Between loads of cattle last fall, John was enjoying a regular day at home on Thursday, September 29, 2016 when he decided to visit his local doctor for a prescription refill for what he thought was the recurrence of a kidney infection. He had some concerns about high blood pressure and arthritis. On arrival, his "painless jaundice" and a urinalysis and blood test led the doctor to believe a CT scan was needed. The results were, in their words, "life-changing". We were told his gall bladder was "huge", that there was a cyst on his kidney, that masses surrounded the liver, lungs, and lymph nodes, and his liver enzymes on a scale of 1-50 were 1,500. We learned that his bile duct was blocked by tumors, and since the gall bladder was full, bile was backing up into the liver and causing a yellow/green appearance. We heard the words that no one ever wants to hear - pancreatic cancer - with 8-18 months to live, three massive prescriptions, and advice to go home and rest. True to John's nature, he did not follow those instructions! He was experiencing quite a bit of back pain, but all other symptoms were manageable (without pain meds) at that time.
In researching pancreatic cancer, the statistics are more than disappointing. John had (or had in past months) all of the symptoms, except for nausea/vomiting and diabetes - but had attributed all of this to normal aging combined with a significant amount of stress in our lives. Dr. David Christianson (at the St. Vincent Frontier Cancer Center in Billings, MT) reviewed his CT, PET, and CT Assessment of Resectability scans and consulted with three surgeons, determining that the tumor was not resectable/operable. Radiologist Dr. Rebecca Tarlton believed that the pancreas was not a candidate for targeted radiation.
John received an Infusaport from Dr. Jeff Rentz early on Wednesday (10/19/16) and then had an unexpected admission to the hospital due to a mysterious, sudden, and excruciating pain in his right hip/leg. With massive pain meds on board, he experienced minor hallucinations while inside the MRI. The MRI revealed a bulging disc and pinched nerve, which were thought to be repairable with a third surgery, but according to Dr. Katherine Dietrich, if this was caused by cancer, the status would be elevated to Stage Four and shorten his life expectancy - mentioned was three weeks to a year.
Dr. Stephen Baum completed an ERCP, biopsy, and placement of a biliary stent on Thursday (10/20/16) and this procedure went as expected but additionally revealed minor blockage of the small intestine, which was resolved. John had a hard time fully recovering from the second anesthesia due to total exhaustion, and was very sleepy all day/night with many hallucinations to entertain (and concern) our family. Surgery #3 was placed on hold. Neurosurgeon Dr. Jon Taveau indicated that he would not operate on the disc causing the pain and that John had a spinal instability requiring a major surgery - Lumbar or Spinal Fusion - which one's body cannot heal from while on chemo.
Friday morning (10/21/16) brought an early meeting with Dr. Christianson, who after confirming no spinal cord involvement or presence of cancer, persuaded Dr. Taveau to remove John's right L3/L4 disc, releasing pressure on the nerve, and to fabricate a screw-and-rod spine support system. The five-hour surgery was successful but he spent the night in ICU after experiencing aspiration after surgery, resulting in pulmonary edema.
Saturday, 10/22/16 brought surgery #4 to reposition a screw in the spinal cage. This fourth anesthesia, combined with a week of assorted and powerful narcotics essentially shut down his body functions - mental and physical - and resulted in a three-night stay in ICU.
Chemotherapy protocol was shared, but the start date was delayed by three weeks to allow a healing period for the back surgery. Additionally, due to a degree of uncertainty with the tumor, Dr. Christianson referred John to UC-Denver for a needle biopsy and consultation.
Eleven chemo infusions (Gemzar/Abraxane) began 12/13/16 and ended 3/28/17. Daily radiation treatments (19/28 together with 24/7 5FU chemo began 4/18/17 and ended 5/15/17. A consultation in Denver on 4/3/17 changed the tumor status to resectable (due to shrinkage) and while John fully expected to not survive it, the 9.5 hour Whipple Procedure was completed by Dr. Richard Schulick on July 28, 2017 and John returned home August 10, 2017. Pathology reflected continued presence of microscopic cancer cells in the remaining pancreas and at least one lymph node, and the removed section of portal vein was also cancerous. In consideration of this, it is assumed that the cancer has invaded his entire bloodstream.
Because John did not recover his strength after the Whipple Procedure, he did not receive further chemo afterward. In comparing the 9/7/17 and 10/25/17 PET Scans, it became apparent that the cancer metastasized to bone - aggressively, and in multiple locations.
John Bilbrey passed away on Tuesday, January 16, 2018. Thank you for your continued prayers and support as our family struggles to navigate the path ahead without him.