October 14th, 2008: Today my entire treatment plan was altered. When I woke up this morning, my strategy was to wrap up the team building visits with Drs. O’Donnell and Gottschalk today. Then, meet with Dr. Greene, my lead surgeon tomorrow and verify that I would be having surgery in the next month to remove the sarcoma in my pelvis. The first visit with Dr. O’Donnell changed all that. The shift in directions happened when we looked at the MRI scans taken yesterday. While pointing out that the sarcoma had a presence in the pelvic area as well as an extension to thigh muscle in the groin, Dr. O’Donnell was also worried about a 1.6 cm. spot on my liver and several smaller spots in the lungs.
Dr. O’Donnell: “I haven’t seen a sarcoma metastasize into these tissues before. This acts like a spindle cell melanoma, and you’ve had two melanomas removed in the past.”
Geo: “True. But those melanomas had really clean tissue parameters.”
Dr. O’Donnell: “My concern is that we’re planning to operate on a large sarcoma in your pelvis when the real activity may be happening in your lungs and liver. It may be more effective to use chemo to take out the spots in the lungs and liver, shrink the pelvic sarcoma and go from there. I think the first step is to make sure we have the right diagnosis. I’d like to do an open biopsy tomorrow and get some serious tissue to look at. Then, take the results to the tumor board on October 24th for an assessment.”
Geo: “Open biopsy?”
Dr. O’Donnell: “I make an incision and retrieve more tissue than the first time.”
Dr. O’Donnell: “Right. There isn’t a lot of time here. Your pelvic tumor is growing and causing you pain. But the other spots are also active and we can’t remove them surgically. There are too many. We need to find out what this is before we do invasive treatment.”
Geo: “OK. I don’t want to go through major surgery only to find out that the bigger problem is with metastasizes. Put me on your calendar.”
Dr. O’Donnell: “I’ll get Dr. Jahan involved because he knows about chemo and sarcomas. However, we may need to switch to a melanoma guy. After looking at the pictures from yesterday’s MRI, I’d say that everything is on the table.”
Geo: “Right. Everything is on the table.”
Special thanks to my friend Eileen Lemus who has been at my side during these long clinic visits. Her care and guardianship has been very, very comforting. She's heard the whole story and has excellent instincts for the most comprehensive care.
Tomorrow, Wednesday 15th, I go into UCSF Mt. Zion for the open biopsy. I’ll stay in the hospital for one or two nights. I have to say, it was hard to give up the plan for one surgery to treat my one tumor. It was hard to accept that I have quite probably many tumors. But, I also didn’t want to endure a major surgery that weakens me during a metastasis of the cancer. As with all sudden changes, near term plans evaporate. The hardest change was to call my friends Bob and Jeremy and tell them that I couldn’t attend their wedding at City Hall on Thursday. It’s been so joyful in the past months going to weddings of my friends. Each occasion is unique because the couple is unique. After calling Bob, I wept. I could short-term deal with the fact that I have a much more complicated cancer, but not being with Bob and Jeremy during a peak of their happiness felt like a horrible, unexpected loss. Such are the curious byways of my feelings. Also, I’m embarking on a crucial few weeks at work where I had my days mapped out for what I planned to accomplish. Now, the rest of the week is gone. I called my project manager Belinda and explained the sudden biopsy. She was totally empathetic and caring. Her only question was, “What can I cook for you?”
I’ll be in the hospital for a couple of days. When I return home, I’ll get back to the blog. Please, please don’t call me in the hospital. Just send me your good wishes telepathically. You can do it. It works. I’ll get the vibe. So, thanks in advance.