The Struggle Has Ended

Greg Hewlett passed away on January 17th after nearly eight years of battling colon cancer. While we grieve his loss, we are comforted to know that he is with his Lord.

If you would like to leave your thoughts on Greg, please see this thread.

If you would like to make a charitable donation in Greg's honor, please see this thread.

Tuesday, July 29, 2003

No stent and some promising signs

Early this morning, I had a procedure at MDACC during which the medical team evaluated the possibility of obstruction of the digestive tract. They were prepared to put in a stent if it looked probable that I would become obstructed in the next few months, forcing surgery at an inopportune time.

The Procedure
It was immediately apparent during our pre-op discussion with Dr. Lahoti, who performed the procedure, that he felt my situation did not warrant a stent. The problem with a stent is that if my chemo shrinks the tumor, then the stent could become dislodged, causing a realm of serious problems. A stent, he said, is usually not used unless the chemo is found to be ineffective. Because it appears that I will continue chemo, as my side effects in the first round were tolerable (albeit not enjoyable!) and early indications are that it may be doing something good (see below), he wanted to hold off on placing a stent. The risks of waiting were better than the risks of putting it in.
Unfortunately, he was not able to get the probe through the narrow tunnel at the tumor location. He got some pictures and then after I woke up from the anesthesia, he sent me to get a barium enema (BE). More fun. I remarked to the technician that MD Anderson seems to enjoy sticking tubes up peoples butts. But to tell you the truth, these unpleasantries (yes, an understatement) seem smaller and smaller in comparison to the big picture. I am recalling how, in the process of treating cancer, one's modesty and sensitivity to pain go down as one gets carted off to this and that procedure. During the BE, the few times I groaned at bad cramps, they asked if I was alright. I always answered yes because I wanted them to take their time to get the best pictures possible. The BE indeed gave us a good idea of how long the tunnel was through the tumor and assured the doctors that things were not ugly on the other side.
The combination of procedures revealed that the narrowest point in the tract is 4mm across and about 2-3cm long. This corresponds to an approximate 85% blockage at that point in the colon. This sounded pretty narrow to me. However, I was told by Dr. Rodriguez that pretty much everything that goes through this point in the colon is liquid. That�s why I�m not currently having any abnormal symptoms of blockage. As long as the tumor is held in check by the chemo (or better, if it shrinks), I have a decent chance against becoming obstructed.
The consensus between Dr. Lahoti and Dr. Rodriguez (my colon surgeon) is for me to get back on the chemo plan full throttle and continue to keep a close eye on the blockage. Part of this will be a more restricted �low residue� diet. This will assure the liquidity of what gets to that point in the colon. I was also coached by both doctors on recognizing the earliest symptoms of obstruction so that if this occurs, we may be able to put in a stent at that time, holding off emergency surgery.
Is the chemo working?
They have told me several times not to put too much faith in the CEA blood level - that it should only be considered serially over time. This is a marker for indicating the overall aggressiveness of my particular type of cancer. In general, if it goes up, the chemo is not working and if it goes down, it is. For the first month I knew I had cancer, it hovered around 60-75. The normal non-cancer level is below 5. Mine moved as high as 123 just before beginning chemo. At that time they said I shouldn�t be concerned or surprised � after all there was nothing keeping the cancer in check. Yesterday, after one complete round of chemo and a week of rest, my level was 14! I�m interpreting this on my own (we haven�t discussed this with a doctor yet), but that seems to me to be a good sign. My impression of the chemo drugs I�m taking is that sometimes this type of chemo doesn�t work at all, sometimes it only works for a while, and sometimes it works well. The big drop in CEA to me is a good indicator that my cancer is currently in retreat. For now, I am very thankful that it plummeted far more than I even imagined it would. Thursday I will listen to the doctor's interpretation of this number.
Another thing that I noticed was a big difference in the colonoscopy photos of this morning compared with those of two months ago. Yes, it has been that long. Dr. Lahoti did not want to make any qualitative assessment because they were different kinds of photographs. But my job at TI is evaluating digital images and the ones from today looked much better to me, even given the difference in image capture devices. I thought today�s photo clearly showed less bloody walls and a tumor that is less out-of-control looking in form. To me, it looks like the chemo has been stabilizing, even neutralizing the tumor.
�So was it a good day?�, people ask. Well, the 4mm opening is a big concern, but can be overcome if we monitor it carefully and the tumor does not grow. The two indications that the chemo may be working, while not interpreted by a doctor, were encouraging� Two small indicators. Two reasons for thanksgiving. Two small steps towards the goal. And the way to walk 1000 miles is one step at a time.
The rest of the week�
Wednesday is a day off. Christine�s parents are here and we hope to enjoy some time away from MDACC together with them. Thursday I meet with a new clinical oncologist (we are switching from Dr. Xiong and his team). Friday I take the intense IV chemo, followed by the 14 day oral regimen. We will stay in Houston over the weekend because of how I felt last time I took the IV chemo and so that we will be close to the hospital should any problems arise.
Christine and I cherish your prayers. If you are praying, please ask the Lord that my digestive tract would not become obstructed and that the coming second round of chemo would be very effective and would not cause serious side effects. Also, please pray for Christine's migraines. The past weekend was very bad, but today was pretty good.


Steve said...

i hope that 85% blockage decreases
so you won't need a stent
hope the IV chemo on Friday is very
effective without causing any serious
side effects
hang in there Greg !

Jim MacNally said...

We do continue to pray daily for both of you and will be adding you to anew group we are meeting with tonight here in DC.
Thanks for sharing your "journey" with us. Remember that "...He who is in you is greater than he who is in the world."
Keep the faith.......

Ruth Reitmeier said...

Is there something Tyler and I can do this week for you or for Christine's family in town? Are you up for church on Sunday?
Ruth 281.866.0801

Judy Wu said...

Enjoy your day off, Greg and Christine. I'm glad to hear Dr. Lahoti's assessment. (He's a good gastroenterologist.) I hope you have a good meeting with Dr. Hoff tomorrow. I'm happy that you're switching oncologists. You guys are in my thoughts and prayers. Much love...

Randy Bihm said...

Hi Greg, I didn't know of any other way to reach you to give you a report on your home water heating system. It passed every test I could put it through. Temperature, volume and flow capacity are OK. I checked with the manufacturer and their return email states: "There are no recalls on this heater". The reason for the occasional sediment in the bathtub is your waterfall-type water dispenser doesn't have a strainer to filter out normal sediment so it becomes more noticeable. This can be remedied by a routine flushing maintenance procedure that I'd be glad to help you with. I can't explain why the tub doesn't provide enough hot water in the winter unless the piping insulation is inadequate. After I left your home I wondered if your whirlpool tub has a water heater built in and if so does it work? To make a long story short, a new $800 water heater would deliver the same performance as the one you already have. If you still want it replaced let me know and I'll make arrangements. Please let me know. Randy Bihm (972) 571-4140

Curtis Frodge said...

praise God for a lowered CEA level! thats great man!!! well i am still praying for you, be sure to tell me when you figure out what times of the day you will be taking chemo pills so i can pray for ya then.
sorry to hear about md andersons strange tube procedures, that is no fun at all man :( that would definately concern me about their operations too haha.
well i guess its back to work, but did you get the matrix quote i put in my last post? apparently some of the lady folk from church didnt pick up on it. disappointing so long greg, love ya man! God bless

mark hewlett said...

I continue to keep you close in mind. I am only a short drive away if any errands or needs come up.

Tim Ryan said...

Hope you get good news from the Docs today. You are in our prayers, and the prayers of the Church of Christ on McDermott Rd. You are on our weekly prayer list printed in our bulletin, so you have a few hundred others you don't know thinking of you each and every week.
Keep the faith.