Dear Loved Ones,
I have some hard news that I must share with you. Beginning in the middle of April, David began having some substernal / epigastric pain with a degree of reflux and a decreased appetite. He saw his primary care physician and despite treatment for what we all thought was probably an ulcer, his symptoms didn’t really resolve. He then underwent an endoscopy, which did not show signs of an ulcer and really nothing to explain his ongoing symptoms. So, on June 11th, he had an abdominal CT study that revealed a pancreatic mass. A biopsy followed on June 14th, which revealed that the mass is an adenocarcinoma.
Our next step was to decide where to have treatment. David, his brother, Nelson (who is also an MD), and several of David’s close MD friends did a good deal of investigating a number of incredibly good cancer treatment centers around the US. The chemo regimen for pancreatic cancer doesn't vary that much from site to site (there aren't a lot of different options available for this type of cancer), so we have decided to go forward with treatment at UCSD’s Moore’s Cancer Center. We believe that there is something very powerful in being home in our own environment where things are familiar and we have more resources available to us than we would have somewhere else.
This past Tuesday we met with Dr. Andrew Lowy, the oncologic surgeon, who spent about 45 minutes with us. He came across as a kind and professional man, humble despite his expertise in the world of gastrointestinal/pancreatic cancer surgery. He told us that he considers David to fall into a category of marginally resectable pancreatic cancers in that his tumor is locally invasive with some degree of vessel involvement. He told us that although there are no imaging signs of gross metastases, with pancreatic cancer there is likely microscopic metastases. He said David is not surgical now and his recommendation would be to do chemo +/- radiation to eliminate microscopic systemic mets and arrest the tumor growth with reassessment of David's response to treatment over the next four to six months prior to proceeding with surgery. He said that his criteria for down staging David's cancer would be if his cancer marker on blood work (a thing called CA 19-9) and his imaging characteristics stayed the same or better (in other words, if the cancer doesn't progress, we are stronger surgical candidates). He's no cowboy, and his philosophy is that he is not going to put anyone through a big surgery if he doesn't feel there is going to be a good outcome.
Then we met with Dr. Paul Fanta, the oncologist, who spent about 75 minutes with us. He was extremely personable, warm, caring, and highly knowledgeable in the treatment of pancreatic cancer. He and Dr. Lowy are currently in the process of writing a book chapter on the treatment of pancreatic cancer -- so, they have been around this block many, many times. He outlined the treatment regimen for chemo +/- radiation and was very reassuring that while the treatment is extremely toxic and comes with a number of side effects, that he was not going to blast David with chemo. They check blood parameters before each chemo treatment to see if they need to postpone or reduce the dose of a particular drug being given. So, while they have a protocol that has been determined as most advantageous for treating pancreatic cancer, he will make adjustments as David's body demands. Chemo is typically delivered every two weeks for a two month period followed by repeat CA 19-9 levels and abdominal imaging study. Depending on those results and how David is overall tolerating treatment, they will either continue with chemo or take a break from chemo to do some radiation for a period of time. He said that along the road all of our needs will be addressed by the multidisciplinary team and that they are available to us seven days a week (he even provided us with his cell phone number!).
David will have a catheter port placed in his subclavian vein in his upper chest by an interventional radiologist (he actually received training by a couple of these folks during his radiology residency at UCSD) tomorrow (Monday), meet with Dr. Fanta's nurse practitioner on Tuesday to do what they call a chemo consent (she will go over all of the particulars about chemo and resources available to us), and then the first chemo treatment, which is an all day affair, is scheduled for Wednesday.
We are not naive to the dismal numbers that this particularly awful cancer holds, but the doctors were encouraging, David is willing to give the fight everything he has, I am willing to support David in any way I can, and we are so very blessed to have family and dear friends (all of you guys) for support.
We just returned from a few days at Lake Tahoe. Tahoe has always been a place where we find great peace, gather strength, and connect with the universe, which is exactly what the visit did for us this time.
While we would love to connect with each of you individually, phone calls are still very difficult for us. However, we find that cards, emails, and text messages give us strength and brighten our days. Our home address is 2164 Sea Village Circle, Cardiff, CA 92007. David’s email address is roentgenread@gmail.com. David’s cell phone number for texting is 619-977-4674 and my cell phone number for texting is 619-997-4674.
FIGHT THE FIGHT!!!!!!!!!! Janet
I have some hard news that I must share with you. Beginning in the middle of April, David began having some substernal / epigastric pain with a degree of reflux and a decreased appetite. He saw his primary care physician and despite treatment for what we all thought was probably an ulcer, his symptoms didn’t really resolve. He then underwent an endoscopy, which did not show signs of an ulcer and really nothing to explain his ongoing symptoms. So, on June 11th, he had an abdominal CT study that revealed a pancreatic mass. A biopsy followed on June 14th, which revealed that the mass is an adenocarcinoma.
Our next step was to decide where to have treatment. David, his brother, Nelson (who is also an MD), and several of David’s close MD friends did a good deal of investigating a number of incredibly good cancer treatment centers around the US. The chemo regimen for pancreatic cancer doesn't vary that much from site to site (there aren't a lot of different options available for this type of cancer), so we have decided to go forward with treatment at UCSD’s Moore’s Cancer Center. We believe that there is something very powerful in being home in our own environment where things are familiar and we have more resources available to us than we would have somewhere else.
This past Tuesday we met with Dr. Andrew Lowy, the oncologic surgeon, who spent about 45 minutes with us. He came across as a kind and professional man, humble despite his expertise in the world of gastrointestinal/pancreatic cancer surgery. He told us that he considers David to fall into a category of marginally resectable pancreatic cancers in that his tumor is locally invasive with some degree of vessel involvement. He told us that although there are no imaging signs of gross metastases, with pancreatic cancer there is likely microscopic metastases. He said David is not surgical now and his recommendation would be to do chemo +/- radiation to eliminate microscopic systemic mets and arrest the tumor growth with reassessment of David's response to treatment over the next four to six months prior to proceeding with surgery. He said that his criteria for down staging David's cancer would be if his cancer marker on blood work (a thing called CA 19-9) and his imaging characteristics stayed the same or better (in other words, if the cancer doesn't progress, we are stronger surgical candidates). He's no cowboy, and his philosophy is that he is not going to put anyone through a big surgery if he doesn't feel there is going to be a good outcome.
Then we met with Dr. Paul Fanta, the oncologist, who spent about 75 minutes with us. He was extremely personable, warm, caring, and highly knowledgeable in the treatment of pancreatic cancer. He and Dr. Lowy are currently in the process of writing a book chapter on the treatment of pancreatic cancer -- so, they have been around this block many, many times. He outlined the treatment regimen for chemo +/- radiation and was very reassuring that while the treatment is extremely toxic and comes with a number of side effects, that he was not going to blast David with chemo. They check blood parameters before each chemo treatment to see if they need to postpone or reduce the dose of a particular drug being given. So, while they have a protocol that has been determined as most advantageous for treating pancreatic cancer, he will make adjustments as David's body demands. Chemo is typically delivered every two weeks for a two month period followed by repeat CA 19-9 levels and abdominal imaging study. Depending on those results and how David is overall tolerating treatment, they will either continue with chemo or take a break from chemo to do some radiation for a period of time. He said that along the road all of our needs will be addressed by the multidisciplinary team and that they are available to us seven days a week (he even provided us with his cell phone number!).
David will have a catheter port placed in his subclavian vein in his upper chest by an interventional radiologist (he actually received training by a couple of these folks during his radiology residency at UCSD) tomorrow (Monday), meet with Dr. Fanta's nurse practitioner on Tuesday to do what they call a chemo consent (she will go over all of the particulars about chemo and resources available to us), and then the first chemo treatment, which is an all day affair, is scheduled for Wednesday.
We are not naive to the dismal numbers that this particularly awful cancer holds, but the doctors were encouraging, David is willing to give the fight everything he has, I am willing to support David in any way I can, and we are so very blessed to have family and dear friends (all of you guys) for support.
We just returned from a few days at Lake Tahoe. Tahoe has always been a place where we find great peace, gather strength, and connect with the universe, which is exactly what the visit did for us this time.
While we would love to connect with each of you individually, phone calls are still very difficult for us. However, we find that cards, emails, and text messages give us strength and brighten our days. Our home address is 2164 Sea Village Circle, Cardiff, CA 92007. David’s email address is roentgenread@gmail.com. David’s cell phone number for texting is 619-977-4674 and my cell phone number for texting is 619-997-4674.
FIGHT THE FIGHT!!!!!!!!!! Janet
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