Riding the Range

So what’s going on now?

I met a new doc this week to discuss next steps. We had a lengthy discussion and I came away feeling much better than I did for the preceding week. Not only does he seem confident that the next stage of treatment will yield positive outcomes, the diagnostics that he’ll use to confirm whether or not the new “veiled cancer” has been impacted make sense. Here’s the plan:

I go in for an MRI that looks specifically at my liver. This will be the baseline roadmap to use for the next step. Then, sometime in the next week or so, chemotherapy-infused pellets will be injected into my liver. They will cut down the oxygen and blood flow to the offensive areas, basically “starving” the cancer cells. The chemotherapy drug, Irinotecan, is emitted from the pellets and flows to the cancer cells. Since they aren’t getting clean blood supply, they’ll be duped into thinking that the blood supply with the drug in it is good for them…but we know better. In theory, they’ll drink deeply of this poisonous blood supply and die. (Blunt, I know, and I apologize.) But we have a war going on at this stage and I don’t want them to just wither away.

It takes about ten days for the supply of chemicals to dissipate through the liver. Side effects should be minor. Constant readers of my blog will remember that Irinotecan was one of the drugs in last year’s cocktail, but didn’t give me much trouble.

The plan will be to have this done as soon as schedules permit, definitely before Thanksgiving. I’ll be in the hospital for an afternoon to take the treatment, and then released to go home. With a day of rest following, I should watch my activity for a few days but should be pretty healthy for the entire period the Irinotecan is killing the little buggers. Then, we’ll give my system a month to rest.

We’ll do the same thing in December and January. Then, we take another look inside with the MRI. Assuming all goes according to plan, I’ll begin 2009 with a healthy liver and we go back on the diagnostic schedule every 90 days…likely to replace the CT with MRI for the first few. The CT checks ALL organs, though, and I’ll have to continue to do that.

Thanks, as always, to everyone for the kind thoughts and notes. I’m sorry if this is more medically directed than most, but wanted you to have the full scoop. My mood is better as I write this, and I’m anxious to take the next step(s). Having a plan seems so much more positive than just hoping something shows up like magic. Listening to confident young docs is a great way to build the plan and see a positive outcome.

Too Many Horses in the Corral...

When I first consulted the hepatic surgeon, he described situations where “unforeseen” lesions might be discovered during the ablation procedure. This happens when he utilizes an ultrasound device—directly assessing my liver. He suggested that previously unseen lesions appear in about 20% of his cases, and wanted to know how to proceed should that happen to me. I asked that he limit any surgical intervention at the boundary of “if it makes a difference in hepatic function,” and awaken me for further discussion.

Unfortunately, he found some. They describe the cancer as “thinly veiled” lesions, rather than more substantial tumors. At this stage, “how many” isn’t an easy question to answer. My layman’s view is that 40% my liver has spider webs of cancerous cells running through it, very light and wispy. That’s why they don’t appear on CT or PET scans. Is it one large spider web? Seven small spiders with long, interconnected legs? The real answer is that “they” exist…meaning additional cancer cells aside from the known lesion on the anterior surface.

Rather than surgically remove the sizeable segment, they closed me up. The ablation procedure would scar the area, hiding any future lesions that might arise behind it, and we’d have to wait for it to heal before any other types of treatment could begin. The good news, thankfully, is that they found my liver to be very healthy. They could tell that I’d had significant chemotherapy, but nothing else should challenge my liver’s ability to heal from all this attention.

I met with my oncologist on Thursday. We’ve chosen to pursue a course of treatment that will place several/many chemotherapy pellets in my liver itself, as a “targeted response” to the spider web. I’ll consult with an interventional/diagnostic radiologist here in town before this is done. At this point, I don’t know how they implant the pellets into the liver, how many there will be, or much else. They’ll sow the seeds near the spider web, planting others near the lesion we thought we’d burn off. It would be nice to know that the ablation had been completed and things were “finished” for now, but I invited myself into this situation when I said we’d need to talk over any new diagnostics before they got out their scalpels.

Resection is a little frightening, frankly. I’ve proven that cancer cells can invade my liver. Removing a sizeable portion and leaving a healthy segment seems ripe for new invasion….reducing my future options. All of the docs I’ve seen recently agree. My oncologist agrees.

There are many reasons that additional systemic chemotherapy is uncalled for. There are no clear explanations why the multiple scans didn’t pick up the spider web. For now, I’m recovering from Tuesday’s surgical view of my abdomen and feel pretty well. The tummy is just as sore as if they HAD done the ablation, since they put me under the general anesthesia, only to button me back up after looking around. My gall bladder is fine. The adjacent diaphragm is fine.

As I mentioned in the last post, we’re confident they are confined to the corral. We thought one little pony would be involved, yet it turns out I should have been talking about a Barn and Charlotte’s Web.

My mood, frankly, is one of grave disappointment. I’m sorry that I must share difficult news with all the nice people who care so much about me, and somehow feel responsible for the work of the radiologists who simply couldn’t see more. Otherwise, I know the best course is to “just keep playing” and that’s my plan for the next month. Will I miss work? How long does it take to recuperate? All I know it that targeted chemotherapy is much less problematic than systemic, and that I’ve tolerated systemic chemotherapy quite well. I’m confident I’ll handle this just as well.

Thanks so much for the nice phone calls, notes and prayers. We’re still putting them to a test, but so far they seem to be working out just fine!

Fall...Not Springtime?

Gee, the fall comes with USC lazily wandering through its Pac 10 schedule. The Ducks squeaking out victories. Blazer camp with all its worries. THANK goodness for baseball!

Why is it that spring is accompanied by cherry blossoms on the mall, April in Paris, and Opening Day?

We're heading into the dark days of Autumn. Soon, we'll be driving to work in the dark and heading home in the dark. I get a week's vacation coming up, so that I can prepare myself for the dark days...and take care of this current lesion.

It dawned on me, even though it isn't spring, that so many nice people are worried about every new lesion, each new challenge. That is so nice of you. But please, each of you, don't worry. I think of them as horses in the corral. If we find the horses OUT of the corral, perhaps I'll begin to worry. This one, and the past we knocked off last spring, have been confined to my liver and manageable through any number of medical interventions. They are just the next step. We keep them corralled, we get them out and ride them, we put them away.

Tumors. Lesions. "Dark spots." Horses in the corral. They all mean the same thing to me, and though they are serious if left untended, it has never been my style to leave animals untended. We even care so much about the deer in my neighborhood that we transport my apples across the street to the nice lady, they don't cross the danger of 'A' Street. We're taking care of these horses in the corral in much the same way.

A change, but not scary. We know the sun will lighten our lives in Portland, come springtime, and we know that the horses will be handled in the corral this fall.