Monday, September 24, 2007

Surgery Update and No Chemo

Karen's been sick the last two weeks with the exception of yesterday. These weeks have been some of the hardest yet and Karen hasn't been able to do much of anything. At some point I should write down what chemo is actually like as I don't think folks really understand. I know I didn't.

She was scheduled for chemo #10 today but upon examination, Dr. Moriarty decided to give her a break. She's doing well today and grateful for the rest.

There is also talk of switching her from chemo every two weeks to chemo every three weeks, just until surgery. This will help regain her strength. This is not definite but let's see.

We met with Dr. Ravi last Friday. He was pleasant and confident. He spoke quickly and to the point. Overall we were pleased with the encounter.

Dr. Ravi would perform at a minimum a removal of the right lobe of Karen's liver. That brings with it the gall bladder. The colon surgery may or may not be done at the same time.

Unfortunately he did not commit to a surgery date citing the CEA level as being too high and one of her tumors being too close to an artery. It appeared though that he had not had time to review the latest round of test results.

Moriarty promised to call him and review Karen's case again to determine a more definite course of action. I hope they figure it out as it was very tough to leave Ravikumar's office without a date.

Karen's last chemo on September 11th was the last time she received Avastin. She has to be off this for at least 6 weeks before it's safe to undergoe surgery. Ravi prefers to wait 8 weeks just to be safe. He has a zero-mortality rate so I guess it pays to be cautious. That puts us sometime in November at the earliest.

The next chemo session will be next Monday.

Wednesday, September 19, 2007

Surgical Consultation: Prep

Karen's had a tough week battling nausea. The CPT-11 has a character all it's own. Ordinarily chemo is tough but about 8 days after treatment Karen will begin to feel better. That hasn't happened for her this week and I'm hoping it settles down for her soon.

For some time now we have been working towards surgery. Of course it's of paramount importance to find the right surgeon and facility for the job. The default response when someone mentions cancer in New York is "Sloan Kettering Memorial". The main reason (we feel) that you'd want to go somewhere like Sloan is to participate in the wide selection of clinical trials that they are running. Fortunately Karen is not at the point where clinical trials (read experimental treatment) are being considered.

Dr Moriarty recommends focusing on the individual performing the procedure more than the facility in which it'll be performed. Through a sequence of referrals from family friends we have found Dr Thanjavur Ravikumar [LINK] of North Shore LIJ [LINK].

Dr Ravi is the chairman of the department of surgery at LIJ and specializes in hepatic surgery as well as "complicated oncologic surgery".

Although we arrived at Dr Ravi independently of Dr Moriarty, it turns out they have worked together in the past. In fact Dr Moriarty's face lit up when we mentioned him which is certainly a good sign.

This hospital is not the largest in the tristate area however it comes with an excellent reputation for patient care .

North Shore LIJ was voted "Number one hospital in America" by AARP Modern Maturity magazine, the largest circulation magazine in the United States. Whatever doubts you might have, to be voted number one hospital in America is no joke.

The following article highlights the liver surgery capabilities available through LIJ [LINK].

We will be meeting with Dr Ravi on Friday morning and have as always, high hopes.

Thursday, September 13, 2007

9th Chemo - Pump Removed

Karen's sleeping off the effects of her ninth chemo session. Despite all the good news this has been a difficult few days but she's hanging in there. It's not easy raising a 3 year old and a toddler whilst every cell in your body is being attacked by poison. Add to that the fog of medication, nausea and side effects along with life's "standard" set of problems like constant medical bills, lost keys, a cracked windshield, leaky pipe etc. etc. Ok, enough complaining.

Today the pump was removed and K got an updated CEA reading; Last time the CEA had dropped from 156 to 140. This time the CEA is...92!!! That's right, double digits. This is yet another good sign and I'm really delighted with the news.

You have to hang on to every little bit of good news and keep focused and that's just what we're doing. Thanks to all who've sent notes of encouragement. They really really do help and we're very grateful for the support.

Wednesday, September 12, 2007

9th Chemo Session & Scan Results

Karen is currently undergoing her ninth chemo session and all associated side effects. Yesterday we got the results of the PET/CT/MRI scans and I got a copy of the radiologist's report. This scan was compared to Karen's scan from June 1st.

Here are a few snippets from the report:

"Previously a large area of hypermetabolic activity was identified in the liver. This is decreased in size and density. The SUV values is approximately 6. The finding is considered to represent improved metastatic focus. The CT images identified calcification of this abnormality indicating dystrophic calcifications from a treated neoplastic process. The previous examination also identified small focus of activity within the left lobe which is no longer present."

This is translated as "Karen had a lot of big tumors in her liver that have decreased in size and density. The CT scan detected stuff (dystrophic calcifications) you'd expect to see if tissue was dying (neoplastic process). The tumors in her left lobe are no longer there".

"The examination now identified abnormal increased activity throughout the bones of the skeletal system. The SUV values approximately 8. Findings most likely related to a rebound effect from chemotherapy but should be correlated with history physical examination to exclude the remote possibility of diffuse neoplastic disease involving entire bone marrow. "

This either means her entire bone marrow is shot or it's a to-be-expected effect of the chemo. We are assured it's the latter.

"The activity identified within the adnexa of the pelvis previously is no longer present."

In the previous scan they had seen suspicious shadows around K's ovaries. This seems to have cleared up.

"Impression significant improvement identified. Hypermetabolic focus still noted within the liver. The lesion has decreased in size and intensity. It is in the right lobe of the liver."

Essentially Karen's tumors have shrunken but are still there. To paraphrase Dr. Dan "they aren't ice cubes that'll melt away completely".

This is GREAT, GREAT news and when we actually got to see the scans it was obvious the excellent progress Karen has made. This progress is due in large part to the chemotherapy and Dr. Dan but ultimately it has only been possible through Karen's will and determination.

The general consensus of the tumor board and associated oncologists on our team is that it's time to identify and consult with a surgeon specializing in metastatic disease and liver resection. He or she will determine the correct surgical options and we'll go from there.

I think Karen and I are a little hesitant to celebrate just yet but this is terrific news on the whole.

I have a feeling there will be a lot of "hurry up and wait" but that overall things are going to move very fast in the next few months. We remain confident that this is the best approach to treating Karen's disease.

Monday, September 10, 2007

Magnetic Resonance Imaging

Karen's doing well although slightly apprehensive. She had an MRI today. Combined with the PET and CT Scans from last week the MRI will form a complete picture of Karen's cancer. We meet with our oncologist tomorrow to review the results.

Karen will also have chemo tomorrow for the 9th time.

Tuesday, September 4, 2007

PET and CT Scans

Karen will undergoe another round of scans tomorrow to determine the status of her tumors. She's scheduled for a PET scan along with a full torso CT Scan.

These will be followed by an MRI next week. We will get the results of all three scans next week and are very hopeful that surgery will be scheduled soon thereafter.

I am trying hard to distract myself and spent the night painting the living room.