The “C” Word - The Next Chapter, Day 6 - Time Table speeds up

Since the CT scan George has had more difficult days with his digestive system.  He had been having nausea and vomiting spells since June 1 (ever 4-7 days) and most were relieved after a few hours.  The night after the CT scan brought on another spell – probably some related to all the barium he had to drink.  Saturday he stayed low key and did not eat at all until dinnertime when he had something light.  He was fine on Sunday and Monday.  Then, on Tuesday it started again.  This time though he had more painful cramping and mostly dry heaves.  After six hours of him going back and forth to the bathroom (thinking he had to go to the bathroom OR feeling the need to vomit) I finally asked, “When is this enough? You’ve ready on the FB page that small bowel obstructions (SBO) can be common and that what you are experiencing appears to be the same type of symptoms.  So when is it time to get this checked out.  It’s been six hours and you are still in a lot of pain and still spending all of your time between the chair/bed and the bathroom.”  He agreed and, at 11:15PM we were off to the ER.  There they did blood work and an X-ray.  The X-ray showed no visible obstructions.  The blood work showed low potassium.  So he was pumped with fluids and given potassium.  Given pain and nausea meds.  We were home about 2 hours after arriving. 

George slept relatively well but after waking still felt a little queasy.  I headed out to find a pharmacy open early so I could fill the prescriptions we’d been given so I could get to work.  By the time that was done it was 9AM.  At 1PM George called and said he thought he needed to go back to the ER.  I left work, headed home and picked him up.  In the waiting room I texted Dr. Bastidas and let him know we were in the ER and that George had been having issues with vomiting and nausea and we were not sure if it was related to the cancer. (Note:  We picked up the CT scan disk and the printed report on Saturday and, on reading it, learned that there were more lesions/tumors than prior test last fall.  A bit disconcerting.)  Dr. Bastidas then stayed in touch with the ER doctor to help figure out the next step.  After 5 hours the choice was (1) be admitted to help keep symptoms controlled or (2) go home and try to keep symptoms controlled.  We let them know that the Zofran did not appear to work very well so they said we could add a suppository to help.  He was discharged about 7PM (the ER was super busy!)  My friend, Judy, had arrived at the hospital just as we were leaving.  She followed us home and stayed with George while I ran to the pharmacy to get the prescription filled. 

George went to bed about 8:45 and I stayed downstairs to just catch my breath.  Dr. Bastidas phoned about 9:45 and I filled him in on what had transpired.  He asked a few questions and said he was on call this weekend if George had problems retaining food and needed to be admitted for IV nutrition.  I let him know that we had an appointment with him at 9:15 and we would see him then. 

George still had a few episodes of vomiting in the early part of the night – the last time being just before midnight.  The suppository finally kicked in and he slept the rest of the night.  In order to ensure that things stayed as calm as possible, I woke him up at 2:30 and 5AM to give him meds.  (The time in between those I could not get back to sleep.  So my sleep was 12-2:30AM and 5:30-7:30AM.)

As we drove to see Dr. B, George said he was actually feeling pretty good.  As we went in to the office, Dr. B was already asking his assistant to cue up a team and asking for it to be done next week!  Whoa! 

Dr. Bastidas sat down with us and reviewed our past history (this was done for the benefit of his intern).  He explained to us the probably cause of George’s current digestive issues.  Apparently there is a tumor at the base of his stomach near the duodena that is causing some restriction as food leaves the stomach.  So, if George has eaten something that temporarily “gets stuck” there, it will cause cramping and vomiting to expel it.  It makes sense that once George has ‘gotten rid” of food that he feels better.  We are not sure why we had such a prolonged period of these spells in the past 2 days because George’s belly should have been emptied sooner. 
Dr. Bastidas also spoke about the different types of chemotherapy available for cancer (most do not apply to PMP).  This, again, was for the benefit of the intern.  He also spoke about a treatment available that looks very promising for certain types of cancers (Lynch syndrome, I think).  This treatment has so much potential the Dr. George Fischer at Stanford decided not to retire because he is so excited.)

We looked over the CT scan with Dr. B and he showed us where there were tumors or possible tumors.  Then we sat down and discussed the “when”.  His biggest concern is that George get enough nutrients to stay healthy.  Given that George was feeling pretty good today, the decision was made to use meds and diet to try to keep George comfortable for a few weeks.  Dr. B will be gone from 7/14-7/18 so surgery would need to be before or after that.  Given that there can be complications and we really want him to be around after surgery, we decided on the week of July 18. (Note: Date is 7/20/16)   By doing this we can do all the things we have planned over the next few weeks.  First, I need to be at work next week as one staff is out on vacation and our staffing is already low.  Second, we have a planned meeting of some local PMP survivors in Stockton on July 9^th.  (Coming from Sacramento, Stockton and Dublin) We really want to have some personal connection with others because people with other cancers cannot relate to what they have gone through.  July 9^th also happens to be George’s birthday.  The next day we will get the twins who will be with us for a week to attend VBS and hang out with George (aka Poppy).  They are looking forward to coming for the week and Poppy is looking forward to having them here. 

Now, things are moving full speed ahead.  Part of us is reeling from the fact that the surgery date had to be moved so close given that George now has symptoms of the disease taking hold. (Note:  This is the first time he has ever been symptomatic in the entire time he has had the cancer.)  We had hoped to make it through most of the summer and maybe get away for a short bit.  Instead, we will enjoy as much as we can the next few weeks.  Although relieved to find out that the cancer has not attacked the liver, kidney, etc. and is still contained to the outside of the organs, the prospect of having surgery happen in under three weeks is cause for some anxiety.  The surgery will still take at least the same amount of time as the first one (7-8 hours) because the doctor has to “undo” some of the connections in order to adequately get to the tumors and ensure that the areas are as clean as possible.  The HIPEC team will be available and, as long as he can remove all visible tumors, will proceed.  For me, that is the most anxious part – waiting to hear the “Go” of “No Go” a few hours after surgery has begun.  I pray that we once again get the “Go” to proceed.

Our battle against this dread disease starts up again.  Our faith remains strong.  Our prayer warriors have begun to do battle with us.  We are so grateful for the love and support that pours out.  No doubt the prayers led us back to the ER where a doctor knew to give us just that extra “boost” in meds to alleviate the GI spells.  (She even called this afternoon to check in with us.  That’s a first!)  Grateful to have the best surgeon (in our eyes) on our side.
Photo below was of our recent "adventure" day trip to Monterey (actually were only there for 2 hours - basically ate and then found this shop).  The "poop" emoji is popular with PMP folk - because most of them have lost portions of their bowels during the MOAS (mother of all surgeries) and thus this is an issue for them.  I look forward to many, many more smiles like this once we get through this surgery and are on the recovery side of things.