April already......

So, here we are in April.... quarter of the way through the year already.  How on earth did that happen?  This is normally my very favourite time of the year, with the coming of the lighter evenings, spring flowers blooming their heads off, and the promise of even longer, warmer days to come.

This spring though, is shaping up to be more challenging and difficult, as we are currently awaiting a call from King's College Hospital in London, with news of the date of PP's surgery.  It could come any day, and every time the phone rings we exchange looks of mixed trepidation and terror.

Six months into PP's cancer diagnosis and everything has changed.  During the first three months, when she had biopsy after biopsy, trying to identify the type of tumour, we were repeatedly assured that it was inoperable, due to its involvement with various major blood vessels.   We grudgingly accepted the view of the surgeons at the regional specialist HPB hospital but once a definitive diagnosis was confirmed, we requested that her subsequent treatment be carried out by a neuroendocrine tumour centre of excellence, so she was transferred to King's. 

Neuroendocrine tumours are rare, and don't respond to the usual cancer treatments of chemo and/or radiotherapy.  As with other cancers, surgery to remove the bugger is the 'gold standard', but as surgery was off the table, we resigned ourselves to her starting a monthly treatment, with a view to damping down tumour growth and hopefully preventing its spread. 

However, the new specialist team at King's requested another scan, so that their surgeons could review the location of the tumour, and following a multi-disciplinary meeting in January, we were told that their surgeon, who leads the liver transplant team and is therefore experienced in tricky vascular work, was prepared to offer surgery.  

Our relief was tempered with caution, especially when we went to meet with the surgeon, to learn more about the operation. 

The pancreas is a weird, tadpole-shaped organ, situated in a relatively inaccessible spot slap bang in major blood vessel central.  It has many functions.... producing enzymes to aid the digestion of food, secreting a variety of hormones and crucially, producing insulin to control blood sugars.  It is possible to live without a pancreas, but subsequently, life is...... complicated.

PP's surgery is major, life-changing stuff.  The surgeon will remove the head and neck of the pancreas, where the tumour resides.  He will also take the gall bladder, bile duct, bottom part of the stomach and the duodenum as well as various affected lymph nodes in the vicinity.  The recent scan also showed that the tail of the pancreas is atrophied, so probably not working well.  During surgery, if it looks too far gone he may have to remove the whole pancreas, in which case PP will also lose her spleen, which has major implications.  All of the remaining bits and pieces are then completely re-plumbed.

It's quite literally the definition of being gutted.

Even if he manages to salvage some of the pancreas, it may not work properly, so either way the likelihood is that she'll be diabetic.  Type 3C apparently, which no-one has ever heard of, but which is similar to Type 1 in that she'll be insulin dependent.  However not having any pancreas at all means that all the other things that it does, won't happen..... stuff like producing alpha and beta cells, and glucagon, the lack of which will make her diabetes difficult to control.

It's all very worrying and scary. 

She will be in hospital for around two weeks but thanks to the continuing uptick in Covid cases, (just wear the damn masks people..... sheesh!) during that time she will be allowed just one designated visitor for just one hour per day.  The journey time, door to door is 5 hours, so visiting days will also be challenging.

On days when I'm not able to visit we will take advantage of assorted tech solutions to video chat, talk and message.  I'm also hopeful that I'll be able to virtually 'sit in' on ward rounds/doctor visits etc.

I have a long and growing list of 'stuff to do' while she's in hospital..... cleaning the house to within an inch of its life, researching nutritious, easily digestible meals  organising the support she'll need when she gets home and generally making sure that things will run smoothly in the immediate post-surgery recovery phase.  

I'm also hoping that if the weather co-operates, my volunteer garden rescue team will be able to erect the new gazebo which is currently being stored on the patio, wrapped up against the recent snow/hail/rain storms and I'll then be able to create a cosy, covered seating area where she can relax and recuperate outdoors over the summer.

So, the next few months will most certainly be challenging, but we're ready to get on with it now, if only that phone would ring...