Well here we are again. We met with Dr. Ronald Chamberlain this past Monday the 23rd. It was basically a pre-op review and time for any last minute important question that you could possibly try to muster up in your brain. What is proposed to happen is this.
First Dr. C. will perform a diagnostic laproscopy to see what the deal is before the "first incision." Then in "general" what could happen are these three scenarios. These scenarios all have their own sub-scenarios and so on but I won't get into all that.
So the first one is surgery can't take place for any number of reasons, (too much scar tissue, too much tumor etc). If this is the case Dr. C. assured me he will still do radio frequency ablation (rfa) or microwave ablation http://www.ncbi.nlm.nih.gov/pubmed/16227498 to the tumors.
The second one is both sides of the liver are resected to remove said tumors, during the same surgery as well as part of the colon where the primary tumor originated. We want that crap gone!
The third is that the liver resection will take place in two stages, to, as I understand it, safeguard me from liver failure. But the colon resection would take place. With the two stage deal, one section of liver would be removed. I would recover 7-10 days in the hospital come back in 2-3 weeks and the other section would be removed. Dr. C. is sensing the latter scenario will take place. The end goal being to all of this is me have no evidence of disease or (let's be wild shall we...Cancer Free!!). Does all this make sense?
I am incredibly blessed, fortunate and grateful to be in this position. That is not lost on me. Just to have the word "option" in the life of someone with cancer is a golden ray of light. I am grateful to still be able to hear that word.
I really like Dr. Chamberlain. He is very thorough and articulate and obviously very intelligent and good at what he does. I don't know how I have been so lucky to have gotten such an incredible team.
Dr. Moriarty has been guiding and navigating me through these horrible, scary unknown waters and has never given up on me. I don't know what I would do, or where I would be without him or Kathy, Sonya, Kim, Chris, Gina, Miriam and Mylene. The woman, and nurses that care for me always.
And now I have this surgeon who seems to have his stuff together and is ready to go.
Since I met with Dr. C. on Monday I have been at a greater peace. I have been struggling in prayer. Jesus what do I ask for? I just want to be healed, completely healed and I know you can and are doing it. But then the thought sneaks in "well what if your supposed to stay sick, what if God's will is that you die from this?" This has been my internal spiritual struggle.
Then I was praying and felt so strongly Jesus saying to me "Karen what would be the opposite of what your asking me for?" I thought about it and said it would be unhappiness misery and death. Jesus said "I am not here for you to live like that" I am here for life and for joy." Okay so that was pretty heavy and while I was in the bathroom of course.
Then at the end of my meeting with Dr. Chamberlain I asked him if he prayed and he responded a very strong yes. He wrote down a scripture on an unopened gauze wrapper handed to me it was Jeremiah 29:11-14 For I know the plans I have for you," declares the LORD, "plans to prosper you and not to harm you, plans to give you hope and a future. 12 Then you will call upon me and come and pray to me, and I will listen to you. 13 You will seek me and find me when you seek me with all your heart. 14 I will be found by you," declares the LORD, "and will bring you back from captivity.
Yeaaaaa I think I want this guy to be my surgeon.
I am fully at peace. Jesus has plans to GIVE me hope and a future and I'll take it.
Thank you all for everything. Every prayer, thought and kindness is deeply appreciated and as always humbling. There are so many people out there who needs our prayers. So lets keep praying for each other. We all need it.
Fran will be posting the happenings as best he can after surgery.
My sincerest love to all,
Karen
Showing posts with label consultation. Show all posts
Showing posts with label consultation. Show all posts
Wednesday, February 25, 2009
Thursday, November 6, 2008
Moriarty back at his post
Karen's doing well. She met with Dr Moriarty today. Essentially Moriarty read the radiologist's report from Karen's latest PET/CT scan and her overall status is "stable". An amazing result considering where she started from.
It's definitely time to consult a surgeon again to see if surgery is an option and this time we're letting Dr. Dan drive that process for us. We will likely meet with him again in another few weeks. Until then Karen continues the regime of Erbitux as this seems to be keeping things in check.
It's always a stressful and overwhelming exercise whenever these scans come up and this time has been no different. We may not always be conscious of the stresses we're under but they are there nonetheless and no doubt will lift over the next few days.
It's definitely time to consult a surgeon again to see if surgery is an option and this time we're letting Dr. Dan drive that process for us. We will likely meet with him again in another few weeks. Until then Karen continues the regime of Erbitux as this seems to be keeping things in check.
It's always a stressful and overwhelming exercise whenever these scans come up and this time has been no different. We may not always be conscious of the stresses we're under but they are there nonetheless and no doubt will lift over the next few days.
Wednesday, August 6, 2008
Surgery Review and More Chemo
Over the last week our surgeon (Ravikumar) has been reviewing the scans from the 28th July with our oncologist (Moriarty). Today we got a call from Ravikumar's office and spoke to the nurse there.
Essentially he's very happy with the progress and it is significant progress since January. On the down side he recommended 3 more months of chemo followed by a PET scan and another consultation. That will bring us to November.
Whilst it's great news of course that the scans are so good, I can't shake the pit in my stomach at the thoughts of 4 more rounds of chemo with no real knowledge of what lies at the end of it.
We're meeting with Moriarty in person on Friday to discuss in detail and hope to get clarification on what has been discussed. I have a lot of questions. We're going to ask for a 2nd surgical opinion from another doctor we've been researching.
Karen has been a trouper and amazingly strong throughout the day and once again I'm leaning on her instead of the other way around.
Essentially he's very happy with the progress and it is significant progress since January. On the down side he recommended 3 more months of chemo followed by a PET scan and another consultation. That will bring us to November.
Whilst it's great news of course that the scans are so good, I can't shake the pit in my stomach at the thoughts of 4 more rounds of chemo with no real knowledge of what lies at the end of it.
We're meeting with Moriarty in person on Friday to discuss in detail and hope to get clarification on what has been discussed. I have a lot of questions. We're going to ask for a 2nd surgical opinion from another doctor we've been researching.
Karen has been a trouper and amazingly strong throughout the day and once again I'm leaning on her instead of the other way around.
Thursday, July 31, 2008
CT Scan Results - Good News!!!
Karen's doing GREAT and so am I. After an emotional week we finally met with Moriarty this afternoon to review the latest CT Scans (taken this past Monday).
The news is good. Karen's tumors are smaller than they were in April and much smaller than they were in January. The largest tumor is currently 5.5 cm diameter, down from 10cms in Jan 2008.
These tumors were all ablated back in November 2007 and so we are seeing a lot of "calcification" as a result of that procedure. Calcification is exactly what it sounds like, the tumors build up deposits of calcium as a result of being necrotic (dead).
The radiologists' report revealed that the tumors do not "enhance" under contrast. My layman's understanding of this is that the stuff you drink when you're having a CT scan is absorbed by the tumors. This stuff shows up under the scan, making the tumors have higher contrast with surrounding tissue. Karen's didn't do that, therefore they didn't absorb the contrast fluid and hence this is another indication that they might be dead.
How dead they are we don't know. Moriarty said you'll never know they're fully dead but that's ok.
Lastly the scan showed that there is no NEW growth anywhere else. I'd call that a result.
The next step is to get these scans in the hands of our surgeon at LIJ. We burned some CDs and overnighted them this afternoon.
Moriarty and Ravikumar will review and confer this week and we'll have another consultation a week from tomorrow.
The last bit of good news is that Karen's new regime is for Erbitux only. No more CPT-11. Moriarty feels that this is what's having the most effect. The key is to figure out how to keep things where they are and keep improving K's situation. What a great job he and the team have done so far.
It's a lot to absorb, we're both mentally drained. Still taking it a day at a time and for today things couldn't have gone any better.
The news is good. Karen's tumors are smaller than they were in April and much smaller than they were in January. The largest tumor is currently 5.5 cm diameter, down from 10cms in Jan 2008.
These tumors were all ablated back in November 2007 and so we are seeing a lot of "calcification" as a result of that procedure. Calcification is exactly what it sounds like, the tumors build up deposits of calcium as a result of being necrotic (dead).
The radiologists' report revealed that the tumors do not "enhance" under contrast. My layman's understanding of this is that the stuff you drink when you're having a CT scan is absorbed by the tumors. This stuff shows up under the scan, making the tumors have higher contrast with surrounding tissue. Karen's didn't do that, therefore they didn't absorb the contrast fluid and hence this is another indication that they might be dead.
How dead they are we don't know. Moriarty said you'll never know they're fully dead but that's ok.
Lastly the scan showed that there is no NEW growth anywhere else. I'd call that a result.
The next step is to get these scans in the hands of our surgeon at LIJ. We burned some CDs and overnighted them this afternoon.
Moriarty and Ravikumar will review and confer this week and we'll have another consultation a week from tomorrow.
The last bit of good news is that Karen's new regime is for Erbitux only. No more CPT-11. Moriarty feels that this is what's having the most effect. The key is to figure out how to keep things where they are and keep improving K's situation. What a great job he and the team have done so far.
It's a lot to absorb, we're both mentally drained. Still taking it a day at a time and for today things couldn't have gone any better.
Monday, July 28, 2008
Scans and Waiting
Karen threw up this morning after the CT scan but other than that the scan was uneventful. It's probably a bad idea but she took home a CD with the images which we've poured over this evening.
It's hard to know what we're looking at so best not to draw too many conclusions.
We meet with Moriarty on Thursday assuming the radiologist writes up his report by then. The challenge is to keep distracted until then.
It's hard to know what we're looking at so best not to draw too many conclusions.
We meet with Moriarty on Thursday assuming the radiologist writes up his report by then. The challenge is to keep distracted until then.
Saturday, May 17, 2008
Radiologist's Report
This'll be a quick post as I'm typing with one hand.
Karen's doing well. Had Erbitux yesterday and gets next week off. Her scans were read and revealed she's doing well. Some things did show up such as a suspected cyst on an ovary but this is nothing to worry about.
Doctor Dan heads to Mozambique soon to participate in "doctors without borders".
In other news I cut my thumb yesterday and so this week K's taking care of me! The doctor who stitched me up as it turns out has a niece with colon-cancer, diagnosed in '98 with liver and lung mets. After resection and ablation, she's been 6 years without a recurrence. This alone was worth the trip to the ER.
Karen's doing well. Had Erbitux yesterday and gets next week off. Her scans were read and revealed she's doing well. Some things did show up such as a suspected cyst on an ovary but this is nothing to worry about.
Doctor Dan heads to Mozambique soon to participate in "doctors without borders".
In other news I cut my thumb yesterday and so this week K's taking care of me! The doctor who stitched me up as it turns out has a niece with colon-cancer, diagnosed in '98 with liver and lung mets. After resection and ablation, she's been 6 years without a recurrence. This alone was worth the trip to the ER.
Saturday, October 20, 2007
Consultation
We are back to earth with a thump. Yesterday we met with Dr. Dan our oncologist to review where things stood. He was pleased with the news from the colonoscopy but did not over react. I asked him with the surgery, if the cancer was removed and did not come back could that be considered cured. Unfortunately neither Karen nor I were ready for his response.
Dr Dan reminded us that Karen's disease is incurable. There is a chance it will not come back after surgery but it is very small. She may have "no evidence of disease" but will not be considered cured until going 5 years without a recurrence. She may have a recurrence and chemo may keep it in check but ultimately the cancer will grow resistant to chemo.
Dan's words were "Karen will most likely die from this disease". He shared that when K walked in to his office in April he did not expect her to be alive by now. That she has reached the point with surgery as an option is tremendous. The goal is to turn it into a chronic condition that will be treated over many years.
He was simply doing his job and in as caring a way possible but this is just tough to hear. We walked out shell shocked and I took the rest of the day off work to be with my family.
Today we have regrouped. We are focused on
a) non-recurrence. We have heard many stories of non-recurrence with stage IV.
b) That recurrences if they happen will be burned through RFA or kept in check by chemo.
c) that in the next few years new drugs will be approved that will provide a cure.
Perhaps I am in denial but everything in me just "feels" like Karen will not have a recurrence. I am obviously not in a good position to be objective but I cannot picture an alternative and I am usually good at envisioning potential outcomes from a given situation.
Is this where human strength gives up and faith takes over?
Karen goes again for chemo #11 on Monday.
Dr Dan reminded us that Karen's disease is incurable. There is a chance it will not come back after surgery but it is very small. She may have "no evidence of disease" but will not be considered cured until going 5 years without a recurrence. She may have a recurrence and chemo may keep it in check but ultimately the cancer will grow resistant to chemo.
Dan's words were "Karen will most likely die from this disease". He shared that when K walked in to his office in April he did not expect her to be alive by now. That she has reached the point with surgery as an option is tremendous. The goal is to turn it into a chronic condition that will be treated over many years.
He was simply doing his job and in as caring a way possible but this is just tough to hear. We walked out shell shocked and I took the rest of the day off work to be with my family.
Today we have regrouped. We are focused on
a) non-recurrence. We have heard many stories of non-recurrence with stage IV.
b) That recurrences if they happen will be burned through RFA or kept in check by chemo.
c) that in the next few years new drugs will be approved that will provide a cure.
Perhaps I am in denial but everything in me just "feels" like Karen will not have a recurrence. I am obviously not in a good position to be objective but I cannot picture an alternative and I am usually good at envisioning potential outcomes from a given situation.
Is this where human strength gives up and faith takes over?
Karen goes again for chemo #11 on Monday.
Wednesday, October 17, 2007
2nd Colonoscopy Results
Karen's recovering from her colonoscopy today. This is Karen's 2nd colonoscopy and was performed once again by Doctor Lipsky. Sarah babysat so I was able to take K to the surgery center myself. Thanks Sav.
Dr. Lipksy is a gastro specialist and was one of the first doctors we met with when Karen was first diagnosed. The procedure took a while but once completed I was able to review the results with the doctor whilst Karen came-to in recovery.
The results were terrific. Karen's colon is in great shape. Lipsky was visibly excited and I could tell the news was good before he called me in. The primary tumor which was about the size of a golf ball before the summer has disappeared! Gone. Expired. In his words "this was the best possible outcome".
When the first colonoscopy was performed, the area of the tumor was marked with a special dye which doesn't "wash off". That dye helped Lipsky determine this time around where the tumor should have been. Of course only a small amount of dye remained today and the tumor is no more. This type of result is rare and means the chemo has been highly highly effective.
The lack of polyps in Karen's colon may indicate that she is genetically predisposed to getting cancer. This will be further investigated over the coming months and the appropriate action taken. Lipsky also took lots of biopsies of the area where the tumor was for further analysis.
Karen still needs a colon resection but it may be smaller piece taken out now. She also still needs liver surgery and a bunch of other things so no change there.
We are making progress but we are not done yet! Karen has done an amazing job and displayed incredible heart and endurance to get this far. I am so proud of her. That hard work is being rewarded.
We remain confident that this is the best approach to treating Karen's cancer.
Dr. Lipksy is a gastro specialist and was one of the first doctors we met with when Karen was first diagnosed. The procedure took a while but once completed I was able to review the results with the doctor whilst Karen came-to in recovery.
The results were terrific. Karen's colon is in great shape. Lipsky was visibly excited and I could tell the news was good before he called me in. The primary tumor which was about the size of a golf ball before the summer has disappeared! Gone. Expired. In his words "this was the best possible outcome".
When the first colonoscopy was performed, the area of the tumor was marked with a special dye which doesn't "wash off". That dye helped Lipsky determine this time around where the tumor should have been. Of course only a small amount of dye remained today and the tumor is no more. This type of result is rare and means the chemo has been highly highly effective.
The lack of polyps in Karen's colon may indicate that she is genetically predisposed to getting cancer. This will be further investigated over the coming months and the appropriate action taken. Lipsky also took lots of biopsies of the area where the tumor was for further analysis.
Karen still needs a colon resection but it may be smaller piece taken out now. She also still needs liver surgery and a bunch of other things so no change there.
We are making progress but we are not done yet! Karen has done an amazing job and displayed incredible heart and endurance to get this far. I am so proud of her. That hard work is being rewarded.
We remain confident that this is the best approach to treating Karen's cancer.
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.
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.
Thursday, July 5, 2007
Checkpoint Consultation
This morning we met with Dr Moriarty to review Karen's progress and the news is good. All indicators are pointing to chemo-sensitive tumors. We reviewed the CT scans taken last Monday as well as the PET scan.
It's not an exact science but Karen's tumors have shrunken roughly 30% since diagnosis. There are still several large tumors in the right lobe of her liver. One tumor was initially 10cm by 7cm and is now roughly 7cm by 4cm. There are a couple more like that in the right lobe. There is one small tumor (about 1.4cm) in the left lobe. Also, many of the tiny-tumors (smaller than 1cm) have disappeared. If it's working on visible tumors, it's also working on non-visible.
The PET scan had cast some doubt on her ovaries that potentially they may be cancerous also. Dr Moriarty assured us that he does not believe this is the case.
This is terrific news and puts us on a course for surgery.
Karen has completed 2 rounds of chemo. A "round" is actually 2 sessions, 4 weeks long.
The plan is to continue for 2 more rounds at which point Karen will be evaluated for surgery. Dr Moriarty is going to find us the best surgeon that specializes in liver-resection due to colon cancer. We are confident that we will get the help we need.
As a side note, I guess I'm run-down as I got some bug and was throwing up all morning and twice in the car on the way there. I looked so bad that nurse Nancy actually gave ME anti-nausea medication!!! In a weird way I got a small taste of what K goes through every two weeks.
It's not an exact science but Karen's tumors have shrunken roughly 30% since diagnosis. There are still several large tumors in the right lobe of her liver. One tumor was initially 10cm by 7cm and is now roughly 7cm by 4cm. There are a couple more like that in the right lobe. There is one small tumor (about 1.4cm) in the left lobe. Also, many of the tiny-tumors (smaller than 1cm) have disappeared. If it's working on visible tumors, it's also working on non-visible.
The PET scan had cast some doubt on her ovaries that potentially they may be cancerous also. Dr Moriarty assured us that he does not believe this is the case.
This is terrific news and puts us on a course for surgery.
Karen has completed 2 rounds of chemo. A "round" is actually 2 sessions, 4 weeks long.
The plan is to continue for 2 more rounds at which point Karen will be evaluated for surgery. Dr Moriarty is going to find us the best surgeon that specializes in liver-resection due to colon cancer. We are confident that we will get the help we need.
As a side note, I guess I'm run-down as I got some bug and was throwing up all morning and twice in the car on the way there. I looked so bad that nurse Nancy actually gave ME anti-nausea medication!!! In a weird way I got a small taste of what K goes through every two weeks.
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