surgery went fine

They connected his stomach directly to the small intestine, bypassing the stricture. He will be in Joplin freeman hospital over the weekend, then come home feeling much better and stronger. Will probably skip this coming week's chemotherapy for recovery time. We are waiting to go see him in the recovery room now.

overnight in the hospital

Today they were unable to do the endoscope, as they found dad had ulcerated his esophagus with all that fun upchucking, so...they are keeping him overnight,and will do a surgery tomorrow, three tiny incisions and putting in a stent so he can start really eating again. The past few days were tough. The IV fluid will really help him too. Then, we'll see how he does the rest of the week and maybe skip chemo this coming week. Some patients do this therapy every other week, so if he needs the rest by golly, he's gonna get rest.

Some trouble with eating

Dad has been having occasional bouts of getting sick. This is making him lose weight and certainly not helping in the battle. The past couple days and especially last night were tough. It is probably not the chemotherapy but rather, the stricture in his duodenum which is not letting food exit his stomach. So, long story short, he is going to Freeman East tomorrow at 2pm to have an endoscope to check it out, and put in a stent if needed. Sure wish they'd done that a month ago. Will keep you posted.

two treatments done

After the first treatment last week, Dad had one or two days where he just felt wiped out, no energy. But this week, after the treatment which included the third med Oxaliplatin, he
 has been feeling pretty good, no exhaustion. He did, however, experience this drug's most common side effect, extreme sensitivity to cold.  He touched a frozen package of meat and it was like ice picks in his fingers. Yikes. And so he can't eat ice cream, which I imagine would be quite pleasant. Great, right at a time when he really needs the calories! Life is definitely not fair.

Dad's treatment plan in Joplin

We went to "chemo training" once again - this time for a new regimen that has shown some success in fighting mestastatic pancreatic cancer. Dad is scheduled to start on Tuesday. It's a 6 week cycle, week 1 and 3 are two drugs delivered via a pump for 24 hours (he goes home with this pump on) - 5FU and Leucovorin (a vitamin complex which increases effectiveness of the chemo and helps reduce chemo side-effects), week 2 and 4 are those two drugs plus Oxaliplatin (which is an antineoplastin related to Cisplatin he received in his first chemo treatments, when the tumor shrank by 1/3).

Info on 5-FU Antineoplastin
Info on Oxaliplatin Antineoplastin

The day after these drugs are administered, Dad has to go back into Joplin to have the pump removed; so that's 2 days a week into Joplin. Week 5 and 6 are no drugs, but once a week he goes in for bloodwork.  This 6 week cycle will be repeated up to 6 times (36 weeks of treatment).

We all hope to see good results and that Dad doesn't suffer ill-effects and weathers this as well or better than his other rounds of chemo. He has had a couple episodes of vomiting which we believe are caused by the stenosis (stricture) in his duodenum - it is very likely he will need a stent put in to solve this problem.

Overall, he is feeling okay but very tired. Doctors and nurses all have recommended he get in the habit of grazing all day, rather than eating 3 big meals; it's hard to break lifetime habits.

We're home in Seneca

Sorry for the delays in updates, have been posting updates to Facebook and calling family, but forgot there are quite a few folks who don't use facebook and aren't seeing the updates.

How the surgery went:
Unfortunately, when they took dad in for surgery and did the initial laproscopy (where they make a couple of incisions and explore to make sure the resection is safe), they discovered some very small spots on the liver; these were biopsied and confirmed as pancreatic cancer. So at that point, they will not put the patient through this severe whipple surgery since the cancer has metastised beyond what they would remove.  We are all very disappointed but not giving up hope!

Going forward:
Dad has a couple weeks of recovery from the laproscopy surgery (awfully sore for a few days!), and then it is back to chemo therapy. We met with Dr Hassan yesterday (oncologist at Freeman) who is conferring with his St Louis doctors to decide on the best therapy. I found several active clinical trials in Kansas City, Springfield, and even one back at Barnes Jewish involving a new drug showing promise at preventing spread of pancreatic cancer.  Will try to keep this updated more often.  We should have some idea of his next therapy options and be starting that plan next week.

A Date for Surgery at last

CT Scan / radiation results in St Louis:
We headed to St Louis on 5/31, Dad had a CT scan on 6/1, then an appointment with Dr Parikh (radiation oncologist) and they also scheduled dad for minor surgery the next morning to replace his stint, which they did with a metal stint this time rather than plastic. Then they squeezed him in Dr Linehan's schedule (surgeon) to discuss options.  We were first very concerned because Dr Parikh said the tumor did not appear to have shrunk much from the radiation; however, Dr Linehan said it appeared to have moved away from the veins (which was his ultimate goal to make the surgery safer). Dr Linehan wanted to move ahead immediately with the surgery to remove the tumor. 

This is fantastic news as it is curative (ie., successful surgery means no more treatments, cancer is gone and dad would just need regular careful monitoring to make sure nothing returns).

***  The BIG surgery is scheduled for June 15.  ***
Please everyone say a prayer and send good vibes our way! 
It is a major procedure called the whipple, where they remove most of the pancreas, and several other partial organs in the vicinity, and basically re-plumb your digestive track.  It is huge - and success is mostly dependent on the skills / experience of the surgeon and his team. Linehan is highly reputed, as are several surgeons at Barnes Jewish, which is why we wanted to be there - surgeons in smaller hospitals and towns just are not exposed to this surgery enough to have the skill to complete it successfully. Barnes Jewish specializes in this surgery; Linehan does several per week and has been doing so for 17 + years.  We have very high hopes for success!

A Scare and everything's okay
We did have a little complication the evening we arrived home from St Louis; Dad got sick (fever spiked to 103), we paged the surgeon who'd put in the stint, and their oncall surgeon of course said to take him to the emergency room, which we did. We were ushered into a private room (so dad's not exposed to germs); his fever was down to 99 and he was feeling MUCH better, so they simply ran blood tests, etc. to make sure he doesn't have an infection; fever is not unusual in cancer patients and does not necessarily mean there's an infection. No signs of infection except for elevated white count (which he has had throughout most of the chemo treatments); they gave him very strong antibiotics as a precaution.  This took about 7 hours (as expected, on a Friday night, at an emergency room which is now the ONLY one in town, since the tornado took out St Johns). We got home about 1:30 am.  Long Day.

Visit from Steve
My brother Steve is now in town for a visit (SURPRISE!) for the next week; mom and dad are both enjoying his visit and we are very very happy he could get away from his busy schedule to take this trip.  :-)
Wish he could stay longer though.  He leaves on Sunday, and then we head back to St Louis Tuesday. Timing worked out perfectly!