Stable is a Good Thing!

Haven't made an entry to this blog in a couple of weeks because things have been pretty stable, which is a good situation for us!  Let me break this down a bit better & provide some details.

David continues to receive IV antibiotics to treat the abscesses in his liver.  As of today, he has been receiving IV Zosyn via a pump that infuses the antibiotic directly into the chemo port in his chest for seven weeks.  The pump is programmed to deliver Zosyn for four hours, then normal saline for four hours, & repeat this four hours on & four hours off over a 24 hour period before we switch to a new bag of antibiotics.  So, on the final four hours of a 24 hour period, where the pump is delivering just normal saline, we disconnect David from the pump completely to allow him four hours every afternoon of freedom from lugging around a five pound pump -- oh sweet freedom!!  You might recall that David's infectious disease doctor had added an oral antibiotic (Bactrim) to his regimen in an effort to keep the bugs causing his infection from potentially becoming resistant to the IV Zosyn.  Unfortunately, as has been the case historically for David since his surgery five years ago, oral antibiotics cause him to have severe diarrhea (like 8 to 12 episodes a day!).  So, after two weeks of literally "gutting out" the oral antibiotics, David's infectious disease doctor told him to stop taking the Bactrim.  While his bowel is happier off the Bactrim, it will take a couple of more weeks for his system to recover.  On Tuesday, May 7th, David will have a recheck CT to reassess the liver abscesses -- fingers crossed that they will look much improved (we doubt they will be gone as they are notoriously difficult to treat & typically require months of antibiotics).  Based on the CT results, a decision will be made about how to proceed.

The cholecystostomy tube is still present, draining David's gallbladder.  Some days he basically drains nothing from his gallbladder & other days he drains maybe 20 mls of bile appearing material.  This will be rechecked in a couple of weeks & if his cystic duct (the duct that drains bile from the gallbladder into the common bile duct) remains patent, then we may begin to cap or close off his tube & see if his gallbladder can function properly without needing to drain to the outside.  If it passes that test, then the tube could be removed, which would be awesome as David's greatest discomfort right now is coming from having the tube in his side.  We questioned Dr. Lowy (the surgeon that performed David's abdominal surgery five years ago) about whether he thought David might be a candidate to have a cholecystectomy (surgical removal of his gallbladder).  Based on a number of reasons, Dr. Lowy doesn't feel this would be feasible -- bummer!  So, about the best we can hope for is that the tube could be removed & David's gallbladder could function adequately without the tube.

We've not seen any signs of the metabolic encephalopathy re-emerging.  David's not been overly fatigued & his cognition has been excellent.  The oral antibiotic definitely kept David's bowel working overtime so that nothing stayed in his system for very long to allow ammonia to build up.  But, as David's bowel recovers from that insult, we will have to reassess when & how much lactulose to use to achieve the goal of having two to three bowel movements a day.  There is always something to keep us on our toes (or near a toilet!)!

It's been about six weeks since David completed the stereotactic body radiation therapy to the head of his pancreas.  This was the time frame that David's oncologist had mentioned starting back on some type of systemic treatment for the cancer.  However, we can't start back on any type of systemic treatment until the infection in David's liver is cleared up -- we can't do anything that may cause immunosuppression while David is fighting an active infection.  So, again, fingers crossed that we can clear up these liver abscesses & get back to fighting the cancer.

Overall, David is doing better now than he has done since the beginning of January.  His appetite is actually good, his endurance is improving (he is able to walk 3 miles every morning & still have energy to do some other projects in his office or around the house throughout the day), his strength is a little better, & he has been able to gain a couple of pounds (he is now weighing in around 155 pounds).  He is battling with some insomnia, which nothing he has tried has been able to reliably help.  But, we will take insomnia over pain or nausea any day (or night!)!!

I think that pretty well catches you up on us.  Please send your good thoughts, positive energy, & prayers our way next week for some nice improvements on the CT scan!  In the meantime, I hope you enjoy a wonderful weekend & some beautiful Spring weather!

Hugs, Janet