An Interesting, if Unexpected, Day at the Hospital

I thought that this was going to be an unusual week in which I did not have an appointment at the University of Colorado Hospital. I was wrong.

I noted in my last post that fluid was collecting in my abdomen. That continued and caused several unpleasant problems, so last night I sent a message to my oncologists office asking what I needed to be evaluated for a paracentesis—a procedure to drain the fluid from my abdominal cavity. This morning I received a call from the nurse at my oncologist's office asking if I could come in for labs and a visit with the oncology nurse practitioner (NP) and a paracentesis later in the day. Jana and I rushed around and headed to the hospital. I had my port accessed and my labs drawn. Then I saw the NP and went over to IR.

The procedure was interesting. After talking to the radiologist and signing the relevant papers, they wheeled me into the procedure room—a very impressive room with all kinds of equipment. First, the radiologist came in and used ultrasound to determine where the fluid was pooling. I was happy to learn that for this procedure, I would have no anesthesia. I would be awake and could observe what was happening. After deciding where he would install the drain, the nurses prepped me and covered me from head to toe with a sterile drape. Then the doctor returned and performed the procedure.

First, he injected a local numbing agent which stung and was the only pain associated with the paracentesis. He then inserted a needle into my side passing through the skin, muscle, and the abdominal wall using ultrasound as his guide to where the needle was going. As I understand it, once the needle was in place he pushed in a rubber tube that went around the needle and then withdrew the needle. Using a syringe, he withdrew three specimens of about 100 ml each. Then he attached a pump the the tubing and started “draining the swamp.”

Now an interesting procedure became boring. The doctor took a phone call and went out for a while. The nurses hung around doing something at computer screens and watching over the fluid flow into the receptacle. I just laid there with nothing to do. I looked around the room trying to figure out what all of the equipment was used for (with little insight). I was lying on my back with the tubing running from the insertion point on my side, over my right shoulder, and to the pump. If I turned my head to the right I could watch the flow in the tubing. There were bubbles in the fluid which allowed me to see the speed of the flow. So I watched that for a while and saw how the flow stopped and reversed when one container was filled and was replaced. Not very exciting.

They removed about four liters of fluid from my abdomen. When I got home I compared my weight then with my weight when I got up this morning. I lost 9.2 pounds. Before the procedure, if I lay on my back and moved my hands down my skin across my ribs, my abdomen would bulge upward at the end of the ribs like a pregnant woman. Afterwards, my hand fell off of a cliff when the got to the ends of the ribs.

My assumption has been that the fluid collecting in my abdomen was caused by my cancer just as the pleural effusion I had seven years ago led to the discovery of my mesothelioma. It may be that the abdominal mesothelioma is not the only cause. The doctor said that the load of disease in my right pleural area may be impeding the flow of lymph causing it to pool in the abdomen. As I understand it, as blood passes through the body, blood plasma passes through the vessel wall in order to take nutrients, immune cells, etc. to the tissues. This fluid then passes back through the lymphatic system to be dumped back into the blood near the heart. The flow goes up from the legs towards the heart; however, my tumor burden may be impeding the flow causing the fluid to back up in the abdomen. He said there are ways of controlling the flow, and he would talk with my oncologist about this potential complication.

After he put on a dressing, I was wheeled back to the nursing area where they gave me some cranberry juice and made me wait 30 minutes before I was released.

All in all it was an interesting trip to the hospital. The good people in my oncologists office were champs, going all out to arrange for the paracentesis on a short schedule. Luckily there was an opening in IR that they could take advantage of. And, of course, Jana was a champ as usual for getting me there, waiting through the procedure, and bringing me home. 

David

The Beginning of the End

Since my last entry I have been in a holding pattern with regards to my mesothelioma. In the interim, I had cataract surgery on my right eye which went very well. It was pain free and except for my astigmatism, I now have clear distance vision for the first time since I was in the third grade. The thing that impressed me the most was how much brighter and more colorful the world appears now through my right eye. i had no idea I was looking through a yellow-brown haze. I gather that this is a common revelation to others who've had the surgery. I'll have my other eye done on Thursday.

Back to mesothelioma. On Monday I had my first CT since January, and on Wednesday we saw my oncologist for the results.  They were not good.  My mesothelioma has grown through the diaphragm into my abdomen. 

The abdomen is lined with the same kind of tissue as the chest cavity, so the cancer seem very happy to be in the abdomen and is flourishing. It is forming a crust across the top of my liver and down the sides.  However, the lungs seem pretty stable.  Dr. Camidge offered a new chemotherapy and a monoclonal antibody that works against the formation of new blood vessels (thereby starving the cancer).  I asked the prognosis if I did not do anything, and he said probably less than a year.  I told him that I didn't have much faith in the chemo helping, and I didn't want to spend the time I have left under the effects of both the chemo and the cancer.  He understood, and we agreed to give the antibody (minus the chemo) a six week trial and regroup then. 

The monoclonal antibody is called Avastin (bevaciizumab). Monoclonal antibody drugs (generic name ends in ..mab) are man-made antibodies that work through the immune system. Avastin is a member of the class of drugs that are designed to combat angiogenesis, the creation of new blood vessels. The idea is that the cancer needs new blood vessel to grow, and if the drug prevents the creation of the blood vessels, the cancer will stop growing. Avastin is not as effective as some of the newer immuno drugs, and as my doctor recommended is usually given with a chemotherapy agent, so I don't expect much, if any, improvement; however, I'll give it a try. I get my first infusion on Wednesday and then again three week later, assuming that insurance will pay for it. Avastin is not licensed for mesothelioma.

It looks like I'm entering the beginning of the end, and it's time to get my affairs in order. When I was first diagnosed seven years ago, I thought I had six months to live. I realized intellectually that I had an incurable disease, but it never seemed real or my death imminent. After a couple of years when my cancer showed itself to be rather indolent, I realized that I had a longer life expectancy than that. Now it seems clear that my time is getting short, and for the first time i feel my mortality emotionally, a feeling that meso going to take my life.

PS. I knew something had changed because my belly looks like it's inflated. Even our five-year-old granddaughter noticed and remarked on it. When examining me, my doctor said I look like I'm pregnant. He quickly said that I was one of only a few patient that he could say that to. I appreciated the fact that we have gotten to know one another well enough for him to understand that I would not be offended. 

 David