I did a follow-up with my PCP’s colleague on Thursday as my blood pressure continued to be erratic. A decision was made to add more IV fluids and use the inhaler. ($175.00 w/insurance….$459. W/out !!!) I still had trouble breathing and the pressure from the hematoma was making finding a comfortable sleeping position challenging. I started to spend more time in my recliner. Friday I saw my regular PCP and he recommended a Nebulizer which we purchased. We signed up for airlift insurance with the airlift NW through the UW and picked up the fire dept address signs for the house to make it easier to find us. Each day it was getting harder to breathe. Friends came on Saturday to spend the night after the Compass Housing Alliance benefit which we could not attend. After church on Sunday Linnea called the oncologist’s office to inquire about the itching I began experiencing as well as the obvious bloating. My weight was climbing quickly. They recommended begin to use Benadryl and make an appointment with the pulmonologist which was scheduled for Tuesday. I was becoming more sluggish and uncomfortable by the hour and found it difficult to eat or drink because of the pressure on my right side and mid abdomen.

On Tuesday the pulmonologist, Dr Gerbino, performed another thoracentesis and decided that I needed to be admitted to the hospital. The pressure from the hematoma was causing edema in my lower extremities and fluid in my right lung due to obstructed flow back to the heart of the Inferior Vena Cava. Upon admission I weighed 162 lbs, significantly heavier than my normal of 140. After two room changes it was determined that I needed to be observed in the Progressive care (a step below ICU) and we were switched at 2 am. A cot was provided for Linnea and she has been with me through the duration. Several tests and scans were conducted and a team of my surgeon, my oncologist, my pulmonologist, an intervention radiologist and the hospitalist conferred to determine the best course of action. Everyone was puzzled by the size of the hematoma and the fact that it was continuing to grow. But, I was showing no signs of infection or active bleeding. My coagulants were too low to attempt any procedure so they prescribed vitamin K IV and I was hooked up to various monitoring devices. With the addition of the highly concentrated K Centra I underwent an aspiration on Monday morning. They removed 2.6 liters and were also surprised to discover that the hematoma was infected, the source of which is still unknown. Because it would now require a drain in the liver to clear the infection another procedure was scheduled. Again the coagulants had to be bolstered. They decided that the vitamin K was ineffective and so provided a fresh frozen plasma drip prior to the event. Another 450 liters of clearly infected fluid was extracted and now the infectious disease dept became involved. Following the placement of the drain I feel much improved and my appetite is slowly rebounding. The pulmonologist wants another thoracentesis performed prior to my discharge, which we are hoping is tomorrow, April 1st, the anniversary of my Whipple.

This six week long ordeal was not related to my cancer but has served to delay the necessary treatment and I’m eager to get back to the fight.

Yesterday, the Ides of March day, after Pie Day, I awoke miserable, most likely my worst post Chemo day. My entire right side, including all my bony structures felt achy, as if I were suffering the ‘flu,’ though I had no fever. I took my B/P and it was 145/97 so I took two pills of Carvedilol 12.5mg. per instruction from Dr. Koval. Since my liver hematoma, I was limited to using only Tylenol for fear of further bleeding. I took a total of 3.5 gm throughout the day without much relief. There was literally no position whatever of comfort for me. I ate chicken potato soup for lunch and chicken rice soup for dinner. I had two/three bouts of loose stool throughout the day. Dr. Hurlow contacted me @ 8 pm to inquire whether I had any questions/answers about his referral for me to SCCA. They basically concurred with my present treatment plan. But I did mention my current health state of highly fluctuations in B/P and he felt it was partly due to my sudden suspending the Dexamethasone ahead of schedule and suggested that I take one, which I did. He also approved of taking one oxycodone acetaminophen for pain relief.

Finally in getting ready for bed, I took one 6.25mg of Carvedilol, contemplating taking the second one after checking the B/P. Surprise! After multiple attempts, the B/P was 72/56. Linnea contacted the oncologist on call at VM, which happened to be Dr. Picozzo. He suggested going to the ER asap to get this evaluated. We just missed the 9:45 boat and the next one wasn’t until 11:35. Linnea asked the ticket taker to call 911 because she was worried that boat was too late. Both my breathing and speech were labored. I was evaluated by medics in the ferry parking lot, (BP was 62/50) and after debating air lift, I was taken by ambulance (Sirens Blaring) to Harrison Bremerton Linnea followed in her car. I was treated kindly and professionally by Dr. Scott Davarn. He ruled out fresh active bleeding, ruled out fever, took chest X-ray and found the R lung cavity with one/half filled with fluid. Heavy wheezing set in, and I was treated with 10 minutes of nebulization therapy. After the hydration stabilized the B/P he extracted about 450 cc of serosanguinous fluid for culture and cytology. I felt almost instant relief. He couldn’t get more because under ultrasound observation the remainder of the space is occupied by the liver hematoma. We came home late this morning. (~4:00 AM.)

To reiterate, a PET CT scan was scheduled to rule in or out other sites of metastases on Monday 2/20/2017. The test showed that I had bled about 4 units of blood in to my liver post biopsy! My Hematocrit dropped from ~40 to 24 and my hemoglobin from > 12 to <7. Dr. Picozzi was afraid that I’d not make it home and immediately hospitalized me and ordered a ‘bleeding’ CT that night, also checking my blood count every two hours initially then every 4 hour throughout the night. Final answer, the bleeding had stopped, most likely due to tamponade from the maximal expansion of the liver capsule. Current complications I am suffering are from the unexpected inadvertent perforation of one of my arterioles when the liver biopsy was done on the 2/9/2017. I was doing well by felt very weak most of the time post biopsy. However, due to adrenaline of whatever, I was able to give an hour and half lecture including Q & A on Valentine’s Day and served a gourmet Chinese Sichuan hot pot dinner to eight dear friends and Linnea and me on Sunday 2/17/2017. Arranged by my PCP, Dr. Hurlow at Swedish, my case was presented at the Friday Tumor Board of the Seattle Cancer Care Alliance on 3/10/2017. The basic questions I wanted answered were two. A. Is the treatment course I am following the absolute optimal for me? I’ve known of others using Irinotecan and Oxaliplatin and Leucovorin and 5-FU all in combination. At this point, I am ready for full ‘gunshot’ therapy and put up with all of the side effects if that even increases my chances of survival by 10%. B. Is SBRT (Stereotactic Body Radiation Therapy) a possibility for me? My dear friend Wendell Lutz from high school days, now a radiation PhD, has been doing a lot of research for me. His considered opinion after talking with multiple experts lead him to a connection with a fellow scholar he had known at Harvard but now is in Seattle at the UW physics department. This fellow is acquainted a Dr. Smith Apisarnthanarax MD who is the local expert in SBRT and Proton Radiotherapy. Indeed, on the outside chance that I only have just these two liver metastases or even just a few additional oligomets nearby, localized radiation therapy may do the trick. But the consensus opinion at VM and at the SCCA group, (as well as my daughter Catherine Chu, MD at MGH Harvard) is that there are possibly millions of hidden microscopic cells already spreading, like having ‘blown a dandelion) and one knows not where they could be. Thus the collective opinion is to continue with the 5-FU regimen with Oxaliplatin regimen and review the results after four treatments with a follow-up PET scan and hope for success. Well, currently my discomforts stem from: a. engorged liver filled with an object like a 3-4 pt eggplant. b. the liver pushing under my right lower rig cage, exacerbating the fresh needle wound through the intercostals musculature. c. the pleural effusion that has developed occupying about 1/3 of the R lung volume. finally d. my inability to take and deep breathes due to the lung collapse, and the lack of space to expand, must the discomfort when trying to breathe and push against the already engorged and upward displace R liver. But I also don’t wish to develop pneumonia, thus I must try breathing deeply on a more than regular bases. The only sleeping position that yields a little comfort is on the back with pillows under the knees. But this gets tiresome after a while as well. (May be this is a small hint of what women go through during their last trimester. It is not comfortable.) Because of the bleeding, I am limited to be able to take Tylenol or the dreaded narcotics. Thus, I choose Tylenol, but the SCCA oncologist advised against this for it may mask any early fever I may develop with the Chemo treatment! Wonders of modern western medical science!! Meanwhile, my previously easily controlled brittle high blood pressure seemed to have gone awry. I had my second treatment yesterday, March 13th. I am doing well today, continuing my 5FU slow infusion over a 46 hours period. But I am coping. Fortunately I am not suffering from much of the anti-nausea medicines prescribed for the Chemotherapy drugs. I am only taking half to one-third the dosage prescribed and doing well. We’ll talk soon again. Thanks for reading and keep your prayers and good thoughts coming.