What Went On Between the Endos and the Chemo

Now that we knew what was going on the next thing was to find out how much that little bastard cancer spread out. Is it still confined to my pancreas or has it metastasized to other sites in my body?

That’s how I got to meet Dr. Rocha. Melissa & I think he’s cool. His staff is packed with Ivy League Med school grads who chose him & Virginia Mason to continue their qualifications. AWESOME! He needed to stick a laparoscopic probe into my belly button and have a look around, to see if there were any other tumors. He also installed a sub-dermal “port” that would make it a lot easier to drip the chemo into my jugular vein, and while the hood was up he also inflated my abdomen with saline, drained it out, and sent it off to a lab to check for floating cancer cells. The good news – no other tumors and nothing floating.

I also got a bonus. When we were talking about the procedure I asked if he could fix a little belly button hernia that I’d developed several years earlier. He said, “oh yeah, we’ll just throw that in for free”. AWESOME! So not only are we relieved but my sleek physique includes an all new belly button!

Somewhere in there I also had a couple more CAT scans. The good news was that the bastard tumor had not grown either.

I should have started chemo right away. In fact, my oncologist, Dr. Picozzi, had started up a chemo trial that I wanted to be part of. I’ll tell you about it later after I’ve looked up the big words again. My bilirubin from the jaundice had dropped like a rock. I felt energized and even started running a bit because all that weight loss got me below the weight where I can run without blowing out my joints. However, the chemo trial required all participants to have a starting bilirubin concentration of 1.2mg/dL or less.

Why?¬†One of the things required for most chemo treatments is a working liver. A highly functional liver. A liver that doesn’t have sludgy bilirubin still in it from the earlier bile duct blockage. My bilirubin levels peaked just after they inserted a stent into that bile duct to open it back up after being shoved closed by the tumor. Then it just dropped like a rock, and although I felt great it was not quite enough for the study protocol I wanted to join….for 3 weeks. Argh!!!

Dr. Picozzi offered me a choice to either start the chemo with a reduced dosage or hold off until those bilirubin levels went under 1.2 mg/dL. If I chose to start right away that would boot me out of the study, so I asked what his concern would be about the rate of tumor growth and how much another delay would impact my risk levels and he said, “That’s a good question. Over weeks, not bad. Over months, not good,” and since I was staring at him with that professional-let’s-get-this-straight look that I’ve cultivated, he smiled and said, “really no problem.”

So I made the choice to wait. I asked him what we could do about those pesky levels and he and the 2 nurses plus 2 researchers in the room all said “Ursodiol”, and nodded at each other. This stuff is used for folks who are having trouble flushing reluctant gunk out of the liver, like alcoholics and such. I filled the prescription at the center and started taking it twice a day.

I went to get an infusion and could not do it for 3 weeks in a row. WTF???

You can see from the plot my levels went asymptotic over the past few weeks. Waaaa! The good news was that I got another CAT scan and the tumor (that bastard) was the same size.

After the 3rd week we all agreed that since it was soooooo close to 1.2 mg/dL It was OK to note an exception to the protocol and go ahead with me in the trial! YAY! I was really getting anxious to get this chemo stuff rolling.