So, here is where it all stands as of right now. Two CTs an MRI and and X-Ray later. Her Primary Oncologist, Surgical Oncologist, and Infectious Diseases have been working and talking together on a daily basis. This is where everything has settled for now.
Partial small bowel obstruction.
Severe matting of small bowels
Leakage of fecal matter
So the pain is coming from the partial small bowel obstruction.
The abscess is being fed by the small bowel leakage, thus the reason we were right back in. Infectious diseases has verified the bugs and their susceptibilities. IV meds have kept everything back and in check, drainage has decreased and now changed. What is draining is not abscess fluid it is now fecal in nature, green/brown and smells horrid.
Even in the face of this her surgical oncology team does not want to go in. They say an attempt to fix a small fistula and to fix the partial obstruction would be temporary and create more adhesion. Which is understandable. A temporary fix that delays treatment is not optimal.
Plus side further imaging shows no sign of tumor growth and her CEA continues to decline from 35.7 on 10/18 to 21.3 as of 11/22. So she went ahead with her fifth treatment. They are holding Avastin, just in case they have to go in and do something.
Her Surgical oncologist, Dr. Greggory Kennedy, reached out to a close colleague, Dr. Fabian Johnston, at Johns Hopkins to discuss a few things. This also included vetting options for HIPEC, which everyone is still in agreement is an option especially with the affect chemo is having on the cancer. Dr. Johnston recommended Dr. Joshua Winer Emory, whom we have already had a consult with. He did hios training at Piuttsburgh and urged us to reach out to other doctors if we wanted to. It was good to get some information back regarding steps to go form here.
What is interesting is seeing the recommendations and thoughts that the doctors have regarding HIPEC. Number of procedures and experience appear to be the largest factors and determinism in effectiveness of the procedure. Dr. Winer performed 344 last year and has averaged 31 since he began. Emory's HIPEC specialization unit preforms an average of 90 per year. MD Anderson has not been recommended. Three different doctors cited other facilites with much better resultss more experience, they were very particular not to discredit MD Aanderson, but cited proof in experience. Nothings set in stone, but its nice to have a road map with a couple of options.
Thanks for the concerns BS, there are times when Ive felt like we were being jerked around, but recently the cross communication within the teams has been amazing. UAB is a learning hospital, but both her surgical oncologist and medical oncologist have been more than available and responsive. Her surgical onc and medical onc are both well respected and came highly recommended. This whole hurry up and wait game is just what is so damned frustrating. The complications recently just further expand on that.
She was released Wednesday. We got to spend some time together with the babies yesterday. She over did it on the food because she felt so good. She has been cramping all day. Its like one step forward two leaps back. Like you mentioned BS I'm concerned with sepsis. We are monitoring her temp every hour, so far the only issues she is having are the cramping and nausea associated.
Hoping this will work its self out today and I can report back that she is doing better and better.
Thanks again for all of the input and thoughts.
Husband of Fighter!
Diagnosed 5/17 Age: 33
5/17 CR Adenocarcinoma 5x6x6 cm, T4NoMo
No Lymph nodes and clear margins
6/17 Began Xeloda
7/17 PET Showed additional activation
7/17 Lap discovered mets to Peritoneum
9/7/17 Began FOLFIRI
9/20/17 Added Avastin (bevacizumab)
10/17 Abscess on two tumor sites, treatment on hold
11/15 Readmitted, drain placed in abscess, partial small bowel obstruction, fistulas present
11/22 Discharge with drain, resumed FOLFIRI