2017 March 19

Strictures on Eating

Topics

Diagram of the stomach connecting to the duodenum (small intestine)

Two days ago, the Plate List Tour was scheduled to visit Rasika, DC's temple of fine Indian cuisine. Did we partake of pleasing portions of paneer? Taste tangy tidbits of tandoor? Nibble on nourishing nuggets of naan?

We did not. I ate a simple dinner at home that night. And it was delicious.

Two weeks earlier, I had my first bout of nausea/vomiting since starting chemo. This was odd since it happened two days before treatment—in other words, a week and a half after receiving my last dose. Usually side effects appear in the first few days directly after a treatment.

Still, nausea is possibly the single most common side effect from chemotherapy. So I checked it off the list and didn't think much of it. A couple of uneventful days passed, and then another incident hit me the Wednesday after treatment. It was beginning to look like I might be nearing the end of the current FOLFOX line. Friday morning and afternoon were fine. Friday night was miserable.

Anne brought me to the Georgetown University Hospital ER early Saturday morning, and the team there took a quick CT scan. [WARNING: Graphic material ahead!] It turns out the nausea and vomiting were not caused by the chemo drugs after all—there was a stricture pressing against the opening from my stomach to the duodenum (top of the small intestine). With the passage so constricted, food couldn't move normally and was backing up instead.

The immediate question, of course, was whether the stricture was cancerous. While we wouldn't have an answer to that without taking biopsies, the CT scan did show that my existing lesions hadn't grown since the previous scan. So props to FOLFOX for that.

[WARNING: Even more graphic material ahead!] While the team debated the best course of action, I got a stylish tube inserted through my nose, running down the esophagus and into the stomach. This was hooked up to a pump to drain out my stomach. I was also labeled NPO (“nil per os”, Latin for nothing by mouth) and “fed” intravenously.

For four days.

Tuesday night, the team placed a stent in the stomach-duodenum channel. This flexible tube was then expanded to open up the passage. At the same time, they took multiple biopsies from the stricture. My nose tube was removed, and I was able to eat clear liquids (broth, juice).

After tolerating the clear liquids for two days, I was bumped up to full liquids (cream of chicken instead of chicken broth). We also got the biopsy results. The docs didn't know what caused the stricture, but it was not cancerous. For those of you at home keeping score, that's FOLFOX 2, explanations 0.

After a day on full liquids, Friday's lunch was “GI soft”—meatballs, mashed potatos, and stewed greens. Fabulous. We canceled Rasika that night, but I was discharged and had salmon, risotto, and peas for dinner. After the previous week's diet, it was heavenly.