Backstory

Let's start at the very beginning.

Since college, Michelle has experienced on and off problems with her digestive system. She was diagnosed with a hiatal hernia, successfully treated for an ulcer, had her gall bladder removed in 1993, and suffered through several bouts of very painful pancreatitis.

In 1999 she had her first ERCP, a procedure using an endoscope through her esophagus, stomach, and small intestine during which they injected dye into her bile duct and capture images with a CT scan. The results of this exam were inconclusive.

A second ERCP in 2002 revealed 4 stones in her bile duct which caused a major blockage resulting in a "fistula", a new pathway around the blocked sphincter. Microsurgery was performed to open the sphincter from the bile duct to small intestine to eliminate future blockages. About 6 months later she was put on amitriptyline to relieve continuing pain in the area, and that treatment was successful until now.

September 15, 2008
Michelle first began to complain about upper abdominal pain, locate much higher than in the past. The early diagnosis was either cardiac or gastric pain, so the doctors recommended investigating cardiac issues as the potentially more life-threatening condition.

November 3, 2008
After several cardiac tests (one of which hinted at a potential issue), the pain continued to increase and Michelle began to feel more and more strongly that it was gastric rather than cardiac. She stayed home from work and her gastroenterologist put her on Vicodin and scheduled an ERCP was for November 10. She hasn't been back to work since October 28.

November 10, 2008
The ERCP reveals 2 blockages: a stricture in her common bile duct and an unknown blockage in the left hepatic duct. A stent is placed to relieve the lower blockage and cellular brushings are taken for analysis, but the local hospital lacks the technology to biopsy the bile duct or investigate and relieve the upper blockage. Her case is referred to the University of Colorado Denver Medical Center where they have more advanced tools and experience.

Michelle stays in the hospital overnight for observation and comes home the next day.

November 14, 2008
Michelle is readmitted to the hospital with high fever and increased pain. An infection had developed as a result of the ERCP which threatened her heart. IV antibiotics got the situation under control and she returned home on Monday, November 17.

November 18-December 3, 2008
Michelle self-administered IV antibiotic treatments at home. Pain increased, and pain medication was increased accordingly.

December 4, 2008
Two procedures, Endoscopic Ultrasound and ERCP with biopsy, are performed by Dr. Shah at CU Medical Center. Two biopsies are taken from the common bile duct in and near the lower stricture, and a longer stent is placed to open up both blockages and hopefully relieve Michelle's pain. The upper blockage, in the left hepatic duct, is found to be a second stricture. Cellular brushings are taken from that site for analysis.

December 8, 2008
The results are in: both biopsies are positive for bile duct cancer. Another ERCP will be scheduled to take place within 2 weeks to fully explore the upper stricture and obtain better tissue samples. It is critical to identify the extent of the cancer (does it extend to the bile ducts inside the liver?) before a treatment plan can be formlulated. The CU Medical Center cancer team, which specializes in this exact cancer, will be brought in on Michelle's case.