As expected, we received an electronic transcript of the reading of Penny's scan on Tuesday. The main take-aways are
"Slight interval increase in size of some ... metastases, others appear stable."
- Our translation: The cancer is progressing, but slowly. And no new locations were observed. This probably means that the current study drug is not doing much.
"Previously dilated small bowel loop ... is decreased from the prior study."
- Our translation: The blockage that led to three hospitalizations in September and October seems to have resolved. This is consistent with how Penny has been feeling the last several weeks.
"Scattered more proximal small bowel loops are mildly distended without transition point, which likely relate to ileus although early or partial small bowel obstruction cannot be entirely excluded."
- Long-time readers will remember that ileus (a condition in which the bowel does not work correctly, but there is no structural problem causing it) was the word of the day in one of my posts after the July 2022 surgery. At that time it was an anticipated part of the recovery from surgery. Now the cause is less clear -- are the intestines just not working well? or has cancer built up enough to cause physical constriction (a partial blockage)? Whatever the cause, it is accompanied by lots of "gut churning" which ranges from uncomfortable to painful, and at times interferes with both eating and sleep. It may also be the cause of the "full stomach" feeling Penny has been having (although less this week than in the past several weeks -- see below.)
We haven't met with Dr Lakhani in person, but he called and a radiation oncology appointment has been scheduled for next Friday. We expect to discuss at that consult whether there is a targetable location that seems likely to provide some benefit. Because of the amount of cancer involved and the intestines' general dislike for radiation, it isn't possible to do a wide scale radiation treatment. But there may be small areas that can be targeted with minimal risk and potential to reduce causes of future blockages. If that is the determination, we expect daily radiation for about two weeks. We'll know more after our meeting on Friday.
In other news, this week has been a week of relative stability amongst some interesting ups and downs.
stability: Eating has been easier and Penny's weight has actually gone up a pound or two. It seems the reglan is helping to reduce the "full stomach" feeling. Unfortunately supporting evidence was provided by forgetting to take it one day and having symptoms worsen. This is the first week in quite some time (probably July or August) that didn't see weight loss.
ups and downs: Penny took advantage of "prednisone day" to attend two events at Calvin. The next morning she requested a chair for her shower. Energy levels are inconsistent both from day to day and throughout a day, but not usually as extreme as on prednisone day and the day after. Penny tries to take advantage of energy when it is available (for example, to make and eat spanish rice Thursday evening) and is learning to relax/sleep when it is not. If we discontinue the current trial, Penny will likely do a round or two of steroids in attempt to get a more even and lasting version of the prednisone boost. Eating also continues to have its ups and downs, but they have been less extreme and less down this week.
Comments
Marie VanderLinde : Thankful for Prednisone and Spanish rice! Asking for release from gut-churning, and asking for energy for the day. Praying for you both.
George Monsma, Jr.: Thanks for the update, Randy. And thanks to God for more stability and fewer extreme downs. I'm praying that some radiation may be possible and effective, without bad side effects.
Alisa Tigchelaar: Praying as I read and re-read this detailed share, Randy and Penny. Thank you for inviting us in to do that. Much love. 💕
Mary Hulst: Grateful for the updates as it helps to guide prayer. Love to you both!
Pamela Plantinga: Thanks for letting us know the results of the scan, the risks and benefits of radiation, and how dear Penny is doing. Praying.
Teri Warners: Thanks for the update, Randy. Glad to hear Penny has been able to eat a bit more. Thanks, too, for your beautiful trumpet playing this morning in church!
Laura DeHaan: Thankful for the weight gain and a slight improvement in symptoms. Praying for continued abilities to eat and have energy! (We do have a shower chair if you haven't already gotten one!)