Chemotherapy: Day 1

Dad started chemotherapy today. It’s the next step in a medical journey that started back in October.

While helping Mike fix up his new house last fall, Dad fell off a ladder and cracked a couple of ribs. He continued to work through the pain until the job was done a couple of weeks later.
After returning to Maryland, Dad went in for an x-ray for the ribs. The doctors wanted a better look, so they ordered a CAT scan which revealed a tumor in the liver. About the same time they also discovered a blood clot in the leg and put him on anticoagulation medication. All this eventually led to a biopsy of the liver on December 30th and a PET scan on January 19th which confirmed cancer. The diagnosis is gallbladder cancer which has metastasized to the liver.

Typical treatment, and the only way to cure such cancer, is through surgery to remove the gallbladder and the infected portion of the liver. Unfortunately the right lobe of the liver is nearly entirely consumed with the tumor and the left lobe is not large enough to safely proceed with immediate surgery.

To combat the blood clot threat, on February 5th the doctors installed a vena cava filter. This is a last line of defense to catch blood clots and prevent them from entering the heart which can be fatal. Patients who have previously had a blood clot are at a higher risk of future blood clots and cancer tumors can also cause blood clots.

In an effort to prepare dad for surgery, on Feb 11th, the doctors attempted a procedure called portal vein embolization. This happened to coincide with the epic snowstorm in DC. Although few patients made it to the hospital, the doctors were there. They inserted a needle through Dad’s neck and, using x-ray, guided it to the liver where they hoped to block the portal vein which provides blood to the right lobe of the liver. By decreasing blood flow to the right lobe of the liver and increasing blood to the left, the hope was to grow the left lobe of the liver in preparation for surgery. Unfortunately, due to the size of the tumor, the doctors were unable to complete the procedure despite entering the liver from three different angles. This decreases and likely eliminates the possibility dad will become a candidate for liver surgery.

Despite the grim prognosis, all day in the hospital, and our urging him to rest, after returning from the hospital Dad spent most of the evening digging our neighbors out of the snow. Although he tires easily, has lost some weight and has a few aches and pains, Dad’s overall health is such that he is able to largely maintain his pre-cancer lifestyle.

Today we moved into the chemotherapy phase. Over about five hours dad received Gemzar and Cisplatin intravenously. These chemotherapy drugs will be followed by a bevy of anti-nausea medication over the following hours and days. Although the potential side effects are numerous, most, if not all, can be mitigated, controlled, or eliminated through medication. Dad will receive a day’s worth of chemo medication via IV once a week for three weeks and then take a week off. This routine will continue for 3-6 months when the situation will be re-evaluated.

Dad had some pain on the top of the foot which he reported to the doctor today. The doctor believes it is a blood clot and Dad will also start taking anticoagulation medication again.

My brother-in-law is working on a post doctorate at Johns Hopkins University. On Friday I took my dad's medical records up to JHU and had them reviewed by his boss. Although she doesn't know my dad, she has taken a keen interest in his case. She took time to discuss his case with her colleagues and has placed it on the docket for a multi-disciplinary conference today that has surgeons, radiologists, interventionalists, and medical oncologists. We are hopeful something will come of this.