Monday, August 31, 2009

Imagine This

A letter sent out last Friday:

Dearest Family and Friends,

Today, Friday, August 28, Bat had his first appointment with his Green Bay oncologist, Dr. Winkler, since his discharge from Mayo Clinic. Overall, Dr. Winkler is pleased with Bat's improvement. His liver function test (bilirubin) has improved and is now in the normal range. The liver enzymes remain elevated, but they have been for quite some time, and are expected to remain so. This is no surprise and to be expected. The protein in his blood has improved, but is still slightly low. This also indicates improved liver function as well as definitely better nutrition.

Dr. Winkler examined Bat's legs, and he felt that the amount of swelling that is present is acceptable. The swelling is due to a combination of factors, which include compromised liver blood flow due to the the tumor, the aortic stenosis, and the still mildly reduced blood protein levels. He did not feel that the swelling was of any major concern unless it would dramatically increase, in which case a mild water pill (diuretic) would be helpful as needed. Continued walking and exercise will also help minimize the swelling.

Bat was having very mild pain today, but he had not taken any Oxycontin in 3 days. Dr. Winkler explained that the twice daily use of the 12 hour release pain medication (oxycontin) was necessary for satisfactory long term pain control. He stressed that Bat was on a very low dose of oxycontin. Dr. Winkler instructed Bat to resume taking the oxycontin on a regular basis, and to use the oxycodone only on an as needed basis if he had episodes of increased pain.

He examined Bat's gout-afflicted toe, and felt that it was responding nicely to the medication. Hopefully it will continue to improve, but if he has another flare up, then Bat should contact Dr. Winkler for another prescription.

Bat has been taking lactulose to reduce the amount of ammonia in the bloodstream, as well as to prevent constipation, with its accompanying nausea and/or vomiting. This has been working well, but with the improvements in liver function, Dr. Winkler wishes Bat to continue on the lactulose for only one more week. If needed, it can always be restarted in the future.

All of this, of course, was good news, but the best news was yet to come. Dr. Winkler feels that if Bat's general condition continues to improve, there is a fairly new drug which could be tried to slow the tumor growth. Unlike most conventional chemotherapy, this drug is given as a pill, and the side effects are usually quite mild, with diarrhea being the most common side effect. He does plan on discussing this option with Dr. Pitot, and hopefully it may be started in 2-3 weeks. Bat has a follow up appointment with Dr. Winkler in 2 weeks.

The question was raised whether a trip would be possible in the near future, and Dr. Winkler again felt that if Bat continued to gain strength, and to exercise, that traveling would be a very likely possiblilty following his next visit in 2 weeks.

All in all, a very upbeat and positive visit to the doctor. At this point, it certainly seems that Dr. Winkler is anticipating that Bat will have quality time in the future. We can only pray and hope that he is correct.

Once again, thanks for all your prayers and good wishes.

Gary and Fran


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