We spent hours upon hours, day after day, finding the best colorectal cancer doctor we could find. We had some insight from my dear friend Angela who had worked as a nurse in oncology with all of the doctors at Hillman.
I am so grateful we moved her to the main Hillman Cancer Center in Shadyside, even though we had been told, and yes, I quote:
"It would be more convenient for the doctors if she goes to a satellite office in the South Hills."
Deep breath. Deep breath.
Mom's first appointment with the oncologist was on April 26, 2021.
Dr. Nathan Bahary and his team could not have been any more amazing.
Dr. Bahary was smart, gentle, straightforward, and funny.
His PA Toni was equally as wonderful, as was his nurse Kristin.
I especially appreciated that Dr. Bahary has a lot of experience with this type of cancer, and one of his specialties was examining genetics and how they factor into her treatment. At this point, she was not genetically a match for any immunotherapies, but there will be more testing done as her treatments progress.
Mom felt very well cared for.
She felt as if they were listening.
She wanted answers.
She wanted someone to tell her the truth - the good, the bad, and the ugly.
And he did.
Mom's CEA level on April 8th, the day before surgery was 26.9.
CEA is helpful about 50% of the time, and in her case, it is being used loosely as a barometer to gauge the level of colon cancer in her body.
On April 26, post-surgery, her CEA was now 6.6
Dr. Bahary laid out an aggressive treatment plan for her and explained that survival rates vary from person to person. If you Google survival rates for a 76 year old with Stage IV metastatic colon cancer with lymphovascular invasion and perineural invasion (peritoneal carcinomatosis), it doesn't look too great.
Chemo at this stage in the game is not curative. This was a punch in the gut. It was, however, going to give her a chance to extend her life. And she wanted to fight.
Dr. Bahary reiterated that outcomes are different for everyone, and that miracles occur every day. She said she wasn't ready to die and wants to be able to see Hannah and Dylan get married and see AJ graduate from high school.
Dr. Bahary shared information about FOLFOX chemotherapy.
FOLFOX is a chemotherapy regimen for treatment of colorectal cancer, made up of the drugs Folinic acid "FOL," Fluorouracil "F," and Oxaliplatin "OX."
He also suggested she speak with Hillman's GI oncological surgeon to discuss HIPEC.
HIPEC: Intraperitoneal hyperthermic chemoperfusion is a type of hyperthermia therapy used in combination with surgery in the treatment of advanced abdominal cancers. In this procedure, warmed anti-cancer medications are infused and circulated in the peritoneal cavity for a short period of time
Basically, HIPEC includes pouring hot chemo into her stomach during a surgery that lasts between 8-15 hours and they move her body during the surgery in order to "slush around" the hot chemo. We had the consult with Dr. Choudry, who was equally as wonderful as Dr. Bahary.
After the consult and watching several HIPEC videos, mom said NO THANK YOU.
Apparently it results in excruciating pain, complications 30% of the time, and it doesn't cure the cancer. It just prolongs life somewhat. But at what cost to quality of life?
Mom took some time to think about the plan, and decided to move forward with FOLFOX chemotherapy.
Chemo could not start right away since she was still recovering from surgery. She was weak, sick, and still had no appetite. Chemo at this point could have killed her. She needed to be strong and as healthy and hydrated as possible.
The FOLFOX Chemotherapy Regimen
FOLFOX is pretty much the standard of care for colon cancer, and because the main tumor was removed, mom's chemotherapy is adjuvant therapy, which is used to kill remaining cancer that is too small to be detected.
The FOLFOX protocol is 12 rounds of two weeks each, where she'll visit Hillman to spend 5-8 hours getting 2/3 of the chemo, then go home with a pump filled with chemo drug #3 attached to her port. A nurse will come to the house every two weeks to remove the pump after 46 hours. The rest of the time she recovers. Rinse and repeat 11 more times.
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