Surgical Update From Johns Hopkins Mid-July to Late-July

Hi followers of my official health blog. Above is a scene from our vows renewal on 6-21-2024, 12 years married since 7-14-2012. Left to right: Franklin 7, Sir Charles 5, Ms. Maggie 9, almost 10.

Tuesday July 9, I had the pre-op labs, EKG, and anesthesia visit to determine my relative safety for the Whipple surgery. 

Friday July 12, after saying good bye to my children, in-laws, and wife, we departed for Johns Hopkins hospital for my attempt at surgery. 

The anesthesiology people were great.  After i was asleep, they installed a central line to monitor internal pressure and to administer blood or fluids as needed. 

They installed an arterial line to closely monitor blood pressure constantly. 

A Foley Cather was installed to take care of urination both during surgery aftercare. 

When i awoke, i recall feeling for drains in my abdomen. There weren't any. This was my first indication the surgery wasn't completed. I asked the anesthesiologist if they did my full surgery and she said "you'll need to speak with Dr Burkhardt"...i knew this meant "no."

When Dr B and my wife came in, i could see the solemn expressions so I asked, "good or bad news doc." He said "bad."

"Give it to me straight doctor, please get right to the point," i asked. 

He said "we dissected deep beyond the stomach and freed up your duodenum. Behind this was pancreas and we fully mobilized it ready to do your surgery. This is when i noticed 4 small nodules on your liver. We biopsied these intraoperatively, and they were cancerous, 3 out of 4"

This meant they had to abort the pancreas surgery. My gall bladder was giving me trouble in the few weeks leading up, so this was removed during surgery due to inflammation/infection "chronic cholecystitis."

The first night and first two post-op days were very hard. Pain was challenging due to the large incision, and that they messed with the pancreas. Surgeons rules: "rest when you can. Sleep when you can. Don't mess with the pancreas." Playing with it releases lots of inflammatory chemicals into the area. Mine was messed with substantially but not removed. Taking out the tumor doesn't help when new tumors are popping up. 

I was released post-op day #2, Sunday, to our hotel in Baltimore. I was feeling weak Sunday and Monday. There was a set back Tuesday that required ER evaluation. The line was so long, we opted to go to neighboring Pennsylvania where Ellen's parents live. This was a three hour drive starting at midnight Wed morning. We slept a few hours then went to a local ER, much shorter wait time. This showed normal labs and normal CT scan but for a lot of air in the abdomen, a normal finding after open surgery. Still, the PA seeing me wanted to transfer us back to Hopkins. I declined and we went back to Ellen's parents to recuperate. 

Thursday morning we decided it was better to be near my excellent care team in Maine. 14 hours drive to Maine, we slept maybe 6 hours in our own beds then headed out. Dr John Vanadia has been my surgeon for many years. He admitted me to SJH ER all day starting 0700, Friday morning, July 19th. We got more labs, more thorough CT, and a nuclear medicine scan looking at bile duct system for leaks, called HIDA scan.  Great news, these tests were negative. 

I still have to recover from a scar that goes from my chest bone to just above pubic bone. There is ongoing inflammation internally on the right that we know rest and anti-inflammatory meds will resolve in time.

As to the not so great news of metastatic pancreas cancer. It's on the liver. If it's there, it is probably seeded everywhere. That's the prevailing theory. 

I hate to say this folks but my time is limited. My local oncologist in Augusta Dr Liu said the average time remaining is 8 month, with a range of 5 to 11 months. It's been recommended by my doctors that i close the medical practice in a controlled manner. This will be far better than if i die and suddenly it's a crap-shoot.

We encourage people to call EMMC, SJH out patient practices, and PCHC as soon as possible to get on their wait lists. For those who prefer Direct Primary Care (DPC) option, you should call Dr. Jack Forbush in Hampden at 207-945-5400.

As far as DPC or prepaid patients, we will refund any FUTURE credits according to our refund policy, on a prorated manner. 

I am very very sorry to give you this sad news but i prefer you hear it from me and not the rumor-mill. A letter will follow in the coming days.

It has been my honor and privilege to be your physician and friend.

Adam

Adam Lauer, D.O.