Friday, March 27, 2009

Keep on keeping on

I have seen the consultant surgeon this morning. Not very much new, I'm afraid. My main problems are colicky abdominal pains and diarrhea for which I am taking an anti-spasmodic and codeine phosphate. Th surgeon thinks these symptoms are caused by the mechanical effect of the presence of secondaries in the peritoneum and that the remedy is chemotherapy. I am seeing the medical oncologist this afternoon.

The special stains do not tell us anything new. They were negative for carcinoid, but even that is not helpful since the histology of adenocarcinoid can change to adenocarcinoma when it metastasizes, indeed such patients have a rather better prognosis. Although he thinks that the appendix is the most likely source of the tumor, he cannot be sure. The other option, large bowel, has been searched through very thoroughly on several occasions without finding a primary. The overwhelming majority of appendix tumors start life as carcinoid.

Were it not for the colic I would be very well. I have lost 14 pounds, but the weight loss has reversed and I have put on a couple of pounds since the nadir. My nutrition is important now, and the only restrictions on my diet are to avoid high residue products like peas and beans, sweet corn and cabbage, skins and pith.

I was encouraged when my friend George Stevenson brought me in a paper by Yan et al (Annals of Surgical Oncology 2008; 15:1440-6) which describes adenocarcinoid of the appendix that on peritoneal dissemination lacks the neuroendocrine component and appears as adenocarcinoma. Such patients have an improved survival over those who retain the carcinoid appearance, with a cumulative survival of 70% at 4 years and no further deaths thereafter.

This afternoon I saw the medical oncologist, Tamas Hickish. I will have a baseline CT next week with insertion of a Hickman like, starting chemotherapy at the end of next week of the beginning of the week afterwards.

Yesterday we watched the movie of 'The Kite Runner'. Although perhaps not as complete as the novel, it was a moving story and a rebuke to those who wish for an accommodation with the Taliban. These are appalling people who were quite justifiably deposed by George Bush and his allies. It is a common phenomenon found in the Western Democracies that they fail to complete the task that they embark on. They seem to lose heart when adversities stand in their way. Obama is talking about an exit strategy in Afghanistan. Will he be condemning millions of women to a second class life that includes no education, beheading for being raped, genital mutilation and forced marriage. Will the beard police return?

How this contrasts with the attitude of Christ who does not give up on us. "He who began a good work in you will carry it on to completion until the day of Christ Jesus" (Philippians 1:6).

I continue to receive messages of encouragement. From the Manabats in the Philippines and from Mary and Milena, two former colleagues of mine at the hospital whom I happened to meet in the corridor. Sometimes we despair when we have this diagnosis. When we know so many people are praying we wonder whether God is listening. Then he will send the chance meeting to encourage us and to let us know that he certainly is listening - so keep praying.

11 comments:

Anonymous said...

Dear Dr. Terry,
I pray for you a lot. Glad to know your prognosis might be more encouraging. Just have faith.. you will be all right. I am a CLL patient, diagnosed last spring, wait and watch.. started reading your blog.. you touched my life in a very special way. Thank you for all the help you give to us and God bless you!

Pat said...

There are so many many people around the globe who have been touched by you. Of course, we are all praying with you for the best possible outcome.

I suppose we have no right to expect regular updates, but it is heartening to have them and to read what is happening to you and how you are dealing with it all. Thank you for continuing to think of us during this time.

Praying . . .

Randy said...

Dr Hamblin,

I have been catching up on your blog- I am very sorry to hear about your diagnosis...

You're no nonsense encouragement has lifted the spirits of many within the CLL community... Hopefully we can be of value in return- through our prayers...

Keep on keeping on...

God Bless,

John Wagner said...

Yes God listens, aren't you glad of that? I have no idea why He allows these things to occur, but I know we have the promise that He will be with us all the way. As I have said before, I may not know WHEN I am going, but I thank God I know WHERE I am going.

Although I can't adequately repay you for the encouragement, information and direction you have given to me on my CLL journey, you can count on me to be among the hundreds or perhaps thousands praying for you during these difficult days ahead. God Bless!

Deb Light said...

Of course we will keep praying for you.We are selfish enough to want you around for many decades to come.:-)
You have Blessed my life in many ways and I can't repay you enough.Prayers are easy to send up and heartfelt and full of promise!

Stay Strong,
God Bless,
Deb Light

Marcia said...

I rejoice and marvel that you feel good enough to work! Thank you for that review. We CLLers are all strengthened by knowing of the CLL progress.
May our Lord continue to show you the way in your own journey, and grant you comfort. "Keeping on keeping on" has certainly been a big part of my own coping with the several cancers come my way.
God keep you! I'm praying...

Brian Koffman said...

Terry,

We both know that we shouldn't make judgements based on our limited clinical experience, but should look to the the peer reviewed literature to guide us
That said, I have had two cases of cancer of the appendix, both metastatic carcinoid (one presented as an acute appendicitis), that have done quite well.
Wishing you the best
G-d bless

Brian

Chonette said...

Thinking of you from my hospital bed.
Yes I am sure God is listening, and you are a more deserved one with everybody thinking of you in these times.
Good you felt well enough to do some work, hard to be motivated when we feel unwell.
Chonette

Michelle said...

Yes Dr Terry, I am praying for you!!

You are a inspiration to so many!

While I do not have CLL, my mom does and you have helped me along the way!!

Be well dear man!

Wayne said...

Dear Terry,

It is with great hope that you have journeyed through the darkest shadows of your affliction.

As you have educated so many patients and given good counsel in a dedicated and caring way, I feel it is we who need to remind you that rest, in the truest sense, is good medicine for proper healing. You need to pay attention to the demands of all you do and the toll it can exact from you at this time.

Listen to your body, for the best reward for all who know and care about you is your return to good health!

"Doctor's" ORDERS!

WWW

Anonymous said...

Dear Dr. Hamblin,

I Know our Lord is watching over you! You are in my prayers!
I appreciate and love your insight into our CLL challenges. You are indeed a Godsend through your medical experience, Faith, and now, your abdominal surgery.
Thank you for your surgical and post-surgical updates. I know your path has not been easy.
Thank you, sir, for all that you do for the CLL "family"!

Dick Syfrett