Best Laid Plans.....4th Trip to Duke

As many of you know, Joe had scans scheduled for today, Friday 11/26/10, at 1pm and at 3pm.  After overeating way more than either of us should have yesterday we tried to sleep late today.  The rise in overnight temps had made that difficult as both of us woke up in the weee hours of the morning hot.  It took awhile, but we both did manage to go back to sleep for awhile.  We both awoke around 7:30am to cloudy skies and finally went downstairs around 8am.  At 8:05am, the phone rang with caller ID: Duke Univ OIT.  I took the phone to Joe.  Guess what, they are calling to see if he can come in earlier for his scans.  Like now!
Well, of course we are more than happy to comply and get this out of the way rather than spending the entire afternoon at Duke, again.  So after 2 very quick showers and a hurried drive, we arrive at Duke at 8:55a.m, get checked in and traverse our way down the maze like halls of the Radiology Department at Duke.  So as of 9:15am, we are sitting in the waiting area outside of Nuclear Medicine, Joe in 2 lovely hospital gowns (very reminiscent of the photo from a post last week) and me with laptop on my knees.  And we wait.....
UPDATE: 9:18 am - Joe was just called for his first scan.
UPDATE: 9:54 am - Joe has returned from the nuclear scan with his pants almost falling off. Thank goodness for 2 hospital gowns!
UPDATE: 9:56 am - Joe has been called for his second scan and I begin my second episode of "Matlock" on the waiting room TV.
UPDATE: 10:10am - Joe is back, re-dressing and we are on our way out of here with the entire day ahead of us!  YEAH!!

HAPPY THANKSGIVING

HAPPY THANKSGIVING!

Joe, Jeff & Dolly Llama

The Day Before Thanksgiving

In an effort to keep things as normal as possible, we got up this morning and took off for Hardee's for sausage biscuits.  I know different people like different places, but in the Lupton-Holland household, Hardee's is hands down the best in the sausage biscuit department!  Of course, Joe who is a little in the "unique" department, took his own Borden fat free sharp cheese slices to put on the biscuits.  I maneuvered us over to a corner booth so as not to be seen for this one!

Then we were off to get everything we needed for Thanksgiving.  Usually, since we are traveling during Thanksgiving week, we have done this well in advance, so hitting the stores the day before Thanksgiving was quite a shock to our system.  WOW!  Alot of people wait until the last minute, huh?

 

First came the grocery store where Joe was in heaven.  Very few things are as thrilling to him as grocery shopping.  I on the other hand am constantly asking, "are we done yet?" This does not go over very well with Joe.

Then we were off to what Joe practically considers holy ground, Costco.  Several food samples later, and we are off with the trunk of the VW full.  Next stop, home....we forgot the Honey Baked Ham store coupon.

And then we were off to the Honey Baked Ham store where the parking lot was full and we were forced to park on the side of the street and walk a block.  At first, we thought this wasn't going to be too bad since there were no lines outside.

Space inside was at a premium however. It took awhile, but eventually we left with our turkey, ham, dressing, and gravy.  Upon retuning home, I raked the leaves in the front yard, Joe assisted by rolling the yard waste cart around for me and we got plenty of fresh air.

Joe feels really good today.  His jaundice appearance is beginning to fade a little, his energy level has gotten much, much better.  For the last 2 weeks at this point during the day, he has been very tired, but each day this week he has been less and less tired.  He even was up until almost 11pm last night (against my urging to go to bed).

We are looking forward to a wonderful Thanksgiving tomorrow and are extremely grateful for our friends and family and all the prayers and good thoughts coming our way.

3rd Trip to Duke

Joe's third appointment is today at 11am.  We arrived at 10:50am and Joe was SOOOO excited that we got to use the electronic check-in kiosk.  It remains to be seen as to whether or not this is a time savings measure since the waiting room is crammed to capacity with overflow out in the hall.  He is supposed to have bloodwork done followed by a noon appointment with Dr. Zafar.  Anyone want to place bets on what time his bloodwork is done?  How about the actual Dr. appointment?

UPDATE:  11:03 and he now has a buzzer like you get at Ruby Tuesday...and we wait.
UPDATE:  11:08- called for bloodwork, 11:10 back from bloodwork....and we wait.
UPDATE:  11:30- called to the back for vitals and to see the doctor.  Saw his nurse, Minokah and went over the last weeks details with her.  11:45, she's gone and the doctor is us net....and we wait.
UPDATE:  11:45 - Dr. Zafar came in with the news that in deed the cells that they did get from last weeks procedure were malignant, so we are dealing with pancreatic cancer. The plan of action is to begin chemo as soon as Joe's bilirubin count is down enough to begin.  The plan is chemo/radiation followed by surgery followed by more chemo.  We then met with the radiologist, Dr. Czito and he ordered up more scans for today, 3pm and for Friday, 1pm..  There is the possibility that Joe will begin radiation prior to chemo, if his bilirubin level does not improve quickly enough to begin them simultaneously.  Regardless, we will get started with treatment sooner rather than later.
UPDATE:  2:40pm - Joe is drinking his scan "cocktail" so they can get good images.  He says it doesn't taste bad but rather like there is some rum in it.  But on second thought, it's not like he wants to down it all really quickly.  Next they will start an IV so that more imaging can be done.  This scan takes about an hour.  Neither of us has eaten anything since 8:30 this morning, nor drank anything.  Jeff is being his usual martyr and won't eat anything until Joe can (although as soon as he goes back for the scan, Jeff plans on getting a couple of cookies).  I think tonight might be a good night  for some highly fattening burgers or pizza!

This of course was not the news that we wanted to hear, but it is by no means a surprise.  This is the hand we have been dealt and we will deal with it as best we can...fight it as best we can.  We have been given alot of information today, possibly too much to process at one time. Thank you to everyone who has been praying for Joe and keeping us in their thoughts.  As the doctor advised, we will take it day by day.

P.S.  Joe insisted on getting something to munch on IMMEDIATELY after leaving Duke.  And guess where he wanted to go?????

Yep, straight to Dunkin Donuts..... :)

Oncology Appointment tomorrow at 11am.

We have to be at the Duke Clinic Oncology department tomorrow, Monday 11/22/10, at 11am for them to do blood work and then we have a noon appointment with the oncologist, Dr. Zafar.  Even though we do not anticipate having the biopsy results in by the appointment time, we have lots of questions for him.  Joe did go to church today and played for both services.  Jeff drove so he didn't have to worry about that aspect since he does tire easily.  Today he doesn't feel as tired overall as he has the past 2 days, even though he has had a little more activity today than lately.  After church we met 2 friends for lunch, Jill & Mark.  Then we came home, watched the Sprint Cup championship race (well, Jeff did while Joe read the paper) and have been relaxing on the sofa catching up on some shows that were on the DVR.  Tonight will be an early evening so Joe can be rested up for his appointment.

Countdown....and lift off

Day 2 at Duke...
We arrived at Duke Clinic at 9:25am this morning, Joe immediately was taken for blood work and within seconds of returning to the waiting room, where Lucinda Sullivan - THANK YOU Lucinda- and I were waiting, he was called to the back room to prep for the procedure.  A few minutes later, a nurse returned and told me that I (Jeff) could go back with Joe.  I went to the prep-area and sat with him while the nurse asked lots of questions - the same questions asked on every other visit - and explained what the procedures for today were.  Then the first doctor, Dr. Walker - apparently either an Aussie, Kiwi, or Brit - came in, asked the same questions, explained the same procedures and left.  Then we went back to the room where the procedures will be taking place, the nurse there asked the same questions, then the 2nd doctor, Dr. Ombando, sp?, came in and by the grace of God, didn't ask any questions, but rather cut right to explaining the procedure.  The one thing mentioned through all of this is that there is a possibility that they are not going to be able to get a good enough sample for biopsy due to them not wanting to do any cutting if at all possible because Joe's blood is very thin at this point due to Vitamin K deficiency (a result of the bile duct blockage/high bilirubin count).  If they are not able to get an adequate sample, then he will probably have to have a needle biopsy at a later date.  Today their main objective is to get the stint in place so the pancreas can start draining. I left the room as one of the nurses was putting drugs in his IV.   So now the waiting begins.

Ok, at 12:10pm, the nurse came out to the waiting room and told Lucinda and me that he was in recovery.  I went back there to be with him and met the doctor who explained that they were able to put the stint in the bile duct from the pancreas and were able to get some cells from the mass to send off to pathology.  It will be early next week before we have the results.

Isn't he precious!

The above photo is from the recovery room.   He had to remain in the recovery room until 1:30pm but then was released and after a quick stop at the drug store and the grocery store for some soup for his lunch, we are home and he is resting comfortably on the sofa.  Next up will be a Monday morning apointment with Dr. Zafar.   Thanks to everyone for all their warm wishes and prayers.  We are so grateful for our friends and family and the outpouring of love.

PM update:  It's a little after 9pm and Joe has gone to bed.  He has dozed off and on all afternoon and evening. He did eat the soup for lunch and ate a good dinner - Thanks Carrie!  He is complaining a little about his throat hurting and has taken some Tylenol.  They told us his throat would probably be sore from where they inserted the scopes.  He said he was really tired but felt more relaxed than he has the last week so hopefully he will sleep most of the night through.

The Night Before

Jeff & I just got back from seeing a special one night only movie presentation at Brier Creek Cinema of the 25th Anniversary Concert of Les Miserables that was done earlier this year in London at O2. Our favorite line is "To love another person is to see the face of God". This was a good evening to take my mind off everything.

We have to be at Duke Clinic tomorrow at 9:30 a.m. The appointment/procedure is supposed to begin sometime after 10:00 a.m.

Thanks for all of the thoughts, prayers & support from everyone we know.

Monday

Of course, I waited all day to be called on Friday concerning an appointment for the 2 procedures & guess what! I get called this morning to have it done today; however, I was asked if I had eaten anything & I had a bowl of cereal at 7:15 a.m. The person I talked to was under the impression that I was having it today. Obviously, someone neglected to let me know that I was having it today. It would have been so much easier if I had known prior to 9:02 a.m. not to eat breakfast this morning. So now it has been scheduled for Thursday morning unless there is a cancellation for tomorrow.

So How Did All of This Begin?

2 weeks ago tonight, I came home after a week of taking my mother & her best friend since they were 11 years old to Myrtle Beach for a week.  I had a wedding rehearsal first, came home and then Jeff & I went to eat at one of our favorite places, Rudino's.  When we got back home & standing in the harsh fluorescent lighting of our kitchen, Jeff looked at me and said "You're yellow!".  So he immediately sent me to the Duke Urgent Care near our home.  I spent a couple of hours waiting.  They did some blood work and told me to see my regular Dr. the next week for results.  I was able to see Dr. A the following Tuesday at Triangle Family Practice where she went over the lab reports & did more extensive labs and wanted me to have an ultrasound.  That was done last Friday at Durham Diagnostic Imagining.  Next I was called in for a CT Scan this past Monday and then Dr. A called and asked me to come by to let me know that a mass had been found on my pancreas.

Day 1 at the Duke Oncology Clinic: November 11, 2010

As the button on the Duke Oncology Clinic employee says:

CANCER SUCKS

Today we had my first appointment at Duke with the medical oncologist, Dr. S. Yousef Zafar and his team.  Although the initial wait in the lobby of the Oncology department was an extended one, I enjoyed the free cookies that they have out for everyone. Jeff however, abstained and only looked at me with his often seen look of disapproval. (Please note, that it is Jeff, not me that is typing this).  They also had complimentary soft drinks, coffee, tea and water.  After filling out an extended electronic survey of my physical and mental state, we settled in to people watch.  Of course, the moment that I went to the bathroom, they called my name. 

First came the obligatory weigh-in, temperature & blood pressure vitals.  However, the rather short nurse had to call in reinforcements to measure my height as she could not reach up to the top of my head.  From there we were taken to the examination room where I was first interrogated by Dr. Zafar’s nurse and then the oncology resident.  The resident, who speaks highly accented English, proceeded to do a physical exam as well.  We were then left to wait for the “real” doctor.  It really was not that long before Dr. Zafar came into the room with his resident and discussed what he knows thus far and what we will still have to wait to find out.

What he knows:  The CT scan and ultra-sounds show a mass on my pancreas.  The conclusion is most likely pancreatic cancer. However, that diagnosis cannot be verified until there is a biopsy.  The mass has obstructed the duct leading from the pancreas that flows to the liver and is filtered out to the rest of the body.  With this obstruction, the bilirubins are building in my system.  This is the cause of my jaundiced appearance (my skin is yellow).  The obstruction has to be alleviated.  This can be done by inserting a stint into the pancreas to open the duct allowing it to work more normally.  This needs to happen sooner rather than later.  The procedure involves going down the throat to the pancreas. However, if the opening in the duct is completely closed, then the stint isn’t possible.  In that event, the surgeon will need to go through the side of the torso and insert a tube that will be exposed to the outside of the body, allowing the pancreas to drain.  The biopsy will also be performed by going down the throat to the pancreas.  The best case scenario is that the biopsy and stint can be done at the same time on an “out-patient” basis.  The appointment for the biopsy & stint placement will be made ASAP.  Hopefully by early next week, both will have been completed. 

What he doesn’t know: Only the biopsy will confirm whether or not the mass is cancerous.  That conclusion will determine the course of treatment. He did say that if cancerous, the typical course of treatment was: Chemo/Radiation, then surgery, then more chemo.

Where from here: I have an appointment with Dr. Zafar next Thursday, where hopefully, the biopsy results will be in, my bilirubin level will be down due to stint or tube and at that time, we will learn what the course ultimately will be.

Everyone that we came in contact with today at Duke was upbeat, positive and seemed to care.  Jeff and I both left with a good feeling about Dr. Zafar and his team, as well as the future.