Karen's doing well. Her procedure is done, it took all of 3 hours and it went fine. I was able to see her briefly. She was comfortable, very cold but in good spirits. She's in recovery now and will be transfered to a room soon.
I spoke to Dr. Kamienecke who did the procedure. He said it went fine, no surprises. They used two probes and got a good freeze on as much as possible. The tumor is close to her lung and some other warm blood vessels so they can't be sure the required freezing temperature was reached on those bits.
She'll stay at least tonight in St. Barnabas and hopefully be discharged tomorrow.
A PET scan will be scheduled for 3 months from now and only then will we know if we got it "deaded".
For now we'll take this as a result.
Showing posts with label surgery. Show all posts
Showing posts with label surgery. Show all posts
Thursday, January 14, 2010
Wednesday, December 16, 2009
Surgery before Christmas?
Karen's doing well. Earlier this week Karen managed to get a cancellation at the surgeon's so we met with Doctor Chamberlain today. We are a few steps closer to a concrete plan.
The location of the tumor is above a critical vein in Karen's liver. Normally you'd have 2 or 3 veins going in and out of the liver but because of Karen's resection she has only 1 left. That's not a big deal but the location of the tumor is fairly close to this vein and that makes surgery very difficult.
Our best option is Radio Frequency Ablation which involves burning the tumor with radio waves. The radio waves must heat the tumor to 70C for a 14 mins in order to get a good kill. The vein will act as a heat sink since blood is flowing through it, cooling the cells. It is also likely that the radiologist will not want to burn that close to the vein.
To get the remaining cells we'll resort to Cyberknife which is targeted radiation. This can get close to the vein which will tolerate the radiation pretty well. On the flip side the liver doesn't tolerate radiation very well so we're trying to minimize the amount of radiation by using the RFA first.
The game plan is yet to be confirmed but Chamberlain is trying to get us in next Monday or Tuesday (21st or 22nd of December). The RFA would involve a night or two in hospital but overall be non-invasive. The Cyberknife would not be done until a few weeks into January.
Appointments are still being made and hopefully we find out tomorrow what the schedule is.
The location of the tumor is above a critical vein in Karen's liver. Normally you'd have 2 or 3 veins going in and out of the liver but because of Karen's resection she has only 1 left. That's not a big deal but the location of the tumor is fairly close to this vein and that makes surgery very difficult.
Our best option is Radio Frequency Ablation which involves burning the tumor with radio waves. The radio waves must heat the tumor to 70C for a 14 mins in order to get a good kill. The vein will act as a heat sink since blood is flowing through it, cooling the cells. It is also likely that the radiologist will not want to burn that close to the vein.
To get the remaining cells we'll resort to Cyberknife which is targeted radiation. This can get close to the vein which will tolerate the radiation pretty well. On the flip side the liver doesn't tolerate radiation very well so we're trying to minimize the amount of radiation by using the RFA first.
The game plan is yet to be confirmed but Chamberlain is trying to get us in next Monday or Tuesday (21st or 22nd of December). The RFA would involve a night or two in hospital but overall be non-invasive. The Cyberknife would not be done until a few weeks into January.
Appointments are still being made and hopefully we find out tomorrow what the schedule is.
Tuesday, March 3, 2009
Surgery is Complete
Karen's doing great. I have not seen her yet. Surgery is over, she did great. I just met with Chamberlain. My head is spinning so here are some things he said "this is one of the biggest operations you can have", "everything went according to the plan", "she lost very little blood", "this is the first or second biggest operations he's ever done", "she has no visible cancer"!!! This guy has done an amazing amazing job and we are truly thankful to him and his team.
The risk now is infection so he did warn that visitors wash hands, and don't obviously come to the hospital if you have a cold/flu/bug of any kind.
She'll be in intensive care tonight, then a regular unit tomorrow.
I can go see her in about an hour. Teresa/Catherine I assume one of you will update mom and pop Shanahan. I need to go grab a bite. It DOES NOT get any better than this.
Much love.
The risk now is infection so he did warn that visitors wash hands, and don't obviously come to the hospital if you have a cold/flu/bug of any kind.
She'll be in intensive care tonight, then a regular unit tomorrow.
I can go see her in about an hour. Teresa/Catherine I assume one of you will update mom and pop Shanahan. I need to go grab a bite. It DOES NOT get any better than this.
Much love.
Amazing News...Surgery In Progress
Karen's doing GREAT. I am here in St Barnabas waiting room. It's 11AM and I just spoke to Doctor Chamberlain about 20mins ago. I had to take a few minutes to absorb what he told me before jumping online to share.
We got here at 5:30AM and were seen within 15mins. They prepped Karen with IVs and a couple of tests, all went smooth. By 7AM she was wheeled into the prep-area. She and I got to meet all the doctors, anesthesiologists and residents. She has a huge team and the all have the appearance of the utmost competence.
We had a few minutes together and Karen's spirits were really good going into the op. We were nervously laughing and joking and making fun of the residents as we waited.
At 7:25AM I had to leave her as she got her epidural.
At about 9:30AM Stephanie came out and said the laproscopy had gone well and no new disease had been found. That meant the rest of the operation was going ahead.
About 25mins ago Dr Chamberlain himself came out and briefed me. I'm still in shock. He has taken out a portion of her colon and some of her left-liver lobe and the big news is he thinks he can take out the right lobe TODAY!!!
He said "in two more hours she will have no more visible disease"!!! Unbelievable.
She's still in the operating room right now. It's a long procedure with about 2-3 more hours to go. Her gall bladder will be next and about 30 or so lymph nodes. Then the entire right lobe of her liver.
Everything's going great and I am light-headed with the news. I will try to write more later.
Much love to all and thanks again for all the kind words, Karen told me they really do lift her spirits.
We got here at 5:30AM and were seen within 15mins. They prepped Karen with IVs and a couple of tests, all went smooth. By 7AM she was wheeled into the prep-area. She and I got to meet all the doctors, anesthesiologists and residents. She has a huge team and the all have the appearance of the utmost competence.
We had a few minutes together and Karen's spirits were really good going into the op. We were nervously laughing and joking and making fun of the residents as we waited.
At 7:25AM I had to leave her as she got her epidural.
At about 9:30AM Stephanie came out and said the laproscopy had gone well and no new disease had been found. That meant the rest of the operation was going ahead.
About 25mins ago Dr Chamberlain himself came out and briefed me. I'm still in shock. He has taken out a portion of her colon and some of her left-liver lobe and the big news is he thinks he can take out the right lobe TODAY!!!
He said "in two more hours she will have no more visible disease"!!! Unbelievable.
She's still in the operating room right now. It's a long procedure with about 2-3 more hours to go. Her gall bladder will be next and about 30 or so lymph nodes. Then the entire right lobe of her liver.
Everything's going great and I am light-headed with the news. I will try to write more later.
Much love to all and thanks again for all the kind words, Karen told me they really do lift her spirits.
Monday, March 2, 2009
Checking into St Barnabas
Karen's doing well, hungry and working through the prep but in good spirits. All preparations are in place and so this is just a quick note around logistics.
St. Barnabas called this evening, they'd like us there tomorrow morning at 5:30AM. So we'll call that "sometime around" 5:30AM. Surgery starts at 7:30AM. I expect to see someone come out around 9AM to let me know what's going on. She should be done with surgery by 12:30PM.
There is Wifi in certain parts of the hospital and I will try to update the blog once we have some news.
Thanks for all the prayers and well wishes. They really do help.
St. Barnabas called this evening, they'd like us there tomorrow morning at 5:30AM. So we'll call that "sometime around" 5:30AM. Surgery starts at 7:30AM. I expect to see someone come out around 9AM to let me know what's going on. She should be done with surgery by 12:30PM.
There is Wifi in certain parts of the hospital and I will try to update the blog once we have some news.
Thanks for all the prayers and well wishes. They really do help.
Wednesday, February 25, 2009
Surgery Day's A Comin'
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
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
Wednesday, January 14, 2009
Cleared for Surgery - March 3rd 2009
Karen's doing great. We met with Dr Moriarty on Monday, and Dr Chamberlain today. They've spoken and are in agreement that based on Karen's most recent PET scan, she's cleared for surgery.
They are hard men to read but I get the impression they're both pretty amazed at how well Karen has done. Her tumors are still active but barely and perfect for resection. After ~18 months of uphill emotional and physical battle, Karen's gone from terminal cancer to having a possible curative surgery.
Surgery has been tentatively scheduled for the 3rd of March at St Barnabus [LINK] in Livingston. The good Doctor Chamberlain was named in the Top Docs 2008 list [LINK] so that's encouraging.
Surgery will not be easy, as we know. The idea is to open up K's existing scar and possibly elongate it. There will likely be scar tissue from the old surgery which will complicate the procedure. The plan is to remove Karen's right liver lobe and either cut out or ablate the tumors on the left lobe. Her gall bladder will come out and possible 10-12 inches of colon, along with lymph nodes and other sundry items. They'll do an intra-operative ultrasound to be sure every thing's removed and then sew her back up.
There's also a possibility that the procedure will need to be done in 2 surgeries instead of one. The doctor won't know until he gets in there. In the event of two surgeries, the first would actually tie off the right lobe but not remove it. This will trigger growth in the left lobe. Karen would come home and after 2-3 weeks the left lobe would be big enough. They'd go in and remove the right, leaving the larger left. Make sense?
Assuming one surgery, Karen'll be in hospital between 7-14 days.
Between now and the 3rd will be another colonoscopy, one more Erbitux, some pre-admissions tests, Chamberlain and Moriarty visits and likely some pre-operative prep.
The surgery is not without risk, both doctors have said they would not attempt this on a sixty year old woman, but we know what to expect and are ready for whatever comes.
"No Evidence of Disease" does not mean "no disease", it just means no visible tumors. There's also the chance of a recurrence after surgery but Karen's been off chemo since July 2008 with no new tumors appearing so this is a good indicator. If there were tumor cells ready to grow they have had time to do so.
The goal is to have Karen leave the operating room, visibly cancer free. As doctor Chamberlain put it, that would indeed be a true miracle. No one has worked harder for it than Karen.
They are hard men to read but I get the impression they're both pretty amazed at how well Karen has done. Her tumors are still active but barely and perfect for resection. After ~18 months of uphill emotional and physical battle, Karen's gone from terminal cancer to having a possible curative surgery.
Surgery has been tentatively scheduled for the 3rd of March at St Barnabus [LINK] in Livingston. The good Doctor Chamberlain was named in the Top Docs 2008 list [LINK] so that's encouraging.
Surgery will not be easy, as we know. The idea is to open up K's existing scar and possibly elongate it. There will likely be scar tissue from the old surgery which will complicate the procedure. The plan is to remove Karen's right liver lobe and either cut out or ablate the tumors on the left lobe. Her gall bladder will come out and possible 10-12 inches of colon, along with lymph nodes and other sundry items. They'll do an intra-operative ultrasound to be sure every thing's removed and then sew her back up.
There's also a possibility that the procedure will need to be done in 2 surgeries instead of one. The doctor won't know until he gets in there. In the event of two surgeries, the first would actually tie off the right lobe but not remove it. This will trigger growth in the left lobe. Karen would come home and after 2-3 weeks the left lobe would be big enough. They'd go in and remove the right, leaving the larger left. Make sense?
Assuming one surgery, Karen'll be in hospital between 7-14 days.
Between now and the 3rd will be another colonoscopy, one more Erbitux, some pre-admissions tests, Chamberlain and Moriarty visits and likely some pre-operative prep.
The surgery is not without risk, both doctors have said they would not attempt this on a sixty year old woman, but we know what to expect and are ready for whatever comes.
"No Evidence of Disease" does not mean "no disease", it just means no visible tumors. There's also the chance of a recurrence after surgery but Karen's been off chemo since July 2008 with no new tumors appearing so this is a good indicator. If there were tumor cells ready to grow they have had time to do so.
The goal is to have Karen leave the operating room, visibly cancer free. As doctor Chamberlain put it, that would indeed be a true miracle. No one has worked harder for it than Karen.
Tuesday, December 4, 2007
Home After Surgery
Karen's doing well. She came home late last night and is recuperating. The kids were visibly glad to see her and we spent a restful day at home today after what seems like the longest week of our lives.
Between one thing and another, running back and forth to the hospital and cajoling the kids back to sleep each night, I have had neither the time nor the inclination to update this blog but with Karen home it's time to give a little update.
Karen's stay in hospital was not without incident. The day after her surgery, her epidural stopped working. By the time I got to her room that morning she had already been an hour without pain medication and could barely speak. Another hour passed with me becoming more and more irate whilst the nurses frantically looked for an IV pump. I finally hit the right nerve (no pun intended) with the nurse manager and a pump was found. It took the rest of the day to get Karen's pain under control.
Mild fever, low blood counts, shallow breathing kept my nerves on edge.
There were a few other incidents which essentially all stemmed from in-experienced residents all waltzing into Karen's room, treating her like a science experiment without fully reading her chart.
I have to say we were very disappointed overall with the level of intelligence and care displayed by the nurses and residents at LIJ. Thank God for Dr Ravikumar who was diligent in his post-op follow up. He ended up over-riding or supplementing almost every instruction given for K's post-op care. I won't go into the details but it was Karen's determination that finally got her released last night.
An oral form of morphine is controlling her pain now and she's improving every day. We have scheduled a follow up with our oncologist, Dr. Moriarty, next week. The current plan which he'll likely confirm is to proceed with chemo for two months followed by hepatic artery infusion (chemo directly into K's liver) followed by more systemic chemo. A second surgery will be needed to remove the right lobe of the liver.
I will conclude with thanks to all for the loving support which somehow continues to flow into the Shanahan household.
Between one thing and another, running back and forth to the hospital and cajoling the kids back to sleep each night, I have had neither the time nor the inclination to update this blog but with Karen home it's time to give a little update.
Karen's stay in hospital was not without incident. The day after her surgery, her epidural stopped working. By the time I got to her room that morning she had already been an hour without pain medication and could barely speak. Another hour passed with me becoming more and more irate whilst the nurses frantically looked for an IV pump. I finally hit the right nerve (no pun intended) with the nurse manager and a pump was found. It took the rest of the day to get Karen's pain under control.
Mild fever, low blood counts, shallow breathing kept my nerves on edge.
There were a few other incidents which essentially all stemmed from in-experienced residents all waltzing into Karen's room, treating her like a science experiment without fully reading her chart.
I have to say we were very disappointed overall with the level of intelligence and care displayed by the nurses and residents at LIJ. Thank God for Dr Ravikumar who was diligent in his post-op follow up. He ended up over-riding or supplementing almost every instruction given for K's post-op care. I won't go into the details but it was Karen's determination that finally got her released last night.
An oral form of morphine is controlling her pain now and she's improving every day. We have scheduled a follow up with our oncologist, Dr. Moriarty, next week. The current plan which he'll likely confirm is to proceed with chemo for two months followed by hepatic artery infusion (chemo directly into K's liver) followed by more systemic chemo. A second surgery will be needed to remove the right lobe of the liver.
I will conclude with thanks to all for the loving support which somehow continues to flow into the Shanahan household.
Thursday, November 22, 2007
Hurray For Surgery
Life is good. I have wanted to contribute to this blog for quite some time and now is a good time.
Well I am headed to surgery on the 26th and I am cautiously excited and just looking forward to the next few days with my family. I have been trying to get a lot of rest, and stay hydrated (one of my constant challenges) for my big day.
I cannot believe, and I am overwhelmed by how blessed I have been through this whole experience. God has sent to me the best medical people and treatments and I am so thankful for the response I have had to chemo. Yes, cancer/chemo is difficult and not fun but this is life and crappy things happen to people all the time. I really believe you have to extract the good out of all things and find out what it is you are supposed to learn in life whether it be good or bad. I know I am already healed. I know because so many amazing people are praying for us. I know Jesus always hears us and I may not always “feel” like He is there but I know He is. We don’t always have to feel things to know they are real. I have been saying in my mind since this whole thing started, I don’t believe in Jesus, I know in Jesus.
I want to thank everyone for their prayers, thoughts, emails, calls, gifts, etc. People who I don’t know, and have never met, have been kind enough to post comments, and send me emails and that blows me away. It truly does. People are good, and I am humbled.
My family has been awesome. Sarah, there are no words. But we couldn’t have gotten this far, this well without you. That is the truth. You have given up a lot, and we thank you for loving our kids and caring for them in the way you do. I love my brothers and sisters deeper than words can ever describe. You have all been awesome to me and supported me in such amazing ways.
I cannot even begin to speak of my husband because my love for him and gratitude cannot be expressed in words, and are too much to put on this blog.
Let’s all keep praying for each other and for great success on Monday and the weeks ahead. I love you all.
Karen.
Well I am headed to surgery on the 26th and I am cautiously excited and just looking forward to the next few days with my family. I have been trying to get a lot of rest, and stay hydrated (one of my constant challenges) for my big day.
I cannot believe, and I am overwhelmed by how blessed I have been through this whole experience. God has sent to me the best medical people and treatments and I am so thankful for the response I have had to chemo. Yes, cancer/chemo is difficult and not fun but this is life and crappy things happen to people all the time. I really believe you have to extract the good out of all things and find out what it is you are supposed to learn in life whether it be good or bad. I know I am already healed. I know because so many amazing people are praying for us. I know Jesus always hears us and I may not always “feel” like He is there but I know He is. We don’t always have to feel things to know they are real. I have been saying in my mind since this whole thing started, I don’t believe in Jesus, I know in Jesus.
I want to thank everyone for their prayers, thoughts, emails, calls, gifts, etc. People who I don’t know, and have never met, have been kind enough to post comments, and send me emails and that blows me away. It truly does. People are good, and I am humbled.
My family has been awesome. Sarah, there are no words. But we couldn’t have gotten this far, this well without you. That is the truth. You have given up a lot, and we thank you for loving our kids and caring for them in the way you do. I love my brothers and sisters deeper than words can ever describe. You have all been awesome to me and supported me in such amazing ways.
I cannot even begin to speak of my husband because my love for him and gratitude cannot be expressed in words, and are too much to put on this blog.
Let’s all keep praying for each other and for great success on Monday and the weeks ahead. I love you all.
Karen.
Wednesday, November 21, 2007
Pre-Admission Testing
Karen's doing great. Over the last few weeks her color has returned and she's regained a lot of the strength lost to chemo. Today we had pre-admission testing at Long Island Jewish.
The pre-admission testing consisted of a chest X-Ray, CT Scan, blood work (including CEA) as well as an EKG. A huge amount of information was collected through interview along the way. Allergies and pre-existing problem type questions. We'll get Karen's CEA result on Friday.
We also met with Dr Ravikumar this morning before pre-test. That was a good visit. Dr Ravikumar explained the process he'll go through as well as the various decisions he'll make during surgery. These decisions are rather complicated but essentially result in Karen leaving the theatre with varying degrees of weight loss.
The surgery will last 5 hours approximately and starts at 11:30 EST on Monday morning.
He also may look to use a new technique he's developing (with a handful of other surgeons worldwide) that involves PET scanning with a wand DURING surgery. This allows him to detect a negative margin in Karen's liver more accurately. That's surgery talk for "figure out if there's cancer left or not".
It's an innovative procedure that doesn't add risk to the operation so we're signed up. It involves nuclear medicine though and may not be feasible logistically given the holiday here in the US. We'll see. Only a couple of people have received this process so there's no data to backup whether it actually is of benefit or not but it makes sense to me.
My parents have flown in from Ireland and are a great comfort and support during this time. Ethan loves his "DanGrad" and Sydney likes "Nana's white hair".
Karen's in "game mode" and although she's nervous, overwhelmed and a small bit scared she's up for the challenge. Her nerve is steady and we're quietly confident in what's to come.
We are looking forward to a successful result on Monday.
The pre-admission testing consisted of a chest X-Ray, CT Scan, blood work (including CEA) as well as an EKG. A huge amount of information was collected through interview along the way. Allergies and pre-existing problem type questions. We'll get Karen's CEA result on Friday.
We also met with Dr Ravikumar this morning before pre-test. That was a good visit. Dr Ravikumar explained the process he'll go through as well as the various decisions he'll make during surgery. These decisions are rather complicated but essentially result in Karen leaving the theatre with varying degrees of weight loss.
The surgery will last 5 hours approximately and starts at 11:30 EST on Monday morning.
He also may look to use a new technique he's developing (with a handful of other surgeons worldwide) that involves PET scanning with a wand DURING surgery. This allows him to detect a negative margin in Karen's liver more accurately. That's surgery talk for "figure out if there's cancer left or not".
It's an innovative procedure that doesn't add risk to the operation so we're signed up. It involves nuclear medicine though and may not be feasible logistically given the holiday here in the US. We'll see. Only a couple of people have received this process so there's no data to backup whether it actually is of benefit or not but it makes sense to me.
My parents have flown in from Ireland and are a great comfort and support during this time. Ethan loves his "DanGrad" and Sydney likes "Nana's white hair".
Karen's in "game mode" and although she's nervous, overwhelmed and a small bit scared she's up for the challenge. Her nerve is steady and we're quietly confident in what's to come.
We are looking forward to a successful result on Monday.
Tuesday, November 6, 2007
Cleared for Surgery on the 26th, November
Karen's doing well. She has recovered from last chemo and working on building up her strength for surgery. The surgery itself has been scheduled for the 23rd 26th of November, Friday the Monday after Thanksgiving. This doesn't leave much time and the few weeks we have are literally flying by.
We had a consultation with Dr Moriarty last week. He had reviewed the results from Karen's colonoscopy biopsy and was very up beat. The colonoscopy on visual inspection revealed that Karen's primary tumor had disappeared. The biopsy results revealed even better news; that the cancer is not detectable at the cellular level in her colon. We asked if this was good, he said "yes, VERY good". In Dr Dan's words "she has had a 'complete response' to the chemo".
Surgery's job will be to remove the remaining tumors in her liver.
Dr Dan gave us the following tidbit; The percentage of people who's tumors disappear from chemo is small. Maybe less than 10%. Of those people, the percentage of who's tumors are no longer detectable through biopsy is less than 5%. So like I always knew; Karen is very special.
When Dr Moriarty started in 1985, the percentage of people who were chemo resistant was about 95%. Only about 5% of folks actually responded to chemo. These days, with Avastin and other drugs, things have improved substantially. These developments are so new (Avastin is only on the market since 2003-4) that the statistics have yet to be adjusted to reflect these improvements.
On the insurance front; after many phone calls and back and forth with the insurance company and our surgeon it has been determined that Dr Ravikumar is out of network. This would ordinarily leave us footing a 5 to 6 digit bill. By some miracle, Dr Ravikumar has agreed to accept the out-of-network payment offered by the insurance company and waive the remainder. God is sending us the help we need.
Between now and the surgery date Karen has a number of pre-admission tests to do, including various scans, X-Rays, blood tests, MRIs and so on. We also have to squeeze in some Christmas shopping. This year my list will be short, but I know exactly what I want.
Before we left we asked how Dr Dan felt about the surgery. He said "I'm excited".
We are too.
We had a consultation with Dr Moriarty last week. He had reviewed the results from Karen's colonoscopy biopsy and was very up beat. The colonoscopy on visual inspection revealed that Karen's primary tumor had disappeared. The biopsy results revealed even better news; that the cancer is not detectable at the cellular level in her colon. We asked if this was good, he said "yes, VERY good". In Dr Dan's words "she has had a 'complete response' to the chemo".
Surgery's job will be to remove the remaining tumors in her liver.
Dr Dan gave us the following tidbit; The percentage of people who's tumors disappear from chemo is small. Maybe less than 10%. Of those people, the percentage of who's tumors are no longer detectable through biopsy is less than 5%. So like I always knew; Karen is very special.
When Dr Moriarty started in 1985, the percentage of people who were chemo resistant was about 95%. Only about 5% of folks actually responded to chemo. These days, with Avastin and other drugs, things have improved substantially. These developments are so new (Avastin is only on the market since 2003-4) that the statistics have yet to be adjusted to reflect these improvements.
On the insurance front; after many phone calls and back and forth with the insurance company and our surgeon it has been determined that Dr Ravikumar is out of network. This would ordinarily leave us footing a 5 to 6 digit bill. By some miracle, Dr Ravikumar has agreed to accept the out-of-network payment offered by the insurance company and waive the remainder. God is sending us the help we need.
Between now and the surgery date Karen has a number of pre-admission tests to do, including various scans, X-Rays, blood tests, MRIs and so on. We also have to squeeze in some Christmas shopping. This year my list will be short, but I know exactly what I want.
Before we left we asked how Dr Dan felt about the surgery. He said "I'm excited".
We are too.
Tuesday, October 16, 2007
Good News with a Bombshell
Karen's doing well. Really the title of this post should be "potential" good news with a "potential" bombshell.
The good news is we have a tentative date of November 26th for surgery at LIJ. We are "penciled" in for that day. This is further out than we had hoped but we'll take it. My parents have rescheduled their flights to better coincide with the surgery.
The bad news or potential bad news came this evening when I called our insurance company. Long story short it came to light that whilst LIJ hospital is in network, Doctor Ravikumar is not.
This news came despite me checking and double-checking BEFORE our first consultation. After a few phone calls our insurance company located the record of when I spoke to them on August 27th and luckily it contains documentation of the call where I was explicitly told that both LIJ AND Doctor Ravi are IN network. So this proves they screwed up.
Thoughts of switching Doctors at this point are not really an option. We're out of runway and committed to this team. The situation has been escalated to a supervisor and we will hear in a few days whether they're going to cover it. Trust me I will be all over this one.
Obviously the money is not the issue here, we will find it somewhere. Cancer is stressful enough on a family. Despite all precautions on our part, can nothing in this ordeal be simple?
Karen has her 2nd colonoscopy tomorrow to check the status of her primary tumor. Tonight she must drink a full four litres of let's just call it "fluid".
The good news is we have a tentative date of November 26th for surgery at LIJ. We are "penciled" in for that day. This is further out than we had hoped but we'll take it. My parents have rescheduled their flights to better coincide with the surgery.
The bad news or potential bad news came this evening when I called our insurance company. Long story short it came to light that whilst LIJ hospital is in network, Doctor Ravikumar is not.
This news came despite me checking and double-checking BEFORE our first consultation. After a few phone calls our insurance company located the record of when I spoke to them on August 27th and luckily it contains documentation of the call where I was explicitly told that both LIJ AND Doctor Ravi are IN network. So this proves they screwed up.
Thoughts of switching Doctors at this point are not really an option. We're out of runway and committed to this team. The situation has been escalated to a supervisor and we will hear in a few days whether they're going to cover it. Trust me I will be all over this one.
Obviously the money is not the issue here, we will find it somewhere. Cancer is stressful enough on a family. Despite all precautions on our part, can nothing in this ordeal be simple?
Karen has her 2nd colonoscopy tomorrow to check the status of her primary tumor. Tonight she must drink a full four litres of let's just call it "fluid".
Thursday, October 11, 2007
Scheduling Surgery
Karen's doing well. She called Moriarty's office today to touch base. Since her last visit Dr. Moriarty has conferred with a couple other Drs in K's team. Everything is as it should be and so today he gave her the go-ahead to schedule 1 more consultation with Dr Ravikumar as well as schedule the actual surgery at LIJ.
Hopefully we'll get a concrete date for surgery tomorrow. This does bring with it some jitters but it's another step forward and I know we can handle it.
Hopefully we'll get a concrete date for surgery tomorrow. This does bring with it some jitters but it's another step forward and I know we can handle it.
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.
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.
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.
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.
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.
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