Latent Laparoscopy

Yes, that is a picture of the Magic School Bus. Sit tight, we’re going for a ride.

Dad returned to the hospital a few days ago due to a reoccurrence of the same symptoms that brought him in just weeks ago.  Stomach pain and distention with stomach contents backing up into his throat. Nothing, or very little, seemed to be passing through. During his last stay, a general diagnosis of small bowel obstruction was given and after days of testing he was released with a declaration that the obstruction had been “resolved.”  Sitting here now with the same issues, “resolved” may have been more temporary in nature.

So the big question is: What is causing the obstruction?  The CT scans do not definitively show any issue, though they haven’t really shown anything  over the last year. That includes the cancer that was found during exploratory surgery last summer while looking for the cause of a bowel obstruction. With that as the backdrop, the latest CT showing nothing is simply par for the course. I should clarify that one of the doctors believes that the CT shows enough to suggest that there is additional tissue around the intestines. What that vague haziness on the CT could be is unclear, but there is nothing large and obvious stuck in the intestines so it does rule out some possibilities for the obstruction.

Dads last chemotherapy treatment was in early December of 2016. We have all been anxious, curious, and cautiously hopeful to find out if the chemo had fulfilled its intended role. Scans have shown nothing (sounding familiar yet?) and the oncologist went so far as to say that he couldn’t see any cancer so his treatment plan was titled “remission.”  This was positive and happy news that we all embraced – mostly.  A little part of us all has held out; guarding our own emotions for the fact that these scans have shown so little for so long. Add to this the recent CEA blood test which measures Carcinoembryonic antigen levels. The sensitivity and specificity are significant for this test, specifically in patients with stage IV colon cancer. The correlation is even stronger as the values go beyond 5 ng.  Dads test came back at 5.7 which is above the mark, but not nearly as high as other patients according to one oncologist.

Tests and scans have been merely interesting; what we have wanted was a repeat of the same process that showed the cancer to begin with. Something that would allow a true comparison. The invasiveness of the original method of discovery made that option not an option… until now.

This is where the magic school bus comes in.  As great as blood tests and scans are, what we really want is to SEE what is going on in there! While we don’t have a frizzle haired teacher to shrink us down to the size of a human cell so we can go explore Dads abdominal cavity, we do have a surgeon skilled in the use of a laparoscopic camera. This is what revealed the cancer initially and we are hoping this is what will reveal the cause of the bowel obstruction this time.

We hope that the surgeon finds no signs of cancer and discovers a relatively benign reason for the obstruction. Adhesions are a plausible reason and have been mentioned by the doctors several times. This essentially refers to a scar tissue like build up in the abdominal cavity which may attach to intestines. The more of this fibrous tissue there is, the greater the chance that the intestines will become impacted, get tangled or hung up on it, or otherwise become restricted by it – all of which may lead to bowel obstructions.  The catch here is that poking around in the abdominal cavity, even to remove the adhesions, will inevitably cause more to build. In this case the goal would be to remove more adhesions than the surgery will ultimately create.

The other potential is to find cancer as the primary culprit for this obstruction. For this to be the case, it would mean that the cancer has grown and spread. No need to elaborate further here – we don’t want this to be the case.

In preparation for early morning surgery, Dad is not allowed to eat or drink anything after midnight. So, true to form, Dad ordered an orange popsicle at 11:50pm! I’m not sure what it is about these Banner popsicles, especially the orange ones, but Dad will need a 12 step program at some point 😉  Though we both sit here making jokes and telling stories, there are moments of unbridled sincerity that are full of love and tears. We both feel the weight of the unknown. We recognize the surgery and the images to be captured as a pivotal point on this journey, as I am sure you do as well. If possible, biopsies will also be obtained and we may get more actual and useful information from this procedure than many others combined.

So – that is a quick overview of where everything stands. More info, and hopefully results of the laparoscopy, will come late Sunday.  Until then, thank you for your thoughts and support.

With Hope and Love,

Richard