Tinker to Evers to Chance

I just left behind a beautiful scene, Faina snuggled in bed, sandwiched in between Margo and Jamie, giving an account of the past two days. She started a new cycle of chemo today and is carrying the pump pack for the 46 hours of fluorouricil (5-FU). It is a little after 9:00 pm and we just returned from an appointment with Dr. Gertner. Margo once again took care of the TPN so at the moment, Faina has chemo flowing into her right arm and nutrition streaming into her left.

Faina has been encouraged to try eating. It is a tough challenge when the zone from tongue to the last stop on the intestinal freeway feels like an ongoing napalm attack. She had some chicken soup, a few hours later a little bit of Kefir, and several hours later, some rice pudding. It is amazing when ingesting a forkful represents a leap of faith and an expression of bravery. She generally has to lie down for a half hour after even a quarter of a cup of food.

The scoop on some of the doctors visits -
Dr. Schulick - There is no surgical solution to the intestinal problems. HER-2/neu test results - Negative. This is a disappointment. It means she is not a candidate for a new drug, Herceptin, recently approved for recurrent gastric cancer.

Dr. Narayen - checked out the abdominal x-rays that were taken over the weekend. He said there is no blockage in the intestines and suspects that the cancer in the peritoneum (the lining of the abdominal cavity) is interfering with the motility of the intestines, that is, the ability of the intestines to flex and move food through them. He wrote prescriptions, suggested an over the counter product, and advised raising the head of the bed so gravity could help move things along.

Dr. K. - Some serious weirdness here. At one point in the conversation he suggested Faina go off the chemotherapy altogether. The implications are obvious. That proposal was a non-starter. Then for Faina's intestinal discomfort he suggested a G-tube, essentially a pressure valve. We also scheduled Wednesday's chemo.

Prescription slip in hand, I went back upstairs to Dr. N's office to set up this procedure. I spent all of about 30 seconds in the waiting room when, at his request, his secretary ushered me into his office. He told me that he could not insert a G-tube since Faina does not have a G, as in Gastric - "of and related to the stomach." He begged off attempting to do the procedure to the intestines, being honest in saying it would be beyond his capabilities. (Dr. K called later, somewhat embarrassed, realizing the lack of G for a G-tube.)

We were undeterred by this obstacle. In the car, on the way home, we called Dr. Gertner and set up today's appointment. Dr. G is a story in and of himself and figures prominently in this 21 month journey, but I will let that narrative sit for now. Suffice to say, we have well placed, enormous confidence in him. He looked at the CT scan and the abdominal x-ray, did his own sonogram and said he was confident he could laparoscopically run a tube for decompression. He ordered a "Small Bowel Series." This story is to be continued.

It has been a rough night with Faina up every half-hour or so. She's taken Oxycontyn. She's taken Ambien. Time to check her and maybe catch a few Zzzzzz.