Janet's Obituary

DENNIS Janet Victoria (Thring) September 25, 1952 to February 20, 2008, died peacefully at home holding her husband, Mark's hand and surrounded by her loving family after a short courageous struggle with ovarian cancer. Janet always retained her zest for life despite the many challenges posed by her disease. The final phase of her life was eased by the unconditional love and support of her large circle of friends, especially her support team, TELUS management and employees, family and soulmate Mark.

Janet was born to Cy and Ruth Thring (Sinclair) in Yakima, Washington, USA. Shortly after Janet's birth, the Thring family moved to Cy's native Vancouver where Janet grew up with her two sisters Daphne and Marilyn. Janet joined BCTEL in 1970 and worked there until her retirement from TELUS in February 2008. Janet was a unique and special person whose vibrant, fun loving and vivacious personality, outstanding fashion sense, quick wit, contagious laughter and giant smile brightened many a day and endeared her to all. She will be greatly missed by those who knew and loved her. While we are sad for what never will be, we are grateful for what we have had. Janet was truly a gift who has left her imprint upon our souls.

The family appreciates the efforts and skills of her physicians, Dr. Jones her family doctor of 32 years, Drs. Stuart and Lam of the Burnaby General Cancer Clinic, and the assistance and expertise of the Three Bridges Community Health Centre Pallative Care Team, especially Dr. Anne Hansson and nurses Wanda and Jivan.

A memorial service honouring Janet's rich life will be held Monday March 3rd, 2008 at the Shaughnessy Heights United Church at 1:00 pm, 1550 W. 33rd. Vancouver, light refreshments to follow. In lieu of flowers, donations in her name to the National Ovarian Cancer Association are appreciated. Envelopes will be available at the service. Janet may be watching ... pick your shoes carefully!

The end of Janet's Journey

My lovely wife Janet came to the end of her life's journey at 10:15 pm on Wednesday February 20th. The past few weeks were a struggle for Janet but she passed comfortably and peacefully holding my hand. Her sister Marilyn was present as were my parents Betty and Leslie Dennis.

Tonight ends a nightmare for Janet and me that started last May with her diagnosis of Ovarian Cancer. Unfortunately the nightmare did not have a happy ending.

Janet would not have wanted to spend more than a few weeks living as she did for the past week. She was a strong, independent and vibrant woman. Janet hated being dependent on anyone, even those that loved her the most. She would rather be released from the prison that her body became.

Janet Update (and why it took a long time to publish this blog)

I was chatting with my Dad last night and I found myself commenting on writers block. It suddenly dawned on me why I was procrastinating on updating this blog. I was really having trouble finding good news to talk about. When its good news I have no problem telling you all the details. The writers block occurs when there is no good news. With the progression of Janets Ovarian cancer its not always good news. With that as an introduction let me update you on Janet's condition.

Janet went in for paracentisis on Tuesday at VGH. This was the first time she was drained at VGH and she was very pleased with the medical staff. She had a lady doctor from Ireland who actually did the procedure, which involves inserting a needle into her abdomen to drain fluid. Janet is naturally pretty anxious about this procedure and the bedside manner and compassion of the doctor and nurses have everything to do with how much Janet despises or tolerates the actual process. Karen Corcoran, who has made accompanying Janet for paracentisis her personal crusade since last May, accompanied Janet through entire procedure. The VGH medical staff drained about 2.95 litres of fluid from Janet and she was much more comfortable afterwards. Corco made sure that Janet got her standard celebration meal consisting of White Spot fries and large amounts of triple O sauce for dipping. By the time Janet got home on Tuesday afternoon all was well and after the excellent results from the last paracentisis I had high hopes for similar results this time. I was looking forward to a few days of getting lots of calories into her.

Unfortunately it was not to be. By Wednesday night Janet had thrown up much of what she had eaten. It was obvious that even though she felt more comfortable after the draining procedure, she was having almost as much trouble keeping food and calories down as before the procedure. It has been a struggle all week for Janet to keep any food down. Janet is incredibly thin and each calorie counts. For Janet to lose calories at this time is significant. The past few months have been a battle of calories. Calories retained equals winning, calories lost equals losing. This week we have been losing more than we have been winning.

So we are not getting the same "lift" from the procedure this time that we got last time. Janet is weaker and thinner and requires more assistance with daily living. I won't go into the details and lets not dwell on the bad stuff and lets move on to the good stuff.

We started with the home support staff this past week. We had a home care worker in all day Monday and 4 hours each afternoon on Tuesday through Thursday. This was great for me because I was able to leave the house knowing that Janet's care was in experienced hands. Its also good for Janet to get a rest from me. Janet also likes the back rubs she gets from the home support lady while she is having her bath. Apparently I am too rough (no kidding.) In addition to being able to do some leisurely grocery shopping I managed a bike ride around Stanley Park and was able to have lunch out with both my parents at the same time. It was all good.

Janet and I also spent some time last week getting various business affairs tied up and organized. One of the big highlights from those efforts was that the lovely Janet officially retired from TELUS at the close of business on Friday February 15th. This officially brought to a close a career with BCTEL/TELUS that spanned 38 and a quarter years. A true career achievement in anybody's books.

All of you who read this blog have supported Janet and I in many ways throughout the past 8 months. Your love, laughter, good wishes and fond memories have sustained us through many bad moments and we are both so very deeply grateful for that. I want to share a couple of things with you which I hope will help to sustain you in the years ahead. These are things that I have learned from the past 8 months while intimately sharing a life with the lovely and vibrant Janet.

The first is about our attitude towards death. Those of us who are healthy tend to view death from a healthy persons point of view. We naturally don't like the idea of dying because it will stop us from doing all the stuff we like to do, eating, drinking, laughing, loving, thinking, talking, partying, playing etc. When you are really sick though, death is something else. Very sick people aren't doing any of the fun stuff anyway and just living requires a great deal of effort. It also involves enduring some pain and discomfort even if this aspect is well managed. Its worth stopping to remember that death to a very sick person is not like death is to those of us who are fortunate enough to be healthy. I think if you take the worst you ever felt physically in your entire life multiplied it by two and then asked yourself if I had to live like that for the rest of my life how would I feel about dying. You would be approaching how a very sick person feels about death.

I know that Janet does not look forward to death but she does not fear it either. She will be ready for it when it arrives. Please remember that in the days ahead.

This brings me to another important thing I have learned. Death is a certainty, as one of my friends father once said to him "John, none of us are going to get out of this alive." That is most definitely true. We should all live our lives as though each day were our last, because it may be. One of the reasons why Janet does not fear death is because she has really lived her life. Janet grasped at every opportunity to have fun, to eat, drink, talk, laugh, love, think, party and play that came along. She never said no to a single one. We should all do this, because it really smooths out the road on that last mile of the journey.

Okay enough of this really deep stuff.

We are taking things one day at a time around here right now. There is a chance that if you have a scheduled visit with Janet coming up it will get cancelled. We are going to close off non family visits to Janet after this coming Monday and Tuesday. The core support team (and you know who you are) will be an exception. As life has become more of an effort for Janet the reality is it is more difficult for her to have visitors and I also think that as she is not as much fun to look at and be with as she used to be, its harder on the visitors as well. Those of us who deeply love her do not care how she looks or how much fun she is to be with, our cups already runneth over in that department.

If you have not visited Janet and feel it is something that you must complete in your life's journey please send me an email (marknden at gmail dot com) and I will try and arrange something. I would encourage you first though to picture Janet in your minds eye in one of her finest stylish outfits, wearing a pair of her killer shoes and her perfect white smile contrasted against exactly the right shade of red lipstick and ask yourself if you really need to have that image changed. I know that one day I will be re-inserting that image back into my minds eye and living with it forever.

Thank you for being there for us.

Finally an Update or ... How is Janet Anyway?

Sit down and make yourself comfortable because this is going to be a long blog. To steal a line from Steve Jobs 2008 Macworld Keynote Address "there are four things I want to talk to you about today." Lets start with the How is Janet question, then I will get to the others.

How is Janet?

In general Janet is doing well. The last paracentisis (draining of fluid) produced a much more dramatic result than any previous paracentisis. Janet got a whole week of being able to retain most of the calories that she consumed. This is excellent because at this stage of her disease we are really in a battle of calorie retention. Not the calorie battle most of us are fighting which is to limit the amount we are taking in. In Janet's case we are trying keep in as many calories as she expends each day. After paracentisis this is relatively easy because most of what she consumes stays down. However, the calories she consumes during the week after paracentisis and before she fills up with fluid must sustain her until the next paracentisis which is currently scheduled for Valentines Day, February 14th.

Once Janet starts to fill up with fluid she loses much of what she takes in with the exception of water and clear liquids. This is likely because of a combination of mechanical issues, water pressure on her stomach and diaphram and physiological issues, partial bowel blockages being closed down even further by water pressure. Every now and again there are rare exceptions to Janet losing much of what she takes in. Yesterday was an exception because she kept in one and half boost drinks and a small salad with dressing and some nacho chips and dip while watching the last quarter of the superbowl. This is in stark constrast to the previous two days where nothing except water, ginger ale and gatorade stayed down. Not surprisingly Janet's energy levels fluctuate in direct proportion to the amount of calories she takes in, so she is a bit livlier today than usual.

I do need to point something out about Janet's general state of livliness which I have noticed. Janet is very thin, I suspect that most people by the time they reached her state of disease would be completely lacking in energy, very slow moving and with low levels of mental alertness, slow answers to questions and perhaps some confusion etc. This really was the case with Janet before the last paracentisis. Since the paracentisis she has perked up quite significantly. She is definitely weak. For example she needs to rest for about 5 minutes after climbing the stairs in our apartment. When talking to her though, you would think there is nothing wrong with her. She is as sharp as ever. She also moves quite quickly for a person who is as thin and weak as she is. For instance she moves between our bed and her hospital bed (which she uses as a day bed as it reduces the back pain she sometimes suffers from) very quickly. She sits up quickly. Its almost spooky to watch someone as thin as Janet who is still functioning at such a high level. I think if you take another look at the picture at the beginning of this blog, you will agree it proves my above point, it captures her mental state quite well.

This brings me to the next thing I want to talk to you about which is where we go from here with Janet's health.

Health Tactics

Quite frankly 3 weeks ago Janet did not appear to have long to live. Her physical and mental energy levels were low and honestly her quality of life was not particularly good. Since then she has had a bit of a dramatic turn around. Physically not much has changed except that she has consumed more calories and has therefore increased her energy levels. The most marked change is mentally. She is more alert. She is back to reading books, magazines (something she had pretty much stopped doing). She is watching American Idol and insisted she saw the first episode of Lost (live not recorded.) As a result her quality of life has also improved quite a bit. The objective is still to make Janet's life as comfortable as possible but we are going to try and make some small changes in tactics as follows:

1. Transfer Janet from the Burnaby General Hospital Cancer Clinic to the Vancouver Cancer Clinic so that paracentisis is only a 5 minute cab ride away instead of a half an hour car ride.




2. Try and get the paracentisis schedule moved up from 3 weeks to 2 weeks. There is a risk that Janet may fill up more quickly by doing this but at this stage we may well get more days of keeping calories in, which on balance is a good thing.




3. Try and arrage for bloodwork that needs to be done prior to paracentisis to be collected from home. This saves one of the 2 hospital trips that normally accompany each paracentisis cycle.

In addition I have realized that I am going to have to do a better job of pacing myself as the primary care giver. I can be the 7 by 24 nurse (or butler as I prefer to think of myself) for a few weeks, but I don't think I can keep this up for months. I am going to have to get better at delegating, and getting out of the house, when help is around. Luckily with my parents in town and Marilyn's visits, help is quite often around. Iwill also try and work out some kind of better coverage schedule including home care support with the help of the VCH pallative care team. More to come on that though as I further develop the plan.

Next I would like to give you a brief run down on what Janet has been doing with her new found energy levels.

Janet's Recent Past (the partying is over but she still has fun !)

Much of the past week and a half has been family time intersperced with a few visits from friends. When Marilyn was here, Janet and Marilyn concocted up some nice family dinners. Janet came up with the menu and recipes, Marilyn did the cooking and I did the shopping and we all did the clean up. It all worked out quite well. Saturday was my Mom's xx birthday (I can't put the number in here because she wouldn't want you to know what it is.) We celebrated it by eating beef stew, which Mom brought over, and by having champagne and cake with Janet. Janet's Dad has been over to visit quite often. The twins (our niece and nephew Michael and Chanel) pop by on Friday's (somehow they have managed no college classes on Fridays, who knew.) I usually put them to work around here and they are happy to help out. John Nicholson (the twins Dad) pops by frequently and sometimes John and I just sit and chat for a while. Dave and Stephanie, Marilyn's husband and daughter have also been over for a visit. Its all been high quality family time and we have been really lucky to have had the opportunity to fit all of this in.

So that brings me to my last topic which is what happens next ....

What Happens Next

There are a lot of things that happen in this wild and disorderly event called life that we really don't understand and cannot predict. Janet getting ovarian cancer in the first place is but one small example. Realistically Janet is at high risk for a number of things to happen which could end her life quite quickly. If those things do not happen, eventually she will suffer digestive system blockages that will eventually end her life. It could be weeks or months. No one knows. Its very important that when she is feeling good that Janet enjoy her life as much as possible. Janet needs time for herself, her family and for her friends. Visiting does use energy which is in short supply.

If you haven't visited Janet and would like to, please send me an email with your preferred time and date and I will put it in the calendar. Its best for Janet if we can keep the visits to no more than half an hour as she does get tired quite easily. Please do not bring food or flowers we have enough. If you must bring something bring reading material, magazines or books or even old pictures. Janet loves looking at old pictures of times and parties past. We are going to restrict visiting days to Mondays and Tuesdays only and no more than 2 visitors per day in order to conserve Janet's energy. If this really does not work for you and you need an exception you can let me know.

Thank you to everyone for your love and support through this difficult time. I will continue to use this blog to keep you posted on my lovely wife's progress and Janet and I will both continue to track your messages of support. You do not need to log in in order to leave a comment on this blog. Just tick the anonymous box but your name in the comment so we know who it is from.

Honour Circles and Light, Love and the Warmth of Friends

On Friday, a number of Janet's friends arrived for a ceremony led by Karen Goodfellow called the honour circle. I wasn't actually at the ceremony, but that won't stop me from writing about it anyway.

I left after Karen arrived and returned 2 hours later after getting my spirits lifted at the Frog and Firkin a few blocks away. I returned to find many of Janets friends in the living room and a feeling of warmth and goodwill permeating the atmosphere. I ran upstairs and checked on Janet as I always do and found her energized smiling and very happy with the ceremony. She loved it. My mother Betty and niece Chanel (Daphne's daughter) also attended the ceremony.

Friday was a peak for Janet. She benefited from the paracentisis the day before and was energerized by the love, light and warmth of her friends. Janet rested on Saturday, she had two short visits with friends and slept much of the day. I was a bit worried about her on Saturday as she really seemed really depleted of energy.

That changed today though when she announced to Marilyn (who is visiting us again) and I that she wanted to go to Urban Fare and do some grocery shopping. She got herself up, got dressed in very fashionable brown pants, black top, scarf and a brown beret. Walked to the front door and hopped into Marilyn's green volks beetle and the two of them drove off to Urban Fare. I was totally amazed as this was the opposite of the Janet of the day before. Marilyn and Janet picked up some groceries for Sunday night dinner and stopped in at Whitespot for fries and triple O sauce (Janet's fav) before she returned home for a nap.

I have installed a computer and a decent monitor in the bedroom so that Janet can listen to internet radio stations (a little habit she has picked up from her geeky husband) and watch videos and Internet downloads of American Idol and other favorite programs. I also put a web cam in the bedroom so I can keep an eye on her remotely while I am downstairs.

I will be forever grateful to the women that have worked so tirelessly to help me in my mission to make Janet's life as happy as possible. You know who you are, and you are all truly angels. I realize that we are all frustrated by how little we can do to improve Janet's quality of life but its important to remember that your visits, kind words and efforts have such a big effect on both Janet and I. Thank you.

Big Challenges Big Rewards

Janet went in for her paracentisis on Thursday. Janet hates the procedure which involves a shot of local anesthetic to her abdomen followed by insertion of a needle to remove excess fluid. Typically between 1.8 and 2.4 litres of fluid is removed. The physician uses an ultrasound machine to ensure most if not all fluid is removed. Janet then spends an hour or so in the medical day unit while her blood pressure is monitored and if all is well she is released. She is currently on a three week schedule with this procedure performed every three weeks.

As Janet has become weaker paracentisis has become more a big deal because it requires two trips to the hospital, one for blood tests and one for the actual procedure. Janet has to get dressed and get to the car, sit in the car for at least a half an hour drive and then get out and get to the lab or medical imaging department to have the procedure performed. Its a lot for a person in a weakened state.

On the plus side the procedure does make her feel much more comfortable by reducing the fluid pressure on her stomach Reducing this pressure also significantly increases the odds that any food she eats will be retained by her system.

Janet learned after the second time she had paracentisis that the best way to get through it was to take an Antivan which is a muscle relaxant.

Todays game plan went roughly like this. Janet up and showered and ready to go by 10:00 am (I had to help her get ready). We put Janet in the wheelchair to get to the car and I drove Janet to the hospital where Karen Corcoran was waiting with another wheelchair, borrowed from the hospital. Janet transferred to Karen who wheeled her to the medical imaging department for the procedure and stayed with her until the Medical Day Care Unit released her. Karen then drove Janet back home where I met her with a wheelchair. Its a bit of a hassle but the rewards are as follows:

• 3 litres of fluid removed (a record for Janet)
• Janet feels much more comfortable now and likely will for at least a week, perhaps more
• Janet ate and retained half a turkey sandwhich, a can of Sprite, 3/4 of a Boost drink and a small bowl of Chilli. Its been weeks since Janet was able to retain this much food and calories in a single day. This really helps to put some strength back in her. She actually spent an hour this evening downstairs watching TV and her brother in law John N. commented that she looked much more alert than she has in quite a while. The calories provide immediate benefit.
• As Janet is more comfortable she will likely sleep better and this will contribute to her overall well being.

Paracentisis is definitely in keeping with our objective of making Janet more comfortable and treating her immediate symptons. These days its a big challenge for her, but it does have big rewards at the end of the process. We think its worth it.

Monkey Business

Janet's sister Marilyn is a Monkey. Well almost. Actually she was born in July 1956 and in the Chinese calendar that means she was born in the year of the Monkey. I was also born in 1956 (June) so I too am a Monkey. Janet likes to joke that when Marilyn is visiting there are 2 Monkey's in the house. Monkey's are known for their cleverness, or what Janet refers to as Monkey business. Marilyn and I decided to apply that cleverness to improving Janet's view of the world. We rearranged the bedroom furniture so that when the new hospital bed arrived Janet could see the Northshore mountains from her bed.

This afternoon the red cross delivered the adjustable bed with many air pockets and also a bed tray and a bath seat and a wheelchair. Janet loves her new bed. We have positioned it in the space we cleared in the bedroom and on a clear day, such as today, she has a very decent view of the Northshore Mountains. We are hoping the bed will put less strain on her back which has given her trouble lately.

Janet continues to read or (have read to her) emails and comments from this blog site. Tomorrow she will go to BGH for paracentisis. This is the procedure where they drain excess fluid from her belly. We both hope that after the procedure she will be able to hold down more food (and calories). I have booked Sunday through Wednesday of next week as family and rest days for Janet. Janet knows that she is fortunate to have so many friends who care about her. The last few months have been an interesting lesson for me on much one person can influence other peoples lives.

On Tuesday Tim Draper a long time TELUS employee and friend of Janet's visited us. Tim is known for his "good questions" and he asked me after the visit what I remember most about Janet when I think back on the time she and I have spent together. I gave him a quick answer about how happy she was the first time we took a cruise together. It was a fast off the cuff answer without a lot of thought. However, the question really stuck with me and I have sought to find an answer in a single word and I have found the answer. The word is "fun."

Janet is fun. She has always been fun. She may always be fun, although at some point in the future, that fun might only be a laugh when we think back on how much fun we had with her. Last night Janet asked for a couple of hours on her own to rest without Marilyn and I (the 2 Monkey's) popping in and checking on her every 15 minutes. Marilyn and I made dinner for ourselves and drank some wine and about 45 minutes into the couple of hours we realized that we already missed Janet. Even when she is very sick, Janet is still fun and we miss her when we are not interacting with her.

Janet and I continue to be in awe and count our blessings for the friendship and support we have received from all of you. Both Janet and I feel like we are a part of a very large, very supportive family that includes all of you. Thank you for all you have done so far to brighten up this phase of Janet's life. I remain committed to making her life as comfortable and as happy as possible.

Sunday Visitors

Janet had visits yesterday (Sunday) with Anna and Jim, Joycelyn, John Nicholson and Linda and Scott.

Before dropping by our place, Anna and Jim went over to 555 Robson (TELUS' downtown office) and cleared out Janet's cubicle and desk and brought over three boxes of stuff for Janet to go through. Jim and Janet determined I was not eating enough (apparently no one has noticed I am still running 10 lbs over my ideal target weight) and Jim cooked me up a omelette sandwich, which was delicious. Jim and I reviewed all my tech toys and home networking setup while Janet and Anna went through the boxes of office stuff. Janet was pretty tired by the time Jim and Anna left and slept for a couple of hours.

Jocelyn popped by for a visit at 5:00 pm, followed by John Nicholson at about 6:00. At 7:30 pm Linda and Scott Harrison showed up and Linda and Janet had a good long talk. For those that are following the Janet and Linda "thing" both claim that while they still do not agree on "something" peace has been reached on the subject.

Janet ended her day by once again savouring a slice of double cheese and pepperoni pizza. We had mixed success in getting calories in Janet on Sunday. That unfortunately is how it goes sometimes. Right now its more important that she enjoys what she is eating and drinking than what happens afterwards.

She took a muscle relaxant and went to bed at about 10:00 pm. She woke up about midnight complaining of bad back pain and I gave her a pain killer. She woke up again at about 2:30 am complaining of "nagging" low grade back pain and I administered another muscle relaxant and she more or less slept through until about 9:00 am this morning.

A quick view of the schedule reveals that she has a very busy week. Its starting to look a bit like my work schedule. We all know that Janet loves people and would not be happy without them. That said, I am concerned that she gets enough rest. She needs much more sleep than healthy people right now and rest definitely impacts the quality of her life. As the story above illustrates she doesn't always get a good nights sleep.

Knowing that we are all very concerned about Janet's welfare I am going to ask that visitors plan on no more than a 30 minute visit with Janet, and that we keep group visits to no more than 2 people at a time. Karen's healing circle on Friday is an exception to this.

My parents will be arriving in town on Wednesday and are planning on staying in Vancouver for at least a month. They have always been very close to Janet and want to be close to her at this time.

Janet's sister Marilyn is arriving this morning and will be staying with us for a couple of days. Janet is very close to her sister and its great to have her here to help. I know that her husband Dave and my niece Stephanie will miss her, but her efforts are going to a great cause.

I can't tell you enough how much the emails and support we receive from all of you mean to Janet. I know she feels surrounded by love and light.

The Importance of Pizza

Janet sometimes gets food cravings. Its a bit odd and I suspect it may have something to do with a medication she is on, a steroid which as a side effect stimulates her appetite.

She has been through a number of cravings for things that were absolute must have's for a short while and have subsequently passed by the wayside. These have included, Hedgehog Ice Cream, lemons and particularly lemon sorbet, blood oranges, fresh squeezed lightly pulped orange juice (she mixed this with Champagne on Christmas Morning) and her latest which is double cheese and pepperoni thin crust pizza.

The best thin crust pizza in our neighbourhood comes from Rocky Mountain Pizza Company which is only a few blocks from us. They use all natural organic ingredients (including organically fed beef etc.) and tack a extra dollar on every bill to go towards saving the planet. Most importantly they have some kind of Mongolian oven in there which cooks up a really great pizza. Yesterday I found a parking spot within 2 blocks and picked Janet up a 10 inch double mozza and pepperoni pizza. She eats it one slice at a time, savours each bite, and has been working on it for over 24 hours now. Usually the pizza doesn't stay down. But that doesn't matter. The important thing right now is that Janet really enjoys the taste and pleasure of actually eating the pizza. After watching Janet savour each bite of her favourite pizza I don't think I will ever be able to gobble down a pizza again. Its a real lesson in enjoying what you have while you have it.

Janet has had a good day although I would like to have seen her keep more calories in. She spent some time this morning reading emails and well wishes from friends and visited with her Dad and her Dad's wife Joanne and with her friend Anna M. and with Patrick T this afternoon. Janet usually gets tired after each visit and has a sleep for a little while before the next visit. Its good for her to get these cat naps in.

We have had to deal with very little pain today. I get Janet to rank her pain on a scale of 1 to 10 and I break out the serious pain killers once it reaches 5. So far today pain has not gone over 5 and this is an improvement over yesterday. Janet's back has continued to bother her but today its been more an irritant than actually painful. We were able to control that with muscle relaxants instead of pain killers. Its a small victory and it makes for a much more pleasant day for her.

Home Pallative Care and the Community Health Nurse

Janet and I were visited yesterday by a Vancouver Coastal Health Community Nurse who is on the home palliative care team. Wanda our community nurse spent about an hour with us and explained how Home Palliative Care can help us. Both Janet and I were very impressed. Wanda made many notes on Janet's condition asked a lot of good questions and reviewed all her prescription meds. She made some excellent recomendations on timing and delivery of Janets meds as well as some over the counter products that will help Janet. Its good to have a trained professional helping us out.

On Monday a representative of the home Palliative care team will come by to review Janet's bathroom, shower and bed and make recommendations on any changes to make Janet's life a bit easier.

We also now have a list of numbers to call 24 hours per day if we need help, have questions etc. Its a big relief for me to know that help is close at hand if I need them.

Janet had a pretty good day yesterday. She is having a bit more of a problem with back pain. This started last summer mostly as an annoyance but over time has become an issue. We are treating the problem with some meds and so far have been able to manage the symptom fairly effectively.

Thats all the news for now.

Janet's Condition and the F Words

Janet, Marilyn and I have been having some fun with F words.

F words we don't need are:

• Flowers
• Food

(we have enough)

F words we do need are:

• Friends
• Family
• Fun
• Frivolity
• Friskiness

Feel free to add your own to the comments ...

Latest Health Update

Unfortunately the news is not good. For the past couple of weeks Janet has had a great deal of difficulty keeping food or liquid down. As a result she has lost more weight and has become progessively weaker. She has had to work at sipping water and gatorade in order to stay hydrated. Her Oncologist was very concerned about this symptom and scheduled her for a medical test to find out what was happening to food or liquid that she consumed. Her sister Marilyn, who has been staying with us for the past couple of days, took her in for the test yesterday. It was a difficult test for Janet in her weakened condition because she had to drink and hold down fluid containing a radioactive trace and then have xrays taken at various times after consuming the liquid. Janet, always the trooper, hung in there and did her best, and as a result the radiologist managed to get some excellent pictures of exactly what was going on. This means that her medical advisors now know why she is having difficulty retaining nourishment. It is because of multiple bowel obstructions caused by the cancer in Janet's peritoneal (tummy area) cavity. We met with Dr. Lam, Janet's Oncologist earlier today and she explained that the bowel is a flexible tube that has no internal support or structure. Food and stool pass through it as a result of smooth muscle contractions on the outside. Janet has cancer that has attached to the outside of the bowel and has effectively collapsed the bowel in a number of places so that virtually nothing can pass through the tube. Operating on Janet is not an option because of the amount of cancer in the area and also because she is not well enough for major surgery. Even if these blockages could be removed by surgery, or by other means, they would re-occur in other areas of her digestive system. Janet has an impending bowel blockage. We had a long conversation with Dr. Lam this morning about futures and next steps. Janet and I are both determined that she remain at home as long as possible. We have arranged for the maximum amount of palliative care within our home and a palliative care nurse will be coming by starting tomorrow. As a backup plan we have advised May's Hospice (a palliative care facility in our neighbourhood) that we may need a bed there if Janet's symptoms worsened beyond what can be managed at home. At this time we have to swing our efforts from fighting Janet's cancer and extending her life towards making her as comfortable as possible. My full time job from now on is going to be staying at home with Janet.