Sunday, April 6, 2008
After Dr. Riyad Albibi diagnosis of "well-defined adenocarcinoma" located in the sigmoid almost at the rectal junction, things happened rather quickly.
The first thing is to get the beast out of you. After a conversation with surgeon Dr Aziz Ahmad, MD, I checked into our hospital in late February. He operated laparoscopically to remove some 26cm of the sigmoid, from a little below the carcinoma (of 3.5cm length) to well above it, along with the support structures (drains, lymph nodes, blood vessels, etc.).
A problem with a breathing tube kept me in ICU for this day and the next, but I was doped and know nothing of it. Gradual recovery with everyone looking for me to pass something (gas or solid). I finally did and began to feel fairly decent.
Then Dr Ahmad came around with the pathology findings of the sigmoid and support structure removed. Turns out that 11 lymph nodes were removed and seven of them were found positive for cancer. This makes my cancer stage Duke's C2 or 3 on the scale of 0-4. Not good, but not a death sentence, either. Finally I was discharged on the eighth day after surgery.
We went home and loafed that evening. The next day we drove to a nearby new department store, where I walked slowly around getting my legs back under me. I bought a pair of shoes and we went back home. Later in the evening, I felt cold and went to bed. My wife found me about 10pm with a temperature of 102.8* so she took me back to the emergency room. A bunch of tests were run through the night.
Dr. Ahmad came by early the next morning and had me re-admitted. Then came several days of lots of generic antibiotics with no sign of improvement and a generally yucky feeling and no appetite. Dr Ahmad then had a CT scan done, showing an abcess in the abdominal cavity near the rejoined sigmoid; a drain was inserted to let things in it out. Finally, the things coming out were analyzed by an infectious diseases specialist who put me on Zyvox (with the others) and that finally killed the infection. Discharged on the sixth day after admission with all kinds of pills.
During the post-op phase of the stay, a medical oncologist (Dr Syed Mahmood, MD) came by, introduced himself, and asked that I come to his office after discharge to discuss chemotherapy. He noted that the odds of having the cancer return within five years was 50-50, and he felt with chemotherapy he could drive that down to 25-75. Hmm...
We went to his oncology center and discussed the type of treatment he would give (standard FOLFOX, every other week for 24 weeks). I asked if I would offend him by going for a second opinion. He said "No, I thoroughly approve and I'll co-operate if I can with another center".
So I submitted a request to the Mayo Clinic branch in Jacksonville, Florida. Our son and his wife live there, so it won't be a hardship to be there. In due time I received my appointment and was notified who my oncologist will be.
I've sent all the paperwork, slides, PET/CT scan files, and other stuff to them so there'll be a file started when I get there. Some I'll have to take with me - it just got to me too late.
Where I think I stand is this:
1. the PET/CT scan didn't find any definite signs of metastatic spreading to other major organs, although it was wishy-washy due to the incisions that still might be masking something.
2. CEA is low (0.9 to 1.7) and Albumin output is high, a decent indication that it hasn't spread far.
3. the cancer is a well-defined adenocarcinoma, which is thought to move less quickly than some others.
4. I have a healthy attitude and great support people.
So, my goal is to get whatever chemotherapy treatment that Mayo thinks is targeted at my specific situation in the hope that we can kill all of the carcinogenic cells and return to a disease-free life.
More in a bit, after the first Mayo meeting....
Thursday, April 17, 2008
We went to JAX on 4/12 and stayed with our son & his wife. We had fun over the weekend. On the 14th, we registered and then went to a consultation with Dr Elizabeth Johnson MD, medical oncologist.
She had obviously looked at the papers I had sent Mayo. I explained the steps taken till now and asked if there were any changes she would make. She said the FOLFOX is the right treatment for me - she would have done the same. So it's back to PC for FOLFOX.
However, she also said she didn't like the looks of the things in the right lung noted at the home hospital and ordered an un-enhanced CT scan, and another meeting the next day. She was also unhappy with making the call whether or not to use radiation therapy and ordered a meeting with a radiation oncologist.
The CT scan was done efficiently. EVERYTHING is done efficiently at Mayo. It's a beautiful facility with great people - even in the cafeteria.
We returned the next day. Dr Johnson was very happy and said so. An ill-defined shape is decreasing in size, which she now thinks was something left over from bronchitis several months ago. The two little nodules have not increased in size; she feels they're nothing, but should be watched for the next two years to be certain.
She then told us to bug the radiaton people to get in earlier than the appointment two days later. We did, and the radiation oncologist we were to see later gave up her lunch hour to see us. After reviewing the documentation and the dimensions, she felt that radiation therapy was not called for, but she wanted to talk with my surgeon before formally saying that. If called for, it can be done in PC.
We took the kids out to dinner that night and returned to PC the next day (16th).
So now I have confidence that the treatment to be obtained here is correct and know to have the lungs looked at in 3-4 months, then each 6 months thereafter.
Bring on the chemo!!!
We went to JAX on 4/12 and stayed with our son & his wife. We had fun over the weekend. On the 14th, we registered and then went to a consultation with Dr Elizabeth Johnson MD, medical oncologist.
She had obviously looked at the papers I had sent Mayo. I explained the steps taken till now and asked if there were any changes she would make. She said the FOLFOX is the right treatment for me - she would have done the same. So it's back to PC for FOLFOX.
However, she also said she didn't like the looks of the things in the right lung noted at the home hospital and ordered an un-enhanced CT scan, and another meeting the next day. She was also unhappy with making the call whether or not to use radiation therapy and ordered a meeting with a radiation oncologist.
The CT scan was done efficiently. EVERYTHING is done efficiently at Mayo. It's a beautiful facility with great people - even in the cafeteria.
We returned the next day. Dr Johnson was very happy and said so. An ill-defined shape is decreasing in size, which she now thinks was something left over from bronchitis several months ago. The two little nodules have not increased in size; she feels they're nothing, but should be watched for the next two years to be certain.
She then told us to bug the radiaton people to get in earlier than the appointment two days later. We did, and the radiation oncologist we were to see later gave up her lunch hour to see us. After reviewing the documentation and the dimensions, she felt that radiation therapy was not called for, but she wanted to talk with my surgeon before formally saying that. If called for, it can be done in PC.
We took the kids out to dinner that night and returned to PC the next day (16th).
So now I have confidence that the treatment to be obtained here is correct and know to have the lungs looked at in 3-4 months, then each 6 months thereafter.
Bring on the chemo!!!
