Dammit...I'll take a Mulligan

I was fortunate, recently, to play Torrey Pines in San Diego. The fourth hole is the first alongside the ocean, and I greeted mother nature with a quick pull-hook onto the beach. I guess you could say she “got into my head” a little.

Well, this morning I’m fighting to keep surgeons and scheduling staff from getting into my head. After lining up all the work activities, personal time and family responsibilities for the surgical procedure to take place on Oct. 9…I got a call this morning to push it back to October 21. Medically, it makes no difference. Personally, it is a pain.

I’ll comment more when I’m in a better mood. For now, all my nice friends who drew a circle around the 9th will need to get out an eraser and move the circle to the 21st. It works well for family, and enables me to be “done” with this phase by the time Nate gets to town for his award dinner. There are lots of good reasons to put it off.

Just a mulligan. Shouldn't really count for much, but it would have been nicer to hit the fairway than the beach.

Update Xth...

After a few weeks of waiting around, this week has been a rush of physician consultations and decisions. Let me offer up the issues and treatment plan, and then move on to the “how am I doing” part of it all.

Before my recent trip, I got a call that Dr. Mike Pf, wouldn’t feel comfortable doing the microwave zapping we’d originally planned. The lesion is: a) too close to the divide between the left and right lobes, and b) on the outside quite close to the diaphragm. He might damage that muscle.

The best thing good doctors can do is know their limits. I’d hoped that the procedure that was least invasive would be the solution. This week, after my travels, I met with Mike and he went through all the imaging studies, explained the challenges for the technique he might have used, and apologized for not being able to meet my personal needs. He probably felt worse about it than I did.

The referral, then, was to Paul Hansen, MD. Dr. Hansen works specifically with hepatic surgery, meaning he basically only opens people up to work on their bile ducts or livers. In meeting with him today, he described laparoscopic surgery and the remedy he’ll use to quash the life from the liver tumor. It will cost me a day or two in the hospital, some recuperation time following..

Using a video camera and ultra-sound device, Dr. Hansen will isolate the tumor on the outer edge of my liver and utilize (this means “microwave” like we’ve said before, but here’s the formal name) radiofrequency ablation…or “RFA” to kill the offending cancer cells.

I’ve learned a lot in the last 48 hours. First, the reason an older technique, cryogenically freezing the tissue, is not indicated is that the liver has lots of blood flow. Freezing doesn’t cauterize any blood vessels, it simply turns the offending cancer cells into blocks of ice. If bleeding results, it can be quite a complication and would require additional surgery.

RFA, on the other hand, uses a “burning” technique that cauterizes as it goes. Offending areas are cut off from the other, healthier cells, and when the technique is accomplished complications are rare. In both procedures, the important step is to reach beyond the tumor cells to what we call “clear margins” when healthy tissue is alive and well…but not too far into the healthy areas to damage the rest of the liver.

I’ve scheduled this procedure to take place in a couple of weeks. I can cover some important work functions next week, and then ready both my mind and body for the challenge that awaits this next surgical adventure. The doc will use a video-guided tool, with very small surgical entrances to find the tumor on my liver and lift the diaphragm out of the way. It will self-cauterize, no bleeding is anticipated.

After lying around for a weekend watching fancy HD football, I should be fine to return to work. There are chances that I’ll be more sore than anticipated, because my liver has been impaired by chemotherapy in the past. The good news is that livers rejuvenate themselves, and are the only organ known to do so. Mine may rejuvenate on a different schedule than most, in that is has seen some pretty powerful poisons over the past two years.

For the most part, though, I was delighted with the approach and suggestions of the new doc. It was nice of Jillian to come along today, to hear the many different options and learn from the docs. Both of the doctors with whom I met today look about Nate’s age. Dr. Hansen has done several hundred of these procedures, and has specialized in the work related to the liver since he got his medical degree. I hate sitting in an exam room and being reminded that “metastatic disease changes what we have on our plate.” I’d prefer to be a hobbyist, barely knowledgeable of the challenges and prognosis facing me. Now, I’ve become more than an amateur, almost a professional, at cancerous diseases of the colon and liver.

I’m sorry that everyone has to watch this journey with me, and certainly appreciate the care and concern than you all express. Trust me, if I could make it simply go away, I would. We’ll get this handled in the next couple of weeks, and then we’ll move on to the next scan, hope for the best, and look ahead to Winter.

I’ll whip out another update on the eve of surgery, and keep everyone informed as we go. Thanks so much for your prayers, thoughtful cards, and fun phone calls. As Billy Schlager says, TCTFO….we’re taking it one scan at a time and one procedure in step with the next. If you have questions, or want to know than I’ve posted here, just zap me a note and I’ll answer as best I can.

Another Member of the Care Team!

It turns out that the faint image on the latest studies is indeed a cancerous lesion that needs attention. I got to see the pictures during my visit with Dr. Chang on Monday. Compared to “the three brown blobs” that appeared last October, this looks like a faint shadow. It is no wonder that the PET scan had a hard time defining the image last month, we now have a better understanding of what I face.

The most wonderful news, without being PollyAnna, is that I know the doctor whose work I’m going to describe. We serve his clinic professionally, and I’ve had a few conversations with him about “non work” stuff in the past, too. Radiologists no longer just slide an X-ray film into one of those viewers we’ve all seen on TV and rub their chins. Many of them perform a variety of procedures to “intervene” medically and change things.

Anyway, what Dr. Pfeister will do after the anesthesiologist puts me to sleep is insert a probe of some type through my abdominal wall to the liver. This lesion is on the outside, front of my liver at about the crevice that divides the two lobes of the liver in the front. (That’s called the falciform ligament, for those of you attending nursing school…) Don’t ask me how Dr. Pfeister will know how to find the bad guys and leave the good guys there, that’s why we have really fancy medical schools and really bright guys who attend them. The reason a radiologist does this is because he needs imaging guidance to find the right spot. If it wasn’t happening to me, I’d love to watch him guide the probe and zap the little devil.

This will happen in the next month, depending on how fast Dr. Pfeister feels is appropriate. Certainly it is not life-threatening at this point nor urgent. I'll follow his advice and get it done as soon as he feels is appropriate.

In conversation with Dr. Chang, I compared this procedure a bit to the surgical removal I had 30 months ago. “Would there be a reason to do more chemotherapy following this procedure, like we did following the surgery?” At this stage, that is not indicated. We’ll move forward with regularly scheduled tests. We’ll have the Erbitux Artillery in our back pocket should internal tumors erupt elsewhere. We know it works well for me but it hammers my other health systems.

Unfortunately, we all need to recognize that this will be my lot in life. We'll hope nothing new crops up, and deal with whatever may show up if/when it does. I had an interesting trip to the doc’s office. I shared the elevator with a young woman about Vickie’s age, completely locked into a spinal external fixator. You know the kind, where a rack is built around one’s head, anchored to both their skull and shoulders. She looked great, and yet I didn’t really want to start a conversation to compliment her on her mobility. As I stood there quietly, proud of her courage and lack of embarrassment, I was trying to decide who was actually the most ill. She appeared to be in sad shape but probably is doing quite well and has a great prognosis. I look far better, but actually may be sicker and needing more attention than she.

It was a great reminder that all of us face challenges, some of them visible and some of them not. Some are great challenges, immense and serious, while others at times may seem superficial. I’m not describing this latest news as either immense, nor superficial. I’ll just get the work done. As you’ve heard before, I’ll “Just Keep Playing!”

Frankly, I've spent a year learning about hepatic function, geography and terminology, and I'm ready to get back on the History Channel instead of MDTV. But I'll be ok, because I have terrific folks backing me up and listening to me rant from time to time.