Quite a while ago I posted some questions about digestive problems with Whipple survivors. Now I have some answers that may help others, but first a little history.
In 2001 my wife Kathy was diagnosed with pancreatic cancer and a Whipple was performed in Strong Memorial in Rochester NY. Over the past 3 or 4 years her weight has steadily dropped going from 170 to 105 at the start of our cruise.
While on vacation in the Caribbean Kathy had a hypoglycemic
reaction, found out later that her sugar had dropped to thirty (yes 30). We had
just left St. Maarten and when I tried to wake her up from a nap she acted
goofy. I gave her some sugar but when it didn't seem to help I called 911 and
they came within five minutes with the crash cart. The ran some tests along with
an EKG. From her vitals they thought she may have been having a heart attack,
they even turned the ship around and headed back to St. Maarten. She was rushed
to the local hospital by ambulance and by the time she got there the sugar she
had been given on the ship had started to kick in and she became coherent.
She ended up staying over night in the hospital, then
another day on the island before we flew to Antigua to catch up with the ship.
There were no more sugar scares during the rest of the seven days, but she had
her same vomiting problems that surfaced after the Whipple. This time though she
was getting sick after every meal, she ended up loosing ten pounds on the cruise
(problem was I found it). We got back home Feb. 8th and made an appointment with
her primary care doctor for the next Monday. Her doctor re-did some of the tests
along with a set of labs and scheduled an appointment with a cardiologist.
Tuesday morning, the 12th, we got a call from the lab tech. telling us that her
doctor wanted us to go directly to the emergency room. Kathy's potassium had
become dangerously low because of the lack of nutrition for two
weeks.
Of course the ER ran all the tests again along with numerous
others. Bottom line was they confirmed the low potassium and started IVs for
that and the lack of food. Their attention then turned to some other things that
they had found. A CAT scan showed spots in the liver and a mass in the upper
intestine.
(This hospital was where they first detected the mass on
the pancreas in 2001 but the operation was done in Rochester. Also the
oncologists were new to the case because her regular guy was in Geneva, but on
vacation. Previous scans that she had along with her medical records were
scattered between 4 or 5 hospitals, complicating the case.)
The Emergency Room doctor said "With her past history the
mass was probably cancer and that it had metastasized to the liver" the tone in
which she said it was like "bend over and kiss your ass good bye" Well that's
how we felt anyway, it was like getting kicked in the gut. When our heads
cleared we remembered that previous scans over the years had shown spots in the
liver. Kathy's regular oncologist had followed them over the years and
determined they were just fatty deposits and nothing to be concerned about. The
mass could very well be scar tissue that we were also aware of
before.
They did a Gastrointestinal Endoscopy to see about the
obstruction, but didn't find anything inside the digestive system. The mass was
outside the stomach wall pressing on it to cause the blockage. Next they wanted
to do a biopsy of the liver to see about the spots. They wanted to do that first
then if it was cancer they probably wouldn't bother with the stomach surgery.
With Kathy's blood counts she's no longed a candidate for chemo or radiation if
it is cancer. Some of the invasive stuff took longer to schedule because of a
platelet shortage in the northeast and only emergency procedures are to be
performed. They surgeon had gotten the medical information from Strong (Dr's.
notes but no pictures, x-rays scans etc.) and the oncologist in Geneva (Dr.
Rubins) and there is no mention of spots in the liver hence forth they are
assuming they are new. They got a shipment of platelets Monday, performed the
liver biopsy and it was negative and they could proceed in solving the digestion
problem.
They wanted to do an MRI but they couldn't because of an
issue with the dye. Seems like her kidney function was so low that they are
afraid that she wouldn't be able to get rid of the dye from her system. This
would have given them a better idea of what the blockage was. Wednesday the 20th
the surgeon told us that yesterday they planned on going in Laparoscopically to
do another liver biopsy (the oncologists still didn't believe the spots were
benign) and look at the mass. If the liver was still clear and the mass was,
indeed scar tissue they would then open her up and attempt to remove
it.
Because of Kathy's past history of digestive problems most
of her doctors over the years figure that the muscles that move food through the
digestive tract were damaged during the invasive Whipple. Because of that the
plan of attack was to remove what scar tissue they could and bypass that spot
with a section of her intestine. If the muscles were working properly then that
would probably have solved the problem. However to make sure no matter what
happens she will have the best possible quality of life they are installing a G
tube and a J tube. If need be she can use the G to remove stomach contents
instead of vomiting and the J to infuse nutrition into the lower intestine for
nutrition. If just the removal of the obstruction solves the problem then these
tubes can be removed right in the doctors office. (At least that's what I'm
told)
I left her last night groggy but knowing the operation went
well. She has a morphine drip for pain and recovery could take anywhere from 5
to 10 days depending on progress.
For all facing the fight against cancer there is hope, even the second time.
John