Ambiguity and (too much) excitement

The upshot of my trip to Urgent Care and then my 39-hour hospitalization at MSK last weekend was that I received a dose of steroids to flow slowly through my pump to my liver and calm down its inflammation. Yesterday, November 3, Teresa and I went to MSK to see how this was going, and the answer we got was a bit complicated.

First, as usual they took blood and tested it on a wide range of criteria, and the results of this testing were good. The indicators of liver function, and the blood tests in general, showed improved results. Not yet back to where I was before this episode, but improved. Based on this, our oncologist proposed to give me another dose of the steroid infusion, and have me spend two more weeks off of chemotherapy while my liver recovers more fully. She also plans to reduce the chemotherapy dose somewhat. Since a central goal of the chemotherapy is to keep my liver functioning happily, I think all of this makes sense.

Second, however, MSK now had the results of one more MRI, the one done while I was hospitalized. This scan came only 11 days after the previous one, whose encouraging results I discussed in my last post; the reason for a scan so soon after that one was to make sure that the difficulties for which I had been hospitalized weren’t the result of some new development of the cancer itself. The results from this scan came up on the MSK patient portal as we sat in the waiting room, so we read it first without the benefit of the oncologist’s expert assessment.

Reading the scan report on our own was unsettling. The radiologist’s report found that there seemed to be a “slight increase” – too small to measure, our oncologist would tell us when we met with her a few minutes later – in a tumor extending out into the bile duct (which actually carries the liver bile out to the intestines). It seems conceivable that this growth could have caused the liver inflammation that was found during my stay at MSK last weekend.

But whether this new growth even exists is uncertain. On Thursday, the day before she met with us, our oncologist presented the scan results to MSK’s “tumor board,” and she told us that the members of this board themselves found the scan pictures confusing as they tried to measure differences, if any, between this scan and the earlier one. If there has been growth at all, it’s very small, and meanwhile the other tumors – whose contraction was recorded in the previous scan – have not grown. Perhaps most important, the steroid that’s being used to treat the inflammation appears to be working; that makes sense if the inflammation is a chemotherapy side effect, but not necessarily (I gather) if the inflammation is a result of tumor growth. So these possible findings from the latest scan didn’t change the oncologist’s mind about what we should do; the current chemo still seems to her to be a viable treatment, and we are glad to follow her judgment on this.

Since the only treatment I received at MSK yesterday morning was the replacement of one steroid infusion in my pump with a new one (and since we had started the MSK day at 7:15 AM), we were done with our MSK visit by about 10 AM and home by about 11 AM. Then we passed an uneventful day – but not an uneventful night. That night (last night) we went out to dinner at a local Indian restaurant, and I ordered curry. I didn’t order specially hot curry, and in general I’ve had little problem with spicy foods since I got cancer, unlike many patients, but last night apparently wasn’t my night.

By about 11 PM, as Teresa and I watched a rental movie on TV, I found myself in another episode of acute abdominal pain. I’ve had these before, stretching back to December and November of last year, and in fact a shorter episode had been part of what led to my Urgent Care/hospital visit last week. But this one was more intense. It eventually featured a lot of vomiting, and twice while vomiting I passed out (as we later learned, the pressure of the vomiting likely affected the vagus nerve and that would have caused me to faint). By this point, around 2 AM, Teresa was alarmed and I was feeling overwhelmed. Teresa called the covering physician at MSK, who told us we should get seen without delay; we planned initially to drive into New York to make another visit to MSK Urgent Care, but that drive began to seem awfully long given the condition I was in, and in the end we called 911 and an ambulance came and transported me to a nearby hospital in New Jersey, St. Barnabas.

I was not feeling well at all – and then an odd thing happened. I was sitting up in the ambulance (I’d gotten from our bedroom to the ambulance with the assistance of the EMT and ambulance staff), and as we drove the twenty minutes or so to the hospital I began to feel a little better. That may have been because the drive bounced me around a bit, and moved things around inside me. But the ambulance staffer who was sitting across from me also contributed, because instead of letting me withdraw into myself and the discomfort I was feeling he engaged me in conversation. This began with prosaic tasks like confirming my name and address, but gradually moved on to a discussion of the biography I’m writing (which he said sounded “awesome”) and of the work he does (partly as an ambulance staffer, partly as a firefighter at the firehouse nearest to where we live). I'm grateful to this caring man.

We arrived at St. Barnabas, and they quickly hooked me up to IV fluids – I was certainly dehydrated. They also gave me anti-nausea medicine. What I had hoped they would do is give me pain medication intravenously; in the past that had been what MSK did and it had seemed like the only thing that would work once the pain had reached a certain point. But they didn’t do that; they might have done so eventually, but first they wanted to do x-rays, and before I got more radiation we wanted them to look at the MSK information which we had available on our phones. Meanwhile time passed, Teresa and I slept, and gradually it became clear that the pain had lessened, not to zero, but to a point where I didn’t need the intravenous treatment. Meanwhile St. Barnabas did its own blood tests, whose results seemed to my eyes to be reasonably good, and they tested my ability to drink a half a glass of water and keep it down (which I did). So we all decided that nothing more needed to be done, and about 7:30 AM Teresa and I drove home.

Since then we have been taking it easy. I feel better, though my stomach still hurts a bit and I’m tired; Teresa is tired too; and we are agreed that this was way too much excitement. Hopefully it won’t be repeated soon.