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.


12 Responses to “Chopped liver”

  1. Rita Hartert October 17, 2010 at 8:51 pm #

    OMG!! You must have taken anatomy somewhere along the line! Reading all this (altho your mom has kept me up to date) makes me shriek in horror. Yet, you and Nick seem to digest this and are making decision with information, (even if the guys pants don’t fit…I’m giggling as I write this). Thank God you both are intelligent, and are able to use the tools available to make the decisions you face. God be with you both and guide the surgeon’s (whoever he/she is) hands. Much love and prayers. Rita

  2. Barbara McCarthy October 18, 2010 at 9:02 am #

    You are one take-charge gal, Em! Great that you are going for experts, no matter where that search takes you. When I think of you I see success everywhere.

  3. Carrie T October 18, 2010 at 12:02 pm #

    I for one am so thankful for the opinions of others. You are in good hands and I truly believe the right direction will be clear to you once you receive all of the recommendations!

  4. Sandy Ross(aunt, once removed!) October 18, 2010 at 2:42 pm #

    Praying you and Nick find the right specialist to do this procedure.

  5. Sandy Ross(aunt, once removed!) October 18, 2010 at 3:16 pm #

    fyi—your cousin, Jeff Ross, does the procedure that you need. He would be happy to chat with you about it if you want another opinion. He is an interventional radiologist in Colorado Springs. He happens to have this week off, so it would be a good time to reach him. I will give you his number if you are interested.

  6. Casie and Dustin Kindl October 18, 2010 at 6:14 pm #

    We love you so much, Em! You have the best attitude of anyone we know and it will continue to serve you well as you weigh your options and choose the best path for you and Nick. Of course, we are here with you every step of the way – praying and celebrating every win.

  7. Karen Moger October 19, 2010 at 8:23 pm #

    Use every resource available to help you with the physical and emotional path you are headed down. Get the facts, spill your emotions and don’t let the beast totally take over your life, treat it as only a temporary detour, put it all in God’s hands and trust him for the strength you’ll need to face off the ugly predator. Soldier on dear one!!!
    Aunt Karen

  8. Vicki Murrison October 20, 2010 at 7:03 am #

    Hi Megan: We are friends of Lynn and Lon, and Lynn introduced me to your blog.

  9. Vicki Murrison October 20, 2010 at 7:10 am #

    Hi Megan: We are friends of Lynn and Lon, and Lynn introduced me to your blog. I’m in such awe of your wonderful and positive attitude in experiencing this journey. You express yourself in such a way that it brings both laughter and tears when reading your blog, and I look forward to receiving them. We just want to wish you good luck with your surgery, and that you’re in our thoughts and prayers.

  10. Bonnie Hughey October 20, 2010 at 11:33 am #

    Em I’m so proud of you and Nick! You guys are doing the right thing. Keep strong. I’m definately praying for you.

  11. Chris and Katie Kelley October 25, 2010 at 4:19 pm #

    Hey Em, Katie and I wanted to send a quick hi to let you know that we have thinking of you lately. It sounds like you are handling everything like a champ which doesn’t suprise us at all. Good luck with everything and we can’t wait to see you again.

  12. Erin Hammond October 29, 2010 at 3:02 pm #

    Hi Emily,

    I work with Nick at Foliot…

    He gave me your blog site a while ago and I’ve always wanted to jump in and say hello to you.

    What you (and Nick) are going through, how you cope with it, how you continue to write about it; you are both amazing. What you are going through is just unbelievable to me. Wrong on every level.

    But, you are very positive and so is Nick (very funny about the overweight doctor). He has his days, he doesn’t go unaffected. Sometimes he’s transparent sometimes he’s okay (or seems okay).

    I’m happy you are seeking additional advice from other doctors, not sure that who you need is here.

    Anyway, I’m rambling now, I just wanted to introduce myself and tell you that there isn’t a day that I don’t think about you. You are constantly in my thoughts and prayers.

    Take Care Emily,


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