Funeral Arrangements for Mark Silver

Mark Michael Silver
Silver, Mark. Passed away on September 23, 2013. Beloved husband of Mary. Loving and devoted father of Ariel and Lila. Survived by sisters Gail Mizel and Karen Silver. He will be sadly missed and remembered by all his nieces, nephews and extended family, colleagues and friends. Funeral service will be held on Wednesday, September 25, 2013 at 9:30 a.m. at Steeles Memorial Chapel, 350 Steeles Ave. West, Thornhill. Interment to follow at Pardes Chaim Cemetery, Community section. Memorial donations may be made to the Leukemia and Lymphoma Research Foundation 1-866-565-0076.
Date of Death: Monday, September 23, 2013
Yartzheit day: 19 Tishri, 5774
Date of Funeral: Wednesday, September 25, 2013
Time of Funeral: 9:30 AM
Location of Funeral: Steeles Memorial Chapel, 350 Steeles Ave. W.
Location of Burial: Pardes Chaim Cemetery, Community section
Shiva Location:  
   
  Shiva private
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What a long strange trip it’s been.

This will be the most difficult post to write as yet, so I’m going to try to keep it short.
The treatment for Mark’s rare blood disease did not work.

We returned to the Odette Cancer Clinic at Sunnybrook Hospital last month for a follow up bone marrow biopsy and also an emergency lymph node biopsy. He had nodes almost double in size on both sides of his neck. When the neck surgeon examined Mark’s swollen nodes he decided to perform an excision, not an aspiration as I was expecting. Right in front of me he cut Mark’s neck open and removed part of a lymph node – not the whole thing as it was too large. The doctor did not like what he took out.

After 10 agonizing days we finally got a call from Mark’s doctor at Baycrest saying she needed to talk to us right away. The results were in and it was not good. Also, the hematologist at Sunnybrook wanted to see the entire family, except for Mark, first thing the next morning. Nobody likes to receive that call.

To put it simply, the medicine did not work. The disease progressed. Mark is now diagnosed with incurable Acute Myeloid Leukemia.

The lymph node that was removed is called a chloroma, a solid leukemic tumor, which is rare. Even in a healthy man the prognosis is grim. The doctor has given him just weeks as this cancer is very aggressive. He has a new lump in his armpit now. He is slowly losing weight and his energy level is declining. He is conscious and most days he is getting out of bed and up into his wheelchair. We’ve taken him outside on the last few warm days that we’ve had. Sometimes he just feels crummy and he doesn’t know why. Mark was told of his condition and he bravely accepted it. However, because of his messed up short term memory, we’re not sure how much he has remembered and I’m not about to remind him. There is no point in asking why this has happened to him because there is no acceptable answer. We try to make each day as meaningful as possible and enjoy and appreciate his presence. He is loved and cared for and we make sure he knows it.

We’ve decided to treat him in a palliative way. There is no cure and we don’t wish for him to suffer in any way. So far he hasn’t required much in the way of pain killers. He has survived more than 3 weeks post diagnosis as of this writing. We don’t know for sure how or when the end will come, but Mark is finishing his physical journey.

We are not accepting any more visitors now, except for immediate family and the regular close friends, and those who have already made arrangements to see us. This is family time now. Thanks for understanding.

It’s a terrible thing to watch someone die. We are angry and desolate, consumed with hate for this disease. It doesn’t help that we have silently sworn to keep up appearances. Things are about to change and never be the same, and it isn’t a quick flick of fate’s wrist but a slow, wrenching turn, as if the power steering has gone out.”                                          – Carol Radziwill, “What Remains”

January 2013 Update

Mark is still in the hospital at Baycrest, still in Complex Continuing Care, 17 months after suffering and surviving the massive strokes. The only tube in him now is a trach which takes a long time to be weaned off of. He had the feeding tube removed a few months ago which is a huge improvement. It doesn’t happen very often on his ward. He’s still eating a pureed diet, sometimes on his own, and we continue to bring him 2 delicious and highly nutritious green smoothies daily. His short term memory is very much impaired unfortunately but the odd time he does surprise us by remembering what happened earlier in the same day. He is still progressing at physio. The therapists had him up on his feet a few months ago, which was great! (see photo below) No steps yet but his affected leg is strong and working. Because his good shoulder is slightly out of joint again, he is not standing now as he needs the strength of his arms to support himself. We’re working on getting that shoulder muscle strong and hope that he’ll be up on his feet again in the new year.

His doctor is giving us little hope that he’ll ever come home again, unfortunately. He may have to live in long term care, but we’ll cross that bridge when we get to it. We believe in living in the moment. I’m still with him every day, with one or both of our daughters, sometimes alone. I am completely exhausted physically and mentally, but manage to laugh and smile every day, and get Mark to do the same! He’s in much better spirits these days, which is probably due to a new anti-depressant. It’s just such a relief to be able to say goodbye to him at night without him crying.

These past few months we’ve been dealing with another health matter. Mark has a very rare blood disease, a myeloproliferative disease. This is a disease of the bone marrow in which excess cells are produced. His condition is hard to define as he does not have one of the typical genetic mutations associated with CML (chronic myelogenous leukemia) or HES (Hyper Eosinophilic Syndrome) but a rare genetic mutation. This apparently was the cause for the blood clots and the strokes. There aren’t any warning signs for this condition. He’s had it for quite some time. His white blood cell count, specifically the eosinophils, has been consistently high this whole time, and unless you are getting your blood tested on a regular basis, you won’t know you have this. On top of this it was discovered that his spleen is slightly enlarged. Those two factors alone were enough to send him to see a hematologist at Sunnybrook Hospital. We’ve had a few trips there already since the end of August. In fact we waited the entire summer for the first appointment. He’s had several blood tests and the first of many bone marrow biopsies. The biopsy is the only way to see what’s going on inside the bone marrow. He is taking a cancer drug, not chemo but a targeted drug therapy called Gleevec. He had to go on Prednisone for the first two weeks to ward off any bad side effects, and he handled it well. He also had to have an echocardiogram before starting the treatment to make sure his heart is strong and healthy, which it is.  He’s been on the drug for about two months now and so far he’s having a positive response. He is now taking the full dose, after starting off slowly with it. He’ll have to have more blood tests and another bone marrow biopsy in the months ahead to determine if this drug is right for him. If it is he’ll most likely stay on it forever as the disease is chronic and can be progressive. There is no cure. It’s a huge concern, not just because of the history of cancer in his family, but simply because this is another thing for Mark to deal with.

He seems to tire easily, and he sweats easily too. He is maintaining his weight. The side effects of this drug are not nice, but fortunately they’re not as bad as chemo. You can read about it here if you wish: http://en.wikipedia.org/wiki/Imatinib   (Mark does not have the Philadelphia Chromosome, and he is negative PDGFRa (platelet derived growth factor receptor gene rearrangements). His mutation is on chromosomes 9 and 12.) He also had to endure getting his blood sugar tested 4 times a day while he was on the prednisone. He did NOT like that, but it was always within the normal range.

We’ve had a LOT to deal with as you can see, hence my long absence here in keeping you all up to date. I hope you all understand that I am up to my eyeballs in responsibilities and writing this blog is just one more thing to do. Nobody, except maybe other caregivers,  can truly understand exactly how exhausted I am. My peers at Baycrest are pushing their parents around, not their spouses. It’s been a long and difficult road this past year. I feel much older than I am, most of the time. But like I’ve said before, the only way to get through this is to just deal with the day at hand, not worry about tomorrow, and don’t ever think about the “what if’s” of yesterday. That’ll get me nowhere but stressed out and I can’t afford to do that. I’ve got Mark, our girls, our dog and most of all ME to look after. So far, we’re all doing a pretty good job if I do say so myself. Our family may be fractured at the moment, but we try our best to be a family and have fun and be silly, at the old folks hospital.

He stands for the first time!

MarkStandingIn September, 2012, Mark finally got up on his feet with the help of two fantastic physio therapists. As you can see in the photo Mark needs the use of his strong right arm and the gripping ability of *both* of his hands to support himself. He is looking in a mirror here. It takes a huge amount of effort to do this even for a few minutes. He stands up, and then slowly sits back down again, about 3 or 4 times in a row with a break in between. He has to be reminded to keep his left (affected) leg from bending at the knee. He really liked standing up again, but I think more than that he was proud to show these ladies exactly how tall he really is.

On the beach

IMG_3542In August Mark was selected to go on the last outing of the summer. This time it was a trip to the Beach and Ariel was able to go with us. We ate on the boardwalk, Mark had some ice cream, and we took off his sandals so he could feel the sand between his toes. Another beautiful day with a welcome change of scenery!