Amy's 'momentary trouble'

Well, we saw Amy’s oncologist for the first time in about 2 ½ weeks today. He had a family emergency the first week and had a planed vacation the second. It was good to touch base with him and bring him up to date on Amy’s treatment. He told us that both her white and red blood cell counts looked quite good and her Biliruben is down to 1.7. He asked how Amy had been feeling and she told him that she had been feeling quite well Monday and most of Tuesday, but then she started having these sharp pains in her stomach. They started out occurring about once per day, but now they are occurring several times a day. He thought about it awhile and told us that it could be either the chemo or the radiation. Either one by themselves can certainly cause gastritis, but being that the pain is described as coming on suddenly and ending after about 3 minutes, I think it is something else as that pain would be long lasting because both the radiation and chemo are being introduced to your body longer or in the case of the chemo consistently 24/7. So, he thinks that the probable cause could be the metal stent that Amy had inserted into her bile duct three weeks ago! And specifically that the stent may have moved slightly and the sharp ends of the meshed metal weave is poking/scratching the inside of her duodenum. So, he prescribed a quick acting pain medication for her to try, but he did warn that the pain may subside before the meds kick in.

I have had this question/idea about Amy’s treatment kicking around in the back of my head for about two weeks, but haven’t been able to inquire about it because her doctor has been gone. In my research on the pancreas, I wanted to know exactly where the tumor was and to have a good visual image or illustration showing me the anatomy of the pancreas including the surrounding vascular structures. I came across the following site: Click Here. I printed out several selected images and took these with us to today’s appointment and asked her doctor to show me exactly where the tumor was located. He showed me that the tumor was located at or near the juncture where the Hepatic Portal Vein feeds into the Superior Mesenteric Artery.

Knowing this info, I talked with Amy’s surgeon and asked him, ‘Obviously I'm not a surgeon, but I've had this thought floating in my mind for quite some time now and would like to ask about it. As you well know, Amy's surgery (Whipple) has been postponed in hopes that chemo/radiation will shrink the tumor away from the Portal Vein. Is it possible to do a Superior Mesenteric Artery & Hepatic Portal Vein combination bypass, so all of the involved tissues can be removed without risk of having some of the tumor float away?’ and he responded, ‘Possible but the mortality and complication rates would definitely rise. The vein is not however as big a deal as the artery.’ I continued, ‘Are the risks too much so to give this serious thought?’ and he replied, ‘No, but I would wait until the preop therapy is completed to think about it.’ I agreed with him.

This is Amy's story as seen and told by me - V