And the Game Changes Again

We saw Dr. Weekes, the CU Denver oncologist, today. He reviewed the PET scan results and after consultation with Dr. Cavanaugh the radiation oncologist, told us they both agree that the cancer has metastasized to her liver. A lesion is visible on her liver, plus fluid where it shouldn't be in her pelvis, and fluid in the pleural cavity near each lung.

While each of these findings could have alternate explanations, the chances of all 3 occurring at this time from other causes and in the presence of the cellular evidence from the bile duct are astronomical at best. Additional diagnostic procedures (MRI, liver biopsy, lung fluid biopsy) could be conducted to unequivocally establish the diagnosis, but the treatment options would not change. The doctors' opinion is that it is better to get started on treatment rather than spend another month doing tests to confirm what they already believe.

The treatment strategy described last week (when we believed the cancer had not spread) was focused on curing the cancer with aggressive radiation and chemo. The strategy for treating metasatic disease (stage 4 cancer) is to focus on keeping Michelle as comfortable as possible while extending her life as much as we can. The primary focus will be on systemic chemotherapy, with radiation only if it can help alleviate specific symptoms.

We are considering participation in a clinical trial at CU Denver, which would require weekly office visits and IV treatments 3 of every 4 weeks at the CU Denver Hospital 75 minutes from home. The course of treatment also includes 2 other oral medications Michelle could take at home. The main difference between the clinical trial and the FDA approved "standard of care" is the addition of a new drug. Results from the trial have exceeded their expectations so far, but we don't have statistics. If we decide on the "standard of care" treatment, all office visits and IV treatments could be done in Fort Collins.

Michelle has an appointment tomorrow with Ft. Collins oncologist Dr. Marschke to hear his take on the PET scan findings and discuss options from his perspective. Dr. Weekes encouraged us to keep Dr. Marschke involved, even if we choose the clinical trial.

Meanwhile, jaundice has again reared its nasty, itchy, yellow head. We noticed Michelle was starting to turn yellow again Sunday evening, and last night the itching returned. Her labs from Friday indicate her bilirubin level has started to climb again. Since they can't start the chemo (or at least the clinical trial we are seriously considering) until her bili levels come down, Dr. Weekes contacted Dr. Chen (who is currently on vacation - amazing how the right doctor can make things happen immediately) and got him to move up the ERCP schedule to this Friday instead of waiting until January 5. The likelihood is that the stent in Michelle's bile duct is breaking down or has become blocked and needs to be refreshed.

We also noticed Michelle is having difficulty breathing in the evening and at night. We were warned that this might happen, so we have retained the oxygen tanks and concentrator. Her breathing returned to normal Sunday night when we restarted the O2, and we used it again last night.

We've really been feeling the love from all of you recently. Our kitchen and dining room look like a miniature florist shop, and we've been receiving much appreciated cards and emails with warm wishes and prayers. A neighbor brought over a pan of lasagna and a bowl of fresh fruit. A dear friend from Michelle's work brought his famous home-made pretzels, twice! And several people from Bill's work sent a care package from Omaha Steak company which should last us for several meals. Thank you all so very much. It's hard to express how gratifying it is to find out how well we are loved by the people in our lives.

Michelle has started what she calls her "healing wall". She printed 8x10 pictures of friends and family members who have fought the good fight against cancer and other serious diseases, and who now serve as an inspiration to her in her battle. We may be hearing bad news, and we know there is a tough road ahead, but with your support, God's grace, and Michelle's deep wells of strength, courage, and faith, we will get through this.