We are moving past the the point of inquiry and on to the beginning of decision making. Today was filled with tremendous information, opinions, estimations, and emotions. Tomorrow will be similar.
Let’s look at a the diagram to gain an understanding of the peritoneal cavity, where organs are located, and how it relates to our current discussion.
When we eat food, it moves from our stomach to our small intestine which can be over 16 feet long. Our food is broken down and the nutrients and calories are absorbed along the way. Upon exiting the small intestine, the remaining substrate moves into the ascending or right side of the colon. There is a ‘one way valve’ at this juncture that prevents the fluid fecal matter from flowing back into the intestine. As the fecal matter moves through the transverse colon and down the descending or left colon, the feces firms and comes to resemble what we would recognize as a ‘normal bowel movement.’ Now that we have had a brief A&P recap, let’s discuss how this all applies to Dads current situation.
Dad has a complete blockage of the bowels at or near the point where the small intestine and colon meet. This has backed up everything Dad has eaten, plus fluids, plus bile – all the way back up 16 feet worth of small intestine. Associated swelling pushed up on the stomach and caused discomfort, nausea, and a sense of acid reflux.
The NG tube that was placed earlier has been slowly suctioning out all of the liquid that is stuck in the small intestine. This did provide significant relief from the nausea and the abdominal discomfort, though Dad is still experiencing pain from the blockage and the surgery incisions.
The blockage is a problem in and of itself. While it is possible that the blockage is not related to the cancer at all, all testing suggests that cancer is indeed the culprit. Either way, the single most important step is to repair bowel function so that Dad can begin eating and absorbing nutrients and energy again. This will make him stronger and allow for better compliance with chemotherapy and recovery from surgery.
The appendix is not off the hook yet and could still be a point of origin. This is closely tied into the colon and as such the group of doctors are currently deeming this as a stage IV ascending colon mucinous adenocarcinoma, which is essentially a rapidly spreading cancer that started in the right colon and has spread so much that it is in the final stage of cancer. One of the reasons it has spread so much and reached stage IV is that as a cancer, it was metastasising in a fluid portion of the colon which is not restrictive and does not create pain or symptoms. While we are unsure how this cancer began in Dad, it likely began as polyps that eventually led to this unfortunate state over the course of years, possibly as many as 10.
There are many life lessons to learn from this experience. Above all, share love and enjoy each moment. Also, get a colonoscopy! Speak with your doctor, but new guidelines suggest that this procedure begins at age 40.
Back to the update at hand: Both the primary and second opinion colorectal surgeons suggest that we begin with surgery and resolve the obstruction through resection of the bowel at the point of connection between the small intestine and ascending colon.
The primary oncologist initially suggested an aggressive chemotherapy treatment before surgery but after consult with the team, also believes surgery may be a reasonable first option. This oncologist was clear in his message when saying there is no ‘right’ or ‘wrong’ approach as there are no ‘solutions’ to cancer.
We are anticipating a mid Friday morning discussion with a second and third opinion from different oncologists. They are reputable and come with high recommendations. After these discussions we, as a close immediate family, will decide on an initial course of action and choose the best medical team possible to begin this journey.
We discussed many different scenarios and timeframes today with many different treatment options and potentials. We are learning quickly and are supplementing Doctor input with first hand recommendations and copious amounts of scholarly research. As a family we are weighing these options and making the best decisions possible. I will withhold the many details of discussion in this realm as it would not be feasible to write it all down in an explanaotory fashion at this point. While we have detailed notes, they need further context before distribution and consumption. This lengthy and detailed discussion led to increased stress and emotion for Dad and the family. Dad possesses a tremendous amount of strength and continues to press forward with resolve to obtain a successful plan.
Christopher Reeve’ often repeated the quote: “Once you choose hope, anything is possible.”
Jeremy continues to lead us in faith and we are able to feel your love. Faith, together with your postive thoughts of encouragement, provides strength and most importantly, hope.
Much love,
Richard
The Upside of Down - an update on hope, love, and oncology 