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Hazel- 85 year old female, healthy, well nourished, young for age

3/7/04 Mom taken to emergency room of Memorial Medical Center, Springfield, IL presenting jaundice, dark urine, clay stools, abdominal pain. (gall bladder was removed about 20 years ago, same hospital) CT taken, admitted to hospital. She had been having pain in upper abdomen following meals for about a month and kept eating blander and blander foods until finally pain was constant and she quit eating. 3/9 ercp performed, but unable to enter bile duct because of blockage. Pancreatic duct appeared clear. 3/10/04 MRI taken. Diagnosis either cholangiocarcinoma of the distal common bile duct or cancer of the pancreas. 3/11 head of surgery at MMC refers her to Barnes-Jewish Hospital in St. Louis for possible whipple.

3/15/04 to 3/18/04 diagnostic exams at Barnes, including a 2nd ercp, another CT scan (slice?) of pancreas, cardio workup (because of her age) and a hematologic work up (she had been diagnosed with chronic ITP in November 03 because of vacilating blood platelet levels). Cleared for surgery (whipple) and it is scheduled for 4/2. Scope jockeys think it a pancreatic tumor in the head of the pancreas that is constricting the bile duct, surgeon thinks that it is a tumor (perhaps polypoid) in the common bile duct. Feels that the treatment would be the same (whipple) for either type. Note: we wonder if there is a connection between the tumor and the blood platelet problem. Bloodwork throughout November and December of 03 cleared her of any leukemias or lymphomas and CT scans at the time did not show any large masses, hence the chronic ITP diagnosis. One of the hematologists at Barnes suggested that the presence of the tumor might account for the platelet level fluctuations.

4/2/04 At Barnes in St. Louis, laparosopic staging exam doesn't show anything, so surgeon proceeds with the whipple. After about an hour, the surgeon comes out, says that the surface of the pancreas is rock hard and that the superior mesenteric vein has adherred to it. He tried for about 15 minutes to free it and felt that the risk was to great to proceed any further. He then went back in and performed a biliary bypass. She came out of surgery OK given her age and being on the table for close to 5 hours. Was discharged from Barnes on 4/9/04 and is now at home doing fairly well. Pathology reports only show acute pancreatitis (as the surgeon had suggested might happen), so we are still uncertain as to the exact type of tumor. Surgeon thinks the tumor is small at this point and perhaps slow growing and that she might live 90% of her natural life span (2 - 3 years). My own research suggests that 2 -3 years is somewhat optimistic, less than one year is more likely, and that 6 - 8 months is average. But at least the possibility is there, statistics are just that, each person has an individual pathology and prognosis. Surgeon also indicated that he would not recommend chemo or radiation therapies given her age and what he saw. We have been pleased with all of her care at both institutions and with the entire team of physicians and nurses. It's the disease that's the problem.

I should mention that her spirits at this point are pretty good, now that she is feeling well again and without symptoms for a while. We were devastated after the original diagnosis in March, disappointed again in April when he couldn't complete the whipple. A real emotional roller coaster ride. You try to stay on an even keel, but when something positive or hopeful is offered you really grasp at it, and in our case, only to be let down each time. Again, that is just the nature of this insidious disease.

Posted 04/14/2004 01:00 pm by G Smith
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