With the Oncologist 2/27/12

We met with the oncologist, Doctor Stinnett and his staff today.  Sheila’s cancer was classed as a stage 2A.  We had thought that we were in the grey area between the end of stage 1 and the beginning of stage 2.  The actual rating is a T3,N0,M0.  This roughly means that the cancer because of size, shape, penetration past the colon muscle into the colon layers, was classed as T3, there was no migration into the lymph nodes, and there was no evidence of metastases.   We are awaiting the blood test results that will be checking the level of the cancer marker against the original marker blood test when the cancer was present.  They will also be sending in a test for the microsatellite instability (MSI) this week.

The present recommendation of the doctor, pending any adverse information from the 2 incoming tests above, is to NOT proceed with Chemotherapy.  Vigilant surveillance is recommended which means a blood test to look at the cancer marker every 3 months, a CT scan every 6 months, and a colonoscopy every year for the next few years.  While some of the vigilant surveillance testing is uncomfortable, we feel that the side effects are much less than those from Chemo!

We have certainly received many great blessings during this ordeal, and while it is not over yet, we are pausing to ponder the blessings we have received from our friends and from above.  Thanks to all of you who have helped by taking care for our children in many ways, by helping with our physical, emotional and spiritual needs.  The outpouring of love, compassion, and kindness has been truly staggering and humbling.  How blessed we are to live among those who are truly saints!  Blessings have been pronounced and very many prayers were offered in our behalf and we have felt the power from these!!

After Surgery Day 12 - 2/17/12

It has been a really hard week for Sheila.  Vomiting and Diarrhea have been the norm for all but the last 1 ½ days.  We think that we have turned a corner in that she has learned out to control the nausea.  Boost and similar drinks is all she was able to eat for most of the week. 

We went to the Surgeon for a follow up visit today.  He said Sheila was healing well.  She has been off of the pain pills for about 3 days.  Because she has had such a problem with nausea he wanted to wait a week before referring her to an oncologist who is the specialist we will need to see to determine if chemo-therapy is in our future. 

I suppose this means we will not know much more about Sheila’s therapy future for a couple of weeks.  What I do know is that there are a bunch of good cooks near us and my family has been well taken care of.  Thanks to all!!

After Surgery Day 5 - 2/10/12)

Morning:

Sheila woke more refreshed this morning and was able to keep some breakfast down.  Doctor Oberg visited us early this morning.  We should be getting off the IV, taking a shower, and trying an oral pain medication.  We need to see the results of these things before we can progress to the next step (going home).

The pathology report was not available at 6:30, but Dr. Oberg just called me (9:00 am) to relate the results.  The cancer is a low grade Adeno Carcinoma.  It has worked its way through the bowel muscle, but has not broke through the outer lining of the intestine wall.  This means it had not grown into nearby organs.  We had a 16 lymph node sample and all lymph node migration biopsies were negative to the present of the cancer.  I did not get an answer to the MSI, but we may still be in a stage 1 type cancer although because of the size it may still be considered a stage 2. 

It is good news that the lymph nodes have not been affected!  This would be stage 3 and chemo is almost always prescribed for that.  Life expectancy is less too!  We will not know if chemo will be prescribed for Sheila’s case until we meet with the specialist.  This meeting will not be next week, but soon thereafter I suppose.  We will meet with Dr Oberg again in 1 week to see where we go from here and get a recommendation for a specialist from him.

http://www.cancer.org/Cancer/ColonandRectumCancer/DetailedGuide/colorectal-cancer-treating-by-stage-colon

http://en.wikipedia.org/wiki/Colorectal_cancer

Rest of the Day:

We were waiting to see some real good progress and we did today!  We are out of here!  Homeward bound and this will be the last blog from the hospital for this stay!  We will plan on updating the blog when we see Dr. Oberg next week, or if another significant event happens. 

Thanks to all for your love, support, thoughts, prayers, and kindnesses.  We are going to fight this thing and we a planning on winning!  Sheila’s Fight is may not be over yet, but she has given it a hero’s fight this week!

After Surgery Day 4 (Morning 2/9)

Morning

Sheila had a hard night. The pain pill she was given made her nauseous. They gave her several things for this, which delayed the end result to be while the surgeon was visiting in the morning. He had the opportunity to catch it in the barf bucket. TMI! (Too Much Information). This was good however because he ordered her different medications and she is sleeping well now. The colon has started working so she is being upgraded to a full liquid diet. I think that we will see some real good progress throughout the rest of today.

 Rest of the Day:

Well, so much for my optimism this morning!  The nausea continued and then the colon got active, and then hyper active.  The IV leaked out of the vein and her hand swelled up like a softball.  She told them it was hurting, but they said that was because it was a different kind of fluid going in.  She is sleeping well now (10:30 pm).  We will hope for that real good progress tomorrow.  We did not get the pathology report like we thought we would today and will hope for good news there tomorrow as well.

Many people have helped with our children over the last few days.  The fridge is full as are the tummies!  The children have been so well taken care of that it may seem harder for them with their mother at home!!  I don’t think they missed too many scout or YW meetings, ball games, or even ball practice!  Rick has acquired a steady part time job this week doing janitorial work for some of the local schools and has not been able to provide as much help with rides as we were initially planning. If this blog were not published too far and too wide I would mention that his Mother is sure proud of him.  I am told that all of the children have performed as well as could be expected without their mother or father being around much.  I am sure that this was, at least in part, because of the help they received from friends.  Again Thanks to all for your help.  

After Surgery Day 3 - 2/8/12

Sheila’s mobility has increased and she was able to get off of the IV pump this morning.  The outer bandage was removed and the wound looked good.  There was no re-occurrence of the fever during the night.  We talked to the Doctor and tried to determine the stage of the cancer, but he said that we would be referred to a specialist in patient treatment after cancer removal to determine the stage of the cancer.  The specialist would help determine the best course of action after looking at the pathology report on the part of the colon and cancer mass that was removed.  Dr Oberg thought that with the size of the mass that chemo would probably be prescribed, but said there are a lot of other factors and a specialist would be able to give the best diagnosis.  I think this means that even though we will get the results of the pathology, probably Thursday, we will not know the diagnosis for after surgery treatment until after meeting with the specialist.

Later today we had a real battle with nausea. Since we were off of the IV, pain pills were prescribed instead of the morphine IV pump.  Either the pills, or the fact that things were not moving through the bowel, or something unknown, made Sheila very nauseated. It took at least 5 hours and a couple of medications to get this under control.  Many say that the 3^rd day after this kind of surgery is the worst.  We are hoping that this will be the case here and that we are home for the week-end.

Thanks to all for the help with our children at home.  I could not be here with Sheila, if it were not for all of you.  THANK YOU!

After Surgery Day 2 - 2/7/12

Thanks to all of you for your support and prayers!!

Sheila was alert and attentive most of the morning.  She was out of bed on 7-8 occasions making trips to the water-closet and a couple trips down the hall.  I am sure these felt like marathons to her.  The staff agreed that she is doing very well after this type of surgery and may be a bit ahead on the recovery path.

In the early evening Sheila’s condition worsened a little.  She developed a low grade fever (99.5).  She was doing so well earlier that we had decided to take the kids over to see her.  Our children ended up visiting her during this down time.  She was not able to communicate much so we took them home quickly and had her sleep.  After another 2-3 hours of rest she woke up, trekked to the in room facilities, and laid back down.  The fever had subsided and she appeared to be much better than earlier.  She is also developing lower abdomen noises indicating that the colon may be waking up.  This is what we need to have happen next.

I was doing some research and found the following link that discusses the stages of the colon cancer.  We are not exactly sure of the stage we are in yet.  The pathology report will indicate if the cancer has spread to the lymph nodes.  From visual inspections we think we are between stage 1 and stage 2.  I need to ask the Doctor if the cancer had broken through the colon wall which would make it a stage 2.  Stage 1 and some Stage 2 cancer treatments do not include Chemo or Radiation treatments.  What we do not want is stage 3 where the cancer would have traveled to the lymph nodes.  Chemo and some Radiation are usually prescribed in Stage 3 cases.

http://www.cancer.org/Cancer/ColonandRectumCancer/DetailedGuide/colorectal-cancer-treating-by-stage-colon

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001308/

The Rest of the Day After Surgery 2/6/12

Sheila has been in and out of sleep mode all day.  The doctor and the nurses believe she is on or even a little ahead of schedule for recovery from this operation.  She was able to have a video chat with her grandchild Robbie last night.  That really perked her up.  Afterwards she took a dose of morphine and was out for a couple of hours.  She loves her children and grandchild and they have always seemed to help her overcome all odds.

We have received a lot of email, texts, and blog comments.  Thanks to all of you.  During Sheila’s awake times I have rehearsed all of them to her.  We have laughed, smiled, and cried with all of the uplifting and humorous things that have been sent to us from our friends and family.  Thank YOU!!  for all of your prayers and good wishes!

Tomorrow will be a harder day with the necessity to make it to the water closet, and with the pain medication and oxygen levels being lowered.  We are greatly encouraged by the results of today and expect that tomorrow will hold more good things leading to Sheila’s complete recovery.

The Stolen Sample 1/2012

Earlier in January Sheila went to her GP Doctor who she has liked to have a general physical.  Dr. Hobbs gave her the exam and prescribed a colonoscopy as a general procedure for those who have arrived at the age of advanced physical body accountability.  Sheila was in denial about having reached this age and decided that she would not want to do this immediately. 

A week or so later the office of Dr. Hobbs called and informed Sheila that she had the evidence of blood in her stool.  Sheila informed them that they had messed up their records because she did not give a stool sample.  They told her that their records could not be wrong.  Emphatically Sheila responded that she did not give a sample.  A set of sample cards were then provided by Dr. Hobbs office and another set of samples was requested, which all showed positive for blood in the stool. 

Sheila was then forced to admit that the previous test must have been done correctly and that a sample must have been taken when she was unaware of it.  Therefore we have labeled the initial sample as the stolen sample!  We are grateful to Dr. Hobbs for stealing it and following through with the test results!  After the colonoscopy Dr Flanders called Dr. Hobbs directly and informed her that the testing she did had probably saved Sheila’s life.

With the additional information of blood in the stool, Sheila decided that a colonoscopy was needed and consented to the procedure.

Post Surgery Report 2/6/12

Sheila’s surgeon, Dr. Oberg, met with me at about 10:00 am.  He reported that the surgery went as well as could be expected.  They were able to complete the surgery through a smaller laparoscopic incision (from what he told me maybe 3 inches and I have not seen it yet).  As far as could be determined by visual inspection, the removed parts of the colon and lymph nodes looked normal (except for the main cancer mass).  The liver looked normal as well.  This is as good of news as we could have hoped for at the end of the surgery!  It appears that our prayers may have been answered! 

The pathology report on the biopsies of the removed lymph nodes will be the real test now.  The results of these should be available about Thursday 2/9.

This is wonderful news for us.  Thanks to all for your thoughts and prayers! The response from our friends and family has been overwhelming. Thanks are not enough, but it is a start.  Please know that we are grateful for all of you!

Pre-Surgery and CT Scan Results 2/6/12

We arrived at Davis Hospital at about 6:30 on Monday 2/6 and got checked in.  We were able to inquire about the CT Scan results.  Dr. Jon Oberg, who is our surgeon, informed us that the CT Scan looked normal.  He further said that there was no indication from the CT Scan of abnormal sized lymph nodes or any obvious signs of cancer migration.  There were a couple of spots on the liver that they will check during the surgery, but these were probably just normal clusters of blood vessels that sometimes show on this type of scan.  It should be noted that the CT Scan is not conclusive evidence that the cancer has not spread.  This can only be determined after the biopsy of the surgically removed lymph nodes can be performed.  We should receive a pathology report of these about 5 days after the surgery.

Dr. Oberg reported that the cancer mass is at the top of the ascending colon, where we initially suspected it would be.  This means that he will be removing the part of the colon from where the small intestine ends and the large intestine begins to just after the start of the transverse section of the colon.  He will then re-connect the small intestine to the large intestine near the start of the transverse section of the large intestine.  This means that he will be removing about 1/3 of the colon (large intestine) including the appendix.  He mentioned that this side of the colon was the easiest to operate on and he did not see anything that would cause him concern about the operation now.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001308/

Biopsy of Main Mass 2/3/12

The main (cancer) mass was sampled for a biopsy during the colonoscopy on 1/30.  The results of these biopsies came back positive as expected.  The official name of the type of cancer found is Adenocarcinoma.  This type of cancer developed from colorectal polyps.  Sheila did not have other polyps found during the colonoscopy. 

I have found the following link useful in learning more: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001308/

1st Visit With Sergeon 1/31/12

We met with Dr Jon Oberg on 1/31/12 at his office in the Tanner Clinic.  We lined up a paritial laproscopic colonectomy for Monday February 6^th.  It will be early in the morning and will be further scheduled by Friday of this week.

Dr. Oberg talked with us about the cancer and how it was going to be removed.  He felt it was probably in the transverse section of the colon, but could not tell if it was at the top of the descending or ascending part of the colon.  He said this was extremely difficult even knowing the length that the monitor was inserted in the colonoscopy exam.

They will remove part of the colon and it ends up usually being a fairly large part of it depending on where the cancer is located.  They take the blood supply and lymph nodes associated with that part as well.  The lymph nodes are kept and tested after the surgery. 

He said that you cannot tell if the badness of the cancer from the size.  He has removed tumors much larger than the one Sheila has and the patient has been fine.  He also said that he had lost patients whose cancer was only as big as the end of the little finger.

At first they will go in with a scope and look at things, find where the cancer is, look for other problems.  Sometimes they can pull the colon out and the incision can be fairly small.  Other times the growth is hooked to other things and they have to do the old type of larger incision.

A CT Scan of the lower abdomen has been ordered and will be performed on Thursday.  This is a barium dye and since Sheila has had a slight allergy to the dye before she will be given some anti-allergy medication.

The results of the biopsies and the CT Scan should be available to Dr Oberg on Friday prior to Mondays surgery.  Currently we have no appointments set up to review the results of the tests.

Colonoscopy Results 1/30/12

On January 30^th Sheila went into Dr Flanders(resident Tanner Clinc) at Davis Hospital for a colonoscopy to determine the source of bleeding in the stool identified by Dr Hobbs.  The notes and results of this as I took them are below:

Dr. Flanders came into our recover room and told us there was a growth in Sheila’s colon.  He motioned that it was about 2 inches in size.  He took several biopsies and expected results by Friday.  They will be in the office on Friday and we could call and get the results.  He also mentioned that he had tattoo’ed the mass and that the effect of this could make Sheila a little sick for the next couple of hours from the dye used.

Dr. Flanders said that he had informed Dr. Hobbs of the initial findings of today’s colonoscopy and further that she had probably saved Sheila’s life.

Dr. Flanders told us to call the Tanner Clinic Scheduling Desk to get an appointment with a surgeon.  He said if we could not get one scheduled within a 2 week window to call him and he would attempt to intervene.  He appeared to be telling us we should not wait and to get the appointment soon.  He suggested the following surgeons:  Dr Jon Oberg,  Dr. Glen Morrell, and Dr Wade Larson.

Dr Flanders said that the surgeon would need to order some scans (probably CT Scan) of the pelvic and abdominal area, specifically looking for migration of any type of cancer into the lymph nodes or other masses.  He further said that his office or the surgeon’s offices could schedule the CT scan.