I have not taken the ativan since middle or late last week. Yes, of course, it’s not a painkiller per se, but a tranquilizer, which calms one, and that has the effect of significantly reducing pain.
I had to take it because of the return two weekends ago of the particular pain in the gut, the pain in the celiac plexux nerve, which had been removed by my first celiac plexus nerve block in early February. What returned two weekends ago was not the full unbearable pain that had been blocked earlier, but maybe 70 percent of it, which was bad enough. The ativan worked, but it terribly weakened the body until I could hardly stand up from a sitting position, hardly walk, and hardly do intellectual work. That was one reason to stop it after three-times-a-day use of it for about three days. The more decisive reason to have stopped taking the ativan manifested itself this past weekend. About midday Saturday the celiac plexus pain, which had been intense for the previous couple of days (the ativan loses effectiveness the more it is used), went away and stayed completely away for over 24 hours. This morning it seemed to be somewhat back again, but that’s not certain. It might have been another pain; I have several distinct pains in the abdominal region and they are helped by different drugs. For example, I take as part of my pain management regime two tylenol pills every six hours, and if I miss it there is a distinctive pain in the area of my stomach; the tylenol has no discernible effect on the celiac plexus pain. But the fact that the “unbearable pain,” which is my name for the celiac plexus pain, or rather the 70 percent of it that had returned, went away completely for one day and has largely or completely stayed away since then, indicates that the second nerve block, administered last Wednesday, will ultimately work completely. And, if it works, according to the local pain management specialist who administered it, it will stay in effect for six months. It is of a different type from the first one. It is more powerful, but also in 25 percent of cases it doesn’t work. The first one I had, which according to my New York pain management specialist who administered it, lasts between a few weeks and a few months (and in my case it lasted about fix blessed weeks), virtually always works.
If this second nerve block doesn’t work, I am basically finished. The next step would be morphine, and then my functional life is over. If it works, which it seems to be doing, I may have a couple months or more of functional life—and of life itself, which would be ok with me because it would give me time to finish most of my must-do projects.
Beyond that, there are more hopeful scenarios, in which the radiation eliminates the tumors in the brain and spine. That is not at all impossible—this type of radiation treatment is known to be very effective. And if the pancreatic cancer in the abdomen continues in its apparent general course of non-increase since tumors re-appeared last June, I may yet survive for significantly longer.
But (sorry for the confusion) I now have to correct a wrong impression that I may have given. In a sense the cancer in the abdomen has worsened. A view—though not an absolute conclusion—of my doctors is that the unbearable pain was caused by tumors pressing on the celiac plexus nerve, meaning that the tumors had gotten larger or spread. Also my abdomen is quite distended, indicating an increase of ascites (liquid in the abdomen produced by tumors), and thus indicating an increase of tumors. But, as understand, this is also not certain. We are trying to schedule a CT scan of the abdomen this week to check the progress of the cancer in that part of the body.
To repeat my indulgence in wildly hopeful speculation for a moment, if the nerve block works, and if the abdominal tumors don’t increase any further, which, generally and miraculously, they have not done, then, again, I may live significantly longer.
(Even my nurse-practitioner in Long Island, with whom I had a long phone conversation two weeks ago, agreed with me that the (general) non-spreading of the abdominal tumors, given the almost total absence of chemotherapy over the last three months, was “miraculous,” an astonishing thing for her to say. But I’ve been away from New York for a long time and she may not have been up to date on all aspects of the case.)