Mark Birch

Mark Birch - Homepage 2010

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Procedure Date: 02/08/2010

Scope(s) Used Detail: GIF-HI 80-2806447

Introduction: A 54 year old male patient presents for Upper Endoscopic
[ULTRASOUND].

Indications: Mr. Birch is a 54 year old male with a history of pancreatic cancer with
metastasis who presents for
evaluation of a nodule seen near the pancreatic head seen on recent surveilance
PET scan.

Consent: The procedure, indications, potential complications (bleeding,
perforation, infection, adverse medication reaction), and alternatives to the
obtained.

Preparation: EKG, pulse, pulse oximetry, and blood pressure were monitored
throughout the procedure.

Medications: TIVA

Procedure: The endoscope was passed with ease through the mouth under direct
visualization to the duodenum The scope was withdrawn and the mucosa was
carefully examined. The views were good. The patient's toleration of the procedure
was good.

Findings:
EGD Exam: The upper endoscope was introduced into the esopahgus. The
proximal and mid esophagus was normal in appearance. At the GEJ, mild
erythema was noted consistent with mild esophagitis. The GEJ was noted at
45cms. The stomach was carefully examined including retroflexed views of the
angularis, cardia, and fundus. No abnormalities were noted. The first and the
second portion of the duodenum appeared normal with no mucosal abnormality.
EUS Exam: Olympus linear echoendoscope was used for this procedure. The
pancreas was carefully examined from the uncinate process to the tail where the
spleen was seen. The pancreatic duct was not dilated. The pancreatic
parenchyma was normal in the pancreas away from the biliary stent with no
calcifications or lobulations. There was no evidence of a mass or enlarged lymph
node in the pancreas or adjacent to the pancreas. No peri-pancreatic, peri-portal,
celiac, or gastriclymph nodes were found. Hypoechoic changes were seen in the
area of the stent consistent with inflammation. No distinct mass identified around
stent, in pancreas or in peri-pancreatic space.

Other Events: There were no complications.

Estimated Blood Loss: None.

Summary: 1) No lymph node/mass lesion seen in the pancreas or adjacent to the
pancreas. Suspect nodule seen on imaging is the same echogenicity as
pancreatic parenchyma and thus not visualized 2) Mild esophagitis

Recommendations:
1) Consider CT guided biopsy
2) PPI
3) Follow up with referring physician

Feb. 2010

I have been NED for almost 2 years. Considering that I was diagnosed as Stage
IV, with mets in the liver and local lymphnodes with vascular involvement,
inoperable... back in Nov. 2007, and given 3 to 6 months to live, I guess I have
done alright. God has been good to me! Anyone have any doubts?

Well, today's news isn't as rosey as it has been. In January the MRI identified a
identity. Dr. Fogelman scheduled a EUS and fine needle biopsy in February. The
EUS could not locate the 12mm spot that the MRI found so we scheduled another
MRI for March 3rd to try and determine the location and type of "spot" that this is.
Well, today I got the results.

The "spot" has grown from 12mm to 13.9mm, It has become more defined and
looks like it is most likely a recurring PC lession. But it is too small to biopsy. I will
re-start GTX starting Monday. Dr. Fogelman is looking into a possible CT guided
biopsy for later in the week to verify the nature of the lession.

If this is not PC, Great! However, if it is PC, so be it! I will fight until my last breath.
Most people here have read my posts and know that I will not give up. You all
should know that I give it all to Christ! His will be done! As soon as I know it is
Gods will that I leave this world for the next, then I go willingly. Remember, what I
have always preached, Eternity is a long time, Earthly life is short... which is more
important? I, personally, look forward to Eternity.

God Bless all of you fighting this MONSTER!!

MarkB.

CT and MRI results are in!
That little spot that measured
13mm (1.3cm) is now only
10mm and shrinking! I
appears that I am having
another complete response
to chemo. No other
indication or spots of cancer
can be found! See the actual
MRI report on the "latest
scans" page

God Bless and Thank God,
Mark

diagnosed in 11/2007. Patient had multiple liver metastases at that time. The
patient had complete radiographic response to chemotherapy. In 03/2010, the new
nodule was identified between the uncinate process and the SMA which was
biopsy-proven as adenocarcinoma on 03/19/2010. The patient resumed
chemotherapy. Restaging.

Technique: MRI of the abdomen was performed with and without gadolinium
according to pancreatic protocol.

Comparison: 03/04/2010.

Findings: Previously identified 1.3 cm nodule in the most medial aspect of the
uncinate process is noted again, decreasing in size to about 1 cm. The signal
intensity and enhancement pattern of this nodule currently becomes identical to the
rest of the pancreas. Without knowledge of previous location and biopsy-proof of
this finding, it would be very difficult to identify it as abnormality on the current exam.
This nodule is best seen on the axial FIESTA on series 9, image 53 and on the
LAVA on series 8, image 416.

There is no evidence of liver metastasis. There is no focal abnormality in the
spleen, adrenals, and kidneys. The gallbladder shows diffusely thickened wall
suggestive of chronic inflammatory changes. There is no ascites. There is no
abnormality in the visualized bones.

IMPRESSION:

Nodule medially to the uncinate process representing either metastatic lymph node
or an exophytic portion of the primary pancreatic cancer, currently measures 1 cm
versus 1.3 cm in March, with more uniform enhancement pattern suggestive of
response to treatment.
Again, there is no evidence of liver metastasis or other distant metastasis.

Dr. David Fogelman July-Aug. Hero
David did the 100 mile ride, I didn't