[I wrote the following over the past thirty-six hours, so some timing references may be “off”. I apologize. I just didn’t want to take the time to make the corrections… :-)  ]
 
Hi Folks-
 
I guess it is time for another update. Whether or not we want to write it….
 
Since our last update I had abdominal surgery to remove the primary tumor from the lower colon / upper rectum. It was successful. It was also considerably more involved than planned. And the recovery process continues.
 
In order for the body to be able to heal in any meaningful way, chemotherapy must be suspended for anywhere from four to eight weeks. This is because the primary methodology of chemotherapy involves limiting the ability of the body to replicate cells using DNA. The crude science description is that RNA is prevented from replicating DNA, which is how the body replaces aging and dying cells, as well as the repair of any damaged cells, whether from injury or exercise. Because one of the identifying characteristics of cancer is the rapid or uncontrolled replication of cells, if we are able to interrupt this process, cancer growth is at least inhibited, and if we can attack the cancer cells, then the tumors may be diminished or eliminated.
 
The “conflicts” in cancer treatment are the interruption of chemotherapy for surgical purposes, and for radiotherapy, which also needs an extended period of time for the body to recover, and DNA to properly replicate in the affected areas - i.e.:  allowing healthy organs and tissue to be repaired.
 
Because I had radiation for about six weeks, I then had about ten weeks of “recovery” time before the last round of chemotherapy. Then, when the colorectal surgeon felt the window was open for removing the primary tumor, we again suspended chemotherapy and had surgery on Wednesday, February 7th, 2024.
 
It was planned as a laparoscopic surgery, but that didn’t last beyond the initial introduction of the instruments and a first-hand look at the tumor(s). It turned out that there was a tumor outside the wall of the duodenum that was embedded tightly against the abdominal wall along the spine. The doctor described this tumor as approximately the size of a peach. The tumor was dead, for all intents and purposes, and all of the lymph nodes that lay under and beside it were dead as well. All of these were removed, and well as tissue that constituted a “margin” surrounding the tumor. There was also a considerable amount of “near” or ‘pre” cancerous tissue that reached from the dead exterior tumor through the wall of the colon / duodenum to a second tumor that was about the size of a plum tomato. This tumor was considered to be “60%” dead. All of the affected colon and rectum as well as a considerable amount of both that constituted the “margin” were removed. The remaining portions of the duodenum / colon and rectum were then surgically connected.
 
Radiotherapy results in a lengthy or permanent reduction in blood flow in the affected area, so the healing process for the surgically repaired colon / rectum is extended. Because nobody wants to have a leak or rupture of the newly repaired structure, the doctor created an ileostomy. This is a (hopefully) temporary disconnection of the small intestine from the large intestine / duodenum / colon. The disconnected small intestine is then routed through the abdominal wall and a stoma is created by pulling the small intestine through a medical device and turning the end inside out. This is then stitched to both the medical device and the nearby skin. An ostomy bag is then placed over the stoma to collect the waste output that would otherwise flow into the duodenum / colon where the body normally extracts the water and more nutrients to eventually form what we excrete as stool.
 
So, I have become a “bag man”. Ha!
From what I have experienced so far, it does not pay well.
Perhaps my career timing is a little off.
 
Yes, having an ileostomy it is about as exciting (not) as it sounds. It brings a lot of dietary complications, and requires some serious hydration to make up for what the colon is NOT extracting and providing to the bloodstream. And, it is a process to keep the nearby skin healthy and the stoma productive, without allowing the digestive juices to digest one’s skin. So far, I’m holding my own. I’ve had some good and bad experiences (such as the bag inadvertently opening while standing in the bathroom - say goodbye to THAT rug!)
 
Things we learn that we never had anywhere on a bucket list!
 
All of the surgery went fine, despite the change in procedure. Of course, instead of two or three relatively small holes, I now have an abdominal scar that starts about four inches above the navel, snakes down around said navel and travels a LOT farther south than I would have allowed if I was awake! Mercifully, I was not awake until things were all done, stitched, and stapled.
 
The pathology of the removed material showed successful margins throughout. The surgeon was pleased with the results and felt the pathology suggested a positive prognosis. Despite this, he did caution that the affected lymph nodes did show evidence of involvement at some point, and were a probable route for the spread of the metastases in the liver. He suggested that close monitoring of the lymph system was prudent, as well as monitoring for any other spread that might have not yet been revealed by CT scans.
 
So, all in all, the surgery was considered to be quite successful, despite the procedural changes necessitated by the size and locations of the tumors.
 
The “Recovery Room” was not so successful, at least not for the first six hours. As I exited the general anesthesia, none of the IV medications served to mitigate the pain. For those first six hours it felt as though I had been cut in half, and woke up to discover the fact. Over the past twenty-nine years I have had an extensive pain journey, and that was expanded in the recovery room. As the doctors worked through their catalog of medicines, and followed what I am sure are carefully designed procedures, nothing worked.
 
About four hours into the process, the doctors brought Annette and Phil into the recovery room to help me hang on. I am not a screamer, but tears and groans are difficult to control past a certain point. Pain has been a constant companion for almost three decades, but it has never been more intrusive. Dealing with intractable pain in multiple places presents challenges that took me out of my depth. Thankfully, the doctors recognized that two of the three people (Annette, Paul, and Phil) who have been nearest to me for this journey, were available to help me communicate - and encourage me to keep breathing - and not let go.
 
Anyway, eventually the pain management team asked for and were authorized to insert an epidural device. In just thirty minutes the pain went from a newly established definition of “10” to a wonderful zero. While I hope to never duplicate the experience, I am very thankful for the dedicated team of pain management doctors who refused to give up until they found a solution.
 
I am also extremely grateful that Annette and Phil had the strength and grace to accompany me in what was surely a terrifying journey. Their willingness to share in my suffering, despite the pain I know it caused both of them, is a gift of love that cannot be defined or adequately appreciated this side of heaven. I am not certain I would have held on without their gentle encouragement to “keep breathing”. Some things are beyond the realm of these inadequate words….
 
In the intervening almost six weeks, recovery has been much slower than I would prefer. I am restricted from lifting more than ten to twelve pounds. In other words, I am not supposed to even lift my youngest grandson. Though I may have to confess that such MAY OR MAY NOT have happened in an isolated, uncontrolled instance. or maybe two, or … just stop with the interrogation already!!!
 
Onward, to the most recent news:
 
Last night we received the results of the latest CT scans, taken on March 15. I wish I could give better news. But the analysis was just not what we had hoped for.
 
The metastases in the liver have grown; some substantially. There appears to be a new lesion of approximately 2.1 cm. A lesion that was 2.9 x 3.7 cm in January now appears to be 5.7 x 5.4 cm. And four other lesions appear to have doubled in size or nearly so. They were all close to 1 cm in January, and are now 2 cm or nearly so. In addition, there appear to be a number of new smaller lesions that are not readily definable in the scans, but are suspicious in their density and appearance.
 
Additionally, the scans of the lungs show what appear to be new nodules of 3mm and 2mm. There were already a number of nodules that were up to 5mm, but those all remain unchanged from previous scans. The presence of new nodules of such density will likely require investigation, perhaps biopsy.
 
We would prefer to have better news to share. But we are not in charge. Fortunately, we have great confidence in the One Who IS ultimately able to direct our lives and Who holds our times in His hands.
 
The doctors had already scheduled five more sessions of chemotherapy that will start on Monday, March 25th and continue every two weeks thereafter, until such time as the surgeon decides to make a simultaneous ileostomy repair while another surgeon will install a pump that will deliver another chemotherapy directly to the liver.
 
I will elaborate on those surgeries as the time approaches and I learn more about them.
 
Until then, we appreciate your thoughts and prayers on our behalf.
 
Since we apparently did not have enough things to deal with, our apartment complex was the target of an arson attack that destroyed the only elevators available. We live on the fifth floor, so we are getting more exercise than we anticipated (or desired!). With my current lifting limitations, it has made shopping, laundry, and a lot of things considerably more difficult. We really cannot afford to move, even if we could find another location, and the logistics of moving without any elevators is additionally problematic. I am not supposed to lift for yet another seven weeks.
 
I suppose this countenances some items about which we would appreciate your prayers! Even as we ask for your prayers, I want to also express our deep appreciation for the financial support that so many of you continue to send. We really cannot describe the blessing that you have all been to us as we endeavor to navigate this journey.
 
As Annette and I visited this morning we acknowledged the many blessings that have already come from this journey. Of these things we are immensely confident:  God knows each and every one of us. He deeply, unwaveringly, and unconditionally loves each of us. And we love each and every one of you.
 
May God’s richest blessings overflow and support, buoy and encourage all of you.
 
Love.
 
Always.

Dan Glover

Update: March 20, 2024 – by Daniel Glover