by the introduction of IV fluids. unfortunately hydrating her body is a necessary evil to keep her kidneys healthy. In spite of her level of discomfort (weight gain 20 lbs) doctors will not approve the use of a diuretic as it could negatively impact kidney functionality. Angela is expected to manage through these issues until her platelet count is restored at which time the use of Lasix will be approved and a pleural aspiration will be performed to remove water from her lungs.
The source of the majority of her symptoms (low platelet count) has not yet been treated however a plan is in place. Testing of the blood confirmed that her system has developed anti-bodies preventing the use of random platelets to spark bone marrow activity. The treatment moving forward is to specifically identify Angela's platelet type and with the assistance of the Red Cross attempt to find a match in blood banks across the Country. This process could take upwards of a couple of days to complete.
While we are playing the waiting game doctors will continue to do complete blood count tests and monitor her vitals. In fact, today, testing showed that her red blood cell count was less than seven prompting doctors to infuse another unit of red blood. The negative reaction she experienced with the infusion of the platelets has left her fearful of any type of infusion including red blood which has never caused a problem. After a long discussion it was agreed that she would accept the infusion if loaded up first with Benedryl, Zofran,Ativan and Tylenol first. The plan was executed to perfection and the infusion was completed with no ill effects.
A path out of the hospital is in clear view but timing really depends on how quickly the platelet compatibility study can be completed and her type located.
Her mood today was outstanding. She remains upbeat and confident that she will conquer this minor setback.

Spring/Summer Hospital Stay Day #9

May 25, 2016

After being told this morning by the resident physician that the CAT scan of Angela's head showed a spot on her brain the radiologist and attending physician said it was actually normal. Big sigh of relief. Now waiting for HLA matched platelets to be located. Testing confirmed that her system did indeed develop anti-bodies preventing just any old platelet from having an effect. Things are looking up!

Spring/Summer Hospital Stay Day #8

May 24th, 2016

As days go this was a good one. Angela Bursler was very alert today and for the most part in little pain. Fevers have essentially subsided and it appears as though that doctors have found a way to control her blood pressure through the use of another medication. That being said both temperature and pressure elevate during or immediately after platelets are transfused. My understanding is that it is not uncommon for this to happen during
this period of time so it is less of a concern for us.
Her headaches have continued prompting the doctors to to do a scan of her head. The infectious disease doctors had already ordered a scan of her sinuses so it was not a hard decision to make to check her entire head. The ID doctors theorize that the sinuses could potentially be infected as a result of damage to the soft tissue from the Chemo. Examination of her body also revealed a swollen, rigid left forearm. Some concern was expressed by the doctors of the potential for a blood clot to reside in that area. An ultrasound of the left arm was ordered to rule out that condition. The exam, otherwise, with the infectious disease doctors revealed nothing significant.
Angela also received a visit today from Dr. Burger's (Oncologist) assistant. She explained in detail the plan that was/has been developed to treat the condition preventing platelets from being produced. Unfortunately the plan included transfusions of two additional units of platelets a process that resulted in violent nausea and vomiting the last two attempts. The staff tweaked the pre-meds to include higher doses of anti-nausea medications and Benedryl and also extended the feed from one hour to two hours. The higher concentrations of pre-meds and the slower feed would prevent the violent reaction that she experienced previously. Once the two units of platelets are infused into her bloodstream samples will be taken to determine if her system is rejecting the platelets. As I mentioned before if testing reveals antibodies are present than a compatibility study will be performed. Platelets matching her type will be located somewhere in the country and infused. If antibodies are not present (which doctors suspect) than the source of the problem is damaged bone marrow the cure for which is plain old time.
The issue with her lungs can not be addressed until her platelet count is restored to a normal value. There is too much risk of a bleedout by inserting a needle into the body of a person with low platelet counts. We are hopefully optimistic that the two units of platelets infused tonight will restore her count enough for the procedure to be done tomorrow.
She is very tired however her mood was very optimistic and upbeat today. Doctors may never find a cure for cancer but in the case of Angela pure 

Spring/Summer Hospital Stay Comment #6

May 23, 2016

Angela continues to be on a roller coaster ride of good days and bad with today being a bad day. She did not sleep well last night despite being give a dose of Ativan. Symptoms were not the source of her restlessness but instead just an inability to get comfortable. Six days of lying in a hospital bed can certainly contribute if not cause that effect.
Doctors are still attempting to determine if there is an underlying cause, aside from damage to her bone marrow that is preventing platelets from being produced. An objective today was to transfuse two units of platelets testing her counts one hour after each transfusion was complete. If there was movement in her platelet count or at least evidence of stabilization than there would be no need to deviate from the current plan however if the platelet count were to drop doctors would proceed with HLA testing (platelet compatibility study)
That was the plan however Angela’s body did not want to cooperate. Approximately thirty minutes into the first one hour transfusion she was overcome by severe nausea leading to a serious bout of vomiting. Once reported the transfusion was immediately stopped and Angela was treated with the best of care.
Unfortunately the entire unit of platelets had to be transfused to validate the study so the exercise proved to be unsuccessful. As the doctors regrouped in an attempt to understand why the transfusion resulted in such a violent reaction Angela was able to recall that she typically receives Benedryl prior to a transfusion of this type. When brought to the attention of the doctors they concurred that this could or would have prevented the nausea. A second attempt at introducing platelets into her blood stream is scheduled to occur later this evening/night with a plan to administer Benedryl.
The most bothersome symptoms are still shortness of breath and headache. Shortness of breath is attributed to pleural effusion (water on the lungs) and the headache is most likely a symptom of high blood pressure.
A CAT scan w/contrast revealed a moderate amount of fluid on both lungs confirmed by an ultrasound. The ultrasound also confirmed that there are pockets on both sides of the lungs where a needle can be safely inserted to remove the fluid. This procedure is scheduled to occur tomorrow pending a safe level of platelets can be maintained overnight. There is some concern that there could be an underlying factor causing the fluid buildup so once removed the fluid will be thoroughly tested.
Her blood pressure is a source of concern (at least to me) but the staff appears to be satisfied that it is stable even though high. Her BP remains stable at 155/93 however it peaked at 178/113 during her vomiting episode.
Headaches are being treated with Tylenol however when I brought it to the attention of the staff that it didn’t seem to be working they administered Oxycodone.
The most revealing comment of the day that describes Angela’s current mood is “I want this nightmare to be over”. Unfortunately we were told this morning that her stay in the hospital could extend another five to seven days. She is getting the best treatment in the world but she has had enough and I don’t blame her. She’s tough but even the toughest need a break.
Not whining about my feelings but observing her battle is the most difficult thing I have ever done in my life. I can’t fix this Angela Bursler but I love you very much we will get through this!

Spring/Summer Hospital Stay Day #6

May 22, 2016

 Angela's condition is slowly improving but she is still not clearly out of the woods. The three biggest issues are: 1. Bone marrow not producing platelets (Count dropped from seventy-five to twenty-one overnight) 2. Percent breathing @ 93. ( unable to get the right volume of Oxygen into her lungs without assistance) 3. Consistent high blood pressure (last reading was 169/99. Target is 130/80)
The assumption is that the fluid overload is significantly contributing to the high BP and breathing issues so they are attempting to regain control through the use of Lasix. 

In spite of the platelet drop overnight the doctors did not appear to be overly concerned. The plan moving forward is to test the blood again later this afternoon/evening for platelet count. If the number stabilizes they will hold and check again in the morning but if it drops platelets will be transfused. One concern is that her system may have developed antibodies preventing the transfused platelets from having the desired effect. There is a chance testing may need to be done to define the type of platelets that her body will accept. 

A piece of good news is that the fevers appear to have subsided. 

Until the three issues are resolved she will remain hospitalized.

She is in good spirits but still scared. She's a tough woman who doesn't easily show fear but I know she's scared.

Spring/Summer Hospital Stay Day #4

May 20, 2016

The CT scan of Angela's chest revealed pulmonary edema. They have been giving her Lasix in liquid form since last night but there has been little or no change to her condition. I haven't talked to the doctor yet this morning but my assumption is that at some point consideration will be given removing the water with a needle. It appears transfer to Penn hinges on how quickly they can clear her lungs. As for the primary reason she came to the hospital she finally had an opportunity for a consult with an Oncologist, Dr. Stephanie Jean. The doctor recommended that she receive units of Nuelasta. As of this hour the only activity toward correcting the blood count issue has been one more transfusion of platelets the effect of which he not yet been reported. Also, during the night, her blood pressure rose to 187/97 prompting the staff to give her blood pressure medicine to her. This medicine was considered to be off limits for one reason or another until the pressure became elevated. In spite of her current condition I'm still hopeful that the transfer to Penn will happen today. It is very frustrating and difficult for me to watch my wife suffer.

Spring/Summer Hospital Stay Day #3

May 19th, 2016
Angela experienced a setback last night so release has been delayed. She is receiving excellent care at this facility but both Angela and I agree that the team at Penn may be better suited to treat her illness. There may be a transfer in the near future.

Spring/Summer Hospital Stay Note #2

Hot off the presses. Received this text from my wife just as I sat down to go to sleep: "Booyah!! Platelets went to 11😊 they are going to recheck in morning. Still have fever but not as bad. Assuming I get out tomorrow don't worry about bringing any clothes."
I love this woman!

Spring/Summer of 2016 Hospital Stay Day 1

May 17th, 2016

Angela Bursler has done her best to hide the effects of cancer and cancer treatment but reality is that her body is taking a beating. Those who have taken for granted that all is well should take a close look at the photos to understand the extent of the symptoms she has endured the last two and a half years. In spite of how well she presents herself in public with her big bright smile and bubbly personality she is in a fight for life ever single moment of the day and night. She will be spending at least one night in the local hospital to treat the current round of symptoms.
Bide your time and work with the hand you're dealt and ultimately you will whoop this disease once and for all. Love you Angela Bursler!