Baby Steps

More than a week has transpired since I last updated the blog, but I think our progress is going to best be measured in weeks versus days.  Here is the progress David has made over the past week.  He is now able to tolerate having his stomach tube clamped all the time without nausea or vomiting, which means that all of the fluid & food that he is taking in is not just sitting in his stomach, but actually progressing from his stomach into his intestines.  The problem has now become that whatever he takes in only stays with him for about an hour before making it's way through his entire small bowel & colon.  So, to try to combat this problem, David's has discontinued the use of the increased GI motility drug, Reglan, & has advanced his diet to include things like minced up baked potato, minced up chicken breast, & mashed up banana.  He is reluctant to advance his diet to include much more than this at this point because he doesn't want to do anything to cause his intestines to overload & stop working again.  He has managed to gain four pounds over the past week (he is up to 180.5#!), but because his intake is limited, he is still receiving IV nutrition for 12 hours every night.  We are now checking his blood sugar levels just once a day & they are staying in an acceptable range (below 150), so he isn't requiring any insulin at this time.  His incisional wounds are healing very nicely.  He still has a large hematoma (the size of a large egg) associated with the vein graft taken from his upper thigh, but the skin integrity over this area looks much better & we think this will eventually be resorbed.  His mobility is quite good (he can easily walk a mile or two), but he is reluctant to do too much walking because it tends to stimulate his GI tract & burn calories that he can't afford to lose right now.

Some interesting things happened over the past week.  We went into the infusion center at Moores Cancer Center to get some blood work done, have David's chemo port flushed (it needs to be flushed every four to six weeks), & to have the dressing changed on his central IV line (this is a sterile procedure that I don't want to even attempt).  The central IV line has two ports & one of the ports wasn't working (they couldn't flush anything into it & couldn't draw blood back from it), so they used the clot busting drug, TPA, to get this port working again.  Took about an hour to get it to work, but the nurse was excellent & very persistent!  On Wednesday evening, when David was taking a shower, the stitch that was holding his stomach tube in place busted & the tube moved about four inches out of his stomach.  He was able to move it right back into place, but it was clearly not going to stay without a new stitch!  Because this happened at 5 PM, which is after normal clinic hours, we had to go to the emergency room to have the thing stitched back into place.  We were seen pretty quickly & the procedure didn't take very long to do, but we managed to finish up during a shift change & it took us about two hours to get discharged!!  We were both growing very impatient & nearly bailed out of the ER without an official discharge.  We saw Dr. Fanta (the oncologist) on Thursday.  He talked about the next step in David's overall treatment plan.  In a couple of weeks, David will have another CT study of his abdomen & chest, which will be used as his new baseline study for future comparisons.  Then, he will undergo six more months of chemotherapy (this is longer than we were anticipating).  It will be a single agent chemotherapy drug called Gemcitabine, which is administered once a week for three weeks with a one week break, for a total of 18 treatments.  Dr. Fanta has assured us that this drug is kinder & gentler than the Folfirinox treatment that David underwent previously.  So, we need to get David's GI tract back on track & then ready ourselves for the next battle in this ongoing fight.

To me, the most positive thing that happened over this past week is something pretty subtle that we might have overlooked if we didn't tend to pay attention to the details in the paperwork that people hand us on a regular basis.  At the end of each doctor's appointment, we are given an appointment summary.  Up until our appointment this past Thursday, David's list of diagnoses has always been headed by non-resectable pancreatic cancer.  On Thursday, the list of diagnoses read like this:  #1. Pancreatic insufficiency #2.  Malnutrition #3. Pancreatic cancer ......  Unbelievable joy filled my heart to see that David has fought this fight to knock pancreatic cancer from the number one slot to the number three slot!!!  He may just have this foe on it's heels, so, I say, let's keep on fighting until we are victorious!!!  Not only will David be a winner, but for those of us who know & love him, we will win too because he will continue to be a part of our lives for years to come!!!  Now I ask you, could there be a better Christmas present than that?

Optimistic & determined, Janet