INTRAPERITONEAL CHEMOTHERAPY

A (Late) Kalamazoo Fall

 

Okay, this one is going to be heavy, so don’t read it unless you are prepared for a slice of the real world.  I am going to interject Linda’s experiences with the information contained in this article.  Maybe by doing so I will make the situation more real for you, and allow me to come to grips with some painful things that are stuck in my psychic craw.  Be warned.

Chemotherapy is generally administered intravenously, through a needle or a “port” – the latter being a semi-permanent arrangement that allows the stuff to be pumped directly into the heart.  Linda had a port; you can see it in her picture at

 http://ljb-quiltcutie.blogspot.com/2014/02/some-cool-stuff-from-economist.html

However, there is another way to give chemo, one that is strongly recommended by the experts.  It is called intraperitoneal (IP) therapy.  To use IP you drill a hole in the patient’s abdomen and pump the chemo drug directly into the place it is needed.  Then you attach the patient to a machine that tips her about, allowing the drug to slosh into the far corners of the peritoneal cavity.  IP is proven superior to other cancer therapies but is not used in a majority of cases, for reasons described in this article that are not flattering to the medical profession.

Before Linda had her “debulking” operation – it lasted about seven hours – we had been told that she might awaken with a small tube sticking out of her stomach, for the administration of IP chemo.  When she did come out of her drug-induced stupor she immediately looked for that tube and, not finding it, assumed the surgery had found no cancer.  I had told her that I had good news, and she thought that it was that she was cancer free.  What I had meant was that her sister was on her way to stay with us while she recuperated.  That meant that I had to tell her that she had ovarian cancer.  I didn’t know the stage or anything about her prognosis, thank God, or I might have simply lost it all. 

Why didn’t she get IP?  Well, I vaguely remember the surgeon saying that, as the result of a previous major abdominal operation it wouldn’t be effective.  Probably something like that was the case.  One thing I do know, though:  another Bellingham woman operated on at nearly the same time had IP and is still alive. 

I often think about what an awful job being an oncologist would be.  In point of fact, the generality of MDs don’t have it so great, either.  Sure, they are well paid and highly respected, but consider the importance of their decisions.  As a college professor I might decide to give some lad or lass a B when maybe an A would have been appropriate.  Who cares?  They do, but in the long run nothing is ruined.  However, if I tell a woman that some lumps in her abdomen are probably benign and not to worry – and they later turn out to be cancerous – I  have made a mistake of tremendous consequence, one that will follow me for the rest of my life.  MDs face situations like that all the time.  No wonder they screw up now and then.  I will continue to try to cut them lots of slack.

http://www.nytimes.com/2015/08/04/health/ovarian-cancer-abdominal-chemotherapy-underused.html?smprod=nytcore-ipad&smid=nytcore-ipad-share