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.
The Struggle Has Ended
Wednesday, December 17, 2003
Contact info at MDACC
MD 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."
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 popping
Eleven nurses griping
Ten I.V.�s beeping
Nine-year financing
Eight nights a-barfing
Seven aides a-calling
Six hour delaying
FIVE NEEDLE STINGS
Four empty words
Three weak grins
Two port-o-caths
And a bed pan in which to pee.
Twelve pills for popping
Eleven nurses griping
Ten I.V.�s beeping
Nine-year financing
Eight nights a-barfing
Seven aides a-calling
Six hour delaying
FIVE NEEDLE STINGS
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!
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.
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.
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.
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.
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