Pancreatic Cancer? the clock ticks down…

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Earlier this summer I alluded to some medical problems.  I sit here now, with occasional winches of abdominal pain, eight days post-op.  The short version:  I have a history of diverticulosis.  After a couple of flare-ups of diverticulitis, we did a CT scan. The colon showed nothing new but there was something unusual with my pancreas.  So we decided to do an endoscopic ultrasound – a procedure by which an endoscope is dropped down  throat.  Then, from the inside, an ultrasound can be directed toward my pancreas.  Pictures are taken and a needle biopsy is performed.

At first everything seemed okay at first.  We met and decided just to watch and wait.  Just to be sure we did an MRCP, an MRI of the area.  The results of this prompted a call from my GI doc.  He wanted me to see a pancreatic surgeon.  Within 4 hours I get a call from the surgeon’s office.  (Referrals usually take a week or two).  The surgeon wants to see me with the following two days.  Now I start to worry.

I start doing my research: on the surgeon, the possible procedures, and the culprit finding – intraductal papillary mucinous neoplasms (IPMN).  IPMNs are precancerous structures.  Their size, location, and composition influence to potential for becoming malignant.  There are three criteria that guide the decision to do surgery.  They must be thick and sticky – mucinous.  Mine are.  They must be larger then 2 cm – mine are.  They must be blocking the main duct – one of mine does.  Finally the presence of something called a mural nodule, a cyst that could be an early cancer, seals the deal.

The surgeon says the clinic sees about 1200 cases of NPMN per year, and only recommends surgical resection about 35 times out of that number.  That is what he is recommending – removal of the distal portion of my pancreas… and, in my case, removal of my spleen.  Enlargement of my spleen was the predominant symptom of my leukemia, almost twelve years ago.  It has always remained somewhat enlarged and damaged.

The addition of my spleen means the procedure cannot be down laproscopically or thru small incisions.  So it must be an “open” procedure.  If we were in Skpe now, I could pull up my shirt and reveal to you an 8 inch incision, starting at the tip if my breastbone and descending straight down to my belly button where the incision curves around to the left.

The surgery, a distal pancreatectomy and splenectomy, took place last Wednesday.  It was about a four hour procedure.  There were no surprise findings.  Everything seemed to go well.  In fact I did not even need an external J-P drain for blood and fluids.

Pain was a big issue.  My diaphragm was quite angry with me.  So it hurt, especially when I breathed, moved, coughed or sneezed.  The term “gas pain” took on a whole new meaning.  I had a PCA (patient controlled anesthesia) filled with Dilaudid and that surely helped.  But after the first recovery day they wanted you up and moving, up and breathing (you’ll remember I told you it hurt,  hurt, hurt to move or breathe!)

But I came home on Monday.  Tish took off work to take care of me, keeping me hydrated and pain-free, reminding me to get up and move around, do my breathing exercises.  We took a trip yesterday to Goodwill (Senior Day) to buy a cane, then to the library for a few movies.  My diet is still just full liquids plus one egg a day.  As long as I drink 4 protein shakes a day, my surgeon is happy.

And so am I, happy that is, mostly, patiently waiting til Friday, when we get … the pathology results.

Take care til then,

Dennis

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About Dennis Pyritz

Dennis W. Pyritz, RN, BA, BSN, has been a cancer nurse since 1987 and a cancer and bone marrow transplant survivor since 2004. In December 2001 he was diagnosed with t-cell prolymphocytic leukemia (T-PLL), a rare aggressive form of chronic lymphocytic leukemia (CLL). Dennis was treated with the then new monoclonal antibody, alemtuzumab (Campath) as this disease has a median survival of 7.5 months. He achieved a 26 month remission but relapsed in February 2004. He was retreated with Campath and went into a second remission. In August 2004 he underwent an allogeneic peripheral blood stem cell transplant with his brother, Mark, as donor. Dennis has remained in remission since - a near miracle. Throughout his career as cancer nurse and patient, Dennis has had the opportunity to speal to both lay and professional groups. Dennis has spoken on cancer topics and survival issues across the country as well as in the United Kingdom, Norway, Austria, Portugal, Honduras, Panama, Guatemala, Trinidad, United Arab Emirates, Jordan, Cyrpus, Israel, and India.

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