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March update

Apologize in avance if this is a long-ish post, but it's been a little bit of an eventful month.

First of all, the good news, for what it's worth. In early March, Liza had a repeat set of abdominal CT scans to check in on the status of her liver tumors. This was more than a little frustrating, since we had wanted a PET scan, which provides more information about tumors and their activity, but the insurance company wouldn't pay for it. We appealed, which takes some 60 days or so. In the interim, we just got a plain CT scan. 

However, the scan results were very good. Based on volume, the tumors were down over 90% in size! The big one went from >3cm to around 0.6cm in diameter. That's a pretty great response, and we were very happy. The other tumors also seemed to shrink, but the CT is not as precise as the PET, so we really can't say what happened to the smaller tumors. There was also a bone scan which was completely clean.

As the weeks went on, Liza was having more and more side effects from the chemo. The fatigue was getting pretty disabling. She was having worse chronic diarrhea after every meal. Most distressing, all of her fingertips and toes were really red and cracked. This made wearing shoes impossible and made it impossible for her to exercise, and even made it very difficult to do chores around the house. The cracks at the edge of the nails would ooze and develop these proliferative granulomas which bled and were super tender. One night our dog Iris jumped with her 110 lbs directly onto Liza's poor big toe and Liza was curled up on the floor for half an hour in pain. 

Eventually, her oncologist decided that she needed a break from the chemo, or at least the more toxic of the two. So she got two weeks off of the xeloda, and her fingertips and toes did a lot of healing in that time. She also gets a very slight dose reduction on the xeloda going forward.

So our oncologist was really pleased with the tumor response and sent us to the UW for a consultation at the Liver Tumor Clinic, which apparently exists. This was a big-deal, high-stakes sort of day for us. It was carefully orchestrated with a lot of sub-sub-specialists, and a long day for us at the U. The idea was that the liver tumors were so small that they could stick a wire into them with ultrasound guidance and burn the tumors to death with microwave radiation. Liza was really ambivalent about this, just being put off by the seeming risks of such a procedure. But on the other hand, there's something really appealing about just killing the damn cancer directly.

As it turned out, they did not recommend such an approach, nor any direct surgery at all. Their rationale was that a) there was too much tumor in there to get it all (i.e. lots of little ones) and the response to chemo so far had been so good it may not even be necessary. Adding to the frustration was that the CT scan was just not as useful as a PET scan would have been. I don't think it would have changed their recommendation, but it caused a lot of head scratching and a bit more uncertainty.

So the positive spin on this would be "you're doing so well you don't need surgery," but it can easily feel like you're being told "tough luck, we can't help you." And frankly, it felt like the latter. I've got nothing but good things to say about the liver team; both their bedside manner and also the technical explanation were great. But we both left there with a sinking feeling on our guts, that we had gone through this hugely wrenching experience for absolutely nothing. We will follow up with them after the next round of scans and see if things change; it may make sense to do surgery in the future, but not now.

Additionally, it was really emotionally hard for Liza since she had never seen her scans before, and the original PET scan actually looks horrible. Liza said her liver looked like Swiss Cheese there was so much tumor there. It's one thing to abstractly know there's cancer in the liver, but it's another thing entirely to be smacked in the face with it, and have it be a lot more than you'd imagined. So that just made a hard day even harder.

To top it off, when we got home, Liza got a call from her dermatologist. She'd had about 5 moles taken off a week ago, and two of them had some back, not malignant, but "very abnormal" and so they were recommending a wide field excision. Not a big deal in the grand scheme of things, but one more damn thing on top of an already terrible day.

It doesn't help that she did restart the xeloda a few days ago, and while her fingers and toes are marginally OK for the moment, the fatigue is hitting her like a ton of bricks. Its like starting all over again, she says. So she's taking a lot of naps. Ordinarily, you'd think that'd be a good thing -- who doesn't like a nice nap? But a nap implies leisure, really, and that's not what Liza's doing. She's napping because she HAS to, and it's keeping her from doing all the things she needs to (and those she WANTS to). So it's not at all a "pleasant" sort of nap as much as it is a "collapse involuntarily for a couple of hours" sort of nap.

So we have our ups and downs. Honestly, this has been a rough week. Hopefully next week will be better. Thanks as always fro reading and for your positive thoughts.