I've heard it said that God only gives you want you can handle. 

If anyone is in direct contact with him, could you please let him know we are at max capacity?

It has been 57 days since the last update and again much has transpired. 

The last update explained the PET scan in early October showed  evidence of multiple areas suspicious for metastasis or cancer recurrence. Next followed with an appointment with Dr. Spanos (ENT) and Dr. Powell (Oncology) in Sioux Falls, SD. They recommended obtaining a lung biopsy to help guide the direction of Carla's treatment plan. This was deemed necessary because the aforementioned PET scan results showed lung nodules. If these nodules were metastatic cancer, the treatment plan would then lean towards palliative care. Palliative care doesn't mean hospice, but it sure as H-E-double hockey sticks don't mean curative either. As a family we tried to wrap our minds around these words, I don't care who you are, being delivered those words, it felt as though they were one in the same. I shall reference the feeling of falling down a well and trying to grasp the edges to stop or slow your fall, again.  Although this time it felt much faster with nothing to even reach out for. 

So, next was the lung biopsy. This is done semiconscious. Carla had difficulty during the procedure, her lung hemorrhaged at the biopsy site and she was coughing up blood (hemoptysis). She was kept after the biopsy for extra scans and observation to ensure she was stable. She eventually was discharged that evening. Ted and Carla spent a night in a hotel in Sioux Falls in case she had complications. They were able to return home the next day. Then the torture began, the waiting. The biopsy was Tuesday 10/19. They were told to expect results Wednesday, 10/20. On Wednesday, they did not receive a call. The results of the lung biopsy were posted in Carla's Sanford MyChart 10/20. We couldn't help but read them. The results described carcinoid tumors. We were devastated. That day, 10/20, is Jacob's birthday. (Unbeknownst to us, it was good news^^). Thursday 10/21 no call/results. Friday 10/22, I emailed the doctor, I begged not to be left in limbo through the weekend. We finally received a message back. It turns out the carcinoid tumors/lung nodules are neuroendocrine tumors. Tumors that are typically genetic and rarely spread or grow. They are not metastatic. Curative treatment was back on the table. Tears of joy is a term not used lightly to me now after having known/experienced them for real. It turns out Carla is a unicorn, rare is her normal.

Sigh. Deep breath.

The next appointment was with her Dr's in Sioux Falls on 11/2. At this appointment Carla opted to do her chemotherapy and radiation treatments in Watertown. Later that week Carla had an appointments with Dr. Brindle (Radiology Oncologist) and Dr. Rau (Oncologist) in Watertown at the Prairie Lakes Cancer Center. She was met with great compassion and kindness there. They requested another PET scan before planning her treatments. Oral cancer can be highly treatable, if above the clavicle. Her cancer has recurred and spread, so now they needed to delineate exactly where it was to pinpoint treatment as the cancer was growing and changing each day.

The PET scan was 11/9. That same day, shortly after the scan, they received a call. Drive to Sioux Falls now. Her cancer was now in the trachea (still above the clavicle) and she was in danger of losing her airway in the next 24-48 hours. We knew it had recurred in the base of her tongue and into her left neck. This was an unwelcome development. Another punch to the gut. Ted and Carla drove nervously to Sioux Falls and I venture to say we all slept zero winks that night. On 11/10, Dr's attempted a laryngoscopy, unsuccessfully, as they could not see past the tumor in the trachea. Carla had an emergency tracheostomy that night. The surgical consent involved a possible awake tracheostomy placement if they were unable to secure a breathing tube. They could not sedate her if they did not have a viable airway to maintain under anesthesia. If they administered anesthesia, the tone of the airway relaxes and would occlude her airway. Despite our trepidation with anesthesia, we hoped she could have the tracheostomy placed not  "awake". By the grace of God, they were able to intubate her and insert her tracheostomy under anesthesia The surgeon did report he had to de-bulk the tumor in order to get the tracheostomy in. Thankfully, no post operative delirium this time. 

She was in Sanford hospital recovering from the emergency tracheostomy placement until 11/15.  On 11/16, her tracheostomy occluded due to a mucus plug and she got an ambulance ride to the ER in Watertown. She was able to return home that night. Prairie Lakes was able to help coordinate obtaining her compressed air with humidity at home to help liquify her secretions. 11/17 Carla had a CT scan and the cancer center worked diligently to complete her radiation planning. 11/18 Carla had a double dose of radiation! Finally! Treatment to stop that F#$#*!g cancer from growing. She has completed 5 double doses of radiation. Carla started chemotherapy 11/29 and had radiation Monday-Friday this week.  Her regular course of treatment of chemotherapy (1x week) and radiation (5x week) will last a total of 6 weeks. The 5 double doses of radiation are not included in that time frame. One week done, 5 to go. She continues to get her main source of nutrition from a peg tube inserted into her abdomen. She does attempt some liquids and tiny amount of food on occasion. She likes the good ice from the Cenex on highway 20 (shaved ice) and has that often and bless their hearts at Cenex they rarely accept payment for those precious cubes. 

^^ As referenced earlier, on 10/20 (Jacob’s Birthday) we received the news of her lung nodules via her Sanford my chart, we were devastated, but found out later it was good news. While on the phone discussing the results posted, 3 books fell from a shelf on my wall. At the time, I mentioned this off handedly to my Mom. 10/22 we received the call that it was not metastatic cancer. My Mom said with ut missing a beat ”The books falling was Jacob”. Later that day, as I lay in bed, I realized the titles of the 3 books, as I glanced at the shelf: Missing You, Stay Close, and Holy Ghost. I have over 70 books on shelves on my wall. No book has ever fallen from my shelves. They are stacked in a manner that no earthly reason would/could cause their fall. It felt like a message from heaven. I had to call and tell my parents immediately! Goosebumps! Jacob is watching over us. 

I had typed most of this update 11/19. I struggled until today to finish the post. I searched for something lighthearted/positive/uplifting to add, to no avail. The moment with the books and Carla’s immediate feeling it was Jacob, may just fit the bill. Another positive is that she is FINALLY getting treatment! Lastly, today I went to my parents house to help with trach cares, my mom wrote on a paper to me “I want to live”. The will to overcome this is ever present in her. We want that too Mom, so very very much, more than words can ever convey! 

Thank you to all for the kind words/well wishes/positive vibes/prayers. Please, from the bottom of our hearts/souls keep them coming.