Saturday, December 27, 2008

Two separate cancers

As I said in a previous update, just when you think things are figured out, off they go in another direction! When I wrote on the 24th, I thought I'd be housebound for the holiday because of the snow, but as it turns out, I was able to go to Christmas Eve service due to a break in the weather and my dear friend Annie's 4 wheel drive SUV. She got us there with not too much slipping and sliding! And on Christmas Day, Mom was delivered to my doorstep by my cousin (and his 4 wheel drive) and several friends battled the elements to bring food, fun and lots of laughter. It was a really fun day. Hope yours was just as nice.

Talked with Dr. Karamlou today and he confirmed his earlier suspicions - I do have two separate cancers, one in the lungs and one in the pancreas. What was interesting about this is he says it appears that the cancers are not both adenocarcinomas - the pancreas cancer is adenocarcinoma, but the lung is likely a squamous cell carcinoma. Evidently, it looks similar to adenocarcinoma, but is not the same. The pancreatic tissue sample was quite small though and he did say they may want to re-sample it. Dr. Karamlou will be contacting both doctors Jaswari (pancreatic endocrinologist) and Tsen (surgeon) to work out the plans for the next steps. Drs. Mann and Dubay (UCSF) had both said if it turns out to be two separate cancers and the nodule in the pancreas can be removed surgically first, that would be good. For this to work, it would have to be a surgery I can recover quickly from (i.e., a laparoscopy type surgery with a 1-2 week healing time) as an extended healing period would delay chemo and radiation too much. Now I wait to hear for the next steps, but once again, we're moving in a slightly different direction. It's very weird to think that two separate cancers are the better option, and clearly, pancreatic and lung cancers are not good, but this does mean the cancer has not metastasized and that is a good thing.

I was given another gift in all this...my friend Melinda is good friends with a nurse up at OHSU and this nurse (Marty) works with Dr. Brett Shepard, one of their leading pancreas doctors. She told him about my situation and he said he'd be happy to review my file as a 3rd opinion, at no charge. What an amazing blessing.

That's all for now, stay tuned for the next episode! Time for some ibuprofen and off to bed - spent 2 1/2 hours digging my car out from under all the snow and shoveling the driveway clear today and found a few new muscles in the bargain :) Still feeling good, overall, and grateful for the blessings of each day.

Take good care, hugs to all,

Susan

Wednesday, December 24, 2008

Merry Christmas!


Merry Christmas!

Here it is, Christmas Eve, and I'm looking out my window at a true Currier & Ives portrait. Snow falling....and falling...and falling......we've broken records for snowfall in December and the drifts are about 2-3 feet deep in my backyard with more to come. Beautiful, but definitely going to keep me (and a good portion of the Portland area) indoors for this Christmas holiday. I was feeling a bit woeful about that this morning, not being able to go to church service this evening or be with family here tomorrow, no shopping done, etc. and then I stopped cold, remembering the reason for Christmas is not all that, but it is about the hope we are given in the birth of Jesus. He is our Christmas present and what He represents: hope and love and salvation. The blessings He gives me are so many!

The appt. with Dr. Dubay (at UCSF) was good - no clear direction of treatment yet as we're still waiting for the pathology results to determine whether this is or isn't metastasized cancer. The Portland medical offices were closed Monday due to weather, Dr. Karamlou isn't in on Tuesdays and now the offices are closed for the holiday. Dr. Dubay talked about the different methods of chemo/radiation that would be used (depending on the final diagnosis) and provided detailed packets of information about the different types of chemicals that would be used, how often the treatments would be given, methods for determining how well it's working,etc. Not light bedtime reading, trust me, but very informative and information needed to compare with the treatment options Dr. Karamlou will recommend.

I had a wonderful time with my family and it was so good to laugh and joke and cry together. We had our Christmas celebration and the time with them is precious to me.
Sometime I'll tell you the stories of watching my brother, nieces and nephew try to make a gingerbread house.....good thing none of them are thinking about a future in construction.

Even in all this horrible weather and canceled flights everywhere, I was able to get a flight home to Portland yesterday with a minimum of fuss. Very glad to be home and snug in my warm house....I'm going to bake cookies this afternoon and right now, have the Christmas music playing. Lovely.

Thank you for all the wonderful phone messages, e-mails and cards I've received. The notes of love, support and encouragement are so wonderful and mean more to me than I can ever adequately express. God is good and, though I find it difficult at times to be patient waiting for news from the doctors, I know He is in charge and each day will bring the necessary information and what's needed for that day. I still feel good and that is such a blessing.

Sending hugs and love to all, have a very merry Christmas!

Susan

Saturday, December 20, 2008

The McCormick Posse Takes on UCSF

Yet another twist in the cancer journey.....as Mike Dougherty has told me many times, just when you think things are figured out, it all goes in a different direction.

Last Thursday I met with Dr. Karamlou, the oncologist, and just getting to the appt. was a gift from God. For those of you that aren't in the Portland area, you might not be aware of the severe winter weather we're experiencing and offices closing early due to frozen roads and other problems. Sure enough, the scheduler calls to tell me the 4:00 pm appt. was canceled and rescheduled for Jan. 8th....this was the last straw for me in a difficult week for cancer news and I lost it. In tears, I told her I just couldn't wait that long and she was very empathetic, squeezing me in at 2:oo pm. Thank you, God!

Dr. Karamlou is a delightful man, very thorough and he gave me information I hadn't anticipated. In short, he is not convinced the cancer has metastasized and could actually be two different adenocarcinomas. I won't go into the lengthy medical details, but, based on what he saw in the file (or didn't see, I guess) , he is reviewing all the pathology slides and talking with Dr. Karulf before we go further. It still could be one cancer that's metastasized, but until he's sure......we wait. As he explained to me, adenocarcinoma is a glandular cancer, not specifically a lung cancer and the progression from lung to pancreas (or vice versa) is unusual enough to warrant further checking. It still could be just the one cancer, but then again, it might not.

Now I'm thinking to myself "Always the overachiever, now you might have two cancers and how is this a good thing?". Pancreatic cancer is not a positive event, but having two separate cancers means that cancer hasn't metastasized and can be treated individually as two localized cancers....and that is a good thing.

Since treatment will differ greatly depending on Dr. Karamlou's findings, no protocol has been established yet. He expects to know by Monday morning and that will dovetail well with my appt. with Dr. Dubay, the UCSF oncologist on Monday afternoon.

Thursday evening I caught the last flight out of Portland to Oakland and my beloved posse (my brothers Matt and Mike, Kelli Ann (niece) and Mike Dougherty (Matt's best friend and someone dear to me and the person who set up all these UCSF appts in about a week!) went with me to see Dr. Mann, thoracic surgeon, at UCSF on Friday afternoon. Although we all would've hoped for a miracle procedure that would solve all this, Dr. Mann didn't have that to offer. After a thorough review of my file and films, he concurred with everything the Portland doctors have told me. He also agrees there is a definite possibility of two cancers vs. one and thinks Dr. Karamlou is wise to pursue this before a course of treatment is established. We talked at length about options re: chemo and radiation and why surgery just isn't warranted at this time. I'm grateful for his additional counsel and that's he's willing to continue to partner with the Portland group on my file.

It was great to have them all in the examination room with me and you know the McCormick clan.....even in the worst of circumstances, we find ways to make each laugh with our typical bizarre McCormick humor. Kelli must've rolled her eyes a dozen times at how we could joke about this cancer, but you know laughter is the best medicine and God gives us humor for a good reason!

They'll all be with me on Monday too when I meet with Dr. Dubay, the UCSF oncologist. Clearly, the next step is chemo/radiation and I'm ready to get started and kick some cancer butt :) I still feel good and that's a blessing!

Today and tomorrow is time with my loved ones and all the things I enjoy most - we're celebrating Christmas tomorrow and it will be lots of love, laughter, good food and sunshine (sorry, Portland crew, it's sunny and almost tropical here - 50 degrees!). God has blessed me in each and every moment and I take none of it for granted.

Take a moment for yourself and celebrate the blessings in your day, remembering the reason for this season - Jesus. Hug your loved ones, eat a holiday cookie or chocolate for me and find something that makes you smile! Also, ask yourself why AJ Burnette and CC Sabathia would ever sign with the Yankees....oh wait a minute, that's a conversation for another day. :)

Love and hugs to everyone, thanks for being a part of my posse wherever you are!

Susan

PS - Just so the cancer doesn't consume, let's concentrate on one of my favorite subjects. Here's a question for you baseball trivia buffs. It's one that stumped me....Name each position player that won the MVP back-to-back (includes National and American leagues). There are numerous outfielders (i.e., Barry Bonds) that can claim this honor, but only one player per position in the infield. Send me your answers at subedoo_2000@yahoo.com (or call me) and, if you're correct, I'll send you a treat!

Thursday, December 18, 2008

Celebrating pre-Christmas in the Bay Area

Since the recent diagnosis, we have decided to get a second opinion from what I consider the very best in the industry. My best friend Mike Dougherty was able to pull off a feat we didn't think was possible right before the holidays. Below is the note Mike sent Sue Tuesday, just hours after she was diagnosed with pancreatic cancer.

Hi Sue,
I'm sure you already got this information from Harmony, but we got you in to see Dr. Mann (thoracic surgeon) on Friday at 3:00, and Dr. Dubey (lung oncologist) on Monday at 2:00. I got some referrals from Stanford today, and will try and see if I can get you in to see them as well. Harmony is awesome, and she's the one who got it done.

Mike

Mike also sent this note to Sue in preparation for her meeting with the Portland team this afternoon. I am sending this note because Mike is a cancer survivor and approximately 3 yrs ago, we didn't think he had much time left on earth. Today, he is constantly battling this dreaded disease (recent cyberknife procedures when nodules in his lungs expand to a certain size) and has a beautiful baby girl named Charlotte who just turned 1 yr and 4 months.


Hi Sue,
I've come up with a few questions/thoughts for you on Thursday:
Ask them to have your tumor tested for tumor markers, typically they can run a FISH test or a variety of other tests? Very important.
Ask about the use of targeted radiation ie Cyberknife to knock out your pancreatic tumor, and then right away into surgery?
Ask them to consider the use of some of the new "smart" cancer drugs like Avastin, Erbitux, Iressa, and Tarceva, in combinations with other chemo drugs?
Ask them about participating in clinical trials, because you haven't started treatment, you should be a very good candidate. (we will also ask UCSF about these as well)
Really push them on why they wouldn't do everything they could to remove your primary tumor first, you can always do chemo after surgery?
Two weeks after my lung surgery
I started chemo.
If I think of anything else, I will email you. Don't be intimidated by any of these doctors, they are here to help you, but typically they are not big risk takers, ie: will take the easy way, not always the most effective way. Also remember that you are different, you are not a statistic, you are young and strong and want to do everything possible to stay alive, tell them this. See ya Friday.

Mike's blog can be viewed at http://www.mikejendougherty.blogspot.com/

Sue will be flying into the Bay Area tonight returning 12/23 to spend Christmas with Mom, cousins, friends, supporters and everyone else she knows.

Mike & Sue are my inspiration and for many of you as well. May these words inspire you to re-look at certain things in your own life.

Thanks for all your support.
Matt

Monday, December 15, 2008

God said "Plan B"

The best way to describe today's results is to forward the note Sue sent to family this evening.

Hello dear ones,

I've talked with most of you today, so you know what Dr. Karulf told me this morning.....the cancer has definitely moved to the pancreas (confirmed with the biopsy results) so surgery is no longer an option and we move directly to chemo. I meet with Dr. Karamlou on Thursday at 4:00 and he'll tell me what the chemo protocol should be. Matt is talking with Mike Dougherty to see if I can get into his oncologist (Dr. Mann) and cancer team Friday or next week for the second opinion.

I know you're in shock with this news and I was too. Certainly not what I wanted to hear, and actually, didn't really expect, but regardless, God is still in charge and knows the path. I am grateful that God trusts me enough to be on this journey and pray that it will be an opportunity, as a cancer survivor (which I intend to be), to bless others with my story in the future. A very bumpy road ahead for the next months, but I am thankful He still (always) has me in the center of His palm and is with me every step of the way. I'm thankful too that I still feel good - no pain or other symptoms - and am enjoying some quiet time at home. If you've checked the Portland weather reports, you'll know what I mean. We are socked in with some extremely cold, snowy winter weather and schools are closed again tomorrow. With the wind chill, I think it's all of 9 degrees outside right now and I'm happy to be inside, snug and warm! I think there's a dvd and a big bowl of popcorn scheduled for the evening events :)

Love to you all, sending hugs and prayers,

Susan

Saturday, December 13, 2008

Continue to pray for reported results

Everything went great for Sue's biopsy on Thursday. Recovery went well and she was teaching the next day. They were able to biopsy the pancreas and the lymph nodes adjacent to the lung tumor in order to see the full picture. We will find out everything on Monday.

There are basically three scenarios as an outcome of the biopsy.

1. If the pancreas & lymph nodes have cancer, they will likely start chemo right away.
2. If there is no cancer in the pancreas & lymph nodes, surgery will be scheduled to remove the tumor.
3. If there is no cancer in the pancreas, but the lymph node has cancer, the oncologist will determine the road map and Sue will gain a second opinion here in the Bay Area next week.

Please pray for scenario two. Pray that Sue is in full recovery this time next month.

In HIM Always,
Matt

Wednesday, December 10, 2008

Brain MRI came back clean – no abnormalites.

OK, I’ll give you a few minutes to chuckle about all the comments to be made about the brain MRI. It is a hard phrase to put together….”They found nothing”? Or “There is nothing there” or….you fill in the rest. :-)
Regardless, the huge praise is there is no evidence of cancer in the brain – thank you, God!

As I was walking to the admit desk for Radiology yesterday (to check in for the MRI), I noticed a framed quote on the wall that I hadn’t noticed before. Mind you, I’ve walked by this area many times in the past weeks and for some reason, this frame caught my eye. It read “Do not be afraid and know that I am with you” (from Isaiah). I smiled and pointed it out to mom and said “I love how the Lord gives me little reminders and assurances that He is always with me”. Gave me great comfort for the rest of the day.

Later in the day, I met with Dr. Jaswari (the endocrinologist). Delightful man, very thorough and turns out we had lots in common with trips to South America. I’m scheduled for a pancreatic endoscopy on Thursday (the 11th) at 2:00 pm. Another fun “exploration” down the throat and into the intestines to get to the pancreas (with anesthetics!) – he’ll look at/and biopsy the nodule in the pancreas and we go from there. I’d ask what the prize is for winning this scavenger hunt, but I think we all know what I want (as does everyone!). Another “red herring” for Dr.Karulf :-)

The meeting with Dr. Karamlou (the oncologist) is rescheduled for Thursday, Dec. 18th and the outcome of that meeting will be dictated by what is found (or, more importantly, not found!) in the pancreas.

The blessings continue to flow abundantly. I am teaching today and will until they tell me I can’t – it is so wonderful to be with my kiddos. Yesterday, I noticed a tiny yellow rose bud on the rose bush in front of my window, such a little spot of “sunshine” and last night, I held a sleeping baby snuggled up against me for a few hours (Arly is all of one month old now) while visiting a friend. All that and Hawaiian chocolate with macadamia nuts too. The cards and calls and help I’ve received from all my dear friends and family – absolutely wonderful.
I feel so loved and so very blessed.

Driving home last night, I noticed a bumper sticker on the car in front of me. Dark blue background, white letters. It read “Expect Miracles” and I do! God gives us so many each and every day. Take a moment to celebrate the reason for this season – Jesus.

Love and hugs to you all, thank you so much for your prayers. God is listening.

Susan

P.S. It's easy to see why Sue is an inspiration to all. Reading her note inspires me and I'm sure each of you. Matt

Tuesday, December 2, 2008

The Roller Coaster Ride Continues

Well, it looks like I'm getting another ride on this cancer roller coaster.....the MRI showed no cancer in the liver (yeah!), but (and isn't there always one of those these days?), there is a nodule in the pancreas, approximately one centimeter in size. For those of you that aren't up on the metric system (and I wasn't), that's about .39 inches in size from what I'm told.

So, once again, surgery is off the table for the time being and the pancreas issue needs to be clarified. Yep, more tests. I'm scheduled for a pancreatic endoscopy on Dec. 8th at 1:00 pm and Dr. Karulf wants to go ahead with a brain scan - the brain MRI is also on Dec. 8th, at 11:30 am. Dr. Karulf also wants me to meet with Dr. Karamlou, the oncologist, this week, but no appt. set for that yet.

My "A" team of doctors is growing daily and I am grateful for them and all the kind, caring nurses and other staff. Thought it might be helpful to you to know who the docs are and what they do so when I refer to them, you'll know who does what:

Dr. Scott - Primary Care M.D.
Dr. Karulf - Pulmonary/Critical Care M.D.
Dr. Tsen - Surgeon
Dr. Karamlou - Oncologist
Dr. Jasrawa - Pancreatic Endocrinologist
Drs. Sheley and Cox - Radiologists

No doubt there will be more players to add to the list, but that's the lineup so far.

Must admit, this isn't what I expected or wanted to hear and the best word to describe me at the moment is weary. Emotionally, it's tough to go up and down like this, but I am grateful for a God who never wavers, never changes and I can stand firm in my faith. Great message at church on Sunday about how God is with us even in the fire (read Daniel 3 when you get a minute) and I know as I go through this, whatever it ends up being, He is still with me in every moment. My prayers are we get to shake up Dr. Karulf with another miracle from God. Won't it be cool when this nodule proves to be another "red herring"? That's what I'm praying for!

So what's the blessing? I didn't get this news until today so I was able to thoroughly enjoy a wonderful Thanksgiving holiday weekend with friends, family and great food. Hope yours was equally good! And I can now be home in the evenings this week to care for my dog who had to have some minor surgery yesterday night to clear up an infected nail/pad. She's wearing a lovely plastic cone right now - remember the old RCA ads with the dog listening to the old record player? Corbett looks like she's wearing one of the old fashioned cone speakers. Let's just say she's not too happy with the whole thing at the moment :)

Enjoy this Christmas season, keep eating chocolate and savor the blessings of the day. I know I will!

Love to you all,
Susan