Maybe it is just fatty liver?

Today (on 8/15) we received the challenging news that Sara’s cancer – previously seen to be in remission – had apparently spread to her liver.  The words her doctor used were... “Well… there is definitely something there…”

The day had unfolded prior to that point like many of our normal just-for-fun adventures to downtown Fargo.  We arrived early as Sara had to start the day with a CT scan. Later we stopped at a food truck so Britty and Cam could eat hotdogs.  We walked around the Broadway and Robert’s street neighborhoods and looked at some mid-century modern and then Scandinavian furniture.  We stopped at Atomic coffee for some gluten free snacks and enjoyed a blistering game of “Taboo”.  Callum was pretty good at that game!

The waiting room prior to seeing her oncologist was new and looked nice as they had recently renovated the space.  It looked great – but it was way too hot in there!  Callum was busy coloring in his new Where’s Waldo coloring book, while Britty was blasting away tanks on some sort of Android mobile game.  Another patient was listening very loudly to some program that I couldn’t make any sense of.

In the waiting room Sara wasn’t nervous.  This had become a very common experience – now being probably at least the 5th or 6th CT scan she had received.  All of her prior follow-up scans came up very clean.  This was routine and “old hat.”  So much so that we even brought Callum and Brittyn with us, since it would be most convenient.

I on the other hand was very nervous.  Not because I knew something Sara didn’t.  But because I think I have often had a touch of “Scanxiety” every time we’ve had these follow up tests.  In a sense, I think I have seen it as my job to be worried for her, making sure all of her numbers are where they should be.  If they are slightly off… why are they off?

That’s part of the trouble.  She has been feeling well.  At least as well as we thought to expect.  There haven’t really been symptoms that jump out and say – “hey you should really go get that checked!”

So yes, I’ve been avoiding the actual diagnosis part of this story... 

Ideally (and usually) Sara’s CT scans are reviewed by a radiologist prior to the meeting with the Medical Oncologist.  That did not occur yet on this particular day.  So her oncologist reviewed the CT scan image results with us on the fly.  He’d stop his screen every so often to mention that a particular organ looked great and had no concerning issues.  Starting up with the upper chest, through the heart and lungs, it continued to seem like a normal surveillance appointment. 

That ended when he got to the liver.  There he went back and forth in the images, looking over the liver in detail and in deafening silence.  I think the kids even picked up on his silence and could tell something was wrong.  The easy going feeling of the day was slipping away.

Appearing to have been taken by surprise (as I am sure they always are to some degree) the doctor took his time to review the images repeatedly to be sure of his opinion.  He eventually stopped and took his time to explain – and informed us that there appeared to be something of concern in the left upper section of Sara’s liver.  The rest of what he said is honestly a blur as my mind tried so desperately to hang on to the “there-is-something” in the statement – as in something other than cancer. Maybe it was fatty liver disease? 

Sara expressed that this was definitely not what was expected out of the day.  She had no prior symptoms in her liver.  Most of her blood counts were perfect, particularly her liver enzyme levels hadn’t looked this good in two years.  Her CEA was just slightly above normal at 5.4 – a level that is often described as a possibly-false-positive if there weren’t the presence of a tumor in the scan.

Discussion of potential treatment

From there, it was hard to think clearly.  But in talking about next steps, there were comments about possibly doing a PET scan.  Just in case it could provide a clearer image of the liver.  I now know that this is a debated practice and many liver surgeons are not advocates of their usage prior to surgery. And the surgery was noted as likely the key next step for Sara.

There was some mention of what Sara’s next phase of chemotherapy treatment would most likely be, depending on results of testing and tumor tissue pathology.  We asked some questions about studies or alternative treatment.  Sara’s oncologist was doing his best, but ultimately, I think he knew that we needed time to digest the news and understand its implications.

At the end of the day this is obviously news that we never wanted to hear.  In the car ride home, we were all blubbering. (I know I am supposed to be strong for her!)  We all (me, Sara and the kids) needed a few of those moments of laying it all out there and purely expressing our feelings on the situation. 

While we needed a moment to absorb the diagnosis and the implication of what the future holds, we immediately kicked into gear just like we had two years ago - looking into research studies, immediately changing our diets and looking into many of the new ways of attacking cancer.

More news to come soon.  Needless to say this will be a new and challenging phase of our lives.  But we’re going to face it together.

Love Your Buns is a non-profit initiative aiming to remove stigma and improve awareness around rectal cancer, its prevalence and its symptoms. A growing epidemic in young adults, rectal cancer is easy to remove if caught early, however due to a variety of reasons, young adults are not likely to seek screening options like colonoscopies. This gap in screening is leading to more advanced disease at diagnosis and more challenging and strenuous treatment. We're working to Educate young adults to increase awareness of the signs and increasing prevalence of Rectal Cancer and to Empower informed decision making and Improve quality of life in Survivorship.
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