The case for surgery
Eight days after having consulted Dr D, we arrived at Adventist Hospital for appointment with Dr P. He remembered us as well the cancelation of the proximal femur replacement surgery. He told us that Dr D also spoke with him on the phone about my dad's case.
We updated him the results of both Oct 18 and May 19 CT scan results, which showed mild progression. He checked dad and asked us a few questions to be certain the pain was emanating from his left hip and not elsewhere. He ordered an X-ray taken that day itself. Result showed that the bone was on the verge of fracturing, due to the lesions caused by cancer, and that that was causing the pain.
Once again, he recommended the surgery, where 12cm of the femur would be replaced with a stainless steel rod (that last for 10 to 15 years; the most expensisve version, made of titanium, woud last 30-40 years) which would provide buffer against cancer progression (i.e. in case cancer was further down than what was shown on scans and X-rays thus far). It should get rid of the pain and enable dad to walk again the next day. Usually discharged on 3rd day. Takes 2 weeks for wound to heal and 2 to 3 months to fully heal.
Risks:
It was possible to pursue this through GH, as suggested by Dr D, but not only it would be much slower, it was probably not possible, as Dr P forsaw. This was how Ban explained to me later:
GH doctors believed that dad's cancer origin was pancreas and thus no point doing this surgery if he was going to die in a few months time. Hence the reluctance and outright refusal of various doctors to, say, order biopsy on the lumps on his abdomen, and to recommend femur replacement surgery. In fact, a PCU senior doctor prescribed Celebrex for the long term despite it being harmful to my dad's sole kidney, because he expected my dad to live for only a few more months .
Dr P, however, believed it wasn't pancreatic cancer because my dad had lived nearly 3 years after the diagnosis. The irony was that many GH doctors stared and even laughed in disbelief when they learned this because many pancreatic cancer patients die within 3 to 6 months. As I told my aunty when she asked for my dad's current prognosis, "I don't know because he has already lived way past the expected date."
Dr P believed dad would live for much longer and thus it was worthwhile to undergo this surgery and thus giving him better quality of life. This fits my dad's priority very well: less pain, more mobility.
Painful as it was, after talking with my sisters and Ban, we decided to opt for surgery performed by Dr P at Adventist Hospital. In fact, surgery would be this coming Monday!
Two days later, we had appointment with PCU, where we informed them of the upcoming surgery. They recommended no change to pain medication so as to have better assessment post-surgery. As for dad's constipation, although he had been pooing everyday for nearly a week, he did so only with the help of enema, which wasn't good because it would become less effective later. After some discussion, the doctor agreed with my idea i.e. dad refrained from using enema on his first try in the morning and to try again in the afternoon and at night, before using the enema as a last resort.
We updated him the results of both Oct 18 and May 19 CT scan results, which showed mild progression. He checked dad and asked us a few questions to be certain the pain was emanating from his left hip and not elsewhere. He ordered an X-ray taken that day itself. Result showed that the bone was on the verge of fracturing, due to the lesions caused by cancer, and that that was causing the pain.
Once again, he recommended the surgery, where 12cm of the femur would be replaced with a stainless steel rod (that last for 10 to 15 years; the most expensisve version, made of titanium, woud last 30-40 years) which would provide buffer against cancer progression (i.e. in case cancer was further down than what was shown on scans and X-rays thus far). It should get rid of the pain and enable dad to walk again the next day. Usually discharged on 3rd day. Takes 2 weeks for wound to heal and 2 to 3 months to fully heal.
Risks:
- 2-3% chance of infection
- disease progression to the lower part of the femur i.e. may be unavoidable due to unknown origin
- small risk of bleeding
- very low chance of worse mobility
- small risk of dislocation
It was possible to pursue this through GH, as suggested by Dr D, but not only it would be much slower, it was probably not possible, as Dr P forsaw. This was how Ban explained to me later:
GH doctors believed that dad's cancer origin was pancreas and thus no point doing this surgery if he was going to die in a few months time. Hence the reluctance and outright refusal of various doctors to, say, order biopsy on the lumps on his abdomen, and to recommend femur replacement surgery. In fact, a PCU senior doctor prescribed Celebrex for the long term despite it being harmful to my dad's sole kidney, because he expected my dad to live for only a few more months .
Dr P, however, believed it wasn't pancreatic cancer because my dad had lived nearly 3 years after the diagnosis. The irony was that many GH doctors stared and even laughed in disbelief when they learned this because many pancreatic cancer patients die within 3 to 6 months. As I told my aunty when she asked for my dad's current prognosis, "I don't know because he has already lived way past the expected date."
Dr P believed dad would live for much longer and thus it was worthwhile to undergo this surgery and thus giving him better quality of life. This fits my dad's priority very well: less pain, more mobility.
Painful as it was, after talking with my sisters and Ban, we decided to opt for surgery performed by Dr P at Adventist Hospital. In fact, surgery would be this coming Monday!
Two days later, we had appointment with PCU, where we informed them of the upcoming surgery. They recommended no change to pain medication so as to have better assessment post-surgery. As for dad's constipation, although he had been pooing everyday for nearly a week, he did so only with the help of enema, which wasn't good because it would become less effective later. After some discussion, the doctor agreed with my idea i.e. dad refrained from using enema on his first try in the morning and to try again in the afternoon and at night, before using the enema as a last resort.
Comments