I Sold You That Bill Of Goods

Entry 1   9:25 a.m.

Yesterday, Abby and I spent the afternoon together again. This is good because, for the second day in a row, we were out. We went to Old Burien, a place that I have regrettably neglected. Abby said it reminded her of a downtown on a small island. She is thinking Vashon, I would wager, where she has spent some time. We shopped for Advent and Christmas gifts for her mother and Leiney. Most everything was closed. It was Sunday. Even so, we did hit two great shops in the 1/3 mile stretch, a bookstore and some gift shop which I was skeptical about, but am happy to say helped us almost complete my Advent shopping.  Abby was hilarious the whole time, and actually laughed at a terrible pun I made. She never, and really it's understandable, laughs at my puns. But she had a  deep genuine laugh. So, when I can make the teenager laugh, I feel successful. 

Typical teenager that Abby is, she was not dressed for the cold. As she has done since she was about 11, she  declined a coat. She didn't complain, in fact, she was her smart ass self when I offered her my coat, impolitely refusing. She must take after one of her parents.

Mt. Vernon, March 2020.

We stopped at Safeway on the way home. When we got back, Jenny was angry with me. I realize now that sometimes fear comes out as anger. She lectured me on my Christmas shopping, telling me it is pointless to be spending money on her as she won't be around to enjoy whatever gifts I get. I know she doesn't mean it. I
assured her that it will be ok. I found an amazing 1000 piece puzzle, which I have committed to doing with her--something I haven't done in years (puzzles bore me) and which she has asked me to do many times. I also got a bath bomb, which she will enjoy, and a map to help her find Bigfoot--a childhood obsession of hers that has been a running joke (in a kind way) in our family. I have only done Advent shopping, and don't have any ideas what Christmas wishes she will have.

I woke at 4:49 thinking about death and eternity--my death, generic eternity. I didn't go back to sleep, but didn't drag myself out of bed until 6:30. The muttling alarm clock did not go off. Since we have started covering their crates with blankets again, their alarm has been less consistent. This is a good thing. Yesterday I didn't wake until 7:15. That has happened twice this last week, and for that, all praise be to 1000 thread bedsheets, which work well to block the light from the crates.

The morning was interesting. I was in the throes of the morning clean, returning from the garage where I had put garbage in the bin, when I ran into Abby at the washing machine. It wasn't even 6:50 a.m.  She had gotten up to put her laundry in the dryer. I sent her to bed, as putting her laundry in the dryer was the next task on my list. I threw it in and went to continue the treat/breakfast fetch routine.  About 7:15, Abby was back and, except for shoes, dressed. She had to go gather dirt for science lab at school. I gave her my shoes. She was outside for 10 minutes filling a quart bag of dirt. When she got back, I helped her stow it, so she could carry it in her car without spilling it. When she was ready to go, I helped get the ice off her windows and she was off., in a shiny, happy mood.  Seeing Abby in good spirits in the morning is like a 2 hour lunar eclipse, it probably would happen about once every 520 years.

I started working at 8:40 after checking on Jenny, who was awake on her phone, per her morning routine. Moni showed up around 9:15 to walk Willow. I rousted Jenny from bed and she made her way downstairs. As soon as Moni left with the dog, I heard Jenny begin weeping. It wasn't a wailing cry, but a sustained release of woe, like a tire with a medium sized hole in it. The crying just didn't stop. I quickly made my way downstairs to her side and held her for a long time. She is so afraid. When I sit with her and hold her, I don't have the fear I have as I type these words. I feel calm. The fear wells up inside me as I sleep, and wakes me out of sound slumber. Her impending death scares me, and in my subconscious makes me think about and fear my own doom. We are strange creatures. 

After about 10 minutes, she pulled herself together enough to tell me she is worried about being able to even complete Christmas shopping. A valid concern. I told her everything will be alright. 

Last night I stumbled across an article by Dr. P., Rare long-term survivors of pancreatic adenocarcinoma without curative resection.

 

Jenny is non-resected, meaning  she has not had surgery because she is metastatic and surgery would thus be pointless.  So, of 555 resected and unresected patients, 11 survived greater than 5 years--about .02% , and 11% of resected.  There is a decent blog post exploring the article--Long-Term Pancreatic Cancer Survivors Without Surgery - Understanding Pancreatic Cancer Blog (pancanology.com). Overweight patients tend to do better according to the article. Jenny was a bit overweight when diagnosed, so she had some fat reserve to help keep her life extended. I wonder what the tipping point might be between being overweight enough such that it keeps you alive, versus being so overweight it is a detriment to your health. 

So, I am reading along, thinking this might auger well for Jenny, when I came across the CA 19-9 levels of the 11 unresected patients living 5 years-none had levels higher than 397.1. Only 2 had metastatic disease. Clearly, those who had the cancer limited to the tumor bed (the location of the primary tumor) were more likely to survive. Still 2 people, like Jenny had distant metastases and made it 5 years. 

It's an old study, I am sure Jenny will be in his next study, which he has already said is the case.  

It's a slow work day. Hallelujah.

Entry 2     1:05 p.m.

So, the question becomes, Does long-term survival exist in pancreatic adenocarcinoma? Those ever competitive Norwegians seem to have asked and answered that question with a resounding no.  They looked at 2564 patients and found 24 long term survivors out of 1365 verified with PDAC. The takeaway:

"In contrast to the surgically treated patients, the median overall survival of patients with unresected and metastatic pancreatic cancer remained unchanged over time. . . In conclusion, long-term survival in patients suffering from pancreatic cancer is extremely rare. We found that only 1.6% of all patients survived for more than five years. Of the patients who were eligible for surgical resection, 10.1% survived for at least five years." I won't do the math to figure out how many unresected patients had to die to drive the average down from 10.1% to 1.6% for 5 year survival. Not good.