Update as of March 31, 2017

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.

The Ohio State University

During my sophomore year at Wittenberg I decided not to take the second term of organic chemistry. William had an interview at Ohio State for pre-engineering and I decided to go with him. I showed up at the admissions office and asked how to get into their medical school. I had a conversation with Dr. Richard Meiling and he asked me how I was doing at Wittenberg and I told him I had received a C in organic chemistry from Dr Curry. Dr Meiling said that a C from Dr. Curry was a very good grade. He told me that if I transferred to OS and did well in the succeeding terms of organic chemistry it wouldn’t count against me. Then he told me about the accelerated program in human anatomy that I could complete and enter med school a year early. The requirements for admissions would be stellar grades, my MCAT score and a successful interview.
I transferred to OS with this goal in mind.

My first quarter course load included comparative anatomy, physics for engineering, calculus, economics and humanities. Second quarter I added organic chemistry II and continued into third quarter. My life was spent in the 3 different labs which fortunately were open 24/7.
First quarter I earned a 3.7, second was 3.91, third quarter was 4.0. I successfully completed the MCAT and scheduled my interview with Dr. Meiling and he asked me if I recalled the requirements that he said I must meet to be accepted early. I reiterated them and he agreed that I had met them. The only problem was that he had too many qualified applicants. There were 7 Ph.Ds, 30 with Masters and lots who had a BS I with honors. The Vietnam War was providing incentive for people to continue their schooling. However, he told me that I would be the first to be admitted next year. Since I had finished all of my med school requirements, my senior year course load was unimpressive except for physiology which I selected because now I needed a major for graduation. I spent most of my time working at my Uncle Paul’s Chinese restaurant to earn money for school.

Because I was disappointed in Ohio State admissions I decided that the first acceptance I received from another med school I would write a Dear John letter to Dr. Meiling. I went to an interview at Northwestern and was admitted on the spot. Then I decided that wasn’t so hard so I applied to Columbia, Harvard, Univ of Pennsylvania and Johns Hopkins. I couldn’t get to Columbia and Harvard for the interview but I did make it to Hopkins and Penn and was accepted at both. Hopkins offered me a full scholarship and I took it. I have always been grateful for the outstanding comprehensive training I received there.

The Ides of March Day

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.)

Medical Progress Since Cliff Notes, Pie Day March 14th, 2017

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.

Extreme Intimidation

In spite of my unsuccessfully attempted foray as a ‘walk-on’ member of the wrestling team, I truly did benefit from the comradery and the esprit de corps among my teammates. I also thoroughly enjoyed my freshman year at Wittenberg; I had many outstanding instructors including my very young freshly married English teacher who was always late to class, my extremely Dynamic Western Civilization/Political Science educator who required at least 5 bluebooks for his exams, and my Presbyterian Comparative Religion tutor who challenged my knowledge of my Luther’s catechism. My teaching aid in Biology was Al Thrasher, a truly decent and nice guy besides being a ‘buddy’ of basketball fame at Wittenberg. But one of the very best mentors/teachers of my entire academic career was Dr. Paul Glascoe, the chemistry professor. Even though he was the Department Head, he insisted personally on teaching the freshman classes and introducing college chemistry to us himself! Wendell Lutz was publically acknowledged to be the top student in our class, but nonetheless let me proclaim that there wasn’t much light between the two of us. Dr. Glascoe selected seven top students to mentor the chemistry lab experiments and I felt most fortunate to be among the seven. He actually made chemistry come alive! I was in awe and in adoration with the wide range of chemical interactions. It was after consultation with Dr. Glascoe and with his reassurance and encouragement that I signed up to take Dr. Howard Curry’s famously dreaded Organic Chemistry as a sophomore.

We started the organic chemistry class with 47 students. Most of my classmates were juniors and seniors. To my surprise, my high school chemistry teacher, Mr. Haines, was also in this class. This was my first time experiencing being a fish out of water. To be sure, Dr. Curry spoke very clearly and very rapidly. He was exceedingly efficient with his words and never repeated himself. He was able to write and draw benzene rings and methyl radicals perfectly with either hand. As students on the edge of our seats, we were just beginning to copy a reaction he was illustrating and it was suddenly erased and gone. He wiped them away as soon as he had made his points.

Morrison and Boyd textbook was considered the standard year long course, but we were using it only as a supplement to be accomplished in about one month. Dr. Curry liked pulling surprise quizzes about every two weeks. He had what he deemed his ‘quiz formation.’ The classroom seats around 120, but we had only 47 students. Thus his ‘quiz formation,’ had us sitting ourselves in straight rows with two empty seats on either side of us. Dr. Curry would draw the chemical reactions around the room on all four black boards. After ten minutes, he’d randomly erase the reaction off one of the boards! After 30 minutes, pencils were down and he asked the papers to be passed to the left.

I received the grade of 43 out of 100 on the first quiz! First failing grade in my life! I knew the material through and through with competitive reactions both in acid and base milieu. But just could not write them down fast enough. Well, it turned out that 43 was the 3rd highest grade; my high school teacher had a 27.

My Mom would drive me to class sometimes because I needed every last minute to memorize some formula or equation. My teeth would be chattering because of nerves. Mom would admonish me by saying, ‘Franklin, you are a smart young man. You have thoroughly prepared your homework, if you hadn’t, I’d be scolding you. I’ve never seen you like this! Just don’t worry and do your best.’

Even though Dr. Curry was a good ‘explainer’ of organic chemistry, his testing method was beyond intimidation. He made it such that no one could possibly express what one truly knew of the subject; instead it was a test of how well and fast one could draw perfect benzene rings and carbon radicals.
Semester Finals eventually came after the Christmas break. As I stated earlier, we started the semester with 47 in the class; less than 20 showed for the final exam, thus accepting an F or Incomplete. I maintained my 3rd position and ‘received’ a ‘C’ grade, the proudest ‘C’ I’ve ever earned. I truly felt that I had adequate mastery and understanding of organic chemistry.

I will be relating more later regarding my transferring but let me just interject here that I did not take the second semester from Dr. Curry but finished the 2nd and 3rd quarter organic chemistry with labs at The Ohio State University, a total of 12 credits, and received straight A’s with honors without hardly cracking the text. Organic Chemistry and Comparative Anatomy were two of the major courses separating the earnest pre-med students from the rest of the group.