Happy: A Quest for Life After Death

Sunday, July 30, 2006

Surgery Scheduled

Mat's surgery is scheduled for Monday, August 14, at 6 a.m. I think I prefer the middle of the night. I'll be at the hospital, chewing my nails, and J.R. and Amanda will take care of the kids (although they don't know this yet -- surprise!).

If you haven't seen us lately, here's a picture of our family -- from top to bottom, clockwise: Ian (5), Colin (19 months), Kimberly (now officially old), and Mat, pre-hair loss. Oops -- pre-complete hair loss.

Saturday, July 29, 2006

The Surgery

Meanwhile ...
The list of treatment options for treating metastatic neuroendocrine tumors is short, and other than complete removal with surgery, each has a low probability of success. In case the new treatment didn't work, Mat decided to revisit the possibility of removing the cancer by taking out portions of his liver (called resection).

He met with Dr. Tanabe at MGH on July 18, expecting to hear that resection was not an option. Instead, he said yes ... with the condition that Mat's cancer had not grown more than 25 percent since the last MRI.

Mat had tests almost every day this week to check on the cancer growth. We found out on Friday that Mat had a "minor response" to the streptozocin and adriamycin. Although it did not hit the "home run" we're looking for (and that Dr. Ryan keeps talking about -- I think "home run" here may be a euphemism for "miracle") -- it kept the cancer stable, and thus operable!

Although Dr. Tanabe is willing to perform the surgery, one of the things Mat likes about Dr. Tanabe is that he is realistic. Other surgeons he's talked to have been overly optimistic about the probability of a cure with surgery, and lost some credibility with Mat and Dr. Ryan as a result. Dr. Tanabe is managing expectations: He told Mat that he thinks the probability of five-year survival with surgery is 25 percent -- give or take 25 percent. I'm hoping he's a little too pessimistic.

The plan is for Dr. Tanabe to remove 70 percent of Mat's liver -- the entire right lobe and much of the left lobe, leaving the center. The liver will regenerate within a couple of months. This is very hard work, so Dr. Tanabe expects Mat to be very, very tired. The surgery will be performed within the next 2-3 weeks -- any longer, and it may be too late.

It is possible that when Dr. Tanabe examines Mat's liver during surgery he will find more cancer than is shown on the MRIs and CT scans. If that is the case, and if he doesn't think he can remove 99 percent of the cancer, he will not perform the resection. Does everyone know what to fast and pray for? Good.

Here's a web page with Dr. Tanabe's picture and quite impressive resume: http://www.mgh.harvard.edu/cancer/care/adult/melanoma/team_clinician.asp?id=258

We'll have a date for the surgery on Monday. I'll keep you posted.

The Sequel

February 2006
After the surgery, Mat's oncologist, Dr. David Ryan at Massachusetts General Hospital, started him on a schedule of regular follow-up tests. In early February 2006 we learned that the cancer had resurfaced, this time in his liver. The devastating news was that with 10-12 tumors spread through both lobes of Mat's liver, the cancer appeared to be inoperable.

Dr. Ryan is a nice man with a lovely wife (I've heard) and four children. Here's a link to a webpage with Dr. Ryan's (unflattering) picture and resume:

The Drugs - April 2006
Mat first tried a combination of Temodar, a chemotherapy drug, and Avastin, a cutting-edge therapy designed to approved therapy designed to inhibit angiogenesis, the process by which new blood vessels develop and carry vital nutrients to a tumor. He received infusions of Avastin at MGH every two weeks, and tolerated the treatment well. Mat was occasionally tired, but kept up almost full-time with work. His nausea was pretty well managed with medication.

New Drugs - June 2006
The Temodar and Avastin didn't work -- after eight weeks of treatment, the cancer had grown substantially. In late June, Mat started on an older chemotherapy combination of Streptozocin and Adriamycin, which sucked. Mat had daily infusions for a week that made him very tired and, about a week later, made his hair fall out. As an amusing follow-up to the week of infusions, Mat was hospitalized for pneumonia on July 4. In the middle of the night, of course.

Mat was scheduled for infusions every three weeks, but Dr. Ryan had him skip Cycle 2 because his white blood cell count was too low.

The Beginning

When I signed up for this blog months ago, I thought it would be a showcase for my witty comments and insightful observations about life. Maybe later. For now, this blog is about Mat's cancer. I hope you, our friends and family, will be able to get updates about Mat without worrying about whether you're asking annoying or inappropriate questions. I can't think of how to write this week's update without the background, so here's the history.

The Beginning - April 2005
Mat was diagnosed with a neuroendocrine tumor in his pancreas in April 2005. As it always seems to happen, it was the middle of the night. Mat woke up with excruciating pain in his abdomen. He tried to get back to sleep for a couple of hours, and finally drove himself to the nearest emergency room. Nothing obvious was wrong with him -- vital signs OK, no profuse bleeding, no bones poking out -- so he sat in the ER all day. Mat said he thinks the receptionist there was hoping he would leave.

He didn't leave, so finally he was given an MRI that showed a "mass" in his pancreas. (ERs and doctor's offices are full of euphemisms.) He was admitted to Mt. Auburn Hospital in Cambridge, Mass., and had surgery the next evening. Dr. Armen Kasparian performed the surgery. Everything went well -- Dr. Kasparian got clean margins (indicating he removed all of the cancerous tissue) and sent Mat home after about five nights in the hospital.