The End and the Beginning

Deborah Lynn Keller Harrell June 15, 1959 to September 12, 2016

I never saw it coming. Sure, she had cancer, two bouts with chemo and ongoing pain, but last fall I never saw the clues or guessed that she was starting her final journey.

She had such warmth and happiness and was hopeful that her chemotherapy days were behind her. She was still taking medication and occasionally she would have pain, or a bad day, but the only change I saw was that she reminded me of every detail of everything we did together. Turn here, don't forget that and so on. 

I should have known that it was a reaction to her condition and that she was gripped in a struggle, a journey to death that was a secret to all except three people.

But the fall of 2015 would bring certainty that her cancer had spread to her lungs, spine, skull and bones. We got through Thanksgiving and Christmas and then in February she started chemo again. The side effects were so severe that they had to lower the dosage to try and control the nosebleeds, the battle (a losing one) with nausea and an inability to eat.

In the New Year we talked about camping and going places, we had normality until the chemo. Then it seemed like there was nothing that anyone could do to relieve the constant pain and the damage to the taste buds so dominant that all Deb could eat was broccoli cheese soup from Panera. Everything else came up. So while not getting much food or nourishment she was also abusing her digestive system.

People tell me now that even through the pain and side effects she was upbeat and cheerful. She did not like to give in to anything. And yet somehow she still found ways to be close to me and lay her head on my shoulder. She would snuggle with me and I would hold her, hoping beyond hope that if I could hug her enough that the sadness and pain would leave her. 

Fast-forward to August 26, and our visit to the doctor. She was still feeling pretty good but tired and needing more rest. Her platelet count had slipped from 195 in July (normal) to 47. We found out the next week that her tumor markers had gone from 70 something to 353. She had a conversation with Dr. Weyburn and he ordered a CT scan and a bone scan. 

Deb started to have trouble climbing stairs and walking. She had to rest more and more. She helped me cook and was able to shower but unable to do much of her normal routine. 

September 8th she had the scans and needed a wheelchair to move around the hospital. She seemed chipper and we waited together for her final scan and talked. 

That night was one of her worst, with constant pain and vomiting that kept her from sleeping at all. The next morning she consented to an ambulance ride to the hospital and was admitted. Her red blood cells were low and the platelets were low. She received two units of blood and one of platelets. Even with that, while the numbers went up they came back down. Visiting her on Sunday she was in a good mood and she had been placed on full time oxygen. Kathi and Miku with me and we spent some time chatting with her. She was smiling and talked about coming home. The next day she was gone. 

The culprit was DIC. 

Blood clots develop throughout the bloodstream, blocking small blood vessels. The increased clotting depletes the platelets and clotting factors needed to control bleeding, causing excessive bleeding.

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There are a number of possible causes, including infection and surgery.


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Excessive clotting is followed by excessive bleeding.


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The amount of clotting factors in the blood is measured.


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The underlying disorder is treated.


Disseminated intravascular coagulation (DIC) begins with excessive clotting. The excessive clotting is usually stimulated by a substance that enters the blood as part of a disease (such as an infection or certain cancers) or as a complication of childbirth, retention of a dead fetus, or surgery. People who have a severe head injury or who have tissue damage caused by shock, burns, frostbite, other injuries, or even a bite by a poisonous snake are also at risk. As the clotting factors and platelets are depleted, excessive bleeding occurs.

Symptoms and Diagnosis

DIC that develops suddenly usually causes bleeding, which may be very severe. If the condition follows surgery or childbirth, bleeding may be uncontrollable. Bleeding may occur at the site of an intravenous injection or in the brain, digestive tract, skin, muscles, or cavities of the body.

If DIC develops more slowly, as in people with cancer, then clots in veins are more common than bleeding. If clots form in veins (usually in the legs), the person may have swelling, redness, or pain in the area. However, sometimes no symptoms develop. A clot that forms in a vein may break free and travel (becoming an embolus) to the lungs. Clots in the lungs may make people short of breath.

Blood tests may show that the number of platelets in a blood sample has dropped and that the blood is taking a long time to clot. The diagnosis of DIC is confirmed if test results show large quantities of plasma d-dimer (indicating that more clots are being produced and broken down than usual, ) and often a low or decreasing level of fibrinogen (a protein produced when blood clots).

Treatment

The underlying cause must be identified and corrected, whether it is an obstetric problem, an infection, or a cancer. The clotting problems subside when the cause is corrected.

DIC that develops suddenly is life threatening and is treated as an emergency. Platelets and clotting factors are transfused to replace those depleted and to stop bleeding. Heparin may be used to slow the clotting in people who have more chronic, milder DIC in which clotting is more of a problem than bleeding.

I've had lots of time to think and go through so many photos and memories. Why she ever wanted to marry me is a mystery.  Maybe it was a God thing. A way of giving me a wonderful love that was unconditional and constant.

I'm so proud of her and sparing the family of a premature time of mourning. What strength she had to keep her secret from last fall until now and continue to respond to pain with smiles. There is no amount of gratitude I can express that would come close to the wonder I feel in being her husband, lover and friend. 

My life has changed but it goes on and someday I hope to be with her, because I know that she is happy in paradise the place where all angels go. 

January 14, 2016

Today Deb's posted on her Facebook medical update page the following.

Happy New Year Facebook friends and family! It's time for an update. I had a CT Scan and Bone Scan performed Wednesday 1/6 because my recent blood tests have shown my tumor markers to be elevated. Unfortunately, the results, which I received yesterday, show that the cancer is continuing to spread to my skeleton. On the plus side, there is no evidence that it is spreading to my organs and I am not experiencing pain.

The next step is a weekly chemotherapy regimen, which will start in February. The drug will be Abraxane, which is a newly packaged form of Taxol. I was treated effectively with Taxol previously. After a couple months of treatment, my tumor markers will be checked again via a blood test and the next phase of treatment will be determined at that time.

While the diagnosis is a crummy one, I am feeling good physically and mentally as well as blessed knowing I have so many who care and are praying. I truly believe that is what has kept me so positive and feeling well.

Love and Blessings,

Deb

I (Dan) would add that Deb has good and days that are not so good, more the former than the latter. She still enjoys life and isn't melancholy about this turn of events.

There was an article in the Chicago Tribune today that spoke to why cancer has not been cured, since polio and tuberculosis, to name two, have all but disappeared. But cancer appears to be not just one disease but many diseases that are wily and not willing to give up their secrets to the many people looking for a cure.

Strides have been made in gene research and treatment regimens being developed are aiming for a targeted approach. 

But despite all efforts young and old still die from cancer. There isn't a reset button to go back to pre cancerous health. And the treatment costs, the monetary costs, and the pain and heartbreak to families is incalculable.

Still, heart attacks and obesity winnow our number and living a healthy life seems out of reach for many, not because of lack of nourishing options or cost but because we don't choose to be healthy.

Thanks for being with us to fight and to comfort us. 

Hi everyone, I apologize for the lack of posts here. There is a medical page on Facebook that has more information. Where to start? Between my last post in 2013 and this year (2015) the medical picture was stable. Deb continued to get scans and take anti cancer oral meds. She visited her primary care doctor, Dr.Weyburn and occasionally her surgeon but except for the metastasized spot on her liver no signs of cancer or any other involvement. It was just a few months ago that Deb had a scan that suggested some involvement into her skull and bones. Confirmed by a scan a few weeks ago, it appears that while she will continue her treatment it will take a medical miracle to save her. She has some time left, we think but We don't know how much. Deb isn't in any sever pain presently. Here is what she posted on Facebook on September 9, 2015 It's been a few months since my last update, so I wanted to give everybody the latest. I recently had my 3rd CT Scan and 2nd Bone Scan of the year-pretty soon I'll be glowing in the dark. Recall, the scan results from May were inconclusive. I met with my oncologist this afternoon to review and discuss my scan results from last Friday. The CT Scan shows nothing new related to any of my organs, but does show enlarged spots and additional spots on my bones. The Bone Scan confirms spots on my skull, sternum, spine and right humerus (upper arm bone). While this isn't great news, it's not horrible news either as we have a game plan to deal with it. I will no longer be taking the exemestane (estrogen blocker - both of my tumors were estrogen positive. Minimizing the estrogen in my body minimizes the spread of the cancer), as that is obviously not keeping the cancer at bay. One option is to start taking tamoxifen, which is the first estrogen blocker that I took after discovery of my first tumor. I stopped taking it after my second tumor was diagnosed, as it obviously did not prevent the second tumor. Apparently there has been success in going back to this drug after an unsuccessful attempt, but I wasn't feeling confident with this approach. While chemotherapy is another option, it isn't really called for at this point. Instead, I will be going for monthly injections. I will be receiving two injections per month. One is an injection of Faslodex (generic = fulvestrant). This is another estrogen blocker. It is used to treat metastasized breast cancer when other anti-estrogen medications fail. Additionally, I will receive an injection of Xgeva (generic = denosumab). This drug will target and destroy only certain cells in the body, while protecting healthy cells from damage. It is used to prevent bone fractures and other skeletal conditions in people with tumors that have spread to the bone, which in the case of breast cancer is pretty common. So, that is pretty much the long and short of it. My injections begin next week. Many of you who knew that I was having more scans have passed along well wishes, positive thoughts and prayer. It means so much - thank you! For now, I'll see you out and about. Love and Blessings, Deb We bought a fifth wheel travel trailer and a truck to pull it and plan to see as much as possible in the time we have left. I am reminded every time I write something about "time left" that we don't know, any of us, what time we have left to be in our earthly life. We could have the second coming or we could die unexpectedly. No one knows by God. So my prayer is that you join me in doing what you can to not only enjoy what is left of this life but to make an effort to help others to enjoy their time here too. When Jesus talked about the two greatest commandments, that is to Love God fully and to love your neighbor as yourself he wanted us to stop being judgmental and to let our love wash over our friends and family and even strangers. So I'll add my thanks for your prayers and love and hope that we see you soon.

A Year Has Passed

Hi Everyone, It's November and a year since the last update. It snowed Monday, November 11th, with over an inch of snow on the grass. The first snow this year. The roads were still warm enough to prevent any issues except where bridges and ramps exist. Being retired gives you the option of staying home in bad weather. Deb is now a volunteer at The Chapel, where we attend, helping the pastor with some administrative duties every Monday. Since she left Kemper she was very busy with our two exchange students, until they returned home in late June. She's on the lookout for opportunities to help and stay busy. Katorine and Emma went home in June and we continue to adjust to a quiet house and missing two wonderful girls, with their sunny smiles and laughter. We went through the year with only some minor hiccups and having both of them was a bonus. They became close, like sisters, and in spite of their different backgrounds, formed a friendship that will last a lifetime. We went through homecoming and prom and they saw Chicago, Milwaukee, Galena and later we went to St. Louis, Memphis, New Orleans and then on to Disney. They both played soccer and appeared in the school play. Kat sang in the choir and both had top grades. Another trip saw them both fly to New York and travel by bus on to Philadelphia and Washington D.C. They had a great 11 months with us.

Deb had a CT scan last week and it was normal. Still a spot of breast cancer on her liver, but no change. Her health insurance should run out next June, so we will have to go into the marketplace to see what the affordable healthcare act offers. Nothing cheap out there, I'm sure. Deb and I have adjusted to being together and both of us have stuff we do to get out alone. We have enjoyed some short trips to Michigan to visit family. It's great having the time to go during the week and come back for the weekend. There are still more goodbyes than I care to have, but also some hellos. My 50th high school reunion was a blast. We managed to renew many friendships and there is a good chance another gathering will happen in two years, when most of us will be 70 years old. Thanks to all of you for reading this. I hope the news continues to be good for us, and I'd encourage you to drop a note and let us know how you fare in this time we call life. God Bless each of you, Danny Harrell

The View from Here

Good Morning to all of you following this infrequent summary of Deb's health Deb's overall health, as related to cancer remains the same. Scans are repeated with the same overall results. A spot of breast cancer remains on her liver. Deb was fortunate to loose her job as of May first. She ended almost 35 years of employment with Kemper. She was fortunate in that she received her severance shortly before the State of Illinois Insurance Department (I think that's correct) took over Kemper (Lumbermen's Mutual Company?). Oh yes, the other development. In addition to having me around every day, she has two teenage daughters, Harumi Katori from Japan, and Emma Bonde from Denmark. YFU (Youth for Understanding) worked with us to select Emma in March. Emma, a wonderful, beautiful girl (a Bond girl?) arrived August 8th after a flight from Denmark to Germany to Dulles airport in Washington D.C. to O'hare. Looking a bit tired and lost, she arrived about two hours late. We loaded her bags and took the long drive home. She met and charmed Strider (the wonder dog) and settled into our family and hearts. Harumi, called Katorine, was a wonderful development that happened in the beginning of September. YFU asked us to pick up Katorine at O'hare and be a welcoming family for her. Get her started in school and they would place her with a permanent family as soon as possible. After two weeks we decided to keep her and she has been a terrific addition to our family. She has been fun, and we have been learning about Japanese customs and language. She is affectionate and very happy. She helps with everything and is a great friend to Emma. Who would have ever thought that we would have two 16 year old students at the same time. But what a great development so far. The girls share a lot; classes, friends and us, they have charmed the family and each other. Katorine's patience and Emma's fluency in English compliment each other and they are both great students with lots of "A's" on their report cards. Deb cooks every night and she and I rest during the day until the girls get home at 3:15 PM. So Deb has a lot to keep her busy, something she worried about from May to September. We've traveled to Milwaukee, Galena and Chicago, and this month we plan to go to Michigan. Our vehicle is equipped with a DVD player, so a trip of any real length allows the girls to sample our collection. Homework keeps both Deb and I active. I personally enjoy having Deb home and the twins here. The holidays are just around the corner. Wow, where did this year go? We take Emma and Katorine through Halloween (their first) followed by Christmas and Thanksgiving. Every day is a new discovery about Japan or Denmark. Every day brings new challenges and sometimes a crisis or two. It's great. I always like to remind myself to live in the moment, love large and limit worry. God Bless you all.

Good News

Hi everyone,

Deb's CT scan results were good. No new cancer and the cancer present on her liver hasn't changed.

We view this as good news and a blessing.

Other than that, there isn't much to report. We continue to enjoy our small group and the emotional support of friends and family. Deb will have another CT scan in six months, I assume.

Thanks for keeping up with us.

God Bless all of you.

Dan

Merry Christmas 2012

Here is our Christmas thoughts for all of you,


December 24, 2011

Merry Christmas to all, and our wish for a Happy New Year.

This Year has been a special one for us, with all the surprises we could want and God’s blessings through all of the year. We didn’t send a letter last year because when I put one together, it seemed much too sad, and in reality, 2010 had some bright spots too, brought into focus by looking backwards over time.

We celebrated our twentieth wedding anniversary in 2010 and decided to go back to Montreal and see if anything had changed. Our trip had all the mystery of France, with a convenient North America location, coupled with a side trip to Quebec City, for the crowning Francophile experience. We stayed at the Queen Elizabeth, as before, and got caught up in the Montreal, Philadelphia hockey play off game excitement. Chicago won the Stanley Cup, the first since 1961, and I was very proud to be able to watch the games and root for the Blackhawks.

A year ago Deb was diagnosed with right side breast cancer, confirmed by a biopsy, a shock really, especially since all the exams had been normal. Chemo started in early December and a mastectomy followed in May. The good news is that Deb is doing well and getting her strength back, slow but sure and still working full time. The breast cancer had attached to her liver but is thought to be stable. She will have another CT scan Monday to see how things look.

I had my right hip replaced in May, so for almost a month we convalesced together, enjoying our time together at home. Deb returned to work and eventually so did I, for a week, and then retired on August first. Not only do I really like being home, Strider is thrilled to have me here so she can nap on the love seat next to me.

I was in Michigan in August to visit Kathi, Erin and Kris. Kris and Bud live in the Grand Rapids area so I spent some time with them and the grandkids, Mitchell and Madelynn. Then I went to the Pontiac area to visit with Kathi and Jim and to attend a Pontiac Central High School band reunion. I think my friend Peggy and I were the oldest ones there. I’m glad I wasn’t asked to play anything.

Erin and Quinn were visiting in the area so we all congregated at Kathi’s and later had dinner at the Clarkston Union restaurant. Erin’s husband Rob, a career USAF member, returned from his yearlong duty in Korea, and they have now moved to his next duty station near Pensacola Florida. Erin hopes to be there long enough for Quinn to complete high school. Quinn is sixteen.

Sadly, we put Gabby, our cat, down in June. She was sixteen years old and had come to have just too many health challenges to go on without being miserable. Our vet and her team sent a nice sympathy card and Gabby’s paw prints to help us remember her. It is so difficult to lose a loved pet, after so many years. It’s hard to believe Strider is nine years old now.

We are part of a great small group through church that has helped us keep our balance through all the ups and downs. There have been times and days in the past year that we were scared, overjoyed, angry, in denial and riding the roller coaster of emotions as our situation evolved, but through it all we were comforted by great friends, family and most of all our Lord, who marked a path for us through this year and gave us the strength to survive.

Someone wrote that the secret of happiness is to walk slowly through life, savoring the exercise, and to make no left turns while driving. Three right turns make a left turn, as you all know. And statistics show most senior driver’s accidents come during left turns. I want to be around to continue my driving Deb up the wall.

We have enjoyed a wonderful Thanksgiving and look forward to Christmas and New Year. We hope and pray for healing for Mary as she battles leukemia, Jack as he treats for skin cancer and keeps an eye on his lymphoma, currently in remission. We mourn the passing of our friends Jill and Herman from cancer, and the health problems that seem to visit everyone we know.

This year we have tried to look at our life and feel the contentment that comes from knowing that God has given us so many blessings, and that He has only asked us to be good stewards of those blessings and to share them with others. We are certainly blessed by your prayers and petitions to our Lord asking for healing for us and we’ve seen the results of those prayers in the recent positive medical exams.

God Bless each of you in 2012

Dan, Deb and Strider, the wonder dog