July 20 2024 – Update on my Dad

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Hello everyone,

Thank you all for continuing to pray for my dad.  Physically he continues to do very well.  He finished his radiation July 8th.  During the 3 weeks of treatment, he didn’t experience much negative side effects.  The week after, he did have a couple days of fatigue, and one day he was a little disoriented.  But otherwise, the side effects have been fairly minimal.  So, praise the Lord with us for that. 

This week we had 2 appointments.  We had his ERCP, the procedure to replace his stints, and a consultation with his cancer doctor.

ERCP:

  1. His ERCP was pretty routine.  The GI doctor had the scope in for about an hour.  He was able to clean his bile ducts out, and replace his stints.  One of the stints had fallen down and embedded into the side of his small intestine.  But, it did not perforate the wall, and the GI doctor was able to remove it.  He said there was a small ulcer where that occurred so he placed some clips to close it up.  It didn’t sound concerning to him at all though.  While he was in there, he took some more samples of the tumor for biopsy.  When I asked him if he could tell if the radiation had done anything.  He said it was too early to really tell.  He did say he did not notice any reduction in the size.  But, that sounded normal from the way he responded.
  2. The current stints are a little longer lasting than what he has been doing.  The previous rounds, the stints were replaced after 6-8 weeks.  This time, his scheduled a replacement procedure (ERCP) for 12 weeks out. 
  3. At 12 weeks he will perform the first of 3 RFA procedures.  Basically, this procedure is done following a successful round of radiation where the tumor has been neutralized and is no longer cancerous.  This entails inserting a catheter-shaped electrode into the bile duct in the area where the tumor is. The electrode is then used to burn the cholangiocarcinoma tumor in order to cauterize the cells to prevent the cancer from spreading.  (According to Google, RFA is a palliative treatment for unresectable cholangiocarcinoma.)  This definition seems consistent with what I am understanding from both the GI doctor and the cancer doctor.  The GI would like to perform 3 RFA procedures with 3 months between each.

Consultation with the cancer doctor

  1. The cancer doctor and the GI doctor are part of separate practices, so I’m learning that it seems like they aren’t really talking and comparing notes much.  (Although Dr Simmer (GI doctor) did say he would put a note in dad’s chart for Dr Chandana to see.  The first question Dr Chandana asked was what the GI doctor had done.  And when I explained the GI doctors plan for the RFA procedure, De Chandana’s response was, “Well, that’s a good plan if his cancer is not progressing.” 
  2. Chandana was less optimistic that the radiation and ablation / RFA treatments will take care of the cancer.  So, he said, “We need to just continue to watch and see.”  When I asked him what that looks like, he said, “Well, we could schedule scans every month, but I don’t think we’ll see much change, so every month is not needed.”  When I inquired how often, he said, let’s try 6 months.  Then when we talked about our schedule, and the plan to return to PNG, he said the 6 months is a little flexible.. could be 7 if needed.  But we don’t want to go much longer than that.
  3. Dr Chandana said that at the moment dad’s care is more with the GI doctor than his care, but will continue to monitor his case, and will continue to be a part of making sure his care moves forward.
  4. Dr Chandana also said that the biopsy Dr Simmer took on Thursday will likely still come back possible for cancer because it hasn’t been enough time for the radiation to do all its work.
  5. He scheduled a CT scan for August 23, then a follow-up visit with him on August 30.  (We leave for PNG on September 1st, so we scheduled it as late as we could in order to ensure the radiation has had as much time as we can for it to do its work)
  6. After August 23 he would like to repeat scans and visits every 6 months, unless something shows up on a scan.

So, now the question is, what does all this mean for us?  We are waiting for the result of the CT scan to make final plans.  But, at this point, after hearing these doctors and talking through things with Dr Chandana, we feel like we will try and return to PNG for 6 months.  We will try and return to the US in time for the next CT scan and consultation with Dr Chandana (around the 3rd week of February).  The other thing Chandana asked about was dad’s living situation, and how we/he thinks he’ll do on his own.  We are working on getting some help for him (nurse checking in, non-professional help for house cleaning when needed, etc)  With those things in place, Dad feels he will be OK.  So, we feel we’ll try for 6 months.  When we return, it will be to check on him medically, but also to really assess how he is doing being on his own, and whether any changes would be needed on that front, and to help make that happen if change is needed.

While we are gone he will undergo 2 ERCP/RFA treatments (October, January).  So, he will need someone to take him and be with him for both of those.  So, we’ll have to figure that out.  We want to also make sure he has a good network of people checking in on him, as well as activities that he is involved in… some of which he is already engaging in.

Another factor for us is, what does this mean for our ministry.  Our program in PNG will run from October until 1st week of February.  So we will fulfill our obligation for this next program in PNG.  But, if/when we return to the US in 6 months, we will not have any more home assignment time, which means we will need to have a ministry to continue to engage with for the time we are here.  This will entail working with both the US and PNG to decide what we can do from Michigan while we are caring for my dad.  I have already had a conversation with the US regarding some ideas.  We will need to have a similar conversation with PNG and come up with a plan.  So, please pray for us as we walk through these challenging days.

Thank you for your support, encouragement and prayers for all of us.

David Watters

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