New York, New York!
I have heard it said you either love New York, or you hate it, I mean New York City to be specific. Put me down in the column of loving New York. I say that from the standpoint of both my knowledge and my limited experience of time spent in the City. Most of the time spent there is somehow linked to cancer, both the Redhead’s and now mine. What a terrible reason to be in New York but if I am in New York I am trying to enjoy. We did enjoy this briefest of trips but that is for another blog entry. This is all about my liver cancer.
We have been extremely fortunate to have one of the best Surgeons around in Dr. Keith Gray at UT. He has performed surgery on the Doll and her late daughter, Mandy. He is like a friend who is also a kick ass surgeon. I too have jumped on his bandwagon and he has embraced me as a patient. I have every confidence in him
The reason for our trip to NYC was to visit the splendid doctors and staff at Memorial Sloan Kettering Hospital. The hope was to have some other procedure that would shrink the tumor or a radical new surgery that might be effective. Memorial Sloan Kettering is well known as one of the top cancer hospitals in the whole world and you can tell from the other patients there that they hail from everywhere. They have come there for lots of reasons. A second opinion on a very difficult case; to obtain top notch treatments not usually available in their hometown; and sometimes to participate in a last-ditch clinical trial in a desperate attempt to continue living. The several trips that Teresa and I made were in all three of those categories.
Here is how they stack up. https://www.glozine.com/lifestyle/10-best-cancer-hospitals-in-united-states.html
One of the reasons that I didn’t hesitate when Shelia helped by setting up the consultation is that my experiences told me that I would be treated with love and kindness from the entire staff at the hospital: that the doctors that I would be seeing would be at the top of their fields; and that if they had any answer for me it would be the best course of action. I also knew that there was a chance that they would tell me that what my plan of action here in Knoxville was a solid approach.
We were fortunate to get a direct flight to Newark Airport and back with United. The hospital schedulers worked with us to ensure we had enough time to get to our appointments. We left on Monday morning at 8:30 and we had two appointments scheduled with oncologist, Dr. Wungki Park, and liver surgeon, Dr. Peter Gingham. There was the possibility that we would also see an interventional radiologist, so we thought it best to stay overnight and fly home the next evening. We stayed at the Wellington which was a nice older, distinguished hotel near Central Park and Times Square.
After getting to Sloan Kettering and filling out a ton of paperwork and submitting my various CT and MRI scan we were I the que to see Dr. Park. The meeting with Dr. Park was very good. He asked plenty of questions and explained that since I wasn’t in a chemo treatment or a clinical trial now that he would act more as a coordinator for me with the other doctors. He shared with me that Dr. Gingham was one of the top liver surgeons who dealt with difficult cases like mine. That was encouraging for sure.
We had to go downstairs to the 3rd floor and fill out more forms and wait to see Dr. Gingham. We met with his nurse for some vitals and then his colleague, Dr. Cohen came in for some preliminary questions regarding my condition and family history. My mom and several of her siblings all died with smoking related cancers but that was the only types of cancer in my family history.
I was so very impressed with Dr. Gingham. He gave us a diagram showing my large tumor in a very hard to treat location and the smaller mass that might not even be a cancer. (Image in the post with tumor in green) He explained what surgical options are used when possible. Dr. Gingham confirmed that my tumor was too large for resection at this time. He explained that one method to shrink a large tumor was with a needle ablation directly into the tumor using a heat source to shrink the tumor. He also explained that the tumor size could cause complications and cause my liver to be unstable.
The other methodologies were all embolization techniques to starve the tumor of its blood supply and therefore shrink the tumor. I have already shared on the blog both the local Chemo and Radiation therapy. Both send beads into the blood supply to the tumor and use the radiation or chemo to also shrink the tumor.
He also mentioned that embolization can also be tried with just microscopic beads with no radiation or chemo involved. He explained that all these treatments could be effective, and all have some advantages and disadvantages.
One of the last conversations was that he could go in and take out the tumor but that I would not like the results since there may not be enough healthy tissue to keep from going into liver failure and survive. And it could also spread and that it would be too risky.at this time.
So, the result was that he concurred with my treatment plan in Knoxville and said my choice to try the radioactive bead (TheraSphere – Y90) first and monitor the results was valid. This alone was worth the trip to me.
One very encouraging conversation was that if we could adequately shrink the tumor to 5 CM or less then it would meet the criteria for resection. This is the same analysis that Dr. Gray at UT has. If it meets the criteria and I have enough good liver left, then resection could be curative. That is a stretch at this point but certainly a goal to stretch for.
He went on to say that if we could shrink it enough and we had stable disease (Cancer is still local to the liver) that I might also be eligible for a liver transplant where they remove my entire liver and replace it. There is a catch for this one though. Since my liver function still is and should be stable then, I would not be eligible for a liver transplant list.
So, the only way for a transplant even if I meet all the other criteria is to receive half of a living donor’s liver. This is possible since a person’s liver regenerates and grows back to where it is supposed to be in a relatively short time.
This is one remedy that I would be very reluctant to pursue. Even though it is a procedure that is done a lot it still has a lot of risks to the donor and even if they meet all the criteria as a match, I just don’t see asking anyone for that.
I will close with a couple of things. First the Doll and I managed to squeeze more fun into our two-day trip than we thought possible and we will be sharing that later with a lot of pics.
The second is that I did undergo the mapping procedure today at UT and will post all about that tomorrow so stay tuned.
I do want to thank all of you who have sent prayers, healing energy, good vibrations and positive thoughts to us. And thanks for following the blog to see how I will be doing over time. Thank you all for your love and support!!
Love and hugs, Jim
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My Rodeo 