October 22 was supposed to be surgery day

As I walked onto the beach this morning, I realized, “The plan was to be in the OR at Duke today, but instead I’m seeing this glorious sunrise.”

Dr. Hillman and I spoke again by phone last night. I am so thankful to have him on my team.

He has talked with Dr. Rossi, and on Friday, Dr. Rossi will call me. We do not have a new surgery date yet, but it looks like I will soon have a full open abdominal procedure (similar to the surgery I had in May 2023), followed by a new drug therapy (the specifics of which are still undecided).

After the last 12 days which were full of uncertainty, this morning I am at peace with what may lie ahead. Although I wish all of this could have moved along a little more quickly, I am thankful that by not rushing to a decision, I’ve had plenty of time to process changing circumstances and prepare my heart, my mind, and my body for the days that are coming.

“I will remain confident in this, I will see the goodness of the Lord.”

Psalm 27:13

A brief update - Oct 11

As many of you know, I had labs, a PET CT scan, an appointment with a nutritionist, and my pre-op visit yesterday. I will have more to share next week, but as a number of you have reached out by text to check on me, it’s easier to just share a brief update now and fill in details later. The PET scan information has not been published to MyChart, though I have seen it and discussed it with my health care team at Duke.

The basics:

• The scan showed interval increased size of the previously seen nodules, as well as new hypermetabolic peritoneal nodules, consistent with worsening peritoneal disease.

• Surgery is canceled as it’s no longer a realistic option.

• Dr. Rossi and I talked last night about the possibility of pursuing chemotherapy and/or a different endocrine hormone option.

• I am seeking a second opinion from Dr. Tyler Hillman at UCSD, but I do not have any intentions at this time of transferring my care from Duke.

Thank you to those who reached out by text yesterday with encouraging words, not expecting a response. That was meaningful to me.

I know many will ask how I am feeling. Physically I feel great. I have no real symptoms. Emotionally I am pragmatic and moving into planning mode, though we don’t fully know yet what that will look like.

For this weekend, there are plenty of other things to concentrate on, most importantly Hannah’s baby shower which is tomorrow. She and Ethan are having a GIRL!

When I was a child, I memorized the entirety of Psalm 27, and this morning verses 13 and 14 are on repeat in my head:

I remain confident of this:
    I will see the goodness of the Lord
    in the land of the living.
Wait for the Lord;
    be strong and take heart
    and wait for the Lord.

September 16 appointment

It was an early morning as I left for Duke before 6 a.m.

The redeeming factor in the early start was I got to see a gorgeous sunrise on the drive.

I went to Duke today for my new patient/pre-op appointment with Dr. Sabino Zani, Jr. Duke’s website lists his areas of expertise as:

• Metastatic Disease

• Complex Biliary Surgery

• Robotic Surgery

• Liver Cancer

• Pancreatic Cancer

I check three of those boxes, so I am hopeful we’re a good fit!

This was a simple appointment with conversation and time for questions on both our parts.

A few key takeaways:
1) No dietary restrictions before the liver resection. I’m thankful that I have a healthy liver apart from the noted areas of concern.
2) He is cautious about the idea of my leaving the hospital same day. He said there's a possibility of needing to stay one or two days. There's a lot that is unknown until they have a clear view of the inside of my abdomen.
3) He believes I'll have 5 incisions, the largest being reserved for the portion of the liver being removed.
4) He did a rotation under Dr Rossi during residency, and they’ve now both commented to me that they work well together.

Today marks one more appointment down that brings me one step closer to surgery on October 22. There are still details to work out and a number of unanswered questions, but I feel like today was productive.

I even stopped at The Mad Boar for their Build Your Own Sides plate lunch, a great way to break up the long drive back home.

I was reminded today of an old hymn from my childhood. The words seems fitting.

“I don’t know about tomorrow,
I just live from day to day.
I don’t borrow from its sunshine,
For its skies may turn to gray.
I don’t worry o’er the future,
For I know what Jesus said,
And today I’ll walk beside Him,
For He knows what is ahead.

Many things about tomorrow,
I don’t seem to understand;
But I know who holds tomorrow,
And I know who holds my hand.”

— Ira Stanphill

The surgery date is set

Important dates:

• September 16 - consultation with Dr. Zani who will do my liver resection

• October 10 - PET CT scan & pre-op visit with Dr. Rossi

• October 22 - Surgery with Dr. Zani and Dr. Rossi. They are hopeful that this procedure will be able to be done laparoscopically, but because Dr. Zani will be re-sectioning my liver, my recovery time will be longer than it was 6.5 years ago when I had my first laparoscopic surgery.

• November 14 - post-op visit when we will discuss adjuvant therapy options.