Three month labs

This happened like 2-3 weeks ago now and I completely forgot to update it on the blog here!  Sooorry!

Scott had his three month post-op labs done and his thyroid levels are finally good!!!!!  We have worked on getting to this point for over two years now, since they removed his thyroid, and never dreamed it would take so much work.  He's yo-yoed up and down and we've changed his Synthroid dosing several times.  But, he is feeling great now and we are thrilled he's leveled off and we're finally at a good dose!

His calcitonin levels (markers for MC) are still about the same.  We were hoping they would drop off, but no need to worry too much until after we hit the six month mark.  We're in the process of consulting with some other docs from MD Anderson again regarding the whole situation, just to get their opinion and see if they have any other ideas.  As of right now though we don't really foresee any big changes in the plan and are just hanging out.

Thanks for the continued thoughts and prayers!  Hopefully there won't be much to report for a few more weeks.

Radiation?

I guess it's about time to give you all the latest with the whole cancer dealio!  The last time I blogged about this back in December our next step was looking into radiation.  We spoke with other doctors here in town and the following week we spoke with Dr. Moley, the medullary specialist who is a surgeon, in St. Louis.  As per his usual attitude, he was rather unimpressed with the all of the pathology reports (if he ever seems to sound worried someday, that's when I will really freak) and said he has definitely seen this before with this type of cancer.

He told us he hasn't seen much of a positive outcome with radiation killing this type of cancer - it sometimes stops large tumor growth, but doesn't seem to reduce the amount overall.  Dr. M didn't really think that the research was good enough to indicate that we go through radiation at this time, and thought the best plan would be to take the 'wait and see' approach.  However, he left us with the kind advice that he is a surgeon, and so of course he thinks surgery is usually the best approach with this kind of cancer and he gave us the name of a specialist in Canada.

With a little work, we finally got in contact with Dr. Brierley, a radiation oncologist in Canada, who has headed up a large amount of the research in the world on radiation as treatment for Medullary Carcinoma.  Scott gave him his history and they discussed all the latest scans and lab values and various interventions we have tried.

After much discussion, his opinion is also that radiation would not be the best at this time.  Research has showed that this type of cancer just does not respond well to radiation and really shows no long term effects on your chances of dying and would greatly impact Scott's quality of life over the next few months.  Also, if it doesn't kill off all those little specs that are there sitting in his fat, it will most likely make it impossible to do surgery in that area again if that was ever needed.  He recommended that we follow everything closely and if it ever comes to the point where the growth occurs in an area where we simply cannot do surgery because of the risks, then we revisit the radiation possibility.  But for now, surgery and no growth are our best bets.

SO!  The plan of action for now is to wait patiently and live in harmony with cancer.  Sounds so weird to say when you're supposed to be fighting cancer.
We will be checking lab values again in a few weeks and will continue to closely follow them.  Scott will probably be having CT scans every few months for a while.  We are eating our fruits and vegetables and exercising and drinking lots of water and juicing some and doing all the things we "should" be doing as much
as possible - mainly though we are just living.
We are enjoying the small things and carrying on with life and we are grateful for that.  Our hope and prayer that we have gotten the most of this cancer out of his body that we can and that it will not grow anymore.  That those little bits we know about will decide to make peace and his body will stay stronger than them.  

Thank you all for all your prayers and kind cards and words as we continue this journey.  We are truly blessed to have the friends and family and love and support that we do.

The Next Step

We had Scott's follow up appointment yesterday, and as usual for us, we had some good news and some dumb news.
The good:

• Scott is healing fabulously.  The surgeon is very happy with how the incision site looks, Scott's range of motion, and advancement of activity.  In his opinion the surgery just couldn't have gone any better!  So, thanks everyone for all those prayers!
• The lymph node that we saw on ultrasound and CT back in October, which was the primary indication for surgery, was no longer a lymph node at all really - just a big old ugly tumor.  It was definitely time for it to go and we are all glad it's out.
• The left-over thyroid tissue which they removed was all negative for cancer.  We glad for this and think it's better to have it out and leave no doubt in our minds.
• The enlarged lymph node they suspected higher up in his neck (close to the base of his skull) was negative for any cancer.  In fact, they removed about 23 lymph nodes from that area as they were trying to get to this one specifically, and all of them were negative.  However, this leads us into the not-so-good news.

The Bad:

• The fatty tissue that was surrounding the lymph nodes which were close to the base of his skull was interspersed with medullary carcinoma.  
• It would be prudent to continue exploring various forms of treatment and we aren't done yet.

This is a big bummer for us, but we're diving into the next step.  The docs are all rather confused as it is unusual for cancer to spread through the fat in this way.  It would make more sense in our piddly minds for it to keep spreading through the lymph nodes as it has done so far - where it has an understandable blood flow and lymph flow and we can see why it easily travels throughout.  But no, Scott's already confusing and rare cancer has to get even more weird.
We've searched case reports and are pouring over the research, but unfortunately nothing similar to our situation has been published and nobody we've talked to has a clear cut answer.  The next step that our surgeon recommends, and which some new research is recommending, is that we move onto a type of radiation just for Scott's neck.  Since there are no tumor borders, the cancer in this area isn't something we can just go in and cut out as we've been doing with everything thus far.  Also, we wouldn't even know where to start (besides just harvesting every last little bit of fat from his neck which would be silly) as none of this showed up on any of the scans.  We are also running into the concern that if we just leave it, and it continues to grow and spread, each neck surgery we have begins to carry greater risks.
SO, in the next week hopefully, we are meeting with Scott's endocrinologist, as well as a radiation oncologist, to further discuss treatment options.  We are also consulting with our specialist in St. Louis to see if he has any other ideas.  I have finals next week and am working on my 20+ page paper for another class due after the weekend, so our plates are getting a liiiiiiittle full.  Also, Scott goes back to work on Saturday and we're hoping that all goes well.

Sexy socks and SCD's are on....

Sexy hat is too....                 

And we're ready to go!

He just rolled back to the OR, so here we go!  Keep the prayers coming!

We have a date!

Today we met with Dr. Moore at Ochsner.  We really like him.  Scott knows all the residents with him right now too and likes them, which makes everything a little bit like a party when we go in for these appointments.  We had a very long chat about everything and looked at the scans together and have a plan.  Scott will be having a PET scan on Friday - just to make sure nothing else lights up. (This is the glorified CT scan where they give him the special dye that the cancer loves and measure uptake times to see what shows up).  Next week we have a follow-up appointment for that to review scan results and sign consents and do pre-op stuff.

Monday, November 21 we're on the books for surgery.

The plan is to do a little more involved of a surgery than originally thought.  The first lymph node that we noted definitely needs to come out.  There is another good sized lymph node that doesn't look too bad yet, but the consensus is that we should just take it out now while we're in there to avoid another surgery later.  Also, they will be taking the tiny little border of Thyroid tissue that was left from the first surgery as the idea is that while it's in there - it's just a risk for growing more cancer.
So, please pray for us.  Lucy has surgery scheduled next Wednesday for her knee (an appointment we have agonized over how to handle, and then waited and waited for, and cannot move now), the house will be ready to be moved into by next weekend, and then Scott has surgery the following Monday.  I am fighting to get ahead with school and have an overwhelming amount of work to get done in between all of this.  Also, it would be good if I found time to go to the grocery store sometime and could clean my nasty fridge out.  Details that are low priority for now... Again, *deep breaths* and one day at a time - I kinda wanna puke when I think as far ahead about everything as I just did.

News finally!

We finally heard from our surgeon in St. Louis on Monday evening.  Scott and him discussed the worrisome scans and increasing lab values and figured out a plan of action.  He said that this surgery should be relatively straight forward and not as involved as the last one, so we can do it here!  Also, he was somewhat dumbfounded that there could even be anything there still, as he said he took 87 lymph nodes out of that area of Scott's neck in the first surgery, which means there shouldn't be any left.  I guess this little one's a fighter - it's days are numbered though now.
We have been in contact with a surgeon here at Ochsner in town, and he had a cancellation today and will be fitting us in for an appointment this afternoon.  (Thank you so much Eric for agreeing on such short notice to cover the ICU for Scott for an hour so we can go to this!)  So, hopefully we'll have more news following this, and possibly even a surgery date!

It's back.

Yes, the C-word.  It's reared it's ugly head again and we're gearing up for the next battle.
We had Scott's routine lab work done a couple weeks ago and were a little concerned when his Calcitonin levels came back at 930 - the highest they've been since his thyroidectomy and radical neck dissection almost two years ago.  So, since it's been almost a year since we last did CT scans and ultrasounds, we decided that should happen.
They did them on Monday and by Thursday morning we had official confirmation that yes, he has another lymph node that looks bad in his neck and it needs to come out.  Meaning it's time to start planning surgery again and it should probably happen within the next month.
His scans are on a CD and in the mail right now, headed to our specialist in St. Louis.  He will review them and we should know within a few days whether we need to go back there for surgery or if it can be done here locally.  So, for now we don't really know anything.  Except the cancer is back and surgery is needed.

We're pretty bummed about the whole thing, but trying to stay positive.  It could be worse - the lymph node is at least in a relatively easily accessible location.  It's in his neck right next to where his doctor in St. Louis took out all the other ones in January 2010.  The timing is not ideal (when is cancer timing ever ideal though, right?) with everything going on with our house, school, and residency. We will get through though.  We just need lots of prayers and are trying to take it all one day at a time.  I'll let you know when we know more.

Recovering from the Ickies

Scott's on the mend.  Slowly, but surely.
We came to the conclusion that his problems were directly caused by him swinging from extreme hypothyroidism to being quite hyperthyroid within a little over two weeks.  After some reading and talking with his doctors we realized there were three reasons for this:
1) He was very hypothyroid so his Endocrinologist raised his dose of Synthroid, by a fairly significant amount.
2) He started being much more strict about food intake around the time of taking his medicine and stopped even drinking coffee with it.  The synthroid loves to be a greedy medicine and absorbs best when it is taken on a completely empty stomach.
3) He's been taking the medicine at bedtime.  Scott always takes his synthroid in the morning.  He's been working nights for the last few weeks and therefore takes the medicine immediately before going to sleep.  We discovered that synthroid has a much higher rate of absorption if you're sleeping when it starts being metabolized.
So, after over 9 hours straight of continuous palpitations on Thursday morning, and then several hours of them again that evening, along with just feeling terrible, they rearranged things at work again that night and Scott was able to stay home.  We had a phone conference with his Endocrinologist (thankfully she's awesome and didn't make us come in) first thing Friday morning, she lowered him meds again and discussed what we're going to do from here.  He slept the day away again on Friday and got up that evening (basically his first time out of bed in over 30 hours) and went to work that night.
You would think with him being hyperthyroid he would have been running around like a crazed, productive maniac, but apparently when you get really hyperthyroid you also get really tired.  And can't focus.  He decided the nurses must have hated him Friday night, because he could not think of aaanything and was a bumbling mess.  (Sorry ER nurses at University - thank you for putting up with him!)
Fortunately, he had last night off and has finally started feeling like he's among the living again.  He's lost over 13lbs in less than three weeks (I'm slightly jealous) and has had a headache for the last two days.  He's still having palpitations, but they subside within about 15 minutes now and are not as continuous anymore.  Because of the long acting time of Synthroid, it's going to take a couple days still for him to feel good again.  Thanks for the prayers if you sent them up for us.  Hopefully we can get somewhat regulated soon, because this is no fun.

The Ickies

Scott is feeling awful and we're a little worried.  They sent him home from work early last night (which NEVER happens as a resident) after doing an EKG and a load of labs on him.  He's been having intermittent palpitations over the last few weeks but usually it will just be one or two here and there.  

He started having them last night around 1am though and they wouldn't stop.  His pulse is completely irregular and he is feeling really just out of it and awful.  If you've ever had a palpitation you know they are uncomfortable - it almost takes your breath away and feels like your heart is flipping in your chest.  

After the palpitations continued for over two hours they did the EKG and ran labs.  The EKG showed that he's throwing PAC's (usually harmless but he shouldn't be having this many of them for such a long period of time).  His labs were normal except he has gone from super hypothyroid to very HYPERthyroid within about three weeks.  Now, this is not a steady level (it takes about 6 weeks to reach that), but his thyroid levels are definitely way off, which could be the primary contributing factor as to why he feels like crap.  He's finally asleep now after a very restless morning with a very irregular pulse still and I'm hoping he can sleep the rest of the day and feel better.  It's a little unnerving.

We'll be consulting our Endocrinologist about what to do, but are hoping we can get this fixed ASAP.  Please say a few prayers for him.  He's scheduled to work again tonight and I'm hoping he's feeling better - at least well enough to focus and get through eight hours.

Follow-UP

We went in for Scott's 6 month cancer follow-up appointment this morning.  He had his labs drawn last week so results would be back from Mayo and they are GOOD!

His calcitonin (the most accurate marker for this type of cancer at this time) is 757. Which means it is holding steady!!!! As well as his CEA level which is right about where it was last time too!

This is a very good sign!  His levels have held steady for a year now and we can finally say that he is in remission.  That's the first time I've dared to type that word and it makes me a little giddy and nervous all at the same time.  From here on out we are cleared to wait another 6 months before we check CEA and Calcitonin levels again or do any more repeat scans unless anything should change. Yay. Yay! YAY!

He's pretty hypothyroid (went from < 2 to 10) which completely explains the tired, icky feeling he's been having that was scaring me for the last few weeks.  We upped his Synthroid dose and will follow-up on that in 8 weeks.  We'll take hypothyroid-tired over cancer-tired any day though and are thanking our Father for this wonderful blessing.

C****r talk

Yes, the C-word.  We haven't mentioned it in a while on here and more and more people have been asking us about it.  No fear though, consider no news as good news for now.
As you may remember, all of this and that happened last July (along with several other things in between, which you can read about here). Following that drama the doctors watched Scott like a hawk for six months with blood draws and scans every few weeks.  In December his levels finally dropped the slightest amount and there were no other signs of growth big enough for us to see.  SO, we have been free birds since then!  Kinda. We just live everyday knowing that Scott still has cancer in his body, but that there is nothing we can do about it, and we are grateful that it's under control for now.
It's so weird that something so traumatic and stupid can start to become "normal" to live with.  We've made many new friends since Scott's diagnosis (when everyone we knew, along with their uncle, was aware of what was going on), and I find myself somewhat surprised when Scott cracks one of his stupid cancer jokes, or I casually mention it in a conversation, and people get uncomfortable or are shocked that it's true and not just an inappropriate statement.  It's so "normal" to me, I almost feel like it's a feature of us - like the way your nose is shaped or your eyes are spaced on our face.  Of course it's there, everyone can see it, but whatever - it's part of him.  I'm sure this will change with time - but it's what it's like now and most days I don't think of it as anything too serious.  It's just our life.
Anywho, my reason for re-hashing all these details is this: Scott's next appointment for lab draws and such is in the middle of July.  I just wanted to give you plenty of time to get your prayers going for good results.

The Latest

I know lots of you follow our blog to stay updated on Scott's status.  As some of you know, this week marks one year since he received his nice, big, tough man scar across his neck and got his Thyroid and lots of cancer ripped out.  We've had our ups and downs since then - our roughest time being July when we thought everything was growing again with a vengeance.  However, we are quite happy that the cancer has seemed to calm down since then.
Scott's latest rounds of scans found absolutely nothing and the best thing out of it all was that his Calcitonin levels finally dropped a little bit!  749 is the lowest they have been since July (when they jumped from 500 to over 800) and we are thrilled!  We are planning some great vacations in the next few weeks and happy to not be thinking as much about cancer right now.  Thanks to everyone for your prayers - for now life with his currently-napping cancer is just the norm.

Nothing New

And we're perfectly ok with that!  Scott had an Ultrasound of his neck and CT Scan of his chest and neck this last week.  Both came back negative.  The nodules in his lungs have not changed size, and they couldn't find anything new!  It seems that his Calcitonin is still elevated like it was in July, but it has not increased any more since then so we are happy about that!  Whatever little bit of cancer went through a growth spurt to cause the elevated level has decided to lay low for now.

I will be flying to Kentucky on Monday morning for my school orientation.  I'll be there for the week and I'm getting pretty excited.  As you may remember, I was accepted this summer for the fall class, but decided to defer due to us thinking Scott needed surgery.  They graciously pushed me back to the winter class and now I start on January 10th.  This next week I'll be meeting the faculty and staff at the school, as well as the rest of my classmates, who I will be communicating with online during school.  I'll also be meeting my advisor and registering for classes.

And, for the last little bit of good (depending on how you look at it) news - I am planning on giving up my full time position at work at the end of December!  We were thinking I would need to stay at least part time to keep my benefits because the health insurance has covered Scott's cancer testing/treatment/surgeries so well this last year.  Benefits re-enrollment was last week and we were shocked to find that if I went to part time and kept benefits I would be paying OVER $800/month for Scott and I's health insurance.  I would almost be working solely to pay health insurance!  SO, we are going to be changing to insurance through Scott's job, and I no longer have to work even part time, if it seems too stressful once school starts! This has been a little black cloud hanging over my head since getting accepted to school and I feel so relieved to have the option to not be forced to work 20+ hours on top of my 40 hours of school each week.  We'll see how everything goes once classes start and go from there, as far as figuring my schedule out, but for now it's nice to have options.

Update on Scott:  It is time again for repeat testing!  October 21st (next Thursday) is Scott's follow up day.  We're going to be having all the regular blood tests, as well as some additional scans done to see where we're at with cancer.  Or hopefully our lack there-of, right?  :)

Lab Levels

The lab levels from Monday came back:
Scott's CEA (the tumor marker blood test) was within normal limits!  We are happy for that :)
Scott's Calcitonin (the hormone this specific cancer makes in Scott's body) is still elevated.  791.  Down 19 points from three weeks ago, but that's within the margin of error.  We are unsure what to make of this and hoping to talk to Dr. Moley (our Medullary Carcinoma specialist in St. Louis) on Monday so we can figure out the next step.  We are in a difficult place right now because the increased levels indicate something is growing in there, but we don't have anything to take out due to the negative PET Scan.  What to do, what to do...?

Labs

Scott will be getting his Calcitonin and CEA levels drawn tomorrow.  We should hopefully have results by the end of the week and are praying for good results!

PET Scan Results

So, as many of you know, Scott had his PET Scan this morning.  I had to work.  :P
The scan was at 7:30am and we had the results by 10:14am.
Good news:  The radiologists were baffled.  Everyone is baffled.  They pulled up the scans and the lymph node that was big and abnormal looking last month is now completely normal.  It's uptake time of the radioactive dye was within normal limits (the cancer cells uptake the dye quickly because they think it's delicious, so that's how you can see the abnormal cells on the scan.), and nothing around it looked suspicious either!  They looked through the rest of the scan of his body and could find NOTHING - meaning that Scott doesn't have to have surgery for now!   I wanted to jump up and down the hall at work when I heard the news and scream it in everyone's faces!  We are so happy and thankful that our prayers were answered beyond what we even dreamed we could have hoped for!
We still don't know why Scott's calcitonin levels jumped so quickly and we will have to continue to monitor that closely.  He will probably have another one drawn soon.  The PET Scan can't really detect anything smaller than 1cm, so we will have to repeat it in a few months to make sure nothing is growing. In the meantime, a copy of today's scan has been mailed off to Dr. Moley, our specialist at Washington University, to review.
We feel like we live in a world of emotional extremes right now.  We've spent the last few weeks completely accepting this surgery and diagnosis, only to have it wiped away.  I'm thrilled - completely thrilled - but still can barely believe it and don't really know what to do with myself.  It's a total shift of thinking again.

SO, thank you all for all of your prayers and encouragement!  We know that God had His almighty hand in this and are grateful most of all to Him.  We'll keep you updated as we follow this over the next weeks and months.

I have been blessed

A peace has settled over me today and I am ok with cancer once again.  I have come to an acceptance point I guess, and although I do not like it one bit, I am not going to let it control my attitude anymore.  For now. This morning a friend called asking for advice.  Someone she knows was recently diagnosed with cancer (a different kind than Scott's) that presented much the way his did.  His prognosis is not as good as Scott's though and his treatment will be worse in some ways, making for a difficult road ahead.  After talking with her I felt a burden lift off of me and Martina McBride's song "Blessed" has been running through my head ever since.  Hearing a story similar to ours snapped me out of my sulky bitterness I've been walking around with since we got Scott's CT results.  Scott and I definitely don't have the best circumstances all around at this time, but when I consider how much worse things could be, I have nothing to complain about right now.  God has dumped more grace in our laps than we know what to do with and I am stunned at people's generosity and kindness continuously.  So basically, I could blabber on about this longer, but it all boils down to the fact that I have chosen to be thankful today for the good things we have in our life.

We met with Dr. Abbas, a cardiothoracic surgeon (the best we've been told) at Ochsner today just to get another consult.  We have a new game plan that has developed over the last 24 or so hours and he agreed with it.  We have Scott's PET scan next Tuesday and it will be read immediately.  If the lymph node in Scott's Mediastinum is still the only thing they see we will probably be having surgery here in town by the first week in August with Dr. Abbas.  If there are more areas of concern - say in Scott's neck, or elsewhere - we will stick with our surgery date of August 25th in St. Louis with Dr. Moley and Dr. Patterson, the cardiothoracic surgeon he works with.  The surgery to remove the lymph node we know about is rather basic for a cardiothoracic surgeon and, if possible, it would just be easier to be here in town where we are close to home and know lots of people.  So, please pray that there are no other naughty spots to deal with and that we can hopefully get this all over with sooner, rather than later.

Bummers

This last week has been full of calls to insurance, consults with doctors, making appointments, and lots of cell phone minutes used talking to friends and family.  We talked to Dr. Moley after he reviewed all the reports and he has said the lymph node needs to come out within the next month.  We are also getting a PET Scan (basically a detailed CT Scan) on Tuesday morning to look at the rest of Scott's body and make sure nothing else has popped up.
Dr. Moley contacted one of the Cardio-Thoracic Surgeons he works with to do the surgery.  Scott will need to have a Microsternectomy, which makes me sick to my stomach as they will have to cut through bone to get to the lymph node(s) behind his sternum.  After Dr. Moley's scheduler worked for a whole day, re-arranging schedules, the soonest time we are able to get into an OR at Washington University with both of these doctors is on August 25th.  Because Dr. Moley originally said he wanted to do surgery sooner than that, we are still waiting to see if this date can be moved up.
Scott is still consulting with other doctors and we are going to try and see a Cardio-Thoracic surgeon here in town this week to get more opinions on the plan of care.  We may also talk with another Ear, Nose and Throat doctor and see if they have more ideas.  We want to continue to explore all of our options, to be absolutely sure of our choices.
As a result of all of this, I will be calling Frontier School of Midwifery tomorrow to decline my spot to start the Graduate School program this fall semester.  The week of orientation would start a few days after Scott's surgery and we both think school + work + cancer are a little too overwhelming at this point.  We are also going to miss two weddings we were really looking forward to, and our two week vacation out of the country  set for the beginning of September.  Major bummers all around, but we are moving on and trying to accept it all.  We hope that we can get this icky stuff out of the way now, and we're sure there will be plenty more vacations later.
Thanks for the continued prayers and calls and texts and comments and love you send!  We are so grateful for it all :)

Cancer Frustrations

Well, today was disappointing.  It has been almost six months since Scott's surgery and we had our big follow up appointment with Dr. Panunti, our Endocrinologist at Ochsner.  Earlier this week Scott had a CT Scan of his chest and neck and repeat labs drawn.  We had three goals for today:  1-Calcitonin levels would be below 500.  2-Scott's thyroid levels would be within normal range.  3-The spots on Scott's lungs would not have increased in size or number since the last CT Scan.

SO, the good news:  We achieved one of our goals!  The spots they saw on Scott's lungs are still the same, meaning they are probably just granuloma's (scars from a previous sickness of some kind).  The bad news though, is that Scott's Calcitonin levels have increased to 800 in the last two months.  Normal range is 0-15, Scott's were almost to 3,000 before surgery, and have been at about 500 since surgery.  The increase is an indicator to us that cancer is growing again somewhere.  Dang it  (confession: I said a much different word to myself in the office).

The CT Scan also found an enlarged lymph node in Scott's mediastinum, the area behind his upper sternum (breast bone).  Also another dang it.  I tried to take the news in stride and managed not to cry in the doctor's office in front of her and her fellow and the medical student following our oh so very interesting case.  I think Scott was trying not to just get up and stomp his feet and yell like an angry 2 year old.  We both did a pretty good job controlling our emotions.  Dr. Panunti says it's time to go somewhere else again for further care.  Scott's is the second case she has ever seen and it's time to go to the experts.  It's hard hearing a really good doctor say she doesn't know what to do with you anymore.  This means either back to Washington University in St. Louis where Dr. Moley is, or to MD Anderson.  The news is so frustrating.  We wanted so badly to be normal again.

We faxed all of Scott's results to Dr. Moley and will probably hear back from him next week.  The next step will most likely be to biopsy the lymph node that is enlarged.  Then we'll probably have another surgery and possibly try a new experimental drug that just came out.  It's overwhelming thinking about doing everything over again that we recovered from in January.  What happens to grad school?  And now I really need to stay at least part time at my job when I start grad school because we need my benefits since they've already approved everything and cover everything so well. That overwhelms me that it's no longer just an option, but a necessity.  What happens with residency?  Scott's program has been absolutely AMAZING and so gracious in dealing with him and his sick self throughout this last year, but if we need another extensive surgery or experimental chemo it's hard to take any more time off than he already has.  What happens to our vacation we were going to take in September?  And getting chickens?  And who will take care of the dogs when we go out of town?  And feed the chameleons their gross bugs that Scott doesn't mind? And is this going to be something we have to deal with for the rest of our lives???  When will we ever have kids if we're always fighting cancer?  Why Scott? Why us? All these questions have been flooding my mind since the appointment and trying to swallow me up.  I'll be the first to admit I'm being a little irrational and over dramatic about it all, but that's my first reaction.

Now I'm just trying to take deep breaths and not freak out too much about next month and two months and six months from now.  I'm going to put my makeup back on and go to dinner and laugh and carry on like a rational human being.  We're just going to continue to take it one day at a time and deal with it.  I remember feeling this way and much worse when we first got the diagnosis in December and we came through that first surgery just fine.  Everything will work itself out along the way.  Stressing just gives me an ulcer and makes me want to cry all afternoon.  Which I still did for a while anyways.  And then napped.  We are thankful it's not Scott's lungs.  And that it's only one lymph node so far.  And that we have great doctors who are willing to go the extra mile for us.  And amazing family and friends who pray for us everyday and are so supportive.  Life will be ok.  It's just going to be more work.

*Heavy sigh*  Alright, done ranting about all that.  Last thing from the appointment is that Scott is now Hyperthyroid.  Meaning he's got all sorts of extra hormones in there going crazy.  He feels the best he's felt since last spring though, so for now Dr. Panunti says it's alright.  The benefits out-weigh the risks.  He's not symptomatic and so we'll just continue to keep an eye on it for now and let him be happy and have energy.