Update from the oncologist: Surgery is off the table for now.

Hola mi familia & friends,

Today was the first day back to school after the three week snow/Christmas break - it was great to see the kids again and hear the stories of their snow adventures, but all of us are out of the classroom routines and needed a little "school WD-40" to smooth out the kinks. That alarm sure did go off awfully early this morning!

I met with Dr. Kate Morris this afternoon - she is an oncology surgeon and the appt. was to determine whether or not the pancreatic nodule could be removed before chemo-rads begin (my new word for the day, this is how the doctors refer to chemotherapy and radiation). Another really delightful doctor and I know I will work well with her as we continue on this cancer journey. Anyone who has a large stuffed hippo in one of her office chairs and a great story to go with it.....we'll get along fine!

The upshot, after lengthy conversation and reviewing the MRI that shows where the pancreatic nodule is in relation to other organs, blood vessels, etc. is we are not going ahead with the surgery at this time. As was explained to me before, if the nodule can be resected with minimal complications and a quick healing time, it would the optimum thing to do. Dr. Morris explained why they (she and Drs. Tsen and Karamlou) are not convinced this is the best option. The nodule sits at the tail of the pancreas (that is good) but is right next to a major blood vessel connected to the spleen. Ideally, the nodule can be removed with no impact to the blood vessel (about the thickness of a thumb - it's a big one), but this is an unknown until she is actually in there. If it turns out the blood vessel is impacted by the nodule, she would have to remove the spleen and it would not be a quick recovery at all. Also, if there are any leaks in the pancreas (digestive juices going places they shouldn't in the intestine) after the surgery, that could also be a major problem. Evidently, the tissue in the pancreas is the consistency of wet Kleenex and not easy to work with. I asked about Cyberknife and she is very familiar with it, but says in this case, it would make surgery at a future date very risky. One of the times it would hurt more than heal.

To use her words, taking the nodule out right now is a gamble. If all goes well and I heal quickly, the gamble paid off. If it doesn't and I don't heal quickly, the gamble would mean no chemo-rads. for a long while and that, truthfully, could take away any chance to heal me. Very hard words to hear, but not a surprise. I knew this going into the appt. today and it is the reality of where we are on this cancer path.

She met this morning with Drs. Karamlou and Tsen and they are evaluating many options to come up with the best overall plan. As I've heard from just about every doctor in Portland and SF, my case is not typical at all and there isn't a large data pool to draw from in terms of prior treatments. Not that my situation hasn't happened before, just not a lot of data to compare. There is a "circling of the wagons" with all the experts right now - the Legacy group here in Portland, the UCSF group and Dr. Brett Sheppard at OHSU. Turns out Dr. Morris knows him (Dr. Sheppard) well and plans to contact him tomorrow for his input. Also, the pathology stains have been sent to UCSF for a second review by their pathologists, just to be absolutely certain that everyone agrees on the final diagnosis of the two cancers. The lung stain was sent last week and the pancreatic stain was sent FedEx today.

The remainder of the appt. was spent talking about chemo-rads., what types will likely be used and how they will be administered. I have choices about the different types of ports/pic lines that can be put in either my arm or under the skin by my collar bone - pros and cons to both, but it's up to me. The purpose is to have an insertion point for the IV (for the chemo) so they don't have to put a new needle in me every day (works for me!). The chemo agents are the same as the ones Dr. Dubay talked about in SF (remember the light reading material I was given about the different drugs?) and Dr. Karamlou will confirm all this when I see him on Thursday. He is also researching any clinical trials that would be beneficial for treatment. Also, I will meet the radiation doctors too - a few new folks to add to my "A" team. Unless there is a significant change of opinion, I expect to start chemo either this Friday or early next week.

The goal now is to shrink/eliminate the tumors with chemo and radiation. Surgery is not completely out of the picture, but it will be at a much later date, if at all. I'm still feeling good and that's such a blessing. Dr. Morris checked my lungs and abdomen and, just like Dr. Dubay, didn't hear or feel anything wrong. Both have commented about how unusual it is to have absolutely no symptoms, given the size of the tumor - quite an anomaly, I'm told. I just smile and tell them God has His hedge of protection on me and I'm grateful for His mercies.

Lots ot digest, I know, but we are moving fast now. As I was told before, once all the information was in and evaluated, things would move quickly and they are. I know I'm ready to kick some cancer butt! :) Have to get all this cancer stuff healed so I am ready for my summer trip to Ashland for the Shakespeare Festival, Charlotte N.C. in November for my gal pal trip and baseball (pitchers and catchers report to spring training in just a few short weeks - yes!). This is the year my Giants go to the World Series, I just know it!

As I start this next step, the chemo and radiation, I am reminded of one of my favorite passages, Philippians 4:13 which reads "I can do everything through Him who gives me strength". These are words that give me great comfort and I hope they do for you too.

Love you all much, will talk to you soon, hugs all around,

Susan/Sis