1-30-08 Wed.– We left for Baltimore Late Monday night and because of some slight delays, didn’t get to bed until 3:00 A.M. Tuesday morning. We were up early Tuesday and got dressed and ate breakfast before catching a cab to Univ of Md Medical Center where we waited for a long while because they initially lost our file. Not an auspicious beginning but we met Dr. Alexander who turned out to be a really nice guy who spent a couple of hours talking to us and reviewing Shana’s medical history. He went over all of the componants of the procedure and discussed the fact that when he was with the National Institute of Health (NIH) he helped develop this procedure which has had amazing results. In essance he said that chemotherapy is simply not effective at present but there may be something coming that will be useful but it is not really available yet. He explained that about 10 years ago while at NIH he found that Peritoneal Mesothelioma patients were basicly being treated for pain and told to go home and die. In conjunction with other similar cancers, he and others at NIH started this program of drastic cytoreduction or removal of all visable tumor and then heating up the chemotherapy and flushing the open abdomen with the chemotherapy which put the chemo directly in contact with the cancer in a much stronger concentration. He said they found that the procedure worked miricles. He said that the recent studies he has which are not yet published show a common life extension in many cases of close to 10 years. Since he has been doing this for about that length of time he said that it could mean a much longer life span than that. He explained that the surgery might last from 8 to 14 hours but that was not terrible for modern surgery. He expects Shana to be in the hospital for about 10-12 days and then to be back in normal form in about 12 weeks. He stated that almost no one dies on the operating table any more but that about 10-20% will have minor complications like infections or a sleeping intestine. When they work on the torso, they have to move the intestine around so much that the intestine goes into a sleep or paralysis for a period of time. In this particular surgery, they have to deal with intestines that ’sleep” for as much as 4 days. Properly ‘waking up” the intestines is a primary goal of aftercare that they seek. He said when Shana left the hospital, she should be able to walk to an airplane and be mobile if not yet back to full strength. He pointed out that Shana had a lot going for her: overall good health, being female, being relatively young, being strong with no other health concerns and the fact that it appears her type of mesothelioma is slow growing–all of which are major predictors for a successful outcome.
The Doctor said that after the surgery, if they were able to cytoreduce the tumor completely, he did not even recommend chemotherapy because the chemotherapy is not effective and there was no reason to weaken the body for anything that was not effective. They will monitor certain markers regularly thereafter to look for indications that the cancer might return and if it does we just do the surgery again. He said that he has at least one patient who he operated on about 10 years ago that has had to come back in 2 more times for cytoreduction to cut away all of the visible tumor but the patient is still going strong.
So, it appears that Shana is a strong candidate for a successful surgery and we are scheduled to have the surgery done on February 20 or 27 this year. Dr. Alexander is making a speach in Los Angeles to the AMA on this surgery and returning on February 19th and depending on his flight times we will go out for presurgery on Feb 16 to check into the hospital and begin preperations for the surgery. If his flight is going to be late on the 19th, we will wait until the 27th to do the surgery. He has a special team he pulls together and a special operating room with a chemotherapy perfusion machine that has to be coordinated. Because Shana has a slower growing form of this cancer, he does not think the delay is going to be critical and he wants her to be off of chemotherapy for as long as possible prior to the surgery.
I really liked Dr. Alexander and thought he was very professional. I’m not sure Shana liked him as much as I did but he is probably the best at what he does so this is the horse we need to ride. On a side note, with just Shana and I going to Baltimore we had some fun. It was sort of like a date. We didn’t have to spend too much time at the hospital so we stayed at a really cool older hotel that is very pretty and we went out to eat seafood at “Mo’s”, a famous local restaurant. That was probably the best crabcakes and shrimp that we have ever eaten. We decided to order a crab dip that was out of this world and Shana ordered an appetizer crabcake that was the size of a grapefruit. I ordered a special of some sort that came with crabcake, a full lobster, crablegs and shrimp. No way we could eat all of this food. So, Mo’s seems like a great place to visit if you are in Baltimore. I was struck by how nice all the people in Baltimore were to us. It seemed like everyone went out of their way to help us and provide us with needed information. While we were trying to get to the hospital yesterday morning the traffic was all tied up because the President had come to Baltimore to make a speach and that backed traffic up a lot. The joke at the hospital,, once we got there, was that we were the second most importent people from Texas in town that day. One of our taxi drivers, a pakistani, swore that Shana was a dead ringer for Laura Bush and went on and on about it. Anyway, we flew back in today and it took an hour longer to fly back nonstop from Baltimore to DFW than when we flew to Baltimore two days before. Maybe we were flying against the jet stream and it was very bumpy and windy on the whole flight. We also had a bunch of military passengers coming back from Iraq and it was really exciting to see how the passengers applauded them and how their familes reacted when they got off the plane at DFW. Times have changed a lot since the Vietnam days. God Bless those young men and women for what they do.
So, we are normal to fear any 12-14 hour surgery but the long term prognosis is very good and a hell of a lot better than any other option. Getting through this operation will not be easy by any stretch of the imagination but we can and will do it because it means Shana can have a future and we can have our Shana. While I was there, I also found that the doctor is perfectly willing to work on Medicare patients and so we will pass that on to Larry Williams who has this same disease. I was told what he needs to do to get the process started and to go from there. Maybe we can have a couple of victories in a row.
Luv you,
Jim and Shana