Oma's Appt with the Pancreatic Surgeon

Oma had another CT scan of her abdomen and pelvis yesterday, both with and without contrast.

Oma finally had her appointment with the pancreatic surgeon today.  According to him, it appears that the mass on her pancreas (On top of her pancreas? Near her pancreas? Behind her pancreas?  The location isn't exactly clear.) is a cyst.  There aren't too many things that can cause the cyst.  Auto-immune hepatitis (which Oma has) can cause auto-immune pancreatitis, which in turn, could have caused the cyst.  It was discovered that Oma also has gall stones and a rogue gall stone could have caused pancreatitis as well.  Many of Oma's symptoms are consistent with those of pancreatitis.

If it is a "pseudo-cyst," it will most likely resolve within twelve weeks.  As of right now, there has been no change in the cyst.  The CT scan taken yesterday looked the same as the CT scan taken six weeks ago.

There are a few cysts of the pancreas that are cystic tumors and can be cancerous.  One cystic tumor is called a mucinous tumor, but none of Oma's pathology reports saw any mucine.  There is a 25% chance of malignancy with these tumors.  Another cystic tumor is called a serous tumor.  Typically, these have a honeycombed appearance, which again did not show up on Oma's pathology.  There is a 1% chance of malignancy with these tumors.

It is the recommendation of the pancreatic surgeon that Oma undergo another CT scan in 6 weeks (to see if maybe it was a "pseudo-cyst" and has resolved itself, as it will have been 12 weeks from the time it was first noticed).  It was further recommended that she be re-imaged approximately six months from now to look for any growth, spider webbing, or nodules (none of which was seen at this point).  They want to make sure that the mass is not growing into something dangerous.  There is no need to do anything surgically unless the mass grows or changes.  Because Oma is going to undergo surgery for the ovarian mass already, if the pancreatic surgeon is available, he indicated that he may want to take a "peek" at the pancreas during the surgery.

Oma has to have some more labwork done tomorrow.  Although we were previously told that the the CA 19-9 (a tumor marker test for the pancreas) was normal, the pancreatic surgeon could find no record of it in Oma's file.  Therefore, he is ordering another CA 19-9.  He is also ordering another tumor marker test for neuroendocrine tumors called the Chromogranin A.  If those labs are elevated, there would be more imaging in store.

That's it for now.  Oma is still waiting on a date for her ovarian surgery.

2012 Medical Expenses

I finally got all our receipts and EOB's (Explanation of Benefits)

 compiled into the "2012 Medical Expenses" binder.  

It's a 3 1/2 inch heavy duty binder. 

 I held it down in the first picture, and it was 6 inches tall.  

That's just crazy!  

(How cute is that boy that photo bombed the picture though?)

I had to hold my hand on the side of the binder in the second picture or it kept sliding open.  

It was that full!  

Anyways, it measured about 8 inches tall.

And in case you're wondering how that calculated for our pocketbooks ...

Let's just put it this way ...

We paid more in out-of-pocket medical expenses in 2012 

than I made my entire first year working as a Juvenile Probation Officer.

A Wise 3 Year Old

Last night I was really missing E. and the tears were trickling down my cheeks.  Peanut asked me what was wrong and I told him, "I'm just missing your daddy."

He crawled up in my lap and wrapped his arms around me.  He told me, "It's okay.  Daddy still loves you."  And then he added, "And I do too."

He told me to close my eyes and he took my hand and put it over my heart.  He then asked, "Do you feel him?"

Not only did I feel him, but I also felt the love of a pretty incredible 3 year old.

Oma's Appt with the Gynecological Oncologist

Today Oma met with the Gynecological Oncologist.  He had reviewed all of Oma's scans to date and still wasn't sure exactly what the mass was on her ovary.  He indicated that it was a cyst about the size of a golf ball.  Cysts of this size on women Oma's age have a less than 5% chance of being cancerous.  It admitted that the cyst was not normal and most likely benign, but the only way to know for sure was to remove it and send it to pathology.

The Gynecological Oncologist explained that Oma had two options:

        Option #1 ... The "watch and see" approach.  Oma would be monitored with ultrasounds every six weeks for a period of time, then every three months, then every six months to eventually once a year (so long as the cyst did not change).  When asked if the cyst could transform into the cancer, the doctor stated that the answer was unknown.  He did state that most cases of ovarian cancer are already at a Stage 3 by the time they are found.

        Option #2 ... Surgery.  Oma would have a laparoscopic surgery to remove both ovaries and the mass.  Like any surgery, there are risks of complications.  The mass would go through a freezing process and several sections of it would be examined under the microscope.  If everything is benign, Oma may stay in the hospital overnight and could expect a couple weeks of recovery.  If anything was malignant, a more invasive surgery would be completed and the lining and lymph nodes would be removed.  This would require a hospital stay of 7 to 10 days and recovery could be expected to take 6 to 8 weeks.

The cyst could have been there a long time.  There is no way of knowing.  In post-menopausal women like Oma, the cyst is unlikely to shrink.  Although Oma's tumor marker test (the CA-125) came back normal, the doctor didn't give that a lot of weight.  He indicated that of all Stage 1 ovarian cancer diagnoses, 50% of them had a normal CA-125.  Furthermore, 25% of Stage 3 ovarian cancer patients also had a normal CA-125.

Oma didn't hesitate to say that she preferred to have the surgery.  She doesn't want to take any chances.  I don't blame her.  I think I would have done the same thing.  There is still a chance that the pancreatic surgeon will want to "check out the pancreas" while the Gynecological Oncologist is in there doing his thing.

Oma has an appointment with the pancreatic surgeon on January 15th.  The day before that, she'll get another CT scan of the abdomen and pelvis, which will provide current information and give the doctor something to compare.  Then, finally, surgery will be scheduled.

Oma's Doctor Appts

Oma had two doctor appointments today.

The first one was with the GI who had performed the endoscopic ultrasound.  He reviewed the results with us once again.  The biopsy had come back benign, as did the final pathology report.  All good news!  There are a few things that the mass could be, but the doctor kept talking like it was more like a cyst than anything.  According to the GI, Oma still needs to be monitored closely.  He'd like another CT on January 16th to compare to the original CT.  The hope is that the mass is shrinking.  If that's the case, it sounds like she'll continue to be monitored and it will eventually just shrink and go away.  If instead the mass is getting bigger, then in all probability, another endoscopic ultrasound will be performed with another biopsy collected.

The next appointment was with the oncologist.  He didn't have much to add.  He was thrilled that all the pathology reports were showing that the mass was NOT cancerous, since it certainly wasn't looking that way in the beginning.  He shared with us that the two tumor marker tests (the CA 19-9 for pancreatic cancer and the CA 125 for ovarian cancer) were both within the normal range.  He obviously had nothing but respect for the OB/GYN oncologist that we're meeting with next week.  We won't know more about the mass on Oma's ovaries until she actually has surgery.  If that mass does turn out to be cancerous, the OB/GYN oncologist would oversee any and all treatment.  Therefore, unless the pancreas turns up something cancerous, the oncologist is stepping off the team at this point.

The next appointment is on January 9th with the OB/GYN oncologist, followed by an appointment on the 15th with the pancreatic surgeon.  The oncologist did tell us that he's seen both these doctors work well together and often coordinate surgeries together, so that was good news.  We'll see how it pans out.