we're home and have a plan

we drove back from farmington on thursday afternoon. my mom did a great job driving considering she had just had brain surgery a few days earlier. i kept telling her to slow down but she wouldn't have it...... just kidding. bill and i thought the visual was kind of funny, she does look a little like those crash test dummies, and we could use some levity every now and then. no driving for her until after treatment.

it's amazing how easily we forget about the small everyday joys in our lives. coming back home after being in the hospital was so comforting for all of us. eating food from the refrigerator (which i have to force myself to do. my mother, on the other hand, is eating like a horse, as always), sitting on the couch together, playing with the dogs, smelling the crisp mountain air.

my mom continues to do well. today is the first day she's let herself relax at all. she's been very tired and had a headache most of the day. it's literally the first day she's sat still since her surgery. before today she's been on the phone or in the kitchen cleaning up nonstop. her spirits continue to inspire me. i sat down with her and really tried to talk to her about her feelings and fears. here's what she said, with complete assuredness. "This wasn't supposed to happen. I just can't believe after this long that it could come back. I'm sad about it. I'm angry. I'm annoyed. But, I'm not afraid. I really don't think this is going to kill me. I'm not going to die from this. I don't know how I know it, I just do.. As my grandmother used to say, "from her mouth to god's ears". May it be so!

and now for all the details.

the doctor's appointments:
yesterday was a big day. we spoke to many docs.

gamma knife tumor board - first i heard back from one of the doctors who had presented my mom's case at the UCSF gamma knife tumor board that met thursday afternoon. their conclusion was that this was a tumor that needed to be surgically excised and gamma knife wouldn't work. there's good and bad in this. the bad is that gamma knife is very non-invasive and has high success in small tumors. the good is that through surgery they can gain much more information about the tumor itself by actually looking at it and the brain and can do pathology analysis on the tissue. for anyone who is interested, gamma knife is a device that aims gamma radiation through a target point in the patient's brain. The patient wears a specialized helmet that is surgically fixed to their skull so that the brain tumor remains stationary at target point of the gamma rays. A killing dose of radiation is thereby sent through the tumor in one treatment session, while all surrounding brain tissues receive less than a killing dose.

phone consult with UCSF neuro-surgeon Dr. Andrew Parsa - we then had a conference call with dr. parsa, one of the neurosurgeons from UCSF. I had fedexed him my mother's MRI, cat scans, and all the reports. Here's what he said: surgery is absolutely necessary and soon. She is fortunate because of where the tumor is (right temporal lobe), because it's easily accessible through surgery. He feels very confident that he can have a great success doing this surgery and can excise a great amount, if not all of the tumor. Another benefit of the tumor's location is that the risk of paralysis, infection, bleeding, and stroke is very (he emphasized this word) minor. There are always risks in doing surgery, but we're lucky the tumor isn't too deep or in a more intricate location in the brain. he believes the tumor is somewhere between 3 and 4 cm. in its greatest dimension. the most important question we had for dr. parsa was whether my mom can have a glass of wine in the evenings. He said "only one glass? how about 2 or 3?" he then told us he had moved things around in his schedule and had made time for us next monday, dec. 10 for the surgery.

Dr. Francisco Ampuero, my mom's GYN oncologist from 11 yrs ago and ever since - then we went to meet with dr. ampuero at the cancer center in santa fe. he spent close to two hours with us, answered every question we had. if there are angels on earth, this man is one. aside from being a fantastic first rate GYN oncologist and surgeon, he is, without a doubt, the most compassionate, caring, kind doctor i have ever met. so here's what dr. a said: he agrees completely with dr. parsa's suggestion of surgery, and agrees that it should be done with the best doctors possible. we went through the MRI with him onscreen and measured the tumor which he thought seemed to be about 3cm in size. he did a physical exam. the rest of my mom's body looks healthy and great.
our big question to him was "how did it get there after 11 years?" he doesn't have an absolute answer for this, because it's impossible to know. it is possible that an ovarian cancer can have a single site brain met. it is, however, very unusual. because of this, he wants us to do more tests. although we already did a full-body CT scan that was clear he wants us to get a PET scan, as well. apparently a CT scan is only 85% accurate. a PET scan is 95% accurate. a PET scan is a different kind of imaging scan. a short-lived radioactive tracer isotope is incorporated into a metabolically active molecule of sugar and injected into the blood stream. the sugar is only metabolized by "bad" cells, so that the image will show dark areas, except where there is cancer. those areas will be "lit" up. Our intention is to see only a lit up area in my mom's head where we know the cancer. May the rest of the body be in darkness for this photo only!

the treatment plan and timing
the surgery is scheduled for monday, dec. 10 @ 9am. we are flying to san francisco on wednesday afternoon. we'll have an in-office appointment with the surgeon on thursday, followed by a visit with anesthesia. on sunday she'll have another MRI. they will place some small markers on her head that will remain there for the surgery. we'll check into the hospital at 9am on monday. the surgery is apparently relatively "easy" or "routine" surgery for a high level neurosurgeon. it will last between 3-5 hours. she'll be in the hospital for 3-5 days, and recovery, which she can do in santa fe, will be 3-5 weeks. pretty straightforward. he will immobilize her head and go in the through the right side of her head. he will take a piece of the bone out so he can access the temporal lobe. he then pulls back the dura (which is the the tough outermost layer of the brain) and does his magic. He'll then replace the bone he removed and attach it with a screw and a plate. our hope is that the tumor will present on the smaller side of the range and that it will be completely excised. May this be so!

there will undoubtedly be a fair amount of pre-op before surgery. i'll let everyone know what time the surgery is so you can all say a little prayer and set an intention for a fantastic outcome.

i have to keep reminding myself of the little joys right now. like walking upstairs to my parents room yesterday and seeing my mom cradled in bill's arms with the dog next to them in the bed. they all had looks of such joy on their faces. you don't get much better than that. and i mustn't forget the little blessings we receive each day in the news we receive and the care we are getting, as well as the amazing outpouring of love and support and prayers from y'all. we received fantastic care in farmington and have been able to get on the schedule for some very fine doctors. i am doing what i can to stay strong. i have moments of feeling completely and utterly devastated, but underneath that i find my strength, again, and remember our purpose here - to rid my mother of this cancer once and for all. and i am resolute and unwavering in this goal.

my next update will likely be after the surgery. i'm sure everyone will be eager to know how things go. feel free to call my cell phone 415.609.5355. if we aren't available, we'll turn the phone off. i'll set up a phone tree for my mom's friends in santa fe so everyone gets the news.

please continue to keep my mother in your hearts, minds, and light.

my prayer for today

may this tumor continue to shrink and disappear.
may the PET scan be clear
may the surgery go perfectly. may the doctor's fine hands remove the tumor in it's entirety
may my mother's recovery be smooth and fast.
may the waters of health and vitality wash over my mother's brain and body so that she is, again, free and clear of cancer forever

I'll leave you all with something that one of my mother's dear friends, dick moskowitz, wrote to me in an email yesterday that pretty much sums it all up....

We can all take comfort in the fact that you alluded to: your mom is endowed with a rare gift, a life force that is capable of taking up whatever comes her way and by some inner magic turning it into an occasion for self-healing.