My Introduction

Porter, I’m still undecided on the adjuvant chemo. I’m 8 weeks post-op now and still have a few open wounds on my incision that need a few more weeks to heal up. I don’t think I could start chemo with these open wounds – I assume they would stop healing and infection would likely set in, but I don’t know for sure.

I spoke with my primary doc at Mayo this week and his opinion is still “why do something that has no evidence of being effective”. I also got a the notion from him that the length of time that has elapsed since resection might be a factor – the longer you wait to do it, the less effective it would likely be.

Of course the oncologists at Mayo recommended it…

Please keep us updated on your chemo as you go and best of luck to you!

-Matt

Here’s a timeline with a few more details of my journey thus far:

Wed 12/11/2013 Initial Visit to General Practitioner:
After several weeks of itching, fatigue, and mild abdominal discomfort I finally go to my GP where they drew blood for some testing.

Thu 12/12/2013 Emergency Room Visit:
A 6:00pm call from my GP with results from the blood testing the previous day freaks me out and I go to a local ER hoping I have gallstones or Hepatitis and not this cancer thing on the Internet that I don’t even know how to pronounce.

Blood test results from 12/11/2013 were Bilirubin (total) 5.3, ALT 741, AST 352, Alk Phosphatase 833

At the ER they do more blood tests as well as urine tests. They do an ultrasound and a CT with contrast. CT shows intrahepatic biliary dilation. UltraSound shows mildly dilated common bile duct, mild intrahepatic biliary dilation, and mild thickening of gallbladder wall.

I’m discharged from the ER after midnight. I’m scared and exhausted and decide to take the following day (Fri) off work to search for a specialist. I chose a local Gastroenterolgy Hepatology practice associated with the local medical college, Virginia Commonwealth University / Medical College of Virginia (VCU/MCV) and was able to get an appointment with one of the doctors for Tue of the next week. Now I’ve got all weekend to continue worrying and doing my own research. I had Hepatitis blood tests even though it was a long shot, and the results were not yet in, so I was still hoping that might be it.

Tue 12/17/2013 Specialist Visit:
This was a brief visit just resulting in more blood tests.

Wed 12/18/2013 Admitted to VCU/MCV for Testing:
I’m back at work and receive a call at 9:45am from the specialist I saw yesterday. He says to me “I have your blood test results and am very concerned. I am admitting you to the hospital for more testing. Go home now and pack a bag. Expect to spend a few nights. Someone will be calling you to tell you where to go.” I am in shock and really afraid now. I call my wife at her work and give her the news, find my boss and let her know, and head out.

I’m at the hospital with my wife by Noon. I’m subjected to an MRI/MRCP and told that, depending on the results, I can expect a liver biopsy and/or ERCP the following day. I have to wait on results from the MRCP until the following day.

By now I’ve let my parents (78 & 79 years old) who live in Western NY State know what’s going on and my mother hops on a plane that afternoon. She arrives in Richmond, VA that same evening for support and to help care for the kids.

Thu 12/19/2013 “C” Day:
My wife and mother are with me when the attending physician and a fellow break the news that they see blockage and strongly suspect cholangiocarcinoma.

An ERCP is scheduled but at the last minute they decide not to move forward with it because the head doctor of the local VCU/MCV practice had been consulting with Dr. Greg Gores at the Mayo Clinic and they believe I may be a good candidate for Mayo’s protocol that involves chemo and radiation followed by a liver transplant. I am told that had they performed the ERCP and taken brushings locally, I would not be able to be considered for the Mayo protocol.

I’m in communication with the financial office at the Mayo Clinic at this point so that they can determine if their protocol is covered by my insurance. It was just past 5:00pm ET so I was forced to wait until the following day to hear if it was or not.

Fri 12/20/2013 VCU/MCV Discharge:
I’m still waiting to hear back from the Mayo Clinic’s financial office on the insurance coverage. I asked my attending physician what people with no insurance or people who’s insurance doesn’t cover a transplant do? He looked at me with a stone cold face and said “They die. That’s our system in the US.”. My jaw dropped open. At 47 years old and without a single health issue my entire life I never read the fine details of my health insurance. Annual maximums? Lifetime maximums? Coverage limitations? How can such things exist, I thought.

Thankfully, I work for a fairly large company and have great insurance that does cover transplants and has no annual or lifetime maximums. I received word mid-day that the Mayo protocol would be covered. In fact, my insurance would even cover the related travel and lodging expenses for myself and a caregiver. Amen!

I was anxious to get out to Mayo and begin the testing/evaluation for their protocol and started working with them to that end immediately and managed to get set up for appointments starting Mon, 12/23/2013.

While waiting to be discharged, I made one-way travel plans for my wife and I to fly out to Rochester, MN on Sun, 12/22/2013.

I was discharged from the hospital and home by dinner time that evening. Our heads were spinning. So much to do to get ready to go… so many unknowns… not being home for Christmas with the kids…! My father made arrangements to drive down to VA to be with my mother and four kids for Christmas and beyond.

Mon 12/23/2013 – Fri 01/03/2014 Mayo Clinic Transplant Protocol Evaluation:

I won’t detail all of the testing and meetings here but suffice it to say that I’m no longer afraid of needles or medical tests and procedures and, other than cholangiocarcinoma, have a completely clean bill of health.

While in Rochester, MN we stayed at the Gift of Life Transplant House and I can’t say enough about how wonderful it was. We met lots of supportive people and the rooms and common areas were beautiful.

About a week into the evaluation I had an ERCP and EUS where stents were inserted and within 2-3 days, all of my symptoms were alleviated. I wanted to just pretend this was all a dream. I felt great and other than a weight loss of about 20-25 looked completely normal.

Somewhere along the line we were told that resection was an option for me. We had no idea going into this that it was an option for anyone, so we were on cloud 9 with the news.

Surgery was scheduled for Fri, 01/17/2014, so we headed back home to Richmond, VA for a week of “normalcy”. My wife and I both went back to work for the week and made plans for other family members to watch the kids while we went back to the Mayo Clinic for surgery.

Fri 01/17/2014 Surgery:
The first thing on the agenda was a laparoscopic “staging” where I’d be visually checked for metastasis and also have some lymph nodes pulled out for examination/pathology. At any sign of spreading, I’d be closed back up and no resection would be performed. I prayed to wake up with more than a small hole in my belly button, and I did. The surgery itself lasted about 6 hours.

Unfortunately, the drain that was put in my right side was filling up with bile pretty quickly and it was determined that I had a significant bile leak somewhere and they needed to operate again to find and fix the leak. That was scheduled for the following morning.

Sat 01/18/2014 Surgery to Find and Fix Bile Leak:
This surgery took about 2 hours and they successfully found and tied off a leaking bile duct left over from the liver resection.

Sun 01/19/2014 – Mon 01/27/2014 Mayo Clinic In-Patient Surgery Recovery:
I spent a total of ten days in the hospital, including the two days of surgery. I had a fair amount of water retention from my waist down to my feet and initial difficulty urinating on my own but eventually everything got back to normal. The room at Mayo was private and, by my limited experience, very very nice.

While recovering, I was visited by a Medical Oncology Fellow and his Attending. They recommended adjuvant chemotherapy with gemcitabine/cisplatin or gemcitabine alone for four to six cycles.

Honestly, I was in no mood whatsoever to discuss chemotherapy with them while trying to recover from surgery.

01/29/2014 Mayo Clinic Post-Surgery Doctor’s Summary:
“Mr. Reidy is a pleasant 47-year-old gentleman with a recent diagnosis of de Novo perihilar cholangiocarcinoma. On January 17, he underwent a left hepatectomy, Roux-en-Y hepaticojejunostomy, and hilar and celiac lymphadenectomy and cholecystectomy. His postoperative course was complicated by a bile leak, for which he was taken back to the OR for an abdominal exploration and ligation of the posterior bile duct branch. The remainder of his hospital course was uneventful. He does have partial dehiscence of the skin suture with drainage, for which he has been applying wet dressings three times a day.”

Stats:
[list=*]
[*]December 2013 CA 19-9 was 453 unit/mL[/*]
[*]January 2014 surgical pathology demonstrated moderately to poorly differentiated cholangiocarcinoma, 2.5 x 1.4 x 0.5 cm in size with involvement of the common hepatic and left hepatic bile ducts[/*]
[*]January 2014 surgical margins were negative. Multiple lymph nodes, as well as the gallbladder, were also negative for malignancy. Perineural invasion, as well as small vessel invasion was identified[/*]
[/list]

Closing Thoughts & Questions:

I still have yet to decide if I am going to proceed with the adjuvant chemotherapy or not. I’m still not prepared mentally or physically for it. That and the lack of data suggesting that it’s worth the risk are big deals to me. I desperately want to live for a long time but don’t want to just trade one evil for another (kidney problems, nerve problems, hearing loss, etc) brought on by chemo drugs, particularly if there is no evidence that it’s helpful in the long run.

I’d love to hear opinions or experiences from those with similar circumstances on the subject.

I’m expecting to go back to the Mayo Clinic this summer for “surveillance” where they will do lab tests (check my CA 19-9 I assume) and perform a CT scan.

Question: Which is better for detecting recurrence, CT or MRI? I’ve had a LOT of radiation exposure in the past 10 weeks and would prefer to limit it going forward. It just can’t be good for you…

The stories on this forum both break my heart and give me hope. I really appreciate the level of caring and sharing going on here and hope to contribute myself, for a long long time.

-Matt

Matt@eReidy.com
(804) 464-7245

Randi,

Given the whirlwind of the past 10 weeks from diagnosis to resection, I consider myself one very lucky, unlucky, guy… if you know what I mean.

Thank you for your reply and welcome.

My doctor at Mayo is Gregory J. Gores and my surgeon is David M. Nagorney.

Gores Bio: http://www.mayoclinic.org/biographies/gores-gregory-j-m-d/bio-20053478
Nagorney Bio: http://www.mayoclinic.org/biographies/nagorney-david-m-m-d/bio-20053821