Michelle's procedure yesterday went better than expected. Unlike the ERCP on the day after Christmas, the new stent slid right into place in her left hepatic duct. The doctors also placed a stent into the right hepatic duct. The two stents run next to each other through her common bile duct and both terminate at the opening into her small intestine (imagine a large Y made of 2 equal length tubes). Hopefully these two stents will provide adequate drainage so her bilirubin levels come down, allowing the chemo treatments to start. We'll know the outcome in about a week, as it will take that long for the excess bile to drain.
Our next appointment is Tuesday 1/13 with Dr. Weekes at the UCH Cancer Center in Denver.
We discussed additional therapies with the Gastroenterology team (Drs. Shah and Yen this time) and they have several more tricks up their sleeve in the event additional drainage is necessary.
Assuming yesterday's procedure is successful, and assuming the oncology team agrees, they will replace the temporary plastic stents with "permanent" metal stents in about 6 weeks. They used the plastic stents again because it is more difficult to work around metal stents if additional procedures to add drainage are required.
Dr. Shah also told us that there is a gastroenterology conference scheduled for mid-February, with specialists from across the country to hear him and Dr. Chen speak. The timing may work out such that Michelle could be the subject of a demonstration for placing metal stents (Shah and Chen would perform the procedure). Her face and identity would be obscured, but her innards could be famous! Michelle likes the idea of being able to contribute to the body of knowledge surrounding her condition and enthusiastically agreed to participate. Of course, Michelle's needs come first, and they will not attempt to delay necessary treatment for the sake of this demonstration.
Tuesday, January 6, 2009
Saturday, January 3, 2009
Here we go again - ERCP on Monday
Friday's blood tests showed Michelle's bilirubin remains high, so another ERCP is scheduled for Monday January 5 at 1:30 PM. They'll check out the current stent and probably replace it with a new one.
In the December 26 procecure, the replacement stent was only placed across the blockage in the main bile duct, where the cancer was found. Upon further examination, the doctor concluded the site of the upper blockage (the left hepatic duct) which was stented in early December was probably not cancerous and he believed the blockage was cleared and no longer needed to be stented. Given that Michelle's bilirubin levels have increased beyond where they were on 12/23, it seems likely the left hepatic duct is blocked again.
In any event, Dr. Chen also told us that he wants to place a permanent metal stent instead the temporary plastic stents they have been using, since surgery has been ruled out. He had planned to see Michelle again in mid-February and place the stent then. It seems likely that since he's performing another ERCP now that he'll place the metal stent, but we haven't been told one way or the other. The advantage of the metal stent is that it is somewhat larger and less prone to blockages. Plastic stents can last up to 3 months; metal stents can stay in place for 9-12 months or even longer. We're hoping this will mean fewer ERCP procedures so we can focus on fighting the cancer instead of remediating the symptoms.
Michelle's sister Kim left on Friday to return home to California. We found out before she left that her husband Lindsey has painful shingles! He's in quite a bit of pain, but should make a full recovery. It was great to have Kim with us for a week, she was a big help and enabled Bill to work a full week for the first time since November.
In the December 26 procecure, the replacement stent was only placed across the blockage in the main bile duct, where the cancer was found. Upon further examination, the doctor concluded the site of the upper blockage (the left hepatic duct) which was stented in early December was probably not cancerous and he believed the blockage was cleared and no longer needed to be stented. Given that Michelle's bilirubin levels have increased beyond where they were on 12/23, it seems likely the left hepatic duct is blocked again.
In any event, Dr. Chen also told us that he wants to place a permanent metal stent instead the temporary plastic stents they have been using, since surgery has been ruled out. He had planned to see Michelle again in mid-February and place the stent then. It seems likely that since he's performing another ERCP now that he'll place the metal stent, but we haven't been told one way or the other. The advantage of the metal stent is that it is somewhat larger and less prone to blockages. Plastic stents can last up to 3 months; metal stents can stay in place for 9-12 months or even longer. We're hoping this will mean fewer ERCP procedures so we can focus on fighting the cancer instead of remediating the symptoms.
Michelle's sister Kim left on Friday to return home to California. We found out before she left that her husband Lindsey has painful shingles! He's in quite a bit of pain, but should make a full recovery. It was great to have Kim with us for a week, she was a big help and enabled Bill to work a full week for the first time since November.
Friday, January 2, 2009
Happy 2009!
Happy New Year! 2009 will be a year of hope and healing at the McDonough home.
Time to catch up on what's happened in the last week.
We had a great Christmas with Michelle's parents and Bill's brother Tim visiting. Michelle's folks arrived by car from Arizona the Sunday before Christmas and stayed with us for a week. It was great to have them with us and we really appreciated all their help and support.
Michelle's sister arrived from California Sunday night and has been a big help all week, and even enabled Bill go back to work. She's heading back home tonight (Friday Jan 2).
On the health front, we went down to Denver on Friday, December 26 for an early morning procedure to replace Michelle's bile duct stent, which had become blocked causing her bilirubin levels to rise. It's important to keep those levels down to satisfy the treatment protocol for the chemotherapy drugs.
For the first few days after the procedure, Michelle seemed to get better. We managed to keep her pain under control and she was relatively comfortable through the weekend and Monday. Unfortunately, on Tuesday we noticed she was getting yellow and itchy again, a sign of jaundice and an indicator that the bilirubin was on the rise again. Blood work on Wednesday confirmed levels higher than before the 12/26 procedure. Another blood draw is scheduled for today, and it looks like another procedure may be in the cards early next week.
We'll keep you posted.
Time to catch up on what's happened in the last week.
We had a great Christmas with Michelle's parents and Bill's brother Tim visiting. Michelle's folks arrived by car from Arizona the Sunday before Christmas and stayed with us for a week. It was great to have them with us and we really appreciated all their help and support.
Michelle's sister arrived from California Sunday night and has been a big help all week, and even enabled Bill go back to work. She's heading back home tonight (Friday Jan 2).
On the health front, we went down to Denver on Friday, December 26 for an early morning procedure to replace Michelle's bile duct stent, which had become blocked causing her bilirubin levels to rise. It's important to keep those levels down to satisfy the treatment protocol for the chemotherapy drugs.
For the first few days after the procedure, Michelle seemed to get better. We managed to keep her pain under control and she was relatively comfortable through the weekend and Monday. Unfortunately, on Tuesday we noticed she was getting yellow and itchy again, a sign of jaundice and an indicator that the bilirubin was on the rise again. Blood work on Wednesday confirmed levels higher than before the 12/26 procedure. Another blood draw is scheduled for today, and it looks like another procedure may be in the cards early next week.
We'll keep you posted.
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