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Jay Lake
Date: 2011-04-28 05:19
Subject: [cancer] Meeting with the surgical oncologist
Security: Public
Tags:cancer, conventions, health, personal, travel
Yesterday I met with my surgical oncologist. They were uncomfortable with the whole issue of the surgery, given that last fall they took out the wrong half of my liver. We talked about this directly a little. They were apologetic, but admitted that given what we knew at the time, they would make the same decision again. They did regret not going open incision last time, as an inspection of the liver while I was in surgery would possibly have uncovered this tumor. I pointed out that while we were wrong, in my opinion it was the best decision we knew to make in the moment.

They also talked a bit about this tumor and my current situation. Their concern was providing as effective treatment as possible so we don't have to keep coming back to these issues over and over. They are in full alignment with my medical oncologist's treatment goals.

Fundamentally, the tumor is addressable. It's near the surface of 'segment 6', so they're planning to take much of that segment. They do not want to resect the entire lobe, as that will take too much liver tissue, though they might have opted to do so if I still had my left lobe intact. So they'll be cutting around it, in effect, taking about 15% of my current liver mass.

This go round they are absolutely going open incision. That in turn affects my recovery time, but my surgical oncologist is very much feeling the need to do a close inspection of my entire liver with both instruments and their own hands.

They do believe this tumor predates the last chemo sequence, that what had been diagnosed as a hepangioma was in fact a tumor all along. This may or may not ever be proven, but they will look for evidence of that during pathology.

As I already understood, they view this as good news, the significance being that the presence of this tumor is not evidence that the FOLFOX-Avastin sequence failed. Even so, we still are going to do FOLFIRI because of the possibility that this tumor has in turn shed further groups of 'seed' cells.

My surgical oncologist expressed concern about my weight and my fat intake with respect to FOLFIRI, as the irinotecan component of FOLFIRI can cause liver damage, through chemotherapy induced hepatic steatosis. They want me to go on a very low carb diet, cutting out simple sugars, baked goods and so forth. Essentially, Adkins. They do not want me to go all the way to a ketogenic diet.

We are going to follow my medical oncologist's 4/cut/8 plan of four chemotherapy sessions, the surgery, then eight more chemotherapy sessions. With new appointments made, this now looks as follows:

Tuesday May 10, 2011
Port implant surgery

Thursday May 12, 2011
Pre-chemo party at DiNicola's restaurant in SE Portland

Friday May 13, 2011
First chemo sequence

Friday May 27, 2011
Second chemo sequence

Saturday June 4, 2011
JayCon at Flying Pie on SE Stark

Friday June 10, 2011
Third chemo sequence

Friday June 24, 2011
Fourth chemo sequence

Tuesday July 19, 2011
Liver resectioning surgery with 4-6 day hospital stay

Chemo will resume again in late August, possibly Friday, August 26.

Additionally I may try to go to ReaderCon right before the surgery, and am definitely going to Renovation August 17 to 21.
Post A Comment | 16 Comments | | Flag | Link

User: elizaeffect
Date: 2011-04-28 12:51 (UTC)
Subject: (no subject)
Keyword:kirk this sux
You are awesome and will beat this.
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User: cathshaffer
Date: 2011-04-28 14:18 (UTC)
Subject: (no subject)
Good luck, Jay.
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Brent "Chip" Edwards: Seascape
User: chipuni
Date: 2011-04-28 14:37 (UTC)
Subject: (no subject)
My best goes to you, your doctors, and your surgeons.
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User: torreybird
Date: 2011-04-28 15:38 (UTC)
Subject: (no subject)
Best wishes for strength and courage through this fucking awful ordeal.
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User: shelly_rae
Date: 2011-04-28 15:38 (UTC)
Subject: (no subject)
good luck
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User: threeoutside
Date: 2011-04-28 16:01 (UTC)
Subject: (no subject)
Give 'em hell, Jay.

But then, we don't have to tell you that, do we.

Good thoughts, as always.
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User: madrobins
Date: 2011-04-28 16:03 (UTC)
Subject: (no subject)
You have a plan. You have good people on your side. You will prevail.
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User: keikaimalu
Date: 2011-04-28 16:20 (UTC)
Subject: (no subject)
Are you going to do that low-carb diet?

Best of luck in all this. May you spend the next several months floating in a sea of comforting support.
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W. Lotus: Peaceful
User: wlotus
Date: 2011-04-28 16:22 (UTC)
Subject: (no subject)
I'm holding a good thought for you through all of this.
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User: deborahjross
Date: 2011-04-28 17:30 (UTC)
Subject: (no subject)
In reading your account of the consultation, I'm struck by the sense of collaboration, that you are taking an active part in evaluation and decision making.

What Everyone Said.

Fortunately, we live in an age of specialty foods, so going very-low-carb need not be as onerous as it would have been even a decade ago.
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Kevin Roche
User: kproche
Date: 2011-04-28 17:45 (UTC)
Subject: (no subject)
So glad we will still get to see you in Reno!
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Kari Sperring
User: la_marquise_de_
Date: 2011-04-28 18:39 (UTC)
Subject: (no subject)
thinking of you.
Kari xxx
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cathschaffstump: needlebone
User: cathschaffstump
Date: 2011-04-28 19:03 (UTC)
Subject: (no subject)
Good luck, Jay.

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User: desperance
Date: 2011-04-28 22:23 (UTC)
Subject: (no subject)
Good luck and love attend you. As they shall.

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User: msconduct
Date: 2011-04-29 01:15 (UTC)
Subject: (no subject)
It's a bit ironic describing as "good news" somthing that involves surgery, chemo and (ack!) Atkins, but it sounds very much like what it is. If the tumour predates FOLFOX, barring the trivial little cleanup detail of surgery and a year of hell you could in fact already be post-cancer in terms of recurrence. (Not informing you of this stuff, because you already know it. Just marvelling at it, because it would be deeply excellent.)
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User: emmainfiniti
Date: 2011-04-29 11:39 (UTC)
Subject: (no subject)
Wishing you good luck on the cancer-go-round this time.
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