The Autumn of Toomie's Content

It's two days after my stent replacement, and everything is getting much better. I'm still a little itchy, but I can tell that there are less axe-wielding Keebler-esque itch-elves hewing my flesh into itchy chunks for me to scratch, which is nice. I really have to say that the teams at Stanford are really quite considerate. When talking to the doctor who was going to perform the procedure I mentioned my experience the first time about feeling like an inner tube, and he said they'd make an effort to deflate my gizzards the best they could. I also asked him about foods to eat (or to avoid) because of the stent, and was informed that I could eat anything I pleased, which was awesome news since I've been craving salads and vegetables, and not the smoothie-fied versions, mmm-kay.

True to his word I woke up feeling a little discombobulated from the anesthesia, and totally normal from an internal psi perspective! No one could mistake me for a summer inflatable toy and try to take me out on the lake for an afternoon float, and my darling sister (who drove me down and kept me company) and I proceeded to make our exit.

I did get sick from the anesthesia, but it was a minor inconvenience. Thankfully my sister drives an Element, and she basically told me to throw up as much as I wanted because they could just hose it out like an animal's zoo pen when she got home. I opted to spare her a major mess, and used a Lululemon Poser bag to catch my boot. I can speak with empirical assuredness that those bags (yoga hipster though they may be) are nowhere near liquid proof.

When I got home I was exhausted, and caught some serious Zs. The next day I was out on walk with my youngest son, and the doctor's office called to check in on my progress. I told them that symptoms were fading as expected, and I was feeling no ill-effects from the procedure. After my son picked out a bottle cap from the dirt, and proudly displayed it.

After looking at the photo I reflected on the fact that we are changing seasons, and that I spent the whole summer treating Toomie to poison, and here we were coming into fall, and further contemplated that this was the season where the year's growth is shed and renewed, and likened this tumor to floral detritus that ends up under a log and becomes food for the worms. I'm thrilled that this is all wrapping up in 2012. I want to make this year a package deal for cancer: diagnose, treat, cut open, recover, and burgeon in newfound health.

Adding to the fun

Everything was just going swimmingly along when all of the sudden my skin started itching like it was inhabited by itch-gnomes hatcheting away at my flesh with itch-poisoned blades. "Yay!" I thought, as I plowed my nails into my itch gashes. Needless to say, I contacted the the team at Stanford, and met with them to discuss, and the thought is that the biliary stent placed way back in June is somehow "clogged", and I'm developing jaundice symptoms, so I get to have an encore performance of this awesome little procedure called an ERCP, which I originally had when the stent was first installed.

The best part of the ERCP, aside from being completely out, is that when they put the endoscope into my gullet and start poking around my tender vittles in order to evaluate the condition of the common bile duct and stent is that they may inflate my stomach and other adjacent organs with air in order to move the scope around and do whatever they need to do. From my last ERCP, I can say that this air fills me up like a beer keg, but unfortunately there's no party. This should be an out-patient procedure, and I should be coming home the same day, albeit with a slightly higher psi rating than when I arrived.

I'm not looking forward to becoming a human keg, although I am looking forward in having these jaundice symptoms alleviated because the itching is maddening. Ironically, the stent and all the plumping it's involved in will be coming out with the surgery I'm having in about a week, but if I let this continue then I'll likely start looking like a block of cheddar cheese, and have other interesting side effects like sepsis and/or renal/liver failure.

Of course, it's possible that my first ERCP wasn't 100% indicative of what every one will be like. Here's to hoping that they only need to use the same amount of air to fill up a road cycling bicycle tire, and not the volume used on a mud and snow tire.

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.

Anticlimactic

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.

Posted with Blogsy

Holding

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.

The Moment of Truth

Well...it'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.

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.