During this current admission I had a CT scan (that I mentioned in a the previous post) to assess where things are at with regards to my bowel obstruction and the current issue of obstructive Jaundice.
What I didn’t mention is what it found with regards to my cancer, and unfortunately, its not good.
There is significant progression of the liver disease over a very short period of time. The dominant large lesion is in segment 7 of the liver has doubled in size and there are multiple new lesions in the 0.5-1cm range throughout the liver, with existing lesions also increasing in size. There is also further development in the lymphadenopathy around the renal arteries and in the general retro-peritoneal area, including increasing lymphadenopathy around the hilum of the liver. The infiltrative disease around the liver could well be responsible for the biliary obstruction that I have, and may have been responsible for the duodenal obstruction as well.
Basically its pretty bad. I have missed three rounds of chemotherapy now due to the complications and hospital admissions over the past month, and that is likely to be a big contributor as to why my disease has progressed. However, it is of such rapid disease progression that my oncologist tends to think that it may have starting progressing under chemo, even thought my last scan was stable (and relatively recent).
So what does all this mean???
Well, basically it means I need to get back on to chemotherapy as quick as possible in the hope we can slow down the growth. If in fact regrowth was beginning to happen whilst on chemo, it suggests that chemo is losing its efficacy, and that means i’m starting to run out of options.
In the mean time I have to get past the current main issue, which is my biliary obstruction.
On Thursday I had my ERCP under a general anaesthetic and it unfortunately it wasn’t successful as they couldn’t get access to the ampulla at all due to the duodenal stent being in the way. This means that I have had to go for a PTC drain insertion best described in the video below rather than by me.
This procedure was due to go ahead on Thursday afternoon until I spiked a fever of 39.0 degrees. It was deferred and I was started on IV antibiotics in case this was choleangitis. Choleangitis is an infection of the biliary system and can be a very rapid onset sepsis and can lead to septic shock. The fever I had was absolutely miserable with rigors and lasting for about 5 hours. I haven’t had one since thankfully, and the thinking now is that instead of choleangitis, it was probably a septic shower as result of manipulation around the biliary system in the failed ERCP. Fortunately the latter as a diagnosis is much better than choleangitis.
On Friday I went for my PTC insertion under light sedation and they got as far as getting the drain into the duodenum via my liver. It was a difficult access just because of the location of the left lobe of my liver relative to my ribcage, so they weren’t able to get the stent in. The plan is to go back under general anaesthetic and put the stent in so that I have internal and external biliary drainage. I am currently biding my time in hospital until that can happen early next week and then all things going to plan start chemotherapy the week after that.
So as you can see, there has been a lot happening over the past few days, both in terms of medical management and developments, as well as the processing of the CT report and what that actually means. What it really means is that I am getting down the last ditch therapies now for treating this cancer, and it has established that if you give it an inch, it will take a few dozen miles with that liberty. What treatments are left as options are really speculative, and whether or not I will get response is equally as speculative. Hannah and I have processed this and understand that it means I am unlikely to make Christmas this year, and my time could be up sooner rather later as the decision to go palliative is getting closer and closer.
In someways this hasn’t been as hard to process as you might think, and I think that is in large part due to the fact that I have had the better part of 5 1/2 years with this illness to do this processing. It is however, a brutal shock back to the reality I face, as it has seemed like the past 6 months has been a holiday, as we have seen Elise’s first few months of adventures in this world. It has been an awesome escape from reality as we watch new life blossom…
But now the holiday is now over, and I have to get back to the business of dying. I plan to do that the best way possible, as not everyone has the privilege of anticipating their own end. So often people’s end times are full of regrets and catching up with bucket lists. I don’t have either of those, I am grateful for the life I have lived, I have been given extraordinary opportunities to embrace it in all its beauty, God has blessed me enormously. I plan to enjoy every last moment, savour its delight and its low times. It’s all part of the package.
Until next time..
I recently had to do a presentation at work on a patient, for which I decided to present myself, since I had a semi-interesting presentation. This meant that I was able to get hold of my abdominal x-rays from when I first presented back in 2008.
The first is what was taken when I first arrived at hospital. There isnt too much to see on it, it was considered fairly non-specific in terms of findings, and as such, illicited conservative treatment.
Then there are the three x-rays taken 2 days later, when I was significant worse from a clinical perspective. These x-rays show some large loops of dilated small bowel on the supine, and air-fluid levels on the erect. All signs of a bowel obstruction, and as such I was taken to theatre within about 4 hours of these pictures being taken.
The rest is history.
I’m currently going through a process at the moment of often saying “This time last year..” and then reflecting on what actually was going on at this time last year.
The one year milestone is not necessarily an achievement, but more a moment to stop and reflect on the somewhat unpredictable detour life has taken in such a short 12 months. Having said that, the recent news in my life means that I might actually begin to measure achievements in years, or months for that matter. Either way, The week beginning Sunday the 8th of November 2009, maps back to the week beginning on Sunday 9th of November 2008, a week where everything changed, or began to change, in a direction that cannot be considered for the better.
Sunday = The day where something ‘wasn’t quite right’. After a mammoth meal the night before, my stomach was up to, what at the time, seemed to be a fairly routine grumbling about the quantity of food I ate. I stopped eating, lest I aggravate the belly below, and somewhat disconcertingly, stopped bowel motions, the latter wasn’t intentional.
Tuesday = The day where 3 days of stomach pains began to intensify. Pains would come in waves anywhere from 5 to 30 minutes apart, lasting no longer than 30 -60 seconds long. The day culminated in a nice bout of vomiting in the evening. This was the trigger point for Hannah and I to head to the hospital. Medical alarm bells were beginning to ring in our head, and the fact that we were due to fly out of the country on Friday was also at the back of our minds.
Friday = after a few days of ‘conservative management’ which is medical speak for ‘have some Panadol and lets see what happens’, the pain was significantly worse. Repeat abdominal x-rays showed barn door signs for bowel obstruction. The Oxford Handbook of Clinical Medicine (OHCM) says under the heading ‘Bowel Obstruction’ – “Never let the sun go down on a bowel obstruction”. And so, as the OHCM says, we followed. Surgery was 3 1/2 hours long, and what might have been an atypical presentation of an appendicitis became a full-blown right-sided hemicolectomy.
Thursday = 6 days post op: We got the news that the tumour that had caused the obstruction was indeed an adenocarcinoma of T3N2M1 Histology. Almost as bad as it gets.
Friday (21st Nov) = 7 days post op: Incidentally my 28th birthday, I was discharged.
And so… in that short space of time, in the view of the majority of people, life took a turn for the worse.
I however, prefer to think about it differently. Life didn’t take a turn for the worse, it took a turn down an unexpected route. I am the first to put my hand up and say it certainly didn’t take a turn for the better, but I feel that to say it took a turn for the worse might be a little melodramatic!
There are two reason’s I say this. They are:
- Death is nothing to be feared (although arguably the form death might take could be feared). We all die, it’s an inescapable fact of life. Whether Muslim or Christian, atheist or Buddhist, Caucasian or Asian, we die. How we approach this fact (as with all things in life) will determine how we respond to it. By not fearing it, we empower life, which is the part that comes before death. Many people do not fear death for many reasons. For me, faith in Christ is an integral part of that reason, and it is through my faith that the ‘alive’ part of life becomes empowered.
- Life is actually at its most interesting when there are mountains to climb, challenges to approach, and valleys to be descended (and ascended). The previous year where medicine has been sidelined in my life is proof to this fact. I NEED something to fill my time, I need challenges in my life to overcome, I need to create meaning.
It’s this final point which is pivotal. Life by itself will no doubt, by default, fall into a repeating pattern of routine, which, for all intents and purposes, lacks meaning. Meaning in life is not stumbled upon, that’s an illusion sold to us by Hollywood. Meaning is created. We have the choice to create meaning in our life regardless of what our circumstances are.
I’m dying of cancer.
But I’m choosing to create meaning in that.
Christ enables me to create that meaning; on my own strength I would fail.
Again, the final point is pivotal.
So when I reflect on ‘This time last year’.. I reflect on not why, but how, how I can create meaning. This is why life has only re-routed, instead of taking a turn for the worse.
It’s an interesting route to say the least.
Thanks for Listening.