Archive | October, 2010

Chopped liver

17 Oct


Dr.'s office anatomy lesson


The past few weeks have kept us busy.  In addition to finally recovering from the most recent dose of chemo, I’ve been presented with a few more obstacles to overcome and decisions to make.  Several weeks ago I had a follow up PET scan.  This test would be the first time we were going to learn the true progress of the chemotherapy and radiation treatments.  Overall, the doctors were very pleased with the results.  The rectal tumor had significantly reduced in size.  There were also previously two liver lesions they had seen prior to treatment; the most recent scan now only showed one lesion, which had also been reduced in size – yay!  But…and there’s always a butt in this saga, the location of this one remaining metastasis drew concern from the doctors.

Similar to the upcoming rectal surgery, the plan had always been to surgically remove (resect) any remaining liver lesions that were not killed off from the chemo and radiation.  When these lesions are located along the sides of the liver, they cut a small wedge out of the organ and it’s a very straight forward, uncomplicated procedure.  My lesion, however, was not located in the outer area of the lobes.  Rather, it was located in Section 8 of the liver.  While my current knowledge of liver anatomy was a little rusty, nothing called ‘Section 8’ ever sounds positive!  The surgeon explained that this particular area is located in the top central region of the liver, just below the heart, lying directly over the vena cava – the primary vein carrying blood from the upper half of the body to the right atrium of the heart. Operating near or around this area involves disconnecting the liver – a vital organ – from the surrounding veins, and removing the entire right lobe (not a small wedge) of the liver.  While we were pretty sure we knew the answer to the next question, we still had to ask – is this a procedure that can be done laproscopically (minimally invasive)?  Nope.  In fact, the surgeon explained that this particular procedure entailed making an upside-down Y incision on the central abdomen, just below the breast plate.  “You mean to tell me that you want to put a Mercedes logo on my wife’s stomach?!” Nick exclaimed.  “Well yes,” replied the doctor, “that’s actually what we call it!”  This news certainly was not sitting well with Nick.

The liver specialist went on to explain several non-surgical options as well.  One of these options was radio frequency ablation (RFA), which involves injecting the liver with a needle that would deliver radiation beams directly into the lesion and essentially burn it away.  Another option was to install a port in the side of my torso that would allow doctors to inject small pellets of chemotherapy directly toward the liver.  (Scenes from a very vicious paint ball game were running through my head at this point.)  Lastly, he gave us the option of doing nothing at all.  That’s right – given how well the other lesion responded to chemotherapy, it’s possible that the remaining tumor may still be shrinking, or might shrink by undergoing additional rounds of chemotherapy after the rectal surgery.

Hearing all this was a lot to take in, not to mention this particular specialist did not overwhelm Nick and I with a great deal of confidence or assurance whatsoever.  I didn’t like the fact that he couldn’t make it through our conversation without perspiring due to the fact that he was seriously overweight, how was he going to make it through a strenuous six-hour operation? Nick didn’t like the way his pants fit, and we both disliked the manner in which he delivered this entire barrage of news.  This has always been a difficult aspect of interviewing doctors.  How do you know if they’re good?  Experts in the field?  Patient privacy laws prevent you from being able to call past patients to get their personal feedback and evaluations.  You can’t really ask them to audition via a mock demonstration.  So how do you judge them and decide if they’re qualified enough to make the E-Team?  What if they have the worst bedside manner in the world but are a genius with a scalpel? How do you know when to overlook unbecoming aspects in lieu of their potential expertise?  For us, it’s really just been a gut feeling.

Nick and I both agreed that second, third and fourth opinions were needed – and that there was no one in Vegas that were qualified enough to offer them.  Since this initial consultation with the liver surgeon, we’ve been grateful that friends and family have put us in touch with some renowned experts in the field.  My case is currently being reviewed at the Mayo Clinic in Scottsdale, Washington University in St. Louis, and at USC.  Once we receive treatment recommendations from these other institutions, we’ll weigh them against each other in attempt to arrive at a final conclusion and next steps.  At this point, the rectal surgery still remains on track for November 3rd however that could potentially change in the upcoming days.  The adventure continues, just as we appreciate your continued thoughts and prayers.

Back on the bandwagon

3 Oct

I had to rock the cowboy boots for my last chemo appointment!

This past week I had a follow-up appointment with my oncologist and informed him of the fact that my surgery had been postponed until November.  When he caught wind of this, he immediately ordered up another chemotherapy session…only this time it would be a stronger dosage than my previous treatments, given I was no longer receiving radiation treatments simultaneously.  Not knowing what to expect, the treatment began as it normally had in the past and I was typing away on my laptop on work and emails.  Less than half way through the IV drip, however, I lost complete use of my arm due to numbness.  This is not your typical numbness though – it’s a painful numbness (an oxymoron?) that is similar to the feeling you get when your arm or leg falls asleep…times 100.

Since finishing treatment on Thursday I’ve slowly begun to recover and have slept more these past three days than the past few weeks combined.  My diet has consisted of Ovaltine and macaroni and cheese – my sense of smell is so extremely heightened, I can’t fathom trying to stomach anything else.  Fortunately this past chemo session will be the last one prior to surgery; they don’t recommend any chemotherapy less than four weeks prior to procedures.  I am, however, also on a double dosage of my oral chemo pills for another week.  Also added to the medicine cabinet this week was Premarin – a low dose estrogen pill used to combat menopausal symptoms, namely, hot flashes.  We won’t know for another 2-3 months if the symptoms are temporary or permanent but if they turn out to be permanent we’ll explore some long term options.  More updates to follow…