Cliff Note Summary to Date

For those who wish only to read a synopsis of my medical history and treatment, I summarized the following for a referral consultation. Summary of Franklin Chu’s Health History: re Pancreatic AdenoSquamous Ca. 2/27/2017

10/2/2015 visit to PCP
I have had moderate but easily controlled high BP taking Vasotec 5 mg qd (generic) for 20 years. Then I developed a “Steven Johnson” reaction with total body rash, and sluffing of all integement from head to toes on June, 2015. Then I was placed on 2.5 mg qd of Amlodipine Besylate with good BP control. Now, 10/2/2015, I have an almost constant non specific ache on the left side of my stomach, about the spleen area. A. Is this normal? B. Is this problematic, or will it lead to stomach ulcer or cancer? C. By Putting up with it, will this subside or get worse? Secondly, my urine had been noted to be very dark, intermittently, but more times than not.
Blood tests on 10/2/2015 showed markedly elevated liver enzymes and bilirubin.

CT scan on Monday, 10/5/2015 showed marked blockage and engorgement of Biliary, pancreatic and gall bladder.

Thursday, 10/8/2015 Consult with Dr. Scott Helton at VM

Friday, 10/9/2015 Ultrasound delineation of involvement with the Portal Vein, Bx, and Biliary stent placed.

Monday, 10/12/2015 Power port placed under R clavicle, peritoneal lavage for cytology, negative.

Monday, 10/19/2015 Initiated Chemotherapy with Gemcitabine and Docetaxel, two weekly treatments with the third week as a bye week. I completed 12 of the scheduled 16 sessions when I developed pulmonary complications with fibrosis, edema, and inability to breathe effortlessly.
Chemo Medications were stopped. With initial high steroids Rx followed by slowly tapering, I regained my lung capacity to tolerate a classic Whipple procedure by Dr. Scott Helton on 4/1/2016.

You should be able to obtain the report. Basically, everything looked very good.

Post-op, I suffered one month of gastric paresis with inability to pass any food material and lost about 20 lb, but have had no problems ever since. Subsequently, I was treated with 4 sessions of Irinotecan, Leucovorin and 5-FU beginning on June 1 and had a negative CT scan on July 27, 2016.

Follow-up CT on 10/10 also showed no signs of recurrence.

Follow-up office visit on 12/12 showed slight elevated liver enzymes and increased CA 19-9 by 10 fold, (from 4 – 40) but high norm for VM is deemed 37. Dr. Picozzi suggested watching and follow-up in two months.

Recent CT scan on 2/6/2017 showed the two large encapsulated lesions in the R lobe of the liver.
Needle biopsy on the 9th showed cancer metastasis. Post Bx developed 4 unit sub hepatic hematoma, required 2 units transfusion.

2/24/2017 Reinitiated ChemoTherapy with Oxaliplatin, Leucovorin and 5-FU. Not affected by side effects thus far.

Hope this is helpful.


The February 6th Appointment, Very Disappointing News

I had a contrast assisted CT scan which revealed 2 encapsulated lesions in my R edge/side of the liver, under the R rib cage. One measured greater than 4 cm and the other 3 cm. The liver function tests were all elevated and the Cancer marker increased from 40u two months ago to over 400u.

The CT test is October was clear!! No CT follow-up was performed in December. Therefore these lesions could represent as long as a four-month growth; or the shortest duration, a two-month growth. Symptomatically, I was absolutely feeling fine and very energetic. I played a round of golf at Trophy Lake with friends 3 days before with ambient temperature in the 40’s. The final Par 5 hole was memorable. I drove my best 185 yards right down the center of the fairway; hit my 3-wood straight and landed about 60 yards in front of the creek separating the green on the other side. I chipped the next ball safely onto the landing site, hit the following ball farther away from the pin than I wanted, but was able to par the hole with a ten-footer.

My Oncologist Picozzi remarked that the lesions were atypical and suggested an aspiration biopsy, hoping against hope that this might be a silent abscess rather than a tumor. The interventional radiology performed the procedure on Thursday 2/9. I was told that the result would be available in one week. The usual precautions were instructed such as limit activities, no pain meds other than Tylenol, report fever, bloating, tarry stool, etc. Post –op was totally asymptomatic. We even joined friends for dinner after we returned to the island.

Meanwhile, I had committed to deliver a lecture to the women of the Bainbridge area who are known as SWERV, Savvy Women Exchanging Relevant Views, on aging eye issues. I had been preparing a talk for them, ‘Keeping a Savvy Eye on Vision Thieves.’ be given on Valentines’ Day. There are too many vision thieves; finally I decided to cursorily cover 5 major areas: Cataracts, Diabetic Retinopathy, Glaucoma, Macular Degeneration and Retinotraction/Detachment. Even limited to these topics, I was presented with the great difficulty of time management, how to do justice and yet impart valued ‘pearls of wisdom?’ The event came to past with appreciation both by the audience and as a welcomed distraction for me. My Mom and Elizabeth came to the lecture and joined us with friends for a memorable V-Day dinner that evening.

Wednesday February 15th, we had an office consult with Dr. Picozzi and set up a total body PET to determine the extent of metastasis. That evening we went to our church choir rehearsal where I sang but was unable to stretch my breath hardly to the requirement of the director. Friday we attended the Oscar ‘Shorts’ arranged by Pastor Paul at the Dragon Fly. Saturday we gathered as a family of 22 and celebrated the open house at the new home of one of my nieces in Sammamish. They had planned it for the summer, but moved it up for me to attend. Sunday after church, Linnea and I spent our time in our beautiful kitchen preparing Chinese hot-pot dinner for ten of our very dear friends who have long expressed great interest in my background and Chinese heritage. Trish played the piano for me to sing and record a few favorite hymns with Jim Cauter and Dave Siburg backing me up. I tried my best, but was often out of breath.

Monday morning, February 20th, we took the early ferry to Seattle for the PET scan. Prior, they took blood for CBC and Chemistry. My hemoglobin, (Hgb) dropped from 12’s to 7.5; hematocrit, (Hct) from ~40 to 24. The PET scan showed the lit tumors in the liver, but also a large sub capsular hepatic hematoma. Fearing continued active hemorrhage, I was admitted to Virginia Mason Hospital and had a CT scan that night to verify that the bleeding was not continuing, and I had blood drawn every 6 hours to determine my status being stable. Thankfully, I was. Bleeding has ceased and was no longer active. Linnea, of course, stayed by me constantly; Elizabeth, Mom and son David came with his family, Ana, Fiona and Juliana. Pastor Jimmy Hao also visited and prayed with me. Tuesday evening we had an honest and productive conversation with Dr. Picozzi and mapped out our course of action. He ordered me two units of blood for transfusion over night. Next day, the Hgb rose to 10.8 and the Hct to 34 and I left the hospital.

Friday, 2/24/2017, I resumed Chemotherapy with OXALiplatin, Leucovorin, and 5-FU over 46 hours. I was instructed to disengage IV connection from my power port on Sunday. Thus far, I am doing well and tolerating the chemicals well with hardly any ill effects. However, I also recognize that this is only the beginning of a possibly long, unknown and untrodden journey. Thank you all for walking with me and by me. I truly feel blessed and wholeheartedly appreciate all your love.

I am honored and welcome your reading my medical journey. I will keep you updated as I am able.