Indoor Day

Tried to get to Toronto to visit our friend Maureen who is in town for a couple of days, but sadly it was an “indoor” kind of day today.  She even dressed for the occasion hoping she could will her way out of it, but no luck. Day 9-10 of the chemo and radiation is supposed to be the start of the low point, and it is.  Kathleen had zero energy today and was vomiting from the moment she woke up. And after weeks of constipation, now diarrhea.  At least with former, you can travel, but with the latter… well, a 1hr car ride is no fun.  So spent most of the morning in bed and the afternoon resting in her chair getting caught up on a couple of movies.  On the plus side, the new scary drug does seem to be effective.  She popped one around 2pm and it did control things.  We worry a bit about over using our goto drug gravol as the side effects are manageable.  But its nice to have a number of tools in the drug toolbox.

She did in the late afternoon get a bit of an appetite back and then we tried a little walk around the block.  Had to pop a Zofran mid way, but at least no barfing 🙂  But you can see from the pic below, she is putting a brave face on it and trying to push through

Image

 

Waiting for the Other Shoe Store to Drop

Some days I feel like a guy in front of one of those old 1970’s control boards.  You know, like the ones from those NASA moon shot days ?  Lots of lights on a big console.  When there is a trouble somewhere, a red light would flash and you would flip a switch to deal with the problem.  Then more lights, more switches until there is a fury of lights and switch flipping.  Kind of felt like that this week, just lots and lots of things happening.  PICC lines clogging… again.  No appetite, again… Nausea and vomiting, again and again and this time our last line of defense, IV gravol is slowly starting to loose its efficacy.  Zofran never really cut it, even though its their drug of choice.  So now a new sub lingual wafer, but its one of those scary sounding off label drugs that we need to balance off barfing and… well, the other potentially worse side effects.

Never really got any closure on the CT scan.  Its just going to be yet another thing to just put off and “deal with later”.  Our surgeon, who we also really like and trust, took the time to discuss it with us.  Although he had not yet looked at the report nor looked at the imaging, he would, and he will.  But it boils down to this.  If it is metastatic spread, well, we are doing everything we can and should–radiation and chemo.  If its not, there is no easy way to find out un-intrusively.  And why the 2 months ?  Because typically there will not be any more information to be learned in a such a period of time, and it just stresses people out waiting for report after report…. Yikes

I dont really like that answer, but I can understand it… and we will have to learn how to live with it…. So, one more thing to add to the list.

 

—Mike

 

What a good GP means

Just as we were sitting, waiting for Kath’s picc line to be de-clogged, out of the blue our GP calls on Kath’s cell. We have always had a lot of trust and respect for her and this phone call only blasted that home in spades. Not sure if she will ever know how much that little call / effort meant to us, just when we needed it most. But she just wanted to let Kath know she had been following all her blood tests as well as the various reports, like this achingly troubling CT scan. Long and the short of it is that she was really happy with the fact that her liver enzymes and all other blood tests were all excellent and her hemoglobin was finally going up too. As for the mysterious mass on her pancreas, she too was skeptical about it being cancer and it was more likely that it was a post op complication as its not unusual to have a cyst. But the expert to consult would be the surgeon, which we happen to be seeing tomorrow. Her reassurance and pep talk really meant a lot. Perhaps chemo dr can get some pointers from her on this aspect of medicine.

Update

Just heard no blood clots in the lungs either. Quick pitstop at home for some gravol to go and off to UofW for her wellfit class

Still no Clarity

A pretty frustrating meeting. The scan was the correct one and there is a mass on her pancreas. Its not clear what it is. Could be cancer, could be fluid… Dr. keeps saying in a rather dismissive way that it would be unlikely its cancer as it would not grow that fast… Having heard the word ‘unlikely’ far too often in this whole trip, doesn’t exactly sit well with me. He said there was no easy way to get to that location to examine it in detail, so just ‘wait 2 months and see’… Don’t have a sense of him to know how thought out this plan of inaction is. It might be true. We see her other oncologist tomorrow as well as her surgeon. Those are all super short appointments so not too optimistic we can get any other details.
Off to another type of xray next. They are worried Kath might have a blood clot forming on her lungs. If so, she will need some blood thinners. Not really the day we were hoping for

Team Pain!

Another amazing group of people today to help us at the Cancer Center.  This one specializes in pain and symptom management.  A nurse, a doctor and a resident.  All three, super people.  You can really tell when someone works a job as opposed to someone practicing a craft.  Kath is going through a rather rough spot again, and its helps so much to know that everything possible will be done to help manage these side effects of the treatment, or the impact of the cancer. 

Still no word on the confusing CT.  We asked the resident, and she went to look at the report, but it had not yet been updated.  Frustrating, but we appreciated very much her going to look.  Little things like this can make a big difference.  Not sure if they realize that, but I suspect they do.

Dr. had a real guru look to him.  Big beard.  He would be a UNIX King Nerd, if he were in computers with that beard.  The type of doctor who knows how to talk and convey confidence and trust.  Not in a condescending or impatient way, but just the right amount of gentle assurance in his voice. He answered all our questions, explained why he wanted to follow plan #2 and not #1,3,4, but if need be, there were other strategies in reserve.  

So more waiting.  We are both anxious about hearing about the CT. It wont be until Wednesday morning… at the earliest

—Mike

Ummm, so what does that mean ?

Well, results from the bone scan and the CT and both are kind of odd.  We were hoping for a ‘clean win’ that we could savor into the weekend.  Obviously we were thinking the news would be either bad or good, not of the “Huh?” variety and thats kind of what we got.

Our first meeting was with the radiation oncologist to see if Kathleen was ready to resume treatment and he thought based on her general well being and blood tests, yes…. but he would differ to the chemo guy.  So once that quick meeting was almost over, we asked if he could tell us the results of the bone scan.  He didnt order it, but hey, why not ask. So, he opens up the laptop, starts looking through and says, “Spine looks clear. No tumours” …. Huge sigh of relief…. “But, you have two spots on your ribs” Spots?!?!? WTF!?!?!, “But they appear to be ‘healing spots’. Did you break your ribs sometime in the last 1-9 months?”…. Now that is bizarre.  We scratched our heads and could think of nothing at all.  Not even a fall, although Kath did slip on the ice in the winter a year ago, but landed on her ass…. Hmmm, ok.  A little more back and forth about what it might mean and he says dont worry, its ok.  Then, just as he is about to leave, I think why not ask about the chest CT from yesterday. Perhaps its done.  Sure enough it is.

So, Kath, Elaine and I lean forward as I ask, “So, what does it say?”…. “Lets see…. chest looks clear…” Yes!!!…. “But, there is an unknown mass on the head of the pancreas”…Head of the Pancreas?? WTF, that part was lopped off in the surgery. There is no head left”… “Well, its probably just the scar tissue from your surgery. Its highly unlikely you would have a new tumor in just 10 weeks”… Considering she has had any number of CTs its odd that there would be something there in a just a few weeks.  When we asked the other oncologist what it meant, he said he will get clarification with another radiologist as its odd they would refer to part of an organ that no longer exists.  Did they mix up someone elses’s CT ? Is there a new tumor on her abdominal wall ? But how could the guy/gal misidentify the location so badly.  There really is no head of the pancreas left. Or did they mean, on the part thats left has a new tumor.  Unfortunately, no answers until Monday when we meet with chemo guy again.

Hooking up the chemo took a bit longer than we hopped. There was a bit of confusion about where orders were etc, and its not something that is just on a shelf somewhere.  So that meant Kath was there the whole day.

So, here were are.  Back on the horse again.  Kath is sitting in front of me as I type, looking a little tired, but thats mostly from the gravol.  She attempted a rather large meal (chicken kebabs from our bbq with roasted potatoes) and it gave her a bit of nausea.  So before it got too bad, gravol.  So, some steps forward, but a new limbo until Monday.  Well, hopefully no longer than Monday.

—Mike

Have Gravol, will Travel

An interesting morning with the genetics person. Like the pharmacist, its always cool to meet people who are really into what they do.  She did a detailed family tree to see if there was any potential genetic component and she thinks there might be.  At least enough data to warrant further investigation.  Some details at NIH.GOV as well as the wikipedia entry for Lynch Syndrome.  Its actually a bit of an ethical minefield and the she was pretty good about raising some of the cans of worms it can open.  Kathleen wants to go ahead with it for sure as it might be able to help her biological siblings.  If she does have this genetic marker, some more aggressive screening for her brother and sister might detect some cancers very early when treatment would be a simple zap from a endoscopy or colonoscopy… But if you are ever faced with this decision, I highly recommend the quirks and quarks podcast at http://www.cbc.ca/quirks/media/2010-2011/qq-2011-02-19_04.mp3 which talks about this issue in detail.

Morning started out with a bit of a twist.  Just as we were leaving for her chest CT scan, the vomiting started out of nowhere.  Not sure why as she had no food in her stomach as she had to fast.  So back in the house to get some gravol hung.  So it was gravol to go.  Literally, driving to the hospital while Kathleen is holding up her bag of gravol from the roof of the car.   Ran it a bit fast, so it would finish by the time we got there.  Then, flush the line in the parking lot, junkie style 🙂  But we made it on time.  She is a tough woman.

Had some more annoyances with the PICC line. This one seems to get blocked more often, so she had to spend an couple of hours at the center to get it unclogged.

Another big day tomorrow.  Restarting the radiation, perhaps the chemo ? Not sure.  And then  results from the bone scan.  We are a bit nervous, but trying not to think about it too much.

Fighting the Blues

Reading Email

Back to work today for me and a nice day for Kathleen and Elaine together doing some simple things– going to the mall for a short trip, and washing the new Eddie Bauer order that came in the mail today. (6-8 weeks is a long thing of the past in this instant gratification age).

Still 3 bags of gravol today unfortunately and only a few hundred calories of food. But I think a little better emotionally today.  Doing these normal things help. Certainly for me, I have my work which forces me to focus on things outside the bubble.  For a bit.  But even better, we had a nice walk around the neighbourhood tonight for Orville’s evening outing.  We love this time of year.  Orville is by far a winter dog, but for us, this time of year is the best.  Something about walking under that thick green canopy dappling the evening sun in 30C heat is just so welcome after those dark winter nights.  We took our time, stopped and talked to our neighbours and just enjoyed the moment.  It wasnt “best night ever”, just nice.  But, its great to be able to be in that moment again and enjoy something simple again.

Tomorrow is the lung CT scan.  That can be one of the places it can go, so better take a good look.  Kathleen’s new radiation schedule is up too.  Back to the radiation on Thursday.  No sign of the chemo, but not sure if they just have not updated the schedule yet.  Also, a long 90min appt with the genetics people.  I guess there is some suspicion there might be a genetic aspect to this type of cancer.  No idea what to expect, but we will find out tomorrow.

Kathleen wants to say that she really appreciates all the emails and comments she gets.  She wants very much to respond, but her focus and energy is not quite there yet.

—Mike

Good Weather Helps

Kind of a full slate this holiday weekend.  Kathleen is still recovering from her pissed off pancreas and that means periods of nausea and vomiting, chills, no appetite and then normality for a bit… Then back to the awefulness and then out again… etc etc. ad nauseam…   The gravol kept things mostly at bay which is good, but still a little disconcerting that we had to resort to it 3 times a day, not to mention it makes her pretty tired and dopey.   But, better that than throwing up.

Emotionally, holidays can be hard.  To be frank, our minds both wander to the place where you think, will this be our last Canada Day together ?  We really wanted to go see the fireworks, but the pancreas thought otherwise.  Still, you reach for those small moments of normality where you forget for just a brief moment that you are in that bubble and those can be very nice indeed.  Today for example, we went upto the Conostogo river with Orville in the morning.  Not our normal long walks together, but that was ok, we try to appreciate what we have. We spent the time throwing the stick for him in the river which he quite enjoyed.  Then we went up to Elora for some ice cream and then home for a BBQ.  It was one of those blue, blue sky days with bleach white Simpson’s puffy clouds.  As you can see from the picture, our cat Betty, has a seat to herself– and yes, she is cutting Betty’s chicken for her 🙂   Ending on a happier note, but still kind of a hard weekend.  Sometimes its just not easy to shake things off.

Throwing sticks and drinking a coffee with Kathleen and her Non-Registered Nurse, Orville

Bouncing Back

Things were a lot more under control yesterday. Kath had a bit more energy and the gravol was doing the trick keeping the vomiting at bay.  We were also shown how to hang and regulate the saline drip, so made sure she was well hydrated.  We will call yesterday a win.

Non Registered Nursing Assistant

His skills are limited, but appreciated.  However, suggestions he makes should be used for novelty purposes only.

Dogs are experts at living in “the now” which is a handy skill to have these days.   It was a rough 36hrs for Kathleen.  Last night we were trying to walk off the nausea and the vomiting just suddenly came on her half a block away from home.  Not much fun.  She actually gave quite the fright to a neighbour passing by. As she had eaten a few strawberries just prior … well, things were quite ‘red’ colored on the way back out. ick.   The extreme nausea continued into today and she was really in pretty rough shape when she went in for her radiation treatment this morning with Elaine who looked after her all day while I was at work.  Kath was looking bad enough that the nurse called the doctor and before long the doctor decided to put a hold on things for a week.  More blood tests, and an x-ray to check for a blockage.   Luckily, no blockage, but some dehydration and elevated pancreatic enzymes… again…. Pancreatitis again 😦  Why? Not sure, but she needs a break from the chemo and radiation and things will be re-evaluated next Thursday.  Oncologist #1 wanted to re-admit her to the hospital, but not much point in terms of care management.  Having gone through a few bouts of it now, Kath knows what to do and we have most of the tools at home to deal with it as long as it stays mild… And she promised she would go to emerg if the vomiting got out of control.  But honestly, even then, its just doing the same things we do at home.  BP is 108/68 (low for her), pulse a bit high at 92 (normally mid 80s). Temp 98.2F (good). Pain level 2, Nausea 3, Fatigue 8, blood sugars 7.8….  So stable now and off to bed.  Tomorrow we get to learn how to use an IV hydration kit.  Another tool in the tool box.

—Mike

Roadside Assistance

While flushing Kathleen’s picc line last night, we noticed the tubing was bulging like a bad tire about to blow. So, a quick call to the cancer centre this morning to see if this is something to worry about and within a few min a call back to let us know the IV nurse would meet us after the radiation session to assess. A quick look by the specialist and sure enough, time to replace the picc line. “When?” “Now”… Its amazing how fast these things can happen. When you are outside the bubble, everything is painfully slow by comparison. Full body bone scan ? “How about tomorrow” vs “how is next winter for ya”…. Everything is ‘now’ in the bubble. I kind of miss, ‘how about next winter’

Lots more nausea and cramping today that has carried over since yesterday. Rough roads right now.

repairs

 

Day One of a Long Trip

A long day, but she got through it.  There was a lot packed in today.  First a trip to Nuclear Medicine to inject some radioactive contrast.  Then back to the cancer center to get a session with the pharmacist to learn all about the meds she will be on today and how to manage them.  Pretty neat guy.  Its always a treat to meet people who are really into what they do, and who keep up with developments in their field.

Chemo was next.  Another nice person to meet / work with.  It was a bit unnerving as the nurse puts on a lot of protection gear. Full face guard, mask, one time disposable gown, rubber gloves that all went into a cart with several categories of “danger” on it All, just to hook up the bottle of fluorouracil. There is a bit of “Wait a minute, you are putting this stuff into her veins??” moment as you put it all together.  
Its kind of a strange contrast this building. When you are in the surgical ward, you feel like crap, and the surrounds are… well, crap. So there is a sort of congruence there. But this building and space are beautiful.  As you can see from the photo, the window is open, natural light coming in and birds in the trees.  Just outside the window were a pair of house finches singing away all while you are getting a nasty toxin dripped into your body. Odd feeling.

Radiation wasnt as bad as the first time for her as it was a bit quicker as compared to her initial setup.  Really great staff there too.  They know people are dealing with some pretty heavy shit, and they do everything possible to accommodate your supportive needs. So while Kathleen was being set up on the radiation table, I could be with her to distract and keep her company.  Its quite the room.  Giant whirring box panels with dozens of controls and numerous sensors.  Its something you would expect Wyle E. Coyote to have from the ACME corporation for some crazy scheme as it seems so over the top big.  Plus, when you are on the table, there are a dozen lasers all criss-crossing over Kathleen to help line everything up literally to millimeter precision.   Looking at her you have this urge to hang of a few shelves on her as they look like those laser levels you get from the Home Depot, except there are 2 dozen of them.

Then, you leave the room to wait outside for her, and you would think you are in the lobby of a very pleasantly designed movie theater.  Off in the distance, is the sign displaying the current movie being shown– “Now Playing- Radiation, With Kathleen McSpurren” There is even the little tape barrier to let you know the movie is currently in progress.  Quite the movie.

Once that was done, back to nuclear medicine for the full body scan. Since there are no markers for this cancer that can be tested for, its all monitoring self reported symptoms.  So when Kath told the Chemo Oncologist she had a new pain in her back, he ordered the scan without blinking.

Then, back home to digest the day.  Lots more handouts today.  Possible side effects, possible complications, how to manage the drugs, other support services available etc, etc.  A bit of nausea this aft that she was worried would come to more, but the magic Zofran pills did the trick along with walking around the block a few times… I didnt have to hang any gravol which is a bit of a last resort.  Although very effective, it kind of knocks her out.  But that didnt happen and we got through day one of…. well, ~ 250


—Mike

The Next Nine Months

I’m still digesting all the information we received on Tuesday from the oncology team.  But what I quickly realized was that I’m looking at eight to nine months of treatment…  Radiation and chemo-light begins next week, runs for five to six weeks; one month break is advised after that; then the chemo-heavy starts in earnest, for six months!  To be honest, its pretty scary!

Another thing I realized was that some very sick people go to the cancer centre – I caught a glimpse of some of them  when I went through the chemotherapy area for my blood work.  Up until now, I’ve been quite detached from the cancer side of this diagnosis, since I’ve been focused on the surgery recovery.  Up on 6D, I didn’t see the hair loss, the weight loss, the ravages of cancer treatment.  That’s potentially going to be me.  And since I’m being honest, that’s very scary too…

In contrast to these realities, I have received so much love and support from everyone that I know I’ll get through all the scary stuff!  Thank you all.

Tools in the Toolbox

Kind of a rough 24hrs for Kathleen.  As many of you know, Kathleen has always been a picture perfect eater– good variety of foods, healthy choices etc.  So dealing with the post surgery consequences of having a Pancreaticoduodenectomy have been challenging.  One day its non stop diarrhea and now its serious constipation again.  Last time this happened it landed her back in the hospital.  But this time at least we were much better equipped and prepared with the necessary tools.  We had IV gravol and sublingual Zofran to deal with the nausea and vomiting. IV Pantaloc for acid reflux and better pain management with a patch.  She has 3 different meds to try and move things along as well as a new one that comes in what looks like a shampoo bottle. But so far no “break through” if you know what I mean.  By 1 pm, at least the pain had subsided enough for her to get up.  Since walking really helps, we went off to the air conditioned mall to do laps and that seemed to help somewhat.
We also added a little fruit back to her diet today.  Some cherries and watermelon as well as fresh local Ontario strawberries.  Nothing in normal quantities, but still. Its a start and it went down well.  The big question, is when will it go through!
So a down day today after a couple of pretty good / normal ones.  It was really hard on her this morning, but her spirits are much better now

Oncologist #2 of 2 –-chemical weapons

Ok, we like the guy so far. He was pretty no nonsense– seems like a guy with something to prove and is competitive. To the point, no time for chit chat, but was not the kind of doctor making his way to the door when we said, “we have some questions”….. His nurse was very thorough and helpful as well. He was up front about the fact that there is no established protocol which we knew. He said generally they treat it as a colon cancer type issue which we also knew. 5fu, folofox etc etc, the same drugs and protocols as what we have been reading about, so no surprises.
He asked a lot of questions too and more importantly, didn’t blow off self reported symptoms which both Kath and I really paid attention to. Good stuff, as that could have been a deal breaker. In fact, when we asked how we would know if the treatment was “working” he said there were not any markers we could test for and really it was just patient reported symptoms that would cause specific investigations and would need to be closely followed. So when we mentioned new pain in her upper spine, he said he would order a scan to investigate now. So that was very reassuring he wasn’t going to piss around. There will be of course yearly scans and tests for any obvious return, but he warned us, this type of cancer can be a pernicious little bastard regularly returning….. So, will have to get used to life like that, but better that than no life
Speaking of little bastards, we also got clarity on the pathology report. It’s often hard to tell from the word choices used by that profession. So when they say, “we favor duodenal as the primary” does that mean its a guess? Not sure? Pretty sure ? And considering so much is based on the path report, is this person experienced? Good? Reliable? Yes, very and very. So that bit of info was quite reassuring. When you think of it, everything going forward is based on the pathology report, so if they get that wrong, everything potentially gets messed up.

We had a good chuckle at doctor’s note taking. Her asked about family history, health, longevity and if there was a history of cancer or not. He started to draw a family tree and made a couple of stick figures. He put Elaine on one side, drew her father on the other and said, “well, your mum is here so she is obviously alive and looks healthy. What about your father? ” When kath said he died of cancer, he just put a big violent line (STRIKE!) through the figure he had just made! We both nearly burst out laughing. It’s quite macabre yes, but you really draw on gallows humour to get through this.

There was a really a lot of information today. Good thing the nurse gave us handouts. Side effects out the ying yang. More drugs to manage those side effects. Diarrhea, constipation, nausea, vomiting chills etc…. In other words, just feeling miserable. So, just as she is feeling great, she is ready to get the crap beat out of her. But, on the plus side, she is stronger now and more prepared to give a good fight and she will need her strength. It all start as early as next week. She is a little anxious right now, but hey, who wouldn’t be. Nuclear and chemical war in your guts doesn’t exactly sound like fun, but she is toughing it out.

—Mike

Chasing Normality

Normally I abhor H&M, but it was great to be there today with Kathleen doing ‘normal’ things again. After missing 2 months of regular day to day things with her, banal activities are in a new light. Hello mundane, I missed you.

On the phone with Diane from H&M

20120615-215751.jpg

Having some dinner!  Its great to be out on the deck with the good weather.  Along with the normal TPN dinner, Kath had a bit of a veggie burger.  Then a walk around the block with Orville.  It was great to do something so simple as walk in the neighbourhood together….

My new life

Of course its great to be home!  And when I woke this morning, I immediately realized where I was and just sighed …

Going to the office today was a real treat!  I miss the terrific folks I work with.  And the warm reception I had was just so wonderful!!  I also miss being a working, thinking, creative person – I guess I’ll have to put that creativity and work towards beating this disease.

More to come later…

Kathleen

Back home again!

Good news, I have picked up Kathleen and she is home again out of the hospital!  Not day parole, but full discharge. Just waiting for her fancy new lazyboy chair to come so that she can rest in comfort.
I am more optimistic about managing symptoms this time around.  Unlike last time, we have IV forms of pretty well everything.  For pain, she has a patch that seems to work well which she wore around in the hospital for a few days to make sure it agreed with her.  I know how to hang her IV bags of food and gravol, so should the vomiting start, we have a way to deal with that.  And I know how to flush and clean her PICC line as well.  She is up to about 1000 calories per day, almost enough to be off the TPN feed, but not quite yet.  Soon, stomach willing.

Chapter 3, Atomic Kitty in the Fog

Hello Everyone,

Thought it would be easier to add updates here for anyone wanting to follow Kath’s progress.  As some of you know, today was our first meeting with oncologist #1 of 2.  This guy was a radiation specialist.  Wasnt sure why at first we were going the radiation route, but doing some research, it seems its often done when margins are narrow.  When they did the Whipple procedure, the pathologist examined everything taken out– so all of the duodenum, part of the stomach, some ducts, 19 lymph nodes, part of the small intestine, and a good chunk of the pancreas.  The pathologist was reasonably certain the primary site was duodenal, but that it had invaded (metastasized)  to a large part of the pancreas. The margins were clear on what was pulled out, but only by 1mm.  So oncologist thinks radiation in combo with chemo should be done .  We dont meet with chemo guy until next Tuesday.

The Dr.  seemed good enough.  Young.  Took time to answer our questions, and didnt seem to bullshit.  I like it when I hear answers like “I dont know” as I prefer that to someone blowing smoke.  Chemo oncologist is older on the other hand.  Young, old, either can be a plus or a minus.  He said we could get a second, third opinion and some will agree with radiation, some will not. As this is a very rare cancer, there are no statistically significant studies.  We found a few meta studies that had an n of about 100, but that included patient data from 1974 to now and patients from 30 to 85.  So cant really draw too much from that as there are far too many variables to control– age, general health, stage of cancer, grade of tumor, where it has gone, health of other organs, where they were treated, when it was discovered  etc, etc.

Our assigned nurse gave us a bit of a scare.  I guess something she was reading was not clear or she didnt read it close enough, as she referred to Kath as having pancreatic cancer which is a world of difference that duodenal.  5yr survival rate on pancreatic is 3-5%, Duodenal can be anywhere from 30% to 60%.  Luckily I had the pathology report with me, so we quickly cleared that up.  If you want a good overview, the medscape site is pretty good.  You have to keep in mind the population #s in some of the stats given are extremely small.  So when they say 30% survival rate, that includes people who did not have surgery like Kath did -which is the most important factor for predicting successful outcomes. It also includes people older than 60, who typically are physically not as resilient as someone in their 40s and tend to have other medical conditions going on.

In some ways, the day was a bit anti-climactic.  We kind of prepared ahead of time for the various scenarios.  We didnt of course hear anything definitive and when I asked at the end, what he thought the prognosis was, he really could not commit an answer which is what we figured.  We did talk ahead of time what we would do if he said, something like “Hi, I am here to give you palliative care”, but we agreed we would just ask to see someone else, as its hard to see how things could be definitively dire.

So here we are at the start of chapter three.  Radiation to come and some nasty chemical concoctions we have yet to hear about.  Kath is a bit anxious and understandably so.  She is going to get 25 blasts of radiation and it is all still fog ahead with not much visibility

—Mike