Saturday, September 29, 2012

Green light the production

Friday was a long day. The traffic was expectantly gnarly.
We went to Stanford and met up with the surgeon, after he reviewed the most recent CT scan I had. Doctors wanted to see what the status of the tumor was with regards to positioning with some vascular tissue, as Toomie is nudged up against some major veins and arteries.

The surgeon had some wonderful things to say:
  1. We can operate in conjunction with a vascular surgeon as they need to reconstruct my veins and/or arteries during the procedure.
  2. It's excellent news that the tumor markers decreased another 30%.
  3. The Pylorus-Preserving Pancreaticoduodenectomy (Whipple Procedure) wouldn't involve removing the entire pancreas, and he'll only need to remove a little bit of my stomach (at this point, these are good things given the fact that about only 15-20% of people diagnosed with pancreatic adenocarcinoma are eligible for surgery).
He also said some relatively spooky shit:
  • If the blood loss is too significant in the event there is significant vascular reconstruction during the surgery I could die.
This is the first time I've ever heard "you could die" from a doctor. I've never had any major health problems. Not even a broken bone. The extent of my surgical history prior to all this involves some stitches on some cut fingers.

During the meeting with the surgeon I indicated I wanted to proceed with surgery, so I then was told I need to do another CT + Angiogram study in order to provide the vascular surgeon some insight into my inner workings. My wife and I ended up staying around Stanford until the scan, which was scheduled for 4:30. We grabbed some lunch, where we had some fabulously presented jasmine tea.
We then popped by the Apple Store and charged our phones, browsed some nearby stores, and finally it was time to head over to the imaging center. While charging up the surgeon's office doing the Whipple called and scheduled my surgery. The folks at the imaging facility were downright lovely to work with, and my nurse was able to access my port as opposed to trying to stick me 5 times to get a peripheral IV going. I was truly thankful for this little nugget of goodness. I then ran through the scan without any hitches, and the wife and I foolishly hopped on the road at 5:20 leaving Stanford. It took us about 2 hours to get home. The trip reminded me of my former daily commute to eBay from home. Ah, glorious traffic. I love how you can take hours away from our life and ask for nothing in return but fatter guts, bigger asses, and more burned fuel. I digress.

I go back to Stanford next week to meet with the vascular surgeon, discuss the recent scan and the forthcoming surgery, and then I'll meet with some folks to "map my veins". I'll likely donate some during the reconstruction. Come mid-October I check in for operation. I'll likely be in the hospital for 7-10 days afterwards.

The date is set. It's going to be some brutal recovery, but this procedure is curative in nature. I'll need to do some chemo after I recover from going under the knife, too, so it'll be quite a journey. I'm very happy to be on this path.

Thanks to all our family and friends helping us out. We could not be going through this without your assistance and love.

Thursday, September 27, 2012


Results of the CT scan were inconclusive. After walking into the doctor's office yesterday I was feeling pretty optimistic: I expected to hear that tumor markers dropped, and the tumor itself shrunk 50%. Tumor markers were good. They dropped another 30% from last time. The tumor apparently only experienced very minor shrinkage, and there doesn't seem to be the expected withdrawal of the tumor away from some critical circulatory tissue. It's hard to be definitive because the doctor reviewing the scan didn't really write it in a way that compared the size in a way conducive to being considered apples-to-apples. My oncologist and potential surgeon are discussing to see if they can get a clear picture of the state of the tumor in order to be able to determine a sound treatment plan and ultimately a surgery date.

It could have been worse: the tumor could've grown, and it didn't. There could've have been metastases, and there weren't. I am bummed that the tumor doesn't appear to have shrunk much, however. My oncologist posited that the scan looks at things from a top down perspective, so the tumor could've flattened, which would be nice, but I'm not holding my breath.

Next steps are to continue to meet with surgeons as planned. My oncologist is suggesting another procedure that would do a more definitive measurement, and I'm all for it. In the meantime though, I'm likely going to have to continue doing chemo in order to keep that little fucker Toomie bathing in poison. Lather up you little bastard. There's still a lot of ground left in this race, and I'm going to win. I might also do radiation, which is cool too. I'm still holding out on gaining Hulk powers should I end up going in to be irradiated.

There's likely to be some considerable changes in the days to come. I am not sure how this is all going to play out, and there's likely going to be some flux. We'll figure it out.

Wednesday, September 26, 2012


I haven't gotten the scan results yet. I will have them later today. Yesterday I went in for blood work, which is always a larf. They plug this crazy looking needle into my heartplug, er, vascular port, and then use a syringe to draw out as much blood as needed, which in my case was 4 vials yesterday. A lovely 4-pack sampler of some boutiquely produced gluten/casein-free and transfat absent J-blood. Today should have two interesting data points: a new tumor marker and the shrinkage/orientation of the tumor. Both exciting tidbits are going to be huge. I anticipate both being good pieces of news.
On a sidenote, I recently had a really cool experience. Another pancreatic cancer affected citizen came across one of my postings. She left a comment indicating that her husband was on the same regiment as me and had a CT scan the same day as me. Hope all is going as well as it can for you both!

I'm aiming to get another post out today after I get the results.

Sunday, September 23, 2012

The Moment of Truth's more like a CT scan of truth. Tomorrow I'm going in for a CT scan, following a pancreatic protocol, which is supposed to a) indicate with greater accuracy than a PET scan how much the tumor has shrunk, and b) where exactly it's positioned with regards to some key veins.

I've met with surgeons from Stanford and UCSF, and we're going to meet up again to review the results this week and discuss next steps.

Obviously, this is a very important scan, or rather the results of the scan are going to be of paramount importance with regards to how I proceed with treatment. I've been planning on getting a date set for mid-October, CT scan results not withstanding. Apparently, these imaging systems are still not the most accurate tools to determine the growth/decimation of pancreatic tumors, and I'd likely still go in for the procedure regardless of the result (barring some highly deterministic results that would preclude surgery), and the doctors would be able to make a more informed decision once they open me up and are physically looking at this little fucker inside of me.

I'm both nervous and excited. I honestly feel that as a result of the aggressive chemo treatment I opted into will have seriously thrown a a wrench into the cancer's development, and we'll see good shrinkage, and pulling away from the veins, so the next round of meetings with the surgeons will be discussing the positive news, and scheduling a surgery date.

Regardless of the scan results, I remain optimistic that I will be a candidate for surgery, and I will go under the knife with the knowledge that I'm having the procedure for curative measures, and this will be yet another small (but significant) life obstacle to negotiate.

On another positive note, a friend forwarded me a piece on some pancreatic cancer research legislation that's being discussed in Congress right now:
The Pancreatic Cancer Research & Education Act (S. 362/HR 733) is currently before Congress. The bill requires the National Cancer Institute develop a long-term, comprehensive plan to address pancreatic cancer. More specifically, the legislation would help lead to the development of early detection methods and effective treatment options, which are currently lacking.  The bill has already garnered broad, bipartisan support in both houses of Congress: nearly 60 Senators and more than 280 Members of Congress have signed on.
Don't fumble the ball on this one, Congress. The purple shirted people are watching.

Tuesday, September 18, 2012

Time to roll

I've been neglecting updates because I haven't been feeling the best since my last update. I wrapped up my 4th cycle this past Monday, and feel pretty good about getting a break because it feels like there are some cumulative effects that get progressively worse as treatments go on. I've been consistently battling nausea, on top of some of the less severe side effects. It's finally getting better.

Apparently, one of the drugs (5FU....hahahaha! FU. 5 times. HA!) wreaks havoc on the GI tract, so whoop-dee-doo I get to contend with that awesome experience.

This week and next are doctor visits and scans to cover the next step: surgery. I'm looking forward to seeing what my cancer tumor markers are. I anticipate them to be lower, and the CT scan I'm doing I foresee a shrunken mass ready for plucking out of my body. I wonder if they'll let me keep Toomie. I might want him stuffed in a formaldehyde filled jar, so I can cast insults at him and gloat at the loser whenever I feel the need to do so.

Today I'm meeting with a surgeon from UCSF. Next week I'll confer with one from Stanford, so I'll likely go under the knife at one of these fine establishments.

OK. Time to roll.

Tuesday, September 11, 2012

Round 4

The past weekend was my wife's birthday, and thankfully I was feeling great. We all had a blast.

This past Monday was the fourth and last round of my chemo regiment, which is awesome. I'm determined to make this one a smooth ride out, and stay on top. Coming out of ER my doctor prescribed this anti-nausea patch that I'll wear on my arm. Apparently it's some wonderful new thing, and it's OUTRAGEOUSLY expensive. Fortunately my health insurance covers practically all of it, but $3k for four stickers? You could practically sell these things on the street and take the profits and buy a Vespa-like contraption.

Ironically, when I was feeling nauseas, I couldn't really eat anything, but if I was watching TV and came across the Travel Channel's food programming, "Man Vs Food", my gut was iron. Seriously. Didn't bother me at all. That's just weird.

Once this final round is done I'll be doing visits and scans in preparation for surgery. There's no definite date set yet, although from my perspective the sooner the better. I'd be happy with end of September, but it'll likely be in October.

I'm looking forward to getting some tumor markers, as well! I'm willing the chemo to scorch the earth for Toomie, so I have nice markers, and additional shrinkage of the mass.


Thursday, September 6, 2012

The Second Coming

I thought I was over the hump this past Friday, as Saturday was a good day. The wife and I had some QT, and I ate some heavier food that in retrospect I shouldn't have consumed, but when your neighbor rolls through with fresh lumpia, it's hard to say no.

Come Sunday, and I'm starting to feel like I've just put all of Chernobyl in my abdomen. I ended up having horrible GI issues, and went to the ER on Sunday. They watched me for 5-6 hours, put some fluids in me, gave me more drugs to counteract the nausea, and sent me home. I had a triple threat nurse on Sunday - she is an ER nurse/Oncology nurse/and healer, so I felt like I was getting the crazy advanced 360 degrees of treatment. Unfortunately, as soon as I got home and out of the car I threw up (nothing quite like barfing in your own back yard), then spent the next 12 hours trying to get over the continued GI havoc being wreaked in my guts. Sadly, there was no respite, so back we went to ER on Monday. I ended up being admitted so they could keep fluids in me, run tests, and try to get a hold on the nausea. I think I had just about every anti-nausea drugs known to western science.

Several IV bags later, some skin patches, an MRI, and a couple patchy nights of sleep I finally started to turn around and was discharged on Wednesday. We all think it was a case of the effects of the chemo I'm on, eating not so healthy food the day before, and catching a viral bug that apparently has been going round. For the time being, I'll unfortunately need to keep the kisses separated via dental dams. This was not fun at all. I still don't feel 100%, although I am definitely on the mend.
It's amazing to think that I'll have another round of this coming up this Monday, I'll certainly need to stay on top of nausea, as I don't want to have to spend more time in the hospital after round 4.

I want to thank my wonderful family for helping to take care of my children, while I was down and out, and for all the supportive messages from everyone. One more chemo-related obstacle successfully negotiated. Let's keep the progress moving!