LaryAndNarni.com

Lawrence J. (Lary) Cahill, Colonel (Ret), USAF, died March 6^th after a yearlong battle with pancreatic cancer.  Born in Elizabeth, NJ on December 8, 1943 Lary was a military “brat” during his father’s Air Force career.  In 1965 he graduated from Rutgers University and was commissioned in the Air Force where his 27 year career was in the communications field.  He retired at Scott AFB and had a second career in the Information Technology field and worked at Sparta Community Hospital, Deltanet and the American Red Cross. Lary was preceded in death by his parents, Lawrence and Marie Cahill.  Surviving are his wife Narni; son Sean Robert Cahill of Seattle; son Paul Lawrence (Emily) Cahill and grandson Sean Andrew Cahill of Cincinnati; daughter Megan-Marie Keith Cahill of St. Louis; brother Robert (Jeannie) Cahill of North Carolina; mother-in-law Keith Hatch of O’Fallon; his constant canine companion and nurse, Baxter; and his many friends and coworkers from the Air Force and the American Red Cross.

Lary was devoted to his family.  His wife and children were his first priority and he was thrilled at the prospect of a grandchild.  He was always into a project at his house and garden and will be sorely missed as the “fix anything” man.  He had a dry, quirky sense of humor, an incredible memory and an enviable ability for correct spelling.  He was comfortable with who he was and was never involved in “one upmanship”.  He was highly respected everyplace he worked and his family and coworkers knew he never missed a deadline and always finished what he started.  He was noted for his woodworking.  His home is filled with his beautiful creations.  All of his children learned their computer skills and their work ethic from Lary.

Lary set an example to all who knew him of how to face adversity and never give up, never complain.  Throughout his 11 months of cancer treatment he continued to work for the American Red Cross until the day he entered Hospice.  He was a special man who made a true imprint on the lives of his family, friends and coworkers.

Special thanks:  To Dr. Stephen Sorcher and the staff at the Barnes Siteman Center who helped Lary have many extra months with us; To the BJC Hospice nurses who made his last weeks comfortable; Saint Louis Art Museum and American Red Cross coworkers who sent cards, letters, gift certificates, etc; and To our many friends and family who have been a constant blessing in our lives.

In lieu of flowers donations are gratefully accepted in Lary’s memory at

Hospice Patient Fund, Office of Development, BJC Hospice at St. Louis, PO Box 504043, St. Louis, MO  63150-0001

American Cancer Society, Relay for Life O’Fallon: Team “Lary’s Squad”, #5 Schiber Court, Maryville, IL 62062

Or to a charity of the donor’s choice.

For those that would like to travel, here is the service information:

Tues 11 March 2008 - 6pm at St. Michael’s Episcopal Church (111 Troy Scott Road, O’Fallon, IL 62269)
Wed 12 March 2008 - Jefferson Barracks, MO - service starts at 1130, be there 11am and 1115am

questions? email Paul@PaulandEmily.com

Dad passed peacefully and quietly last night at 6:57pm CST.  Please keep our family in your thoughts and prayers.
-Paul C.

Dad has entered the stage three in the hospice care (the last stage).  We appreciate all the phone calls, emails, and letters.  Dad is not in pain and sleeping peacefully.  We’ll keep people updated as we learn more.

-Paul Lawrence Cahill

Had the third chemo treatment of this series on New Year’s Eve Day and, so far, none of the drastic reactions I experienced following the second one. When we saw the doctor prior to treatment, I mentioned what had happened shortly after we were on the way home (sweats, nausea, instant fatigue, etc. He suggested increasing one of the pre-treatment anti nausea drugs I get before the actual chemo. He said he wasn’t sure it would help but it was a less drastic preventive measure than some stronger anti nausea drugs he could give me. I have always been a fan of simpler, less drastic solutions so we went for it. It seems to have been effective as although I had some minor discomfort on the way home and still spent most of the rest of the afternoon/evening in bed. However, it has been nothing like the second treatment. He will change my standing chemo order to include the higher dosage.

The second chemo treatment of this new series was yesterday and turned out to not the piece of cake the previous one was.  It didn’t help much that we ran into traffic on the Illinois side of the Mississippi and then again once we finally got across that made us late to the hospital.  We did get the blood work and doctor’s appointment in on schedule and then had to wait for about an hour and a half to start chemo.
The doctor didn’t really have too much to say.  He did say that we should not expect to see any results from the new chemo treatments for at least 3-4 sessions so we will be going over into the new year with them before they do any kind of testing to see if they have done anything to the tumors in the three locations.  He did say that the combination of chemo drugs they have me on is a pretty potent and toxic cocktail and it is not uncommon for patients to either end up on a reduced the dosage or stop it completely because of the side effects.  I plan to tolerate it as long as I can even though I do seem to get some rather immediate, but short lasting side effects following treatment.
The chemo itself was uneventful although it seemed really long this time.  The whole thing is a sequenced process that starts with plain saline, then two IV anti-nausea drugs that take 20 minutes, then 30 minutes of Gemcitabine and then two hours of the Oxaliplatin so it is almost a four hour process.  I normally take my Ipod and a book with me but forgot the Ipod and didn’t feel like reading so it just seemed to drag on and on.
After we left the hospital, I began to feel nauseous and broke out in a sweat followed by instant fatigue.  Even though it was about 20 degrees outside, I had to ride with the window open just for the fresh air.  When we got home, I toke an anti-nausea pill and went to bed.  Narni brought me some tea and oatmeal later after my stomach had settled and then I just fell asleep watching Monday Night Football (as boring as it was).  I woke up feeling OK this morning so hopefully it was just the immediate reaction following the treatment.  Had a normal brunch today and no nausea so far. So, fingers are crossed that the treatment can proceed with minimal and controllable side effects.
No treatments until New Year’s Eve day – could make for a boring New Year’s Eve for Narni if I get the same reaction I did yesterday following treatment.  Have to see how that goes. 
We are looking forward to Christmas as the whole family will be here to celebrate together.  Paul and Emily are coming down on 21 Dec and Sean flies in on 23 Dec.   Megan will drive back and forth across the river as work and social calendar permit but we hope all four will be here for our traditional Christmas morning photo on the stairs.
More to come as the journey progresses . . . . . . .

The day after the new chemo process and things seem to be OK – so far.
This new process is a bit longer than my first chemo. The original Gemcitabine infusions took 30-45 minutes, once a week. This process includes the same Gemcitabine dosage as before and then throws in a 2 hour infusion of Oxalplatin. So, including the two anti-nausea drugs that precede everything else, it works out to about a 3 ½ hour session every two weeks. That, of course, as always is preceded by blood work and a doctor’s visit so it pretty well takes up a whole day.
The Oxalplatin drug was originally designed and used for colorectal cancers but has shown some success (9%) when used in conjunction with Gemcitabine in treating pancreatic tumors that have metastasized (as mine has to the lungs and liver). It has one really strange side effect that I have not yet experienced and hope not to. It makes the body very sensitive to cold objects. For example, drinking a cold soda or ice water can actually cause your throat to swell and hinder both breathing and swallowing. Needless to say, I don’t plan to experiment with that effect to see if it really true. Guess I will have to continue drinking my malt Scotch neat.
I had only one initial reaction after chemo and that was while we were going to Home Depot on the way home. As I parked the car, I began to sweat very heavily and had a bit of a bout with nausea and fatigue. We went in the store anyway, got what we needed and then Narni drive home as I did not feel like I could do so safely. Once home, I took anti-nausea pill and spent a couple of hours in the prone position. After that, I felt fine, had a precautionary bowl of chicken soup for dinner and, so far, today has not brought any new and strange effects. Actually, I stand corrected – there was one weird effect I noticed when eating a bear claw pastry. The first bite caused my taste buds to react to the sugar and caused a brief burning sensation on both sides of my lower jaw where some of the salivary glands are. After the first bite, it did not recur. I guess this stuff also makes you sensitive to an initial hit of sugar ??
This duration of this chemo cycle is somewhat open ended. The doctor has not said how many sessions he plans to have me do. I think a lot depends upon any reactions that I have. Apparently some largish percentages of people do not tolerate this stuff very well and they break off the treatments pretty quickly. Given my past lack of reaction (other than fatigue and a little nausea) to the previous chemo and radiation/chemo treatments, he and I are both optimistic that history will repeat for me. Time will tell.
So, we are now back into a routine after more than three weeks of no treatments and looking forward to the holidays and then next March when a new grandson will be added to the family.
More to come. . . . . . . . . . . . . . .

Well, this is one of those good news/bad news updates where the gravity of the bad news probably outweighs the value of the good news.

I had a CT scan this morning to check the effectiveness of the 5 weeks of radiation and chemo and then an appointment with my oncologist to get the results.

- The good news is that the tumor in my pancreas shrunk following the treatment.

- The bad news is that it appears that I now have small tumors in both my lungs and the liver so the cancer has spread.

The oncologist explained that the radiation/chemo was a targeted treatment that focused solely on my pancreas and, was effective at shrinking the tumor. However, because it was targeted, it did not prevent the spread of the cancer. Hence, the tumor was free to run around my lymph system and deposit cancer cells in the liver and the lungs.

I have had nodules in my lungs for many years but they have remained the same size for the last four years when I was getting CT scans every 6 months for my pulmonologist after the bout with pneumonia 4+ years ago. They have never changed so no one worried about them until now. The liver is new but, so far, small.

So, the oncologist offered three courses of action – one that was not acceptable which was to do nothing. The other two involved different types of chemo, both of which offer only about a 9% success rate (as opposed to 20% with the Gemcitabene/Tarceva) that I was on four 4 months earlier this year. In my book, 9% beat zero percent pretty much every time. One chemo involves the Gemcitabene combined with a new drug called Oxyplatin in an IV mode every two weeks for an undefined period. The second is an oral drug whose name escapes me at the moment, also for an undetermined period. There is a potential complication with either of the chemo options in that some insurance companies will not pay for them since they are considered a “third line” treatment. The doctor’s office is checking with my current plan as well as the one to which the Red Cross is changing in Jan 2008 to see if they cover one, or both of the chemo treatments. So, for right now, I have an appointment next Monday for the first 4 hour chemo session of a combination of Gemcitabene and Oxyplatin.

Sorry that this wasn’t more positive news but then I have never believed that what I have is “curable.” All of the treatments that I had so far have been to extend my survivability through “preventive maintenance” and they have been immensely successful. I have already gone beyond what is considered the normal survival rate from diagnosis to end for pancreatic cancer and, even with some of the bumps in the road like fatigue and minor nausea, have done so with pretty good quality of life. I set new goals for myself each day or so and have met all of them so far. I will continue to do that and do whatever I can to meet them.

More to come as this progresses on . . . . . . . .

Today was my last radiation treatment and the end of my 24/7 chemo therapy.  I thought I had another week but it turns out the plan was for 5 weeks of radiation and chemo, not 6.  So, no more 0530 wake ups to get to the hospital by 0700 for the radiation and no more being connected to a little pump with a bag of chemo drugs in it that I keep forgetting and drop on the floor all the time.

I saw the oncologist yesterday.  He was very pleased with how I had handled the radiation and chemo, saying that very few patients come through that with virtually no side effects.  Many end up either having the radiation dosage or the chemo amounts significantly reduced because the body cannot tolerate them.  Not an insignificant number stop the treatment entirely or are hospitalized because of the side effects.  In my case, all I really had (and will for a while yet) was the constant fatigue and an occasionally feeling of nausea.   The 5FU chemo drug processes through the body pretty quickly but the radiation has residual action for a couple weeks so there are some lingering effects.   I told him that I guess I am relatively healthy for a 63 year old former career smoker with COPD and a serious need to lose about 40 pounds.  He agreed.  He was also somewhat puzzled (I think) that I still have not shown any of the symptoms normally associated with pancreatic cancer but just keeps telling me to be grateful (which, of course, I am).  We discussed what happens next.  I will have another CT scan in three weeks to determine if there has been any change in the tumor and if it is still confined to the pancreas.  The hope, of course, is that there has been no spread  and that the tumor has actually shrunk following the 5 weeks of treatment.  Depending upon the results of the CT scan, there are a couple different options that will be considered.  There are some further chemo drugs that can be administered including the one I was on for the first 4 months of the treatment that is teamed with one of several others.  There is an option for additional radiation on a less intense schedule.  My radiation technician referred to it as a “booster.”

So, now I have about three weeks with no treatment and time to recover from the fatigue of the past 5 weeks.  With luck, I will actually be able to stay up past 9:00pm and even watch the late news!!  There is also some woodworking that I really need to catch up on and a few other things that need to be done.  And, most importantly, I won’t be going through any treatments or visits to the hospital over Thanksgiving when we will have all of the family here in O’Fallon!!

If anything changes between now and the CT scan timeframe, I will send another update.  More to come. . . . . . . . . . .

I am remiss in sending any information about my status but there really hasn’t been anything to talk about since the last report. 

I started a combined six week radiation and chemo treatment the first week in October.  That consists of a daily (5 days per week) trip to the Siteman Cancer Center at Barnes Hospital in St Louis each morning (0700 appointment) to be irradiated for about 12-15 minutes.  It is quite a machine.  You are laid out on a table and this machine rotates around your body, stopping at predetermined points and then radiating you (or, more accurately, the tumor) for anywhere from 10 to 30 seconds at a time).  It then moves on to the next location and does it again.  All-in-all, I have 14 separate shots from the machine and then I am done for the day.  Apparently it is quite accurate and has some complex shutter device that actually shapes the radiation as it is being emitted to focus it on a specific area of the tumor.  I’m sure the whole thing cost more than my last car and house together!  Judging from the cost of each treatment (thank you health insurance and Tricare!!!) I could probably buy a very nice home in San Francisco for the same amount that the radiation machine cost.

The radiation is coupled with a 24/7 chemo treatment.  I have a small pump and a bag of 5FU chemotherapy drug that I wear or carry around with me.  The only time it is turned off is when I am in radiation or getting the chemo refilled.  Otherwise, it pumps all day and night (in very small, measured doses).  Apparently 5FU does not remain in your system very long and they figured out it was better to just feed it in on a continuous basis in small amounts – hence the pump.

All of this will continue for another two weeks.  After that, they will wait a week or two and do another CT scan and some blood work (cancer markers) to see what has happened.  We have not discussed any courses of action following that as I guess they really can’t determine one until they see how effective the radiation/chemo has been.

As far as side effects – the radiation and chemo both make me tired so I spend a lot of horizontal time either in bed or my recliner.  Don’t actually get tired enough to fall off into a nap during the day so the horizontal sessions are more like rest than anything else.  I occasionally have a bit of nausea but nothing beyond just the feeling.  I have an anti-nausea drug I can take for that.  In fact, they told me to take it each morning before my radiation treatment because even though the machine is accurate, the proximity of the pancreas and tumor to my stomach prevents them from not hitting my stomach with some radiation – just enough to irritate it into causing nausea.  So far, so good.  And, my hair is actually starting to grow back a little on top.  Apparently this chemo drug does not have the same hair thinning effects that the previous ones I took for 4 months did.

So, that is about it – nothing exciting and not a whole lot of information.  Other than the fatigue and occasional funky stomach, I feel OK.  No pain and no other side effects.  I continue to work although some of it is from the recliner.

More as we learn more. . . . . . . . .