Test Results

This was another one of those weeks. On Monday Michelle had a CT scan of her neck, chest, abdomen and pelvis. The neck and chest scans revealed no tumors or masses that could be pressing on her laryngeal nerve and causing the vocal cord paralysis Michelle mentioned in the blog last week.

This is great news! Tumors would have meant surgery and more complications. It leaves us without a complete explanation of the paralyzed vocal cord, but we didn't want to hear about big tumors.

The CT scan also showed that the fluid in her right pleural cavity looks unchanged in volume from the January 4 scan, which means that all the fluid drawn off 2 weeks ago is back. That's a little frustrating.

The ascites described in past CT scans and the last PET scan is (are?) increasing. Ascites is the technical term for fluid gathering around (outside) the intestines. When there gets to be a lot of it, the result is typically significant bloating, but Michelle has yet to experience that.

Michelle's blood work late last week showed her white cell counts were quite low, but they rebounded quickly and she was well within the treatment range and so was able to receive her scheduled chemo treatment on Tuesday. Huzzah! This result means that she does not need to resume the problematic Neulasta injections. This is the drug that increases white cell production, but at the cost of bone pain. We blame Neulasta for exacerbating the pain Michelle experienced just before New Years that led to the procedure to remove fluid from her chest, so stopping it is a good thing.

Also on Tuesday (actually before chemo), we met with Dr. Medgesy, one of Dr. Marschke's partners and a top oncologist in her own right. She reviewed the test results with us and helped to clarify a few questions. It was interesting to hear her slightly different perspective on things, although she was in complete agreement and consistent with what Dr. Marschke has told us. One clarification I found interesting was regarding metastasis.

Metastasis literally means "in another place" and refers to the spread of cancer from the place of origin to another part of the body. Mutated cells (bile duct cells in Michelle's case) move around the body and attach to other organs: liver, vertebra, intestines, lungs, etc. Once in place, they begin to multiply and create havoc in their new home, but they don't change (for example) liver cells into mutated liver cancer cells. They retain their original identity, so there is a colony of bile duct cancer cells growing on the liver, and it is referred to as metastatic liver disease and not liver cancer. This is true of all types of cancer.

So what, you may ask. Well, the point is that the cancer started in cells that are only 1 or 2 cells in thickness rather than a large organ like the liver. The cancer in the bile duct was undetected by every scan performed to date, and was only diagnosed under microscopic examination. This means that the spread of the cancer may be equally difficult to detect.

Last weeks blood work also included the antigen/tumor marker CA19-9. This number was almost 8,000 in January 2009, down to 56 (one point above "normal") in May, and has gradually increased since then. The current value is 574, compared to 425 about a month ago. This is not a good trend, but at least it's not skyrocketing out of control, which would indicate the chemo treatments are having no effect at all. Dr. Medgesy indicated that there is still no clear indication that the chemo drug (Gemzar) we are using has lost effectiveness. Since Gemzar is still the best tool we have for treating cholangiocarcinoma, we'll continue on this course.

On the human side, Michelle is feeling pretty good except she still can't speak much above a whisper and tends to aspirate (inhale) fluids due to the vocal chord paralysis. She has had no recurrence of the pain in her side, and her other pain is under good control.

The doctor wasn't much concerned about inhaling fluids, because our lungs can cope with it. If she were aspirating food particles, that would be a greater concern: fluids do not lead to pneumonia, but food particles do. At this point the strategy is to proceed with the speech and swallowing therapy scheduled for next week to teach Michelle how to compensate for the vocal chord.

On the home front, just before we left for the doctor's appointment on Tuesday morning, we discovered our hot water tank had selected that moment to attempt basement domination and released it's water all over the floor. We caught it in time and got the water shut off and successfully averted catastrophe. (Score: water heater 0, basement carpeting 1.) A quick review of the magnitude of the water heater replacement project and the cost of having a pro do the job convinced me to let the professional handle it. I'm glad I did. Given that it took him 4 1/2 hours and 2 trips for parts to get the job done and it typically takes me about 4x as long to do the same job, it was well worth the cost. I had added a second water heater about 8 years ago when the kids were teenagers, and let's just say not all my work was up to code. Everything's kosher now.

A couple of prayer requests:

Dr. Marschke had to leave town suddenly for a family medical emergency. Apparently his mother is quite ill and they are concerned it may be cancer.

Dr. Brandon (Bill's therapist) also had to leave town due to a death in his family related to the snow storms back east.

Our long-time optometrist has reduced her practice to the CSU medical center exclusively, due to the sale of the office where she saw her non-student patients. When I attempted to contact her at CSU I was told she was on indefinite leave due to a family medical emergency.

Thank you all for your continued love and concern for Michelle and especially for your prayers. God Bless

Bill