ERCP procedure day 9/24/18

ERCP procedure day or you’ll wonder where the yellow went, when they fix your fellow with a stent.

Oh, the waiting, it's so hard. I did go get my flu shot and go for a bit of a walk. Too cool to stay out for long. I missed the café, it closed at 2. Nothing else it's around here.

Doctor called me in, drew a picture of what they are going to do, what they could do, and what they might need to do in a couple weeks. Also gave us some worse case outcomes. Pancreatitis 5% chance and other 5%.  Now I feel worse not better and the procedure will be at least 45 minutes and it is running late. Interesting that the jaundice is more a cosmetic issue than anything else. Huh.

He mentioned both the oncologist and radiation and his chief (he had inserted the gold markers before radiation) had discussions. Said more than once sounded like cancer is gone, just scar tissue. Could be underlying cancer that has returned but might be hard to tell. They all think the best case and think it is, scar tissue.

Biopsy result in a week or week and half. That's a timing issue for us. This wasn't mentioned before. Do we care?

Surprise, this stint isn't meant to stay in. It is to be removed and replaced in 10 to 12 weeks. The idea is do this 2 or 3 times and hopefully the duct would be staying open on its own. Didn’t hear this before either. I saw a great picture of David's duct. The void or narrowing was very obvious, per paperwork its 1cm in length of distal CBD stricture.

This stent is plastic which will clog up after time, sometimes a metal stint is used but that's not what you want because that's last ditch, means they have given up on any improvement.

The biopsy (cytology brushing – think pipe cleaner) results will be back in 7 10 days. Even if it's negative there is a possibility cancer could still be hiding. There is another procedure, EUS, suggested to do in a couple weeks. Not sure why/if we'd opt to do this. The EUS would show if any cancer was hiding under the scar tissue and action plan would then be determined.

Another interesting picture was of them draining this backed up bile. It backs up in your liver. It was a dark black looking sludge. Sort of like when you haven't changed your oil in a very long time.

David weight was 146 down from his normal 162. That’s how bad he has been feeling with pain and discomfort that he hasn’t been eating well and maybe body's ability to utilize what food he did eat. (Says Dr M)

Dr Chen said they are seeing this more due to radiation treatment. Assume this means for pancreatic cancer they are doing more radiation, maybe similar to the high intense study David was in. And stated that ER Doctors are trained to see a mass, not think about scar tissue. This is way when we left ER we were thinking there was another mass or growth.

David has been asking me and telling me same thing over and over. So I am writing all this for his clarification! It’s a little funny and a little taxing, I know he can’t help it but...

Now our upcoming cruise, cancel or go? That's our next decision. More discussion needed.

Thank you all for your concern and prayers. Stay tuned for the next adventure.

My Yellow Fellow

This picture was to come at the end. Oh well. It's some of David's Pan CAN San Diego purple stride team members. If you care to join up go to PanCAN.org find the team: Fist Bumpers

If you hadn’t heard Dave has obstructive jaundice. This was a bit alarming. Not anything we were expecting or prepared for. We had finished up our summer rv trip and were back in San Diego for a schedule “3 month” follow up CT. David had done the required labs on Thursday and was feeling his usual pain/discomfort. Sunday evening, I said gosh you look yellow. He said yeah he had noticed it but thought it was just light in the bathroom.

Monday morning I looked deep into his eyes and they were yellow! Ok, taking action. Some phone calls and it was decided that he should go get a full set of labs done. As lab results started coming in and doctors got involved he was instructed to go to ER. In fact, one said he should have gone to ER immediately. Wednesday spent in ER and another set of blood draws along with a CT and sonogram.

After what seemed like a very long time (at least to me who was not getting rolled around from one room to another for procedures) it was determined that David needed a stent placed in his bio duct that was collapsed. This will be done Monday as an outpatient. His bilirubin number was 10 (normal is 1 or less) the doctor that will preform this felt the wait was ok as he had done this procedure with a bilirubin as high as 20.

They asked about pain, only would be able to give him morphine which it sounded like he would have to stay in the hospital for that. So he declined.

We left still a bit concerned because what caused the blockage, was the tumor growing or spreading? More phone calls and consultations. Good news, radiologist believes it is due to the radiation. Oncology doctor called for David’s next appointment and it isn’t needed until December. While we didn’t get the usual talk about what the CT showed we knew from these calls and plans that tumor wise he must still be stable. And Monday’s procedure - ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAM (ERCP) should give him immediate relief. So we are really excited about that. It would be great if this takes care of the last months of pain and discomfort, and get’s the yellow out!

The plan we had was to get over to our Yuma place after the results or the originally scheduled CT; returning for the October 7, Purple Stride San Diego 2018 walk at De Anza Cove. (If you didn’t know this walk is to raise awareness and funds for pancreatic cancer with the goal to double survival by 2020 PanCAN.org). Now our plans are not firm because there is a risk of bleeding from the procedure and we will probably stay around San Diego for some extra time, just to be sure.

Have a great rest of the weekend!