Franklin’s passing

Yesterday afternoon, August 11, 2018, Franklin passed away at Virginia Mason hospital, surrounded by family. At the end, his passing was peaceful and he was not in pain.

Earlier this week we had still been optimistic that he might recover enough to begin the clinical trial; Dr. Picozzi said that Franklin still had a spot saved. Franklin was still having considerable trouble breathing, however, and was also eating very little. On Thursday, he had a CT scan to determine whether fluid (ascites) was causing pressure on his lungs, and whether this could be relieved. The scan showed, however, that while there might be fluid, there were also metastases in the lungs.

Franklin continued to receive visitors throughout Thursday and Friday; he was alert much of the time but also sleeping a lot. On Friday, the doctors met with the family for a care conference. The result of this was a decision to evaluate the next steps over the weekend – whether Franklin would stay where he was, move to hospice care at Virginia Mason, or move to in-home care.

One of his last wishes on Saturday morning was to wear “regular” clothes rather than a hospital gown. So Linnea found him a soft fleece shirt that he could wear, which made him happy.

Linnea and Franklin at 7:20am, 8-11-18

He then asked to be removed from supplemental oxygen and other support except for his morphine drip. He told Linnea that he was ready, and that he was not afraid.

Over the course of Saturday, he quickly slipped into unconsciousness and his breathing became shallower, but he did not appear to be in pain. He was attended by Linnea, his mother, his son David, his sister Elizabeth, his niece Kimberly and nephew William and his family, and Linnea’s sons – my brother Matthew and me. David’s, Matthew’s, and my families were also able to come in briefly to say goodbye. Franklin’s daughter Catherine, who had been in constant contact with Franklin’s doctors since she had to return to Boston, joined by phone.

Around 4:30pm, Pastor Jimmy Hao from Grace Chinese Lutheran Church began a commendation service for Franklin. As we held hands and prayed, Franklin took his last breaths.

My mother and Franklin’s entire family are extremely grateful for all the support that you all have shown over the past three years. Franklin would not have lived as long as he did, with the quality of life that he had, without your love and assistance.

We will post details about services and other memorials in the coming days, but the tentative plan is to have services the weekend of August 24-26. For now, the best way to contact Linnea is via text or email (or mail); she is exhausted and is not receiving visitors or calls at the moment.

Yesterday’s date was a palindrome – 8-11-18 – which Franklin would have appreciated.

Health Update 9 August 2018

This is Bill Chu, my sister Kim and I are visiting to Uncle Franklin. I been invited to share this update with the blog community. Please pray for healing.

Franklin is currently in Virginia Mason Hospital room 1822. He is having severe respiratory distress and a lack of appetite. Franklin is hoping to get on a clinical trial a new oral cancer treatment. The clinical trial board is holding a spot for him; however, given his compromised state he does not presently qualify.

Franklin has been in hospital for several weeks with a variety of compilations including infection, bowel obstruction and respiratory distress.

He has friends and family surrounding him. Jenny, Catherine, David, Matthew and Marco are showering him with love and care.

 

July proved to be a challenging period. Franklin spent the first week in hospital for an infection. He was released once infection was under control, however he had to return to hospital after only one day at home. This time Franklin was unable to keep anything down, having difficulty breathing and was retaining water.

Radiologic evidence indicated a obstruction in the distal end of the small intestine. Franklin was treated with a nasogastric tube to release pressure from his belly, and medication to promote clearing of the obstruction.

For two weeks Franklin took nothing by mouth. The internal medicine team was at a standstill and the surgical team elected not to take Franklin’s case given the his current cancer status. Dr.  Catherine Chu was on hand to intercede both as a patient advocate and as a medical consultant. She and Franklin suggested that the Gastrointestinal Team might employ a stent to relieve the obstruction.

Under the pressure of persistent requests for consult from the Doctors Chu , the GI team sent Omar the GI Physicians Assistant to make an initial assessment. The PA thought the stent idea might be fruitful and ordered a Cat scan to determine a more precise assessment of the blockage. Was the there a single blockage or multiple sites? Was the blockage due to impaction within the bowel or were metastatic tumors strangulating the gut? These were the salient questions that the cat scan would answer.

It was determined that the blockage was internal to the bowel and located a single site in the ilium or last part of the small intestine. While this is just outside the typical colonoscopic range, Dr Steven  Ross the GI surgeon felt confident that he could reach the site and repurpose a stent for this “Hail Mary” procedure. Dr. Catherine Chu was pleased that Dr. Ross was Mass General Hospital trained. Furthermore Dr. Ross was able to demonstrate that his hands were steady.  Linnea was satisfied that the surgeon was confident and simultaneously realistic.

On Wednesday Aug 1, the stent was successfully placed in Franklin’s ilium. Within two days x-rays showed contrast dye in the sigmoid colon. These findings were consistent with a successful clearing of the obstruction. However, Franklin was still unable to have a bowel movement, had very little appetite and continued to have a distended belly.

Three days later Franklin had a bowel movement. His first in several weeks.  He still needs to get his appetite up before he can go home or begin the trial.

Health Update 14 June 2018

Again, we were on the 7:05 Seattle ferry for the scheduled Chemo session.  We arrived just in time for the 8 AM appointment and was greeted by Dr. Picozzi for the exam before any tests were started!  He found me to be healthy appearing, my weight stable and I have no discomfort or pain; he continued my same regimen of meds.  He said that the paresthesia may take some time to improve and may not resolve completely.  We queried about the Ca marker rise and he tried dodging it by saying one reading does not mean much.  Well today (result came in after his visit) the marker jumped from 2000u/ml to 4000u/ml since two weeks ago!!  He still wanted to wait after the next CT scan scheduled for my next visit in two weeks before making any changes.  This is somewhat of a discouragement.

I am otherwise doing well.  Wish my balance is good enough to at least go on the golf course to hit some chipping and putting but looks like that’ll yet be a while.

Deep heartfelt thanks for visiting and your continued care and concern.  Update after the CT Scan next visit.

Happy Father’s Day to ALL.

Health Update: 2 June 2018

My apologies for the slight delayed reporting.  I had my scheduled Chemo session on the 31 May without any glitches and I tolerated the treatment well.  All my usual lab tests were acceptable.  Physically I feel well, and I look like a picture of health.  I deferred writing this report because I was a little disappointed and felt a little depressed that my Ca 19-9 went the wrong direction, from 966 to >1700 u/ml.  It seems my current regimen is not ‘winning.”  Hoping to participate in an appropriate clinical trial soon.

My only morbidity is approximately 90% paresthesia of both of my feet; but I am managing well with my walking sticks.  The PT gave and taught me helpful hints and exercises on how to fall to minimize the possibilities of breaking any bony structures.  We also developed a program to attempt to increase the blood flow to the extremities.  Furthermore, these exercises will strengthen the body mass.

Good news is that on May 26th, Linnea, Brother Dan/Sue (wife) and I took a little vacation and flew to Phoenix, AZ.  We spent one day visiting Sedona, another day at the Painted Desert and Petrified Forest, and our last day at the magnificent Grand Canyon.  A most wonderful change of scenery and weather.  Much gratitude and appreciation to Dan for driving and making all the arrangements.  We all had a wonderful time.

Thanks Friends and Relatives for visiting this site.  Keep up your Prayers and your Good Karma coming my way.

6 May 2018, Health Update

p.s  I have been searching my mind for the proper description of the paresthesia of my feet for I knew I had experienced these symptoms before.  Finally it dawned on me.  We all have had ‘numbed’ feeling in one or the other foot sometimes after sitting crossing our legs for a period of time.  Upon rising, not only do we have a heavy ‘dead weight’ leg, but also sensations of pins-and-needles tingling in the toes, accompanied often with a loss of balance.  This describes the way my lower extremities have been for at least three weeks, much more prevalent today.  Although able, I walk very unsteadily today.  Hopefully having stopped the Abraxane last Thursday, these paresthesia symptoms will slowly improve.

Health Update: 4 May 2018

Thursday, May 3, early rise for boat trip to Seattle on the 7:55.  We arrived at the terminal 12 minutes early, but the car capacity was at overload.  For once in a very few times we used our medical priority boarding pass and were placed in the carpool lane, at the bow of the boat, first in line.  Thus, behind the motorcyclists, we had front row seats watching the glorious Seattle morning skyline as we sailed.  Greatly appreciated the Good beginning of our day.

Again, we experienced an efficient staff and technicians at VM as they all performed their tests efficiently and uneventfully by 11:00.

Dr. Picozzi examined me around 12:30.

Blood works were unremarkable.

CA 19-9 rose slightly (996) but most likely still within normal limits. (WNL) of test variation.

CT Scan was a little puzzling.  The ‘older’ lesions seemed to be receding, but there may be suggestion of a few suspicious new one developing!  (though non-specific).  Dr. Picozzi commented that the result and report were conflicting.  The areas of ‘abscess’ monitored by Dr. Woolston showed slight shrinkage.  (I dose myself with IV antibiotic daily and she concurred to continue the current regimen since it causes me minimal inconvenience.)

Symptomatically, I continue to have less stamina and am more aware of losing muscle strength.  The lower extremities paresthesia is slowly and steadily getting more pronounced and more intolerable.  I have very little feelings at the bottom of both my feet.  From sitting to standing, I often lose my balance, having a sensation of falling mostly forwards.  I also stumble some when walking because I don’t feel my toes as I walk.  Sometimes, while walking, the bottom of both feet feels ‘pins-and-needles’ awareness.  Linnea is insisting that I start trial using a walking pole.  We requested a referral to have a physical therapy evaluation and that was promptly arranged today with the New Motion Rx on Bainbridge.  For this time, we also stopped the Abraxane agent as a trial to see if the paresthesia symptoms lessened.

As to the thinning of the mucosa membrane and development of ulcers in the mouth, it was better these last two weeks, but not completely resolved.  Because Dr. Picozzi eliminated Abraxane, he full-dosed my Irinotecan regimen.  (This agent most likely plays a greater role with my mouth sores!)  Oh, Well, although I’ve been on this med in the past and had not had problems.

Bottom Line:  I feel well, I don’t feel sick, my appetite is good, and I am maintaining my weight.  I mostly accomplish trying to exercise by (walk a mile day with Linnea’s urging).  Now with PT regimen onboard perhaps I’ll have more assistance in building more strength.

Again,  Deeply-Felt THANKS to all visitors.  Update in two weeks.

Health Update: 20 April 2018

Again, we were on the 7:55 Seattle ferry for the scheduled Chemo session.  Just so that everyone is speaking the same language, let me differentiate and clarify the terms signs and symptom.  Signs:  any visible observations such as weight loss, change in skin coloration, swelling and puffiness, hair thinning/loss, etc.  Symptoms:  how the body feels such as fatigue, sleepiness, nausea/vomiting, headaches, peripheral paresthesia, mucosal thinning and ulcer formation secondary to the Chemo agent causing difficulty in eating, G-I irregularities, etc.

General Health: I sense that my muscle mass is weakening, and I think I should start some mild arm and leg strengthening training.  The thinning and development of sores in the mouth make eating, (a significant part of joy for me) difficult these last 3 weeks.  For this reason, Dr. Picozzi reduced the dosage of Irinotecan and 5-FU to 75% of my normal dose.  Hopefully this helps to reduce the discomfort.  Additionally, I am having more paresthesia of my ankles and feet.  I can’t tell if I have socks on or off; sometimes I can’t even tell if I have shoes on!  Also, I lose balance momentarily when I stand up from sitting, or whenever I get out of bed.  This most likely is a side effect of Abraxane, but I don’t want any changes in the dosage of this medication until after we get the result of the CT Scan at my next visit.

Physical Exam:  I appear as a picture of health.

Lab Test:  All values acceptable.

CA antigen 19-9, 2 weeks ago when I was pleased when it was 1076.7u/ml, today it came in at 903u/ml.  Very happy with this trend after a high of 3300u/ml on February 8, 2018.

CT scan at the next appointment 3 May will reveal a lot more; can’t wait!!

Deep heartfelt thanks for visiting and your continued care and concern.  Update after the CT Scan next visit.

Health Update 6 April 2018

Returned to Virginia Mason yesterday on the 7: 55 Seattle ferry for a routine Chemo Therapy session. All blood works continued improving slowly toward normality. Asked about new symptoms, I can only say that the GI system was more active with difficulty eating because of the thinning and much increased sensitivity of the mouth and cheek membrane. Even eating a soft croissant hurts because it is ‘rough’ on the cheek mucosal lining. Frequency on the other end was also problematic. Additionally, I felt sleepy a lot. I shut my eyes and I’m asleep. Waiting in line behind Linnea for communion Sunday during the short contemplative time, I truly felt asleep, momentarily, standing upright. I can cope with all this; I am reasonably comfortable. Despite the fatigue, I have enough energy to walk 1 mile with Linnea every other day.

A recap on the factors the doctors consider in determining our present status:
1. General Health
2. Physical Exam and general impression
3. Laboratory tests: CBC, Electrolytes, Liver and Kidney function, etc. Most important to me… the CA antigen 19-9, (TUMOR MARKER)
Remember it was not long ago it shot up to 3300u/ml ?
4 weeks ago, it began to reverse, first good sign.
Today it came in at 1076.7u/ml compared to 1173.9u/ml two weeks ago, I’ll take it even though it is only a 10% change. (may only indicate lab tolerance since normal is <37u/ml.)
4. CT Scan (scheduled next month)

I’ve managed to complete and file our 2017 1040 income tax document. We are planning a leisurely trip to Portland to visit Linnea’s siblings next week. I also have signed up for our Bethany’s Men’s retreat at the end of this month. We are making the most out of living life fully.

Thanks for visiting for I feel privileged of your care and concerns. Hope all’s well with all of you. Update after my next treatment 4/19/2018.

Health Update: 23 March 2018

I had a routine Chemo therapy session yesterday, 3/22. My blood works were reasonable with expected persistent anemia and lower protein and albumin level (though not quite low enough to be causing shortness of breath nor pedal edema). The Neulasta shot given two days after the infusions has maintained the white blood cell levels at normal range allowing my Chemo treatment regimen to remain on schedule. Another sign of ‘improvement’ is that the CA 19-9 correspondingly came down from over 3300+u one month ago; 1738u two weeks ago, and yesterday it registered 1174u!!! Heading the right direction.

I have had mild paresthesia of my hand/fingers and feet for some time secondary to the side effects of Oxaliplatin. Even though that medicine was completed 6 weeks ago, and the symptoms were slowly disappearing, but during these last two weeks I sensed more tingling and numbness, especially in my feet. Dr. Picozzi informed me that this is also a side effect to Abraxane. He was ready to decrease my dosage to 75%. I promised to monitor my progress and when/if it becomes more problematic, we’ll cut the dose then. I don’t want to ‘rock the boat’ when I am seemingly improving. Dr. Picozzi concurred as long as I agreed not to minimize the side effects. Thus, my Chemo ‘cocktail’ consists of Abraxane, Leucovorin, Irinotecan and 5-FU, with daily infusion through my Power Port of a broad-spectrum antibiotic INVanz. So far, I am managing well.

Living life fully. Monday 3/19, my maternal cousin Pastor Andrew Chao and his wife Emily came from Houston for a visit. They stayed with us and we brought Mom here for a few days. We shared some quality precious times together. Showcasing Bainbridge Island, we toured our BI Museum of Art, our Bloedel Reserve, the Japanese Exclusion Memorial, drove around the environmental outdoor experience center and the Lynwood shopping area. They left this morning. We had a very good reunion.

Again, thanks for visiting. Thanks for your loving care and concerns.

Health Update: 8 March 2018

After completion of 6 cycles of treatment with Abraxane, Irinotecan, Leucovorin and 5-FU, Dr. Picozzi ordered a CT scan for today’s visit. We arrived at 8am, had blood drawn, port reassessed, and proceeded to drink 24 oz contrast liquid and concluded with an uneventful scan procedure.

We were again placed in our usual private infusion room and shortly thereafter, Dr. Picozzi arrived and consulted with Linnea and me. Basically, he was feeling upbeat and eager to report to us a little good news. The blood works were acceptable, the CA 19-9 is treading down significantly for the first time in a long while, from over 3300u to 1700u. AND, the CT showed slight decrease in size of all metastatic lesions! Possibly beginning to be heading toward the right direction, hopefully!!!

Thanks for all the Good Karma you all are sending my way.

Brother Dan figured it out that I have about 4 days of improved energy level prior to each Chemo session. He arranged for Linnea and me to fly to Mesquite, NV to soak in a little sun and appreciate some new scenery. (We left on Saturday 3/3 and returned on 3/7, just in time for the 3/8 Chemo session.) Of course, exercising in the form of golfing on courses that are ‘playable’ was NOT a disincentive. We played 2 rounds on the Conestoga course with roughhewn terrain, flashy bunkers and mountain panoramas on Sunday and Tuesday, perfect remedy to our rainy NW. On Monday we toured St. George, UT with its Mormon Temple and Tabernacle, then we drove to the Zion National Park, covering three states by intruding through a small section of AZ.

You are now up-dated. All’s Good. Thanks be to God.

p.s. after returned home we were told that was two pipe bombs found incidentally while a passerby noted someone dropped a bag and left. While we were visiting St George. The authority was notified, and they took the bag to the football field and blew it up. It was activated and was filled with shrapnel and nails, and other sharp implements. Idyllic little quiet Mormon town St. George!

Thanks to all of you, my fervent supporters and cheer-leaders.