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In August 2016 Paul had a skin lesion removed from above his right eyebrow that turned out to be squamous cell carcinoma. Sometime in late September to mid October, he felt a lump at the base of his right ear. A visit to our ENT brought about a CAT scan, a needle biopsy , and a PET scan. The biopsy returned a diagnosis of undifferentiated carcinoma of the parotid gland (the largest salivary gland) with secondary malignancy of the parotid lymph nodes. (if you are looking for a great ENT in the Gettysburg, Hanover, York area, we recommend Dr. Zaher Srour in Hanover)
Our next step was to meet with a ENT surgeon at Penn State Milton Hershey Medical Center on December 2nd. At that time, the PET scan showed that the cancer was localized to the parotid gland and the lymph nodes on the right side of Paul's neck. Surgery was scheduled for Monday, December 19th. We felt very comfortable with Dr. Neerav Goyal at Hershey.
While all of this was happening, Paul's 17 month search for a new job finally came to fruition. He was hired by Select Medical in Mechanicsburg as a Training Analyst for the implementation of Epic Software for the care facilities they own and operate. He was upfront with them about his cancer diagnosis, but they were willing to work with him. At that time, we thought there was a very strong chance of a cure.
On December 19th we drove up to Hershey Medical Center for the surgery. Between the 2nd and 19th we noticed that the tumors in Paul's face and neck were growing noticeably. We expected the surgery to last about 5 hours. It turned out the the tumor was much more involved. The surgery ended up taking 9 hours and 45 minutes. Dr. Goyal was amazing. He came down to talk with me and Gabi twice during the surgery and again at the end. On one of his visits he reported that the tumor was surrounding several of the facial nerves, at which point we decided to sacrifice the nerve in an attempt to remove all of the tumorous tissue. This would mean that Paul would have paralysis on the right side of his face. Dr. Goyal did a cable graft of the nerves to hopefully restore some functionality. That will take time to become established. Because of the extent of the surgery, what we had hoped would be a 2-3 day stay in the hospital turned into a 5 day stay. While there, Paul also had a gold weight surgically implanted in his right eyelid to help him close his eye. His incision looked great and has continued to heal nicely. Dr. Goyal did tell us that he wanted Paul to have another PET scan in January to see if the cancer had spread since it was so aggressive in his face.
After returning from the hospital, Paul felt pretty good. We enjoyed a quiet Christmas Eve at home, just the three of us. I should mention here that we have the most wonderful daughter, Gabi. She is wise beyond her years and possesses the gift of empathy. On Christmas Day we went to York and spent the day at my brother's house with family. Paul felt great and really enjoyed Christmas dinner.
He stayed home the following week and got a lot of rest. Although he was still very tired, he returned to work at Select Medical on Tuesday, January 3rd. As the week wore on, he became more and more exhausted. He also felt sick to his stomach and got very out of breath with little activity. He contacted Dr. Goyal who advised him to see our family doctor or go to the emergency room. On Saturday, January 7th we went to the emergency room at Gettysburg Hospital.
At the hospital they did blood work and ran many tests. He had an elevated triponin level which usually indicates problems with the heart. He had a CAT scan of his chest to look for a blood clot. There wasn't one. He also had several EKGs, a stress test, and an echo cardiogram. These tests all showed that there was not a problem with his heart. The blood tests also showed elevated liver enzymes. Our family doctor, who had been out of town, ordered an MRI to look at his abdomen. There was a theory that he may have gall stones. Unfortunately, the MRI showed that the cancer had invaded his liver and spleen.
On Tuesday, January 11th we met with the nurse practitioner from Adams Cancer Center. She was very compassionate as she delivered the bad news. There were over 50 spots on his liver and over 20 spots on his spleen. The pathology from his surgery told us that he has sarcomatoid carcinoma, a very rare and aggressive form of cancer. The cancer had spread and invaded his liver and spleen in less than two months. On Wednesday, January 12, we met with Dr. Ike at the Adams Cancer Center. We were given the choice of getting palliative care and hospice or trying chemotherapy. The first two lines of chemotherapy usually used to treat this form of cancer cannot be used due to the condition of Paul's liver and his transplanted kidneys. The chemo will offer less than a 50% chance of benefit. After a family discussion, Paul decided that he would try chemo, but that if it wasn't making a difference, he would discontinue and move to palliative care and hospice. Gabi and I completely support all decisions he makes.
We attend a chemotherapy learning session tomorrow and expect chemo to start on Monday.
Please feel free to share this connection with anyone you think I may have missed. I know Paul will appreciate reading any thoughts or memories you would like to share.