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.

Saturday, December 27, 2003

Pressing On To Joy

Greg took his first steps yesterday as he continues his excellent recovery from liver surgery this past Monday. His progress continues to be remarkable and we all were impressed with his strength, determination, and grit.

Items removed on Friday: Foley catheter, IV in jugular, epidural. The removal of all of these so early signifies that his liver function is good and his blood should clot well. This is great news and a real answer to prayer for swift healing.

Of course, great progress does not mean that there are no difficulties or dangers. Please keep the following requests in mind as you pray for Greg:

* That the doctors would let him out of the hospital at the right time, that he and Christine would find the best place to stay in Houston for up to a week after release from the hospital, and that the transition to the new living situation would go well.

* That the wound from his jugular IV would would heal when the bandage is removed today.

* For dealing with the effects of droopiness and incoherence now that he is on morphine instead of the epidural.

* That he would regularly practice the breathing exercises prescribed for him, and that he would not develop excessive fluid in or around the lungs.

* That no infections would develop.
Greg asked me to pass on his thankfulness for the many notes that came to him as a result of the patient contact system at MDACC. Any notes received are printed and hand-delivered to Greg or Christine and they have drawn tremendous encouragement from them. He is also checking the website as and when he can, and will hopefully make a post of his own very soon.

Tuesday, December 23, 2003

'Surgery Went Perfectly'

That's a quote from the surgeon's report, and by all accounts an accurate one. Greg looks good today and was working on crossword puzzles by 11:00 this morning. Everyone is thrilled by the great outcome and thankful for the answered prayers of many.

However, as with any surgery of this magnitude, the road to recovery will be rough at times. Please continue to pray for both Greg and Christine as they face many challenges:

* Greg cannot yet be moved to a regular hospital room until his urinary function resumes normal levels. This is not unusual, especially given that his blood pressure remains a bit low due to the anesthesia that he is still taking via epidural. Instead, his doctors plan to move him to the ICU, not because of any crisis or problem, but because there he will receive greater levels of exactly the kind of care that he needs right now (not to mention the fact that ICU rooms are more private, have more generous visitation rules and have a TV). Please pray that he would be able to go to a regular hospital room very soon - his nieces cannot visit him in the ICU and there are still quite a few limitations on visitors.

* Greg is in a lot of pain; while they have managed to get it under control, the anesthesia causes a lot of itching. Between the pain and the itching he wasn't able to get much sleep last night, but today they seem to have struck a better balance. Please pray for alleviation of his pain and the ability to slowly reduce the amount of medication he needs for it.

* Greg's temperature this afternoon was just about 101, which is a normal post-op temperature, but of course it needs to go down. His heart rate is also high.

* Christine is also in a lot of pain. Please pray that her pain would be relieved so that she can be with Greg as much as possible.

Time and time again Greg has had to Stan' Up and Git Hit. As he stands once again, pray that by God's grace he will stand strong.

Monday, December 22, 2003

Better Than Expected

Greg's surgery ran from 7:45am to noon, and went better than expected with no complications. The cancer was not touching Greg's diaphragm, so none of that muscle had to be removed. In fact, the cancer does not appear to have spread anywhere else in his body. The right lobe and half the left lobe of his liver were removed, which is about what was planned. The area of the cancer was about 2 1/2 inches in size, having been significantly reduced by the chemotherapy. Greg had no excessive bleeding, and there was no need for a blood transfusion.

Greg is doing so well that he was moved directly to the recovery room and is not going to spend any time in the Intensive Care Unit. After spending the night in the recovery room, he will be moved to a regular room.

Sunday, December 21, 2003

The night before surgery


sarabeth_sm.jpgMelina_sm.jpgHere we all are... Carl, Jim, Sue, Judy, Anne, Melina, Michael, Sarabeth, me, and Christine. Ten weary travellers enjoying celebrating our week of hotels, restaurants, and MD Anderson hospital. Well, not really "weary" -- we're having a great time. This was taken at dinner the night before surgery. It was terrific Chinese food... or so I hear... I had chicken broth to satisfy my pre-surgery clear liquid diet.

Christine_on_phone_sm.jpgMelina and Sarabeth had come from the park, where there were face painters. I told them not to wash their faces and show up tomorrow decorated. Here's Christine talking on the phone with my sister, Julie, as we drew near to bedtime. My heart is so full of thanksgiving for the love with which I have been surrounded.

The appointment with the surgeon went well on Friday. We discussed what I should expect and some of the details of what he will be doing. He expects to take out some of my diaphragm with the liver. This is because some of the diaphragm may be "stuck" to the tumor. This is not uncommon and does not hurt long term prognosis, just increases the pain somewhat. They are also taking out the gall bladder, which I don't really need anyway. Finally, the Dr. Vauthey's assistant explained to us about the epidural, which I will have for a couple days after the surgery. Christine replied to him with a straight face, "You mean he might have a baby, too!?" At the end of the appintment I sang the Twelve Days of Chemo for Dr. Vauthey and his assistants at the urging of a nurse. He got a real kick out of it.

Right now, I find myself sitting in bed again contemplating the unknown in the coming days. It seems like such an ordinary night, and yet tomorrow will be one of the most important days of my life. No experience prepares one for an occasion like this because it is a once in a lifetime deal. There seems to be no "right" way to approach major surgery. So I'm just riding the wave of time until tomorrow I'll find myself in a place where they'll say, "and now you'll feel a little drowsy." My prayers become simple. Just as I'm not sure what to do, I'm not sure what to say. So I sit with a raw trust in the love of the Father.

Christine has fallen asleep. We report tomorrow at the hopsital tomorrow morning at 5:30am. Its going to be a rough day for everyone with so little sleep. I won't really mind because I'll get to sleep all day.

So much of life consists of looking forward. The life of a Christian, especially, is characterized by an anticipation of the coming of the Great King. As my own future is uncertain, I am drawn towards those objects of hope for which I am more certain. One of these, as I've written in earlier posts, is what the Bible refers to as harvest time - the coming of Christ. This morning's sermon at Christ the King Church was on ththis very topic. The pastor related a passage in Revelation to a tune by Johnny Cash, recorded shortly before his recent death. The pastor, Rev. Leo Schuster, actually played the recording to our (pleasant) surprise. I'll leave you with a portion of those words...

The Man Comes Around

There's a man goin' 'round takin' names.
An' he decides who to free and who to blame.
Everybody won't be treated all the same.
There'll be a golden ladder reaching down.
When the man comes around.

The hairs on your arm will stand up.
At the terror in each sip and in each sup.
For you partake of that last offered cup,
Or disappear into the potter's ground.
When the man comes around.

Hear the trumpets, hear the pipers.
One hundred million angels singin'.
Multitudes are marching to the big kettle drum.
Voices callin', voices cryin'.
Some are born an' some are dyin'.
It's Alpha's and Omega's Kingdom come.

And the whirlwind is in the thorn tree.
The virgins are all trimming their wicks.
The whirlwind is in the thorn tree.
It's hard for thee to kick against the pricks.

Till Armageddon, no Shalam, no Shalom.
Then the father hen will call his chickens home.
The wise men will bow down before the throne.
And at his feet they'll cast their golden crown.
When the man comes around.

Whoever is unjust, let him be unjust still.
Whoever is righteous, let him be righteous still.
Whoever is filthy, let him be filthy still.
Listen to the words long written down,
When the man comes around.

Wednesday, December 17, 2003

Contact info at MDACC

mailbox.gifMD Anderson has a system such that you can send an e-message to me (or to Christine via me) while I am an inpatient and the message will get to me in hardcopy form. Click here for the web site. You have to enter my birthdate (02/19/68) and patient # (169996). I assume it works - I'ver never tried.

Also, at some point, I will use my laptop to get email - probably later in the week.

Our mailing address will be:
MD Anderson Cancer Center
Gregory J Hewlett, inpatient
Patient ID #169996
PO Box 300206
Houston, TX 77230

You don't need the room number for the address, but delivery may be faster if you include it. I don't know what the number will be at this point.

I will be an inpatient 12/22 (Monday) until estimated 12/29, 12/30, or 12/31.

Tuesday, December 16, 2003

All I want for Christmas is my liver out

Dr. Vauthey has made his decision. One, I'm ready for surgery. Two, he is "quite confident" that my liver can handle the single-stage surgery. And three, he thinks we should do the surgery as soon as possible. That means Monday.

To avoid having to go down there and back and down there again (although that is the pattern these days), we moved the appointment with him from tomorrow to Friday morning. So Thursday, Christine and I will leave for Houston and we'll stay there until I recover from the surgery.

The surgery will be Monday, Dec 22. It is a highly technical surgery, requiring 6-8 hours on the table. Dr. Vauthey is planning on removing 76% of my liver - all of the larger right lobe and some of the smaller left lobe. The surgery is followed by one to two days in ICU (usually just one night). I will be in the hospital for a week to a week-and-a-half, so I'll probably be out by New Years Day. I then have to stay in Houston for at least one more week before I can leave the area back to Dallas.

Needless to say, our already chaotic holiday plans are now scattered in pieces on the floor. Hopefully all the kings horses and all the kings men can work out the logistics. Christine's family from Maryland and New Jersey are all planning to fly to Dallas for Christmas because we couldn't travel up there. The new problem is that when they get here - we won't be here! I'm sure we'll all figure it out. Bottom line is that this is good news.

After surgery, my body will suffer from missing out on a significant portion of liver function. Steve Wei described it to me as "extreme fatigue". Sounds like I will be a weak rag for a while. I hope to be well enough to enjoy my family and Houston friends and to keep up with email.

Dr. Vauthey prepares himself for many contingency plans on how to deal with any discovered cancer when they go in. (e.g. radioactive burning of small lesions in liver remnant, removal of cancerous areas of diaphragm, etc) Please join me in praying that he won't find any such problems in there, that the surgery will be clean, that there will be no major complications, and that my body will be hereafter be void of all cancer. Also, please lift up Christine for strength and relief from pain and for our entire family as we go through this together while celebrating Christmas in a hospital away from home.

There is a curse on my liver. But at Christmas, we remind ourselves, "He comes to make his blessings known far as the curse is found, far as the curse is found."

Thursday, December 11, 2003

Twelve Days of Chemo

On the twelve days of chemo, my doctor gave to me...

Twelve pills for poppingFrosty on Xeloda.gif
Eleven nurses griping
Ten I.V.�s beeping
Nine-year financing
Eight nights a-barfing
Seven aides a-calling
Six hour delaying
Four empty words
Three weak grins
Two port-o-caths
And a bed pan in which to pee.

Tuesday, December 9, 2003

More remarkable shrinkage of tumor

The appointment with Dr. Hoff yesterday was not routine. Chemo is again postponed. But this time it is because of good news...

The tumor in my liver has again shrunk drastically due to the last two rounds of chemo. So much so that Dr. Hoff believes I am now at a state where surgery is feasible. The actual decision will come from Dr. Nicolas Vauthey, my surgical oncologist, who would perform the liver surgery. I would have met with him yesterday, but he is in Europe for an international meeting and does not return until next Tuesday. I will go back to meet with him Wednesday, Dec 18.
The decision that Dr. Vauthey must consider is:
1. I still need chemo to reduce the tumor more, or
2. I am ready for surgery.
If (2), then there are two options for the surgery:
2a. A one stage approach. In this case, there would be one major surgery to cut a large chunk out of my liver. Even though the tumor shrunk, they like to take out every part of the liver that was ever cancerous to better prevent the cancer from returning. So they are talking about resecting more than half of it. This surgery would likely be on Dec 22 (a visit from St. Nicolas Vauthey?).
2b. A two stage approach. If the portion to be removed is large enough, Dr. Vauthey will do a two stage surgery that he has pioneered at MD Anderson. The first stage is called portal vein embolization (PVE). In this stage, they go in and place artificial clots in the liver vein such that the good remnant is fooled into thinking that it is carrying all the load of the liver, so it starts growing. Thus, we get a head-start on the regeneration process. Then, at the time of the actual resection (about a month later), the percentage of liver removed is actually smaller, decreasing complications and increasing chance of recovery. If we do this option, stage one will probably be next Thursday, Dec 18, and stage two will be in mid January. The first stage is not too traumatic - usually requiring only one night in the hospital. The second stage is major surgery. You can read about PVE here.
I asked Steve Wei, Dr. Vauthey's assistant, what he thought Dr. Vauthey would decide. His reply was that he couldn't say because "we don't see this very often." By that he meant they don't see such initially large tumors shrink so much from the chemo. Steve emailed the CT scan report and the digital images to Dr. Vauthey. If the decision is obvious to him, I should hear this week what to expect. But if it is a tough decision, there will be a doctor's conference on Tuesday where Dr. Vauthey will discuss the case with other oncologists and radiologists involved with my case. I get the feeling from the medical team that this is somewhat unchartered territory. I don't think anyone expected that as advanced as my cancer was in June, we would be at this point today.
Because surgery is likely on the near horizon, Dr. Hoff decided that I would not have chemo now. (yippee) I need to be as healthy as possible for what is coming. So after the meeting, I turned around and drove back to Dallas. Mark Dishman accompanied me. Christine unfortunately missed all the excitement due to the bad cold she has. This was very disappointing to both of us.
So what does all of this mean for my overall prognosis? If this surgery is successful (success is declared if they remove all the cancer in the liver and see no other cancer elsewhere when they go in), then my chances of survival are drastically improved from what they have been. Dr. Hoff told me "most of the time" it is successful. However, statistically there would still be a greater than 50% chance that the cancer would come back. I say this not to be pessimistic, but to let you know the urgency of continued prayer. I am continuing to be hopeful. This is now mixed with much thanksgiving. I thank the Lord for the remarkable shrinkage of the tumor. I am thankful for being at MDACC and for having insurance and finances to get all of this expensive care. And in the short term, I am thankful for getting another week off from chemo!

Amateur anatomy

Here is my (very) rough estimate from memory showing what kind of progress there has been.

The lines show the region of cancer visible to the CT scan. My impression is that the surgery will be of most of the large lobe and possibly some of the smaller. They like to get good margin. I continue to be amazed that as small as a quarter of the liver can regenerate quickly back into the full organ.

Saturday, December 6, 2003

Round six on Monday

We decided to come back to Dallas for a few days instead of staying in Houston. I have been feeling great, having had so much time off from chemo. And this is likely the last few days where I will be feeling good before Christmas so we decided to come back. The absence of pain and fatigue is absolutely delightful. Every hour is sweet. Our friend David Clemmons came over last night to provide the muscle behind getting and carrying in a tree - usually a chore, but this year a pleasure. The weeks before Christmas are usually so full of activity, but I had to squeeze everything into this weekend. It didn't fit.

Christine unfortunately was not doing as well and has now come down with a cold, so we are not sure if she'll go back for my appointment Monday. This would be a big disappointment because it is an important appointment for us Monday. The CT scan results will be evaluated and we'll assess how the cancer is doing and make plans for the course of treatment over the next couple months.

Monday, December 1, 2003

Schedule changes again

Christine and I threw a change of clothes in the car and headed to Houston for a quick trip to get chemo. The plan was the same as last time - get out of Houston while the steroids given with chemo were still in effect. That way we only stay in Houston for 36 hours.

Well, today we first met with Dr. Hoff and he decided that it was not wise for me to get chemo today. I was actually somewhat relieved because I still have symptoms from the bacterial infection, and I wondered if I my body could really take another round with the existing problems. He expressed this very concern and delayed this round of chemo until Dec 8 - next Monday. The last thing we need is an aborted round and another stay in the hospital.

Meanwhile, he thought we should go ahead and get the CT scans to see if there is progress in the shrinkage of the liver tumor. At our request, he gave us some more sobering details highlighting again the importance of getting that thing small enough to do surgery. Bottom line is that I need this surgery. So it will be good to get some data on how the tumor is doing.

The catch of this plan is that we may end up staying here for the week for these scans and then chemo next Monday. We'll know the schedule tomorrow morning. I never seem to know much further ahead than one day at a time, anyway.