Wednesday, May 20, 2009

She might be able to garden after all

For the record, I don't watch American Idol. Yesterday and today were the first times I've engaged in the show, but it's certainly turned into a metaphor or parallel universe to our life right now! The underdog won. Mum's been kinda underdogging around the last two months, too, but today we got some real direction. Real, noteworthy direction with timeframes! 'Course, we're used to sticks being thrown in our wheels, so we remain cautious.

Here ya go:
  • Transplant is out. Criteria must be met for a transplant because it's a last-ditch effort for people with liver or bile duct cancer. The tumor must NOT be resectable to meet that criteria, and the committee has determined that mom's tumor IS resectable. They are also concerned about her tumor growing extensively during the year it would take to get a liver. If that happens, she'd be dismissed from the transplant program and unable to receive a resection. There is one way the transplant could re-enter the picture: if mom's cancer has spread into her stomach lining -- we don't think it has. More on this below.
  • Total resection surgery is in. The initial treatment diagnosis mom received was that her cancer had spread too far to be a resection candidate. In a resection, they take portions of the biliary system, accompanying vessels and arteries, and liver. They initially thought her portal artery, which humans cannot live without because of it's important partnership to the heart, was encased with tumor. Now, even if there is some tumor in it, the lead surgeon feels confident that he can reconstruct the artery. Her case has been debated at length by the GI and Hepatology staff, and the top-of-the-line surgeons on both the transplant and resection side have agreed that resection is the best option with the best possible outcome.
  • Why the backtrack? Just par for the course? Kinda. We're grateful they didn't make a hasty decision on treatment and pleased that despite the run-around, a sound decision has been made and each small point, from post-surgery quality of life and the reality of how long it takes to get a liver, have been discussed. At the very least, we've all been heavily educated on transplant procedures.
  • What does a resection mean? Mom's new surgeon (described by head of GI and Hepatology as one of the top 3 surgeons for cholangiocarcinoma [bile duct cancer] resections in the country) feels confident he can remove all of the tumor. One member of mom's healthcare team told us that if he had this disease, he would want mom's surgeon to complete his resection surgery. He has also been described as one that would not take on a case unless he knows it's something he can do to perfection. I would by lying if these statements did not provide supreme comfort to all of us. My dad's cancer surgeon was also top of his field. And, well, that surgeon saved his life.
  • The liver is made up of two, non-equal sides: the right side is typically larger, making up around 60% of the liver. The left side makes up the remaining 40%. The majority of mom's cancer is within the right side of her liver and biliary tree. It does not appear the cancer is on the left side. Because her entire right side will be removed, her remaining left side must encompass at least 25% of liver functioning during surgery and one week post-op. During the first week post-op, her left-side liver will regenerate itself by 80% and hopefully, she will be cancer-free (I screwed that up initially, but editor mom fixed it post-publication!).
  • What next? The docs are having 3D computations rung up on mom's liver size now. Once the surgeon consults on the results, they'll likely move straight into surgery if her left side is big enough. If it's not, they'll perform an embolism where the right side will be shut down via catheter through her leg. Then, the right side will begin to shut down and shrink. The left side will automatically grow larger and become sustainable enough for the surgery.
Here are the next-steps for getting to resection:
1) Determine size of left side of liver.
2) If left side is big enough, we go straight to surgery steps. If the left side isn't big enough, the right side will be shrunk and the left side will grow larger. Once it's big enough, we go to surgery.
3) Surgery is a two-part process: first, a laparoscopic procedure will take place to scan for cancer cells in the stomach lining. If the stomach lining appears cancer-free, the surgeon will move to step two: immediate resection while still in the OR. If cancer cells are found, the resection will not take place and transplant will again be up for discussion.
4) Initial recovery from the resection will be around 1 to 2 weeks, but it will take months for her to fully recover.
5) There will be no chemo/radiation prior to the resection b/c they would destroy the bile duct. They would only occur if transplant takes place.

This changes our scheduling for the remainder of May and all of June, but perhaps we'll be bringing her home healthy faster than we thought. There is a lot of risk in the surgery, but... it is what it is.

I know all of your thoughts and positivity and yellow-ness will help her move through each stage of the coming days with success and good health.

Take a breath. Go yellow!

2 comments:

  1. WOW !!!
    What a game plan they have for you Paulette. There going to have you home, healing in no time.
    Yellow Rocks!
    Love, Mary Kay

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  2. Good Morning, Paulette.

    Wow, although there are still some hurdles ahead, it sure seems as though yesterday was a huge leap from the unknown into the known. Wave the flag for a yellow lap ... not of caution as in the Indy 500 ... but as hope and light and encouragement! Can you picture two people creating a portable chair by crossing their arms and grabbing each other's hands [I'm not so hot at explaining, sorry] and your hopping up on the chair they've created to carry you for the next mile or two? Those are the arms of friendship and the hands in prayer that are carrying you from today into tomorrow into the next day. You don't have to run for now, Paulette, but the race is on more now than ever!

    How awesome is God's Word; we try not to act surprised when He does what He promises us to do in us, for us, and through us. He has prepared your body and has watched over you and orchestrated the tests, the decisions, the particular medical experts working on your case ... and now He is strengthening your body for the surgery. He knows, He cares, He is in control.

    At this time of the year, we open our windows to bring in the cool air throughout the night, and as I type here and the outside is still shrouded in darkness, I am listening to the symphonic selection that the Lord is producing via our wind chimes. The metallic cylinders clink and clang randomly and without exact rhythm, and yet the overall effect is musical and soothing, majestic and melodic.

    Lord, sometimes our lives seem to be at the mercy of the wind drafts that push circumstances together into disharmonic sounds, and we can't find a melody within those dissonant sounds. But we can trust the Holy Spirit as He moves the myriad of situations into an orchestral masterpiece that swells into sounds of strength and confidence, then backs off into almost inaudible tinkles of gentleness and meekness. Often there are even interludes of silence that become mere measures of rest before the next musical tones begin a new movement in the symphony.

    There doesn't have to be much of a breeze for the wind chimes to play because the metallic bars are placed close together. Our lives, too, do not have huge spaces between God-orchestrated events ... and what sometimes we "hear" (consider) as clashes or disharmony or chaotic sounds resolve into musical masterpieces of discovery: we discover once again how much God loves us and cares about the concerns of our hearts, how He has a plan for our lives that began literally before we were even born, how His grace and mercy ground us and keep us planted but also pliable, and how His Word contains the answers to all of the questions in our hearts. He is faithful to the integrity of His promises, Paulette, and His grace is inexhaustible as we daily open our hearts to His awesome wisdom. Do you hear His wind chimes within you?

    Today's Joke: What's the definition of eternity? Four blondes at a four-way stop sign.

    Encouraging Words: "And I am sure that God Who began the good work within you, Paulette, will keep right on helping you grow in His grace until His task within you is finally finished on that day when Jesus Christ returns." (Philippians 1:6)

    God loves you, Paulette ... and so do I.

    Praying for you,
    Joyce

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