Need a New Path

I had a scan last week to check on the progress of treatment and a meeting with Dr. S at which, I had hoped, to talk about how much longer I might be on Vectibix before getting a break.  But my scan was quite poor and the situation now is entirely different.  Evidently, my Chinese hamster had short legs and he ran out of gas.  My tumors are again growing and, even worse, in the week or so before the meeting, I starting seeing signs of a return of jaundice.  The jaundice was confirmed at our meeting, with a reading of 6 mg/dl.  The acceptable maximum for normal is 1.  I am now in a position very similar to the one I survived last fall.

Unfortunately, Dr. S had an emergency last Thursday so I got the news from a fill-in who was, frankly, pretty pessimistic about my future.  He effectively told us that there isn’t much MSK will be able to do for me.  But we scheduled a meeting with Dr. S on Tuesday and insisted that my scan be sent to the surgical areas for evaluation.  So, after a nervous weekend, Robbie and I met with one of the surgeons on Monday and Dr.S on Tuesday and have put a plan in place.

Since Vectibix has now failed, I have only one drug in the cabinet – irinotecan (pronounced like “I’m in a tea can” if you replace the ‘m’ with an ‘r’.)  However, irinotecan cannot be given to a person with jaundice.  This is the exact issue I had in the fall.  The difference this time is that the major liver blockage I have on the current scan is in a place the surgeons can reach.  So, if they can insert a stent, it is possible that my billirubin level might fall below 2.0 and Dr. S might be able to use some irinotecan.  He is not sure that we can get below 2.0 since the major blockage may not be the only one, but it’s worth a try.  Alternatively, if the stent does not get my billies low enough, Dr. S said that he will search the available experimental drugs or try to “finesse” some small amount of irinotecan, although it would be very harmful to me to take very much.  Overall, it’s a long shot, as this paragraph is full of “Ifs” but at least it is a plan.

The technique they will use for the stent is an endoscopy which is pretty non-invasive.  It involves snaking a tube down your throat, taking a left at the stomach and a right at the duodenum.  Then, staying right at the turnoff for the gall bladder, you arrive at the base of the liver’s main billiary duct.  You can mapquest it, if you like.  The important point is that they won’t need to cut anything and I’ll be home in a day – probably with a sore throat! And a side benefit of the stent, even if it doesn’t extend my life, is the clearing of jaundice symptoms – the worst of which are exhaustion and intense skin itchiness.

My endoscopy will be tomorrow and it will take a week or two to see how low my billies will go. Then we’ll figure out what paths may be available for a return to chemotherapy.

And so, much like last fall, I have come face-to-face with the “no more treatment options” scenario but do have a possible path out of it.  I’m hoping for another miracle and a little hope is better than none, I always say.