2013.08.09: 17 - Small Bowel Obstruction

我与癌 (17-小肠梗阻) 2012年的圣诞和2013的新年均在搬家的忙忙碌碌中度过。2月初的PET-CT证实有几处肿瘤微微长大，服完3个疗程的PD332991，Ca125达692时，医生K认为重新启用5年前曾用的Abraxane和一直在用的Avastin（Ab+A）会是明智之举。3月初，Ca125已是1400，虽然保险公司又在Abraxane上给小鞋穿，为不耽误治疗，医生K就给先上Taxol。Taxol的有些副作用还真把我推向忍耐力的边缘，幸亏仅此一次小鞋。换成Abraxane后，我精神重新抖擞。 通常一种化疗药在结构上由两个部分组成，一部有药物作用，另一部有携带药物进入细胞的作用。Taxol 和 Abraxane 有基本相同的药物作用部，但另一部却不同，Taxol 是化学合成结构（人体不喜欢）， 而Abraxane是蛋白质（人体相容），这就解释了我从恍惚朝抖擞的转变。让护士N和我欣喜若狂的是一轮Ab+A后，数字游戏Ca125下跌到240，这就是希望满满，满满希望的体现呀。 4月洛杉矶的新家迎来了LG研究生的婚礼和小闺女16岁的生日聚会。我的任务几乎就是吃吃喝喝躺躺，听听说说笑笑，准备养得壮壮实实去参加大闺女的毕业典礼，她人生的里程碑之一。 5月1日周三凌晨，突觉恶心，以为是饿了，赶紧吞下一片面包。可无济于事，开始上吐下泻轮番做业，推测也许是昨晚的食物在做怪，吐净泻绝该是转折点。周四泻止，仍吐，竟卧床不起伴脐左上方隐痛。周五疼痛情形有加重，Tylenol 失效。周六去针灸，未果。周日，觉得该去急诊，凭借我过时的五年医学教育所得推断，可能又要动刀了。我的同学XW又一次果断决策，让我Call 911 或 让在学校钻研的LG送，XW电告LG，LG回电问，能等吗还是？我答，必须立即马上。 多亏LG送，进急诊后，我已无力回答任何问题。X光很快确诊是小肠梗阻。上静滴止痛补液，上胃管减压。朦胧听见医生说，80%的梗阻保守治疗有效，我窃喜。前脚刚进病房，后脚便有排气，明日周一可出院？过于天真烂漫。周三，终于又开始泻，这回是肠蠕动恢复的表现耶，准许出院。饮食必须从无纤维流汁逐渐过渡到正常。医生认为这次是因以往腹腔手术及化疗导致疤痕形成，肠功能削弱的结果。一旦再有发生，我须学会尽早＂听＂懂信号，自行解决在萌发阶段。经这次折腾，体力大减，但我全身心那叫个轻松哈，止痛药松了我的肠子，也松了我的肩背，一举两得。 感谢美女媚妹ED不惜下厨为我煮粥送饭。借此也感谢＂白富美＂HF和JY接送我化疗数次，为你们带上博士帽骄傲，更为你们穿上婚纱欣喜。感谢Ucla的陈老师一直以来对我的关心爱护，记得六年前，我们在医院邂逅，您的一句＂没关系＂不仅让我悬着的心稳稳落下，还赋予我明亮亮的希望。感谢同事成朋友H的时常问候，不辞辛苦带我美容美发，还年年总是第一位祝我生日快乐。更感谢我的气功朋友们，尤其是亚裔女友们的深深情谊，陪伴我度过最艰难困苦的时段，我享受锻炼后午餐时的谈论，我认真听取各位的经验教训，相信我们之间的患难之交将源远流长。

Me and Cancer (17 - Small Bowel Obstruction) Christmas 2012 and New Years 2013 passed by amidst the tumult of moving to our new home. The PET-CT in early February confirmed that tumors in multiple locations had grown slightly. After 3 treatment cycles of PD332991 and my CA-125 levels had reached 692, Dr. K thought the best course of action would be to go back to using Abraxane, which I had used 5 years ago, plus Avastin, which I had always been using (Ab+A). In early March, my CA-125 levels were at 1400. Though my insurance was again giving me trouble about Abraxane, to avoid delaying treatment, Dr. K started me on Taxol instead. Some side effects of Taxol truly pushed me to my limits of tolerance, but fortunately my insurance didn’t give me trouble for anything else. After I switched to Abraxane, I was again full of energy. Structurally, chemotherapy drugs typically consist of two parts: one  responsible for drug action, and the other for delivering the drug into cells. Taxol and Abraxane have basically similar drug action regions, but the other region is different: Taxol’s is synthetic (which the body doesn’t like) and Abraxane’s is a protein (compatible with the body). This explained my shift from being miserable to energetic. What made Nurse N and I ecstatic was that after one cycle of Ab+A, my CA-125 fell to 240.  This filled me with hope. In April, our new home in Los Angeles ushered in the wedding of one of LG’s graduate students and my younger daughter’s birthday party. My job was basically only to eat, drink, sleep, and socialize, and I planned on getting very healthy to attend my older daughter’s graduation, one big milestone in her life. On Wednesday morning on May 1, I suddenly felt nauseated, but I thought it was due to hunger so I quickly ate a piece of bread. But it was no use, and I started to have vomiting and diarrhea. I speculated that it might be because of something I ate the night before, so after I cleared out my system I would start getting better. On Thursday the diarrhea stopped, but I continued to vomit, and I was bedridden from pain in my left upper umbilical region. On Friday the pain worsened, and Tylenol stopped working. On Saturday I went to receive acupuncture, to no avail. On Sunday, I felt that I should go to the emergency room; based on the medical knowledge I had gained over the last five years, I deduced that I probably would need surgery again. My classmate XW again made the firm decision for me to call 911 or have LG, who was hard at work on his research, take me. XW called LG, and LG called back asking could it wait? I replied, we need to go immediately. It was fortunate that LG drove me, because once I arrived at the emergency room, I was no longer unable to answer any questions. An X-ray quickly diagnosed a small bowel obstruction. I was placed on an IV to relieve pain and replenish fluids, and had a gastric intubation to relieve pressure. I vaguely heard the doctor say that 80% of obstructions are treated effectively with conservative methods, and I was secretly happy. I had just arrived, and there was already hope of leaving. Perhaps I could be discharged tomorrow on Monday? How naive I was. On Wednesday, I finally started to have diarrhea again due to peristaltic function being restored, and I was allowed to be discharged.  My diet was restricted to fluids with no fiber, and I was to transition gradually back to normal. The doctor thought this episode was caused by scar tissue from my previous surgeries and chemotherapy and slightly weak bowel function. If it happened again, I would have to learn to recognize the signs earlier and take action before it progressed further. Following this struggle, I was greatly weakened, but my body and soul were so relaxed, haha. The painkillers loosened my intestines, and also loosened my shoulders, killing two birds with one stone. Thank you to the beautiful ED for always cooking congee for me and sending meals. I also want to thank the beautiful HF and JY for taking me to chemotherapy countless times: I’m proud of your accomplishments in receiving your PhD degrees, and I’m so happy for your new marriages. Thank you to Professor Chen at UCLA for your concern and care. I remember six years ago when we encountered each other at the hospital, your words “It will be fine”, not only allowed me to set down my gripping apprehension, they endowed me with glistening hope. Thank you to my coworker-turned-friend H for always paying me visits, taking me on trips to the beauty salon, and always being the first person to wish me happy birthday every year. Additional thanks to my qigong friends, especially for the deep friendship among the Asian women members, for accompanying me through my most difficult times, and for the lunch conversations after training. I’ve taken your words and lessons to heart, and I believe that our solidarity in the face of adversity will continue long into the future.