12/30/2009 All of Pam's preparations for Christmas certainly created an extremely happy and busy season. We celebrated with all 4 children, 8 grandchildren, and family (immediate and extended) members throughout the past two weeks. The experience was precisely what Pam planned and hoped for. she was active, throughly engaged, and barely affected by the effects of the cancer.

Pam is back in her normal routine. After leading the sanctuary choir on Sunday, she returned to chemotherapy on Monday. She has experienced the normal abdominal pain and lack of appetite associated with chemo since her treatment. She will continue on her plan of a treatment every three weeks.

Pam has been undergoing chemo for about 18 months, yet she continues to maintain her faith and her positive outlook for healing. Your prayers and support have been most welcome and an inspiration to her well-being. May God bless you all.

12/14/2009 Pam has now had two chemo treatments with Doxil and she seems to be tolerating the chemical. It is too soon to determine the effect of Doxil on the tumor, but Pam has not experienced many side effects. She remains active and tries to do everything she used to do, yet she must rest frequently to conserve her energy. Her next treatment comes after Christmas.

The Christmas season really inspires Pam. She has baked cookies, completed her shopping list, sung with the Treasure Coast Community Singers and sanctuary choir, and has about completed preparations for expected company at Christmas. Pam's sister Diane and her husband Art, along with three cats and a dog, will be driving from Connecticut. Our granddaughter Megan, who we have not seen in 13 years, will be traveling alone from Arizona to spend five days with us. All the children and grandchildren will be here on Christmas Day. It will be an emotional and exciting time.

We thank you for your continued prayers and support. They have lifted us up and kept us going. God bless you!

11/25/2009 It has been more than a week and a half since Pam's first chemo treatment with Doxil and she has been able to maintain an active schedule. The side effects of the chemical have been somewhat limited to digestive concerns. Pam still has occasional numbness in her feet and hands and abdominal pain but those effects have been with her throughout chemo.

Pam has been very active preparing for the holidays with shopping, baking, singing and leading church activities. We will spend Thanksgiving in Orlando where son David will host nearly all the Florida family and extended family. That count will include 7 grandchildren and 10 adults. Our daughter Beverly is committed to work and will be unable to join the crowd.

We are so thankful that we will be together with family and friends during these stressful times. We are most thankful for your continued prayers and support.

Happy Thanksgiving!

11-16-2009 Pam started treatment with Doxil on Friday and has shown little, if any, adverse reaction. Pam's sister Diane came for the weekend and the two of them maintained a full schedule of holiday shopping for the families, making cookies for a churchwide event, visiting new and long term friends, and working on a multitude of domestic projects. In addition, Pam played the handbells and sang with the choir in church. Diane kept Pam so busy that Pam had no chance to think about chemo.

The current plan calls for chemo treatment every three weeks. There is no need for Pam to carry an auxiliary infusion pump like she did with the previous chemicals. She enjoys the improved mobility and is looking forward to successful treatment and a busy holiday season at church and with the Florida family.

Thank you for your continuing support and prayers.

11/9/2009 Here are two photos of Pam taken during our recent cruise. She remains radiant despite dealing with the cancer.

11-8-2009 Pam is cleared for the new chemo treatment Doxil. Doxil is classified as an antitumor antibiotic and is developed to act during multiple phases of the cell cycle (when the cells are dividing) and is considered cell-cycle specific. Chemotherpy is most effective at killing cells that are rapidly dividing but chemotherapy does not know the difference between the good cells and the cancerous cells. The normal cells will grow back and be healthy, but side effects occur and need to be considered. Doxil can cause numerous side effects and is formulated to treat ovarian cancer, breast cancer and other solid tumors. This information about Doxil was obtained from http://www.chemocare.com, a site presented by Scott Hamilton.
Pam's treatment plan calls for chemo every three weeks, beginning on November 13th.

Aside from the stress of undergoing the muga scan of the heart and waiting for days for the results, Pam found time to sing in two performances of the Treasure Coast Community Singers, one of her favorite groups, in addition to the regular church choir activities. She showed her determination to do what she loves despite the latest report on the cancer. What an inspiration she is!

God bless all of you for your continuous support and prayers.

10-31-2009 The cruise is over and we are back to the routine. Pam had a CT scan on Wednesday and met with her oncologist yesterday. Pam was down after learning that the scan showed the cancer may be spreading. Some lesions were found on both lungs and the report hinted that they may have been obscured by effusions on previous scans. Some enlarged lymph node lesions were noted in the mid-mesentery area and one on the liver has slightly increased in size. The ascites has decreased around the abdominal area.

Despite the report, Pam's doctor was pleased with her color, energy, and overall appearance. He will change the chemo treatment to doxil. Pam will undergo a muga scan (x-ray of the heart) to verify she can tolerate doxil, which may affect heart tissue .

We have been blessed by the support of all our friends and ask for your continued prayers for Pam's healing. God bless all of you.

10-24-09 We are on our way back toward Fort Lauderdale and will dock on Tuesday morning. Pam did exceptionally well on three side trips ashore-climbing stairs in and out of busses, walking up inclines and around tourist sites, and sampling all kinds of food. She is thoroughly enjoying this cruise and has experienced wonderful endurance and has participated in many activities every day. Many cancer surviviors have noticed her smile, positive attitude and energy and have made special efforts to express their support for her cancer fight.

This cruise has been a wonderful break from chemotherapy. Your prayers and support have been the source of her drive and energy. God bless you!

10-21-2009 Pam is doing very well as we cruise toward St. Maarten. Even winds of 30 knots and seas of 4-5 feet have not affected Pam. She is eating and sleeping with no problem and most of all-she is feeling no ill effects from the cancer. Pam looked great after a manicure and haircut yesterday and wowed the crowd at a formal dinner. People have remarked how cute her scarves are and have admired her needlepoint.

We certainly have appreciated all your best wishes for a successful vacation. Love to al our friends.

10-16-09 Pam finished her residual chemo infusion yesterday, but she has had stronger than normal abdominal pains during the week. Consequently, the CT scan scheduled for this morning has been rescheduled for October 28th. Pam is resting more comfortably this afternoon and she is looking forward to playing the handbells and singing with the choir on Sunday.

Thank you all for your caring and sharing with us during the past 17 months of treatments.

10-13-2009 Pam was very happy she was able to have chemo yesterday. Her white cell count was acceptable, but she does not have an explanation for it. Having chemo this week is very important because we will be traveling from October 19-27 on a cruise to the eastern Caribbean. Pam's oncologist fully supports her travel and he will give her a shot to help stabilize her blood count.

Pam's CT scan has been rescheduled to Friday, October 16th. Since Pam is connected to an infusion chemo pump until tomorrow, rescheduling was the more efficient approach to undergoing the scan.

Pam has been feeling stronger recently. She continues to be active in the church and community choirs and related musical activities.

We believe your prayers and support are responsible for her renewed energy level and Pam' s own determination and optimism to master the cancer. May God bless you all!

10-8-2009 Pam did not ahve chemo yesterday because her blood test showed a low white cell count. Last week the platelets were the problem, but the platelets count was acceptable this week.
Pam is a bit discouraged because there is no real method for increasing the white cell count and she has not had chemo for several weeks. She will try to have chemo again on Monday, October 12th, She is still scheduled for a CT scan on Tuesday, October 13th.

10/2/2009

Pam consulted with her oncologist today to discuss the treatment plan. Her doctor was pleased with here overall appearance and and her positive attitude. He made adjustments to her pain medication to help alleviate the shifting abdominal pains and scheduled a CT scan on October 13th. Her last CT scan was completed in April. She also learned that the toxicity of the chemo affects the blood and no way to ensure sufficient white cell or platelets counts is available.

Pam's doctor had submitted tissue samples from her initial biopsy to a lab for cutting edge tests related to cancer of unknown origin. The tests were designed to analyze the molecular structure of the tumor and help ascertain genetic influences related to the cancer. We learned the tests were not conducted because of an inadequate tissue samples. No plans for an additional biopsy have been discussed.

This weekend will be one for relaxation. We plan to visit the Orlando contingent of our family to watch grandson Jonathan play soccer. Our church will celebrate Worldwide Communion Sunday and the choir will contribute greatly to the service.

Thank for all your prayers and blessings.

10/1/2009 Pam was extremely busy this past week, starting with directing the sanctuary choir on Sunday. She was the substitute director at the rehearsal of the ensemble section of the Treasure Coast Community Singers on Monday. On Wednesday, Pam worked with the children and directed the sanctuary choir rehearsal. Pam certainly enjoyed doing what she loves.

Pam was unable to have a chemo treatment on Wednesday because of a low white blood count and a low platelet count. There seems to be nothing Pam can do to ensure a good blood count. She has eaten well, maintained a steady weight, and experienced little, if any, pain. Pam will meet with her oncologist tomorrow and go over her overall treatment plan. Meanwhile, the next chemo is scheduled for October 7th.

Tuesday, September 29th, was Pam's birthday. She ordered a shrimp po'boy with all the trimmings at a Cajun restaurant. It had been a long time since rich food appealed to her. Our children made certain the house was festive with beautiful flowers, balloons, and carrot cake, Pam's favorite. We also had a earlier weekend celebration at the home of good friends where Pam enjoyed a gourmet meal and a delicious homemade carrot cake. Pam was very happy on both occasions and showed no ill effects from the cancer.

Pam has been able to do what she loves because of the prayers, support, and encouragement of all our friends. may God bless you all.

9/24/2009 This is an off week for chemo and Pam has taken full advantage of increased energy and activities. Pam and our daughters Beverly and Tammy hosted a 40th birthday party for our daughter Diane on the 21st. She sang with the community singers on Monday and the church choir on Wednesday. Pam is looking forward to leading the sanctuary choir on Sunday and optimistic that she will have the necessary stamina to direct. She still experiences frequent episodes of chemo effects varying from feeling hot and cold, numb feet, cold toes, and abdominal discomfort. Fortunately, she has learned to minimize those effects.

Pam is most thankful she is still able to be active in church activities, being a part of the lives of our children and grandchildren, and renewing acquaintances from years past. Your prayers and support have sustained Pam and me.

9-17-2009 Pam has been active these past few days. She presented the childrens' sermon on Sunday and worked with the children at our church family night yesterday. In addition to singing with the community singers group and the sanctuary choir, Pam has set aside time to shop for herself and family members and work on many needlework projects.

Pam had chemo yesterday. Despite the effects of the basic treatment and the fact she is attached to a supplemental portable infuser pump for two days, she remains upbeat and positive. She is an inspiring example of the power of hope and prayer.

God bless all our friends for continuing support.

9/11/2009 Pam was quite relieved to learn that the CA125 test had a cancer marker of 48. Her previous score was 47, yet she has had only one or two chemo sessions since then. This news really helped Pam deal with the lack of energy and appetite she has endured since the last chemo on August 31st. She is ready to ring handbells as a substitute in church this Sunday.l

The next chemo treatment is set for September 16th.

We thank you for many prayers and expressions of support for Pam' healing.

9/7/2009 Pam started another round of chemo last week and all of the physical discomfort and effects associated with the chemo have returned. Pam's appetite, energy level, mobility have diminished and the constant abdominal pain has increased. She maintains an upbeat attitude and hosted a Labor Day weekend gathering of more than 30 friends and family members yesterday.

The new round of chemo has been planned and is scheduled for 6 treatments two weeks apart. We have not received results of the CA125 test taken over a week ago and no scans are planned. We should have some definite information this week.

Please continue to pray for Pam's healing.

8/26/2009 We are back from vacation and Pam is doing very well. We stayed with her sister Diane and husband Art and made many side trips to visit longtime friends and family. Pam needed no wheelchair and was able to walk short distances and climb a few steps. Pam certainly had an appetite and meals from salads to lobster. She has not forgotten the technique and skill needed to eat lobster and thoroughly enjoyed four lobsters during our trip. Despite her eating regularly, she did not gain any weight. She will discuss the weight concerns with her doctor.

All in all, Pam was very active and showed no effects from potential infection from the air travel or any of the symptoms associated with the cancer. The break from chemotherapy was wonderful for her quality of life and personal happiness.

Bless you all for your continued prayers and support.

8/13/09 It is an awesome day. Pam's white blood count went up, well above the minimum level, and she does not require any special shot to ward off infection. In addition to the white count, the values for hemoglobin, red blood cells, and platelets all went up. Pam is ecstatic. These increases were not due to any medication or chemo. We remain cleared for travel tomorrow.

Pam learned today from the nurses at the Cancer Center about a lab that tests for the source of cancer of unknown origin, which is basically describes her situation. We will be studying the literature during our trip. Pam remains a candidate for clinical trials which may be established to study cancer of unknown origin.

We are grateful for the continuing thoughts, prayers and support of all our friends, acquaintances, and family throughout this ordeal with the cancer.

8/9/2009 Pam could not have chemo last week because of a low white blood count. If necessary, she will have a shot to bolster the white count this week to help her resistance to infection when we travel to New England on August 14th.

Meanwhile, Pam continues to be active and energized in her activities. She has been working hard finishing some needlework projects, getting ready for our trip, singing with the choir. We have been to the movies and dined out several times. Today, Pam taught children's Sunday School and gave the children's sermon with enthusiasm and confidence.

We know these signs of progress in healing and Pam's ability to adapt to the effects of chemo are the results of your prayers and unfailing support. May God bless you all.

7/29/2009 Pam has been energized the past 5 days-good appetite, active in the choir, taking the two oldest grandsons shopping for school (Chase is entering college and Ricky will be a high school senior), working on needlework projects and planning a trip to New England in August. She was scheduled for chemo today, but her white blood count was down and not sufficient for treatment.

Pam was a bit disappointed with her overall plans when she had to reschedule chemo for next week. If she has chemo she will have only one week to recover before our trip. This will be a strain on regaining strength and endurance to travel. The original plan was to take August off from all chemo so she could relax and enjoy travel. Her cancer condition remains stabilized and the postponement of chemo today was only a minor setback.

We know the prayers and thoughts of our friends and church family have been instrumental in her improved condition. We ask for your continued support.

7/24/2009 Pam has just about recovered from the effects of her last chemo (on 7/24). She was in a euphoric state today when her doctor called to tell her the cancer marker (CA 125) was down to 47.
The last marker score was 72. Regardless of how unreliable the cancer marker may be, the reduction in the number is comforting to Pam, especially when a score of 35 may indicate a state of remission. This news reinforces her doctor's assessment that her condition is stabilized rather regressing.

Praise the Lord!

7/17/09 Pam had a good report from her doctor today. He was pleased with her overall condition-skin color, no swelling, very alert and feeling good about herself. He plans no CT scan after the next chemo treatment, scheduled for July 29th, because he does not want to inject radioactive contrast in to her system when she seems to be responding to chemo. Pam plans to take the month of August off from chemo, with her doctor's blessing.

This chemo protocol seems to be the one we have hoped for to show signs of improvement. We know your prayers for healing and continuous support have helped Pam to reach this point in her treatment. We thank the Lord for you and His blessings on you.

7-15-2009 After a great weekend of activity, Pam has been slowed by a chemo treatment today. She has lost some weight and her chemo mixture was adjusted accordingly. She is also somewhat limited in her mobility because of the portable infusion pump that is adding residual chemicals for two more days.

Despite the restrictions, Pam went to choir practice tonight-the second consecutive week. She has made it known to all she comes in contact with that she wants to be active to the best of her ability.
This is her passion and her strength to combat the cancer is fueled by all your prayers and support.

7/11/09- This past week, the week after her last chemo treatment, has been really rough on Pam. All the familiar discomforting physical problems arising from chemo returned and Pam was extremely uncomfortable. She is not looking forward to the next scheduled treatment on Wednesday, July 15th.

Today marked a complete improvement in Pam's condition. Pam's college roommate arrived for a two day visit. Carol and her friend traveled from Cape Cod just to see Pam and catch up on the events of the past years. This was a full day of breakfast at the beach, a boat trip on the Indian River, and lunch on the waterfront. Pam enjoyed herself immensely and felt wonderful.

We are convinced this sudden and dramatic improvement in Pam's physical being was due to the continued prayers, support and comfort of our friends and Pam's desire to enjoy being with people without being a liability. Blessings to all!

7/3/2009 Pam has experienced a good week. She had chemo on Tuesday and had the infusion pump removed on Thursday without complications. Both her regular doctor and her oncologist commented on how good she looked.

Pam has been active around the house and at church. She spent three hours at church on Wednesday attending the family picnic, enjoying the people and the music at the handbell choir practice, and joining in the sanctuary choir practice. These are activities Pam loves and has not been able to fully participate in for many months.

As we celebrate the Fourth of July and prepare for church and family activities, we thank all the people whom we know, and do not know, for the comforting prayers and support for Pam's healing.

Blessings to all!

6/27/2009 Pam spent half the week working on family matters and just "hanging out" with her sister and brother-in-law. She was scheduled for chemo therapy on Wednesday, the 24th, but her blood test results convinced her doctor to postpone treatment. The blood test showed a low white count. The previously unexplained high blood pressure was normal and the hemoglobin count was marginal. Chemo is now set for June 3oth.

Pam has kept really busy around the house by completing craft projects, cleaning out the closets, and going out in the evening. She still tires easily; however, she looks much healthier.

All your continued prayers and support have helped Pam considerably, despite a less than positive cancer diagnosis. Thank you and we love you.

6/22/2009 What a wonderful weekend! Pam and her friends spent hours viewing videos of past "get-togethers", doing puzzles, dining, and attending a choral concert. The time together just zipped by. Pam was tired, but happy, and showed no effects associated with chemo.

We spent time with all our children and grandchildren during the weekend because of Father's Day. Our oldest granddaughter, Kailey, is attending a ballet academy for a month and will also compete in a world ballet competition in Orlando this week. This will be an exciting time for her. All the children had a great time either meeting or reminiscing with Pam's visiting friends.

Pam's sister, Diane, and brother-in-law, Art, arrived on Sunday for a stay of several days. Today, Art and Dave and friend Bill went to Kennedy Space Center, while Diane and Pam sorted clothes, worked jigsaw puzzles and just enjoyed themselves. This was another busy, yet enjoyable, day for Pam and she required no naps or special attention. The effects of the cancer were not a detraction from enjoying her day or having a good time.

We thank you for your continued support and blessings.

6/19/09 For the past two weeks, Pam has rested well by taking a break from chemotherapy. Her appetite improved, yet she lost some weight. Her variable high blood pressure was under control, yet other tests have not explained the cause of the elevated pressure. She visited her oncologist today and has scheduled resumption of chemo next week. Her blood count and pressures were good and she had gained several pounds since her last visit. Pam's oncologist thinks she is doing very well since being diagnosed with cancer and beginning chemo a year ago.

Pam is ready for a weekend visit by her three friends from around the South and her sister and brother-in-law.

We have been blessed by all your prayers and support as we continue to overcome this disease,

6/5/2009 Pam had her third round of chemo with the 5FU protocols this week. She is getting used to the two days of being hooked to a portable infusion pump for residual chemo. Pam's blood pressure was elevated this week This was something that had not been a problem since she started chemo months ago. A new prescription for blood pressure was ordered by her regular physician and the medication has had effective results. All the other vital signs have been positive-no weight loss, no stomach bloating, a bit more energy, and a good outlook.
This will be a family weekend. Our eldest grandson graduates from high school tonight, another grandson has a birthday party on the 5th, and we have a graduation party on the 6th. All 7 Florida grandchildren will be here.

Pam has been overwhelmed with the expressions of support, prayers and encouragement from friends and people she does not know personally. She is looking to the time she'll be able to return to more normal activities which she loves regardless of the cancer.

5/28/2009

Our visit to Moffitt Cancer Center in Tampa went very smoothly, except for the results. Although the cancer has been alternately described as ovarian or cancer of unknown origin, we learned there is a diagnosis of "cancer of unknown origin." Traces of cancer are in one ovary, in a mass on the liver and in sites around the abdominal area. There is no one area that is ripe for treatment by surgery or radiation. Surgery would not help longevity.

The bottom line is that the chemo treatments Pam has undergone were selected on the probability of success based on the various test results. There is no "right" one. Pam is using 5FU or FolFox and one or two others may be used later on. The chemo will not cure but we hope will control the spread of the cancer. Whether of not the cancer is ovarian, all the chemo treatments are systemic and "overlap" and attack different kinds of cancers. It is not worth finding the origin of Pam's cancer and find out she has already been treated for it.

Pam was encouraged by a reduction in the CA 125 cancer marker over the past few months, but the CT scans showed some spread of the cancer. The doctors tend to rely on the radiology reports over the blood tests for evaluating her condition. The Moffitt doctors' evaluation of Pam's cancer is consistent with that of Dr. Iannotti in Stuart and the doctors at Sloan Kettering.

Pam is registered now with Moffitt for Phase 1 experimental clinical trials. Maybe one will be established for which she qualifies.

There is no medical or chemo restriction on Pam's activities. We need to help maintain her quality of life. We stopped at the Bok Tower and Gardens in Lake Wales, Florida, where Pam showed great endurance and did plenty of walking.
She is still fighting the remnants of her congestion, which contributes to her discomfort. She is determined to remain optimistic for controlling the cancer.

We treasure your prayers and support. Dr. Iannotti and Dr. Apte (Moffitt) agree that prayer works.

5/20/2009 Pam has pretty well recovered from her cold and chest congestion. She had chemo today and is scheduled for blood transfusions on Friday, after she is disconnected from her portable infusion pump. Pam's hemoglobin was down a bit and her blood pressure was up. We would like to see a balance and some consistency in these vital signs.

We have an appointment at the Moffitt Cancer Center on Tuesday afternoon. Pam has been busy arranging the transfer of biopsy and scan results so the records will be available to Moffitt in time for the appointment. We are seeking another opinion on the most effective treatment for Pam, whether it be surgery or chemotherapy or some other protocol.

Your prayers and support continue to be sources of comfort and optimism to us in dealing with this cancer.

5/15/2009 It has been an uncomfortable week for Pam. She has been suffering from nasal and chest congestion which has really affected her appetite and sleep. We hope that the current treatment of antibiotic will take effect quickly.

The encouraging news this week came from Pam's dermatologist who removed the cysts from her scalp last week. Biopsy test results from all three of the cysts came back benign.

We seeking a referral to the Moffitt Cancer Center in Tampa to have an evaluation by specialists in ovarian cancer. This should be finalized in the next week.

We continue to be thankful for all your prayers and support during this time of various chemo protocols and testing to determine an effective cancer treatment. Pam remains optimistic that he will feel better.

5/10/2009 Pam adapted well to the portable pump that was attached until May 8th. The pump and case were no larger than a waist pack and did not interfered with sleeping or normal activities. The chemo has begun to manifest some of the negative side effects, such as abdominal cramps, swollen feet and lack of energy. Pam has not had any ill effects from cold temperatures and has enjoyed her sherbet and ice cream . Her next treatment is scheduled for May 20th.

Today is Mother's Day and all the local children and grandchildren gathered at the house. They brought all the fixings for submarine sandwiches which appealed to all of us.

Pam had several non-malignant sebaceous cysts removed from her head yesterday. The cysts have caused some minor discomfort for a while so she chose to have them removed. Daughter Diane plans to cut Pam's hair tomorrow. This will be the first hair treatment since Pam started chemo last year.

Thank you for your prayers and continued support. We remain optimistic we will see improvement in Pam's condition in the future.

5/7/2009 Pam had her first treatment with the 5FU Folfox treatment yesterday. The procedure took about 3 hours and Pam came home with a battery powered pump to infuse additional chemicals for two days. One of the reported after effects of this treatment is a sensitivity to cold air or even food which can cause pain. Fortunately, Pam did not require any special adjustment of the temperature at home or need to bundle up to keep warm.

Pam has been quite active since yesterday and she has not had any special naps. We had dinner last night and breakfast today with a couple whom we knew in New Orleans eons ago and were visiting their children in north Florida. Pam then went shopping this afternoon for some clothes that fit her. The shopping was an enjoyable experience because Pam was catered to and not rushed.

The pump will be disconnected tomorrow, the 8th. The next treatment will be around May 20th.

If Pam continues to feel energetic and active throughout this treatment, we will see God's work in progress. We feel the love and support of our friends who continue to pray for healing and relief from this disease. Thank you, Lord.

5/5/2009 Pam had 11 pounds of abdominal fluid drained on Friday, May 1st. She felt much better and and a bit more energetic. Pam's sister and our son visited and we had many searching questions about the nature of Pam's cancer,, especially the meaning of lower CA 125 scores and the apparent spread of the cancer to the mesentery, the connective tissue joining the intestine to the peritoneum, as reflected on the CT scan. We prepared a list of questions and "what if's" for Pam's doctor to help us decide our next steps.

We looked into the possibility of clinical trials which focus on cancer of undetermined origin, alternative chemo treatments and possible referral to another cancer center for another opinion. After consultation with her doctor, Pam has opted to begin the new chem treatment classified as 5FU tomorrow. The plan calls for 4 to 6 treatments two weeks apart. Each treatment will take two days to complete-day one for actual infusion of the chemo and 2 days of residual infusion of other chemicals through a pump the size of a cell phone. This treatment will target the abdominal area,

For the next two months or so, Pam will stick to this treatment plan. At the completion of the plan, she may opt for a referral or other consultation, but we remain optimistic some evidence of controlling the cancer will be realized.

We thank you for your continuous prayers, love and support during the past year of cancer treatments. May God bless you, all!

4/30/2009 Pam met with her doctor to discuss the CT scan and blood tests. The CA 125 marker came in at 72, a marked decrease from the last test of 238, but we now realize the test is unreliable, especially with respect to Pam's cancer. The scan results show the cancer has spread to tissues around the lungs, abdominal area and bowel. Pam's recent experiences with fluid buildup, constipation, nausea, and lethargy are a direct result of the spread of the cancer, which is still loosely classified as of unknown origin.

Pam has opted for a new chemo treatment plan, called 5FU (fluorouracil) or FolFox. This treatment is supposed to prevent cancer cells from dividing and growing normally which leads to tumor cell death. This therapy has been used to treat patients of many different types of cancer and may be effective here. If the new treatment is effective here, the cancer cells will shrink and the symptoms Pam has experienced will be abated.

The abdominal fluid will be drained on May 1st and the new chemo therapy will begin on Wednesday, May 6th.

Pam is determined to see this this chemo work and check the spread of the cancer. Only a Divine intervention will cure the cancer. The prayers and support of our friends remain a source of optimism and strength for Pam. We love you all.

4/29/09 Pam had a CT scan of her mid-section on Monday and has experienced nearly constant discomfort and nausea. The nausea appears as soon as she arises and greatly affects her appetite. On the positive note, Pam has been sleeping very well at night, even after taking frequent naps during the day, and takes frequent strolls around the house. We will discuss the scan and blood tests with her doctor tomorrow, the 30th.

We are very blessed to have so many friends and friends of friends express their love for Pam through prayers, cards, thoughts and calls. Pam remains uplifted and optimistic for the right treatment because of your wonderful support.

4/23/2009 - Pam was scheduled for a chemo treatment today but her doctor was concerned about her lack of strength and her recent problems with nausea, irregularity and fluid accumulation. He felt her condition would have been markedly improved if the chemo were working as planned. It appears that the chemo treatments have had the opposite effect and have diminished Pam's quality of life.

Our plan is to evaluate the extent of the cancer beginning with a CAT scan next week. We should also have the results of the CA125 cancer marker blood test taken today. Although the cancer markers have decreased over the past several months, the test results are not conclusive.

The choice of further chemo therapy is generally up to Pam. Since the three different treatment plans targeted for this cancer have been rather unsuccessful, any new plan would tend to introduce more toxicity in her body. Any treatment plan decision will be carefully weighed.

Although Pam's spirits are down a bit, she remains optimistic for a successful treatment. She continually thanks all our friends for the prayers, expressions of concern, support, and personal success stories.

4-21-2009 Pam is scheduled to resume chemo on Friday, April 24th. She took two weeks off from the treatment for the holidays, but Pam did not feel any noticeable change in how she felt. Aside from a great Easter, she suffered frequent periods of nausea and irregularity. Two different medicines for nausea did not seem to have any significant effect. Overall, Pam has had little energy and desire to move around. We hope to schedule a complete assessment of the chemo treatment and effects this week.

Your prayers and expressions of support have helped immeasurably in enduring this disease for the past year.

4/13/2009 Pam had a good week and a fantastic Easter. Throughout the week, Pam spent most of her time relaxing and resting, while dealing with frequent nausea and little appetite. She was inspired by a special visit by friends from church who gave their testimony of how God helped them overcome a number of health issues and prayed for God's healing for Pam. The prayer meeting seemed to give her energy to coordinate plans for Easter Sunday and the family gathering.

She awoke Sunday with the usual feelings of weakness and felt uncertain about her stamina to direct the children's choir. By the time she arrived at church, she was really energized. The children sang very well, Pam was able to stand for the hymns without assistance, and showed no sign of weakness.

Nearly thirty people visited the house Sunday afternoon for a potluck We had six of our grandchildren, friends we have had since we have been married, four generations of one family, and our extended family. Pam was thoroughly enjoying the children, adults, a birthday celebration, and fellowship.

We are very thankful for the most happy day. The church and family activities were exactly what Pam needed to enjoy life and overcome any effects of the cancer for the day.

Easter was a blessed day for us and we thank you all for prayers, support and comforting thoughts.

The following was written by our 10-year old granddaughter in her homemade card,

" Dear Grandma,

I am praying for U. I have been praying every single night for U. I am so happy that the test results were good. I am happy for U. We all love U, and we all hope that U get better.

Love,

Lauren

P.S. U are the greatest Grandma in the world."

This represents the love and support which helped Pam on Sunday.

4/4/2009 Pam spent all day at the infusion clinic when she received two pints of blood to combat her anemia. She ate a big breakfast and most of her lunch and feels very good. There also was no episode of nausea when she first got up this morning. The act coughing up of phlegm every morning the last several weeks has been uncomfortable and there has been no explanation for it.

Pam had a surprise visit from our three local grandsons (ages 15, 17 and 18) and one daughter after she arrived home. She was very pleased to hear what is happening in their lives for nearly an hour. Not every teenager would think to stop by to see his grandmother just to check on her.

Pam is ready for Palm Sunday and Holy Week. She feels very blessed to receive all your prayers and support. May God bless all of you!

4/3/2009 This has been another up and down week for Pam. When not working with the children at church, she endured general weakness and lack of energy. At her chemo treatment today she learned the hemoglobin count has decreased. The shot she received last week to at least steady the hemoglobin count did not work as planned. Pam accepted her doctor's suggestion to undergo a transfusion tomorrow (April 4th) to bring up her hemoglobin. This procedure will presumably boost Pam's energy level to enable her to complete all the Holy Week events and personal activities until her next chemo treatment on April 24th. Pam believes she needs a break from the effects of the chemotherapy and her doctor has supported her in this decision. A cancer marker blood test will probably be taken on the 24th.

We thank you for your continued prayers and support.

3/28/2009 This week began with an emotional healing service at our church. Pam and I were overwhelmed by the spoken and unspoken prayers, scripture readings and the many laying of hands upon us. It was a most wonderful and lasting experience.

Pam had a chemo treatment which was supposed to be the last one before a two week hiatus, however her doctor suggested she go one more week before a break. The scheduled change would better mesh with the holiday hours at the clinic. Her hemoglobin count was up from last week's report which was close to the threshold for a transfusion. This was certainly encouraging. She has a new medication to counter the early morning nausea which seems to appear for no specific reason.The edema in her feet seems to be easing and her mobility has improved.

Pam's stamina is improving with her appetite. We were out walking a bit today and Pam did very well. She is gathering strength for the Easter season.

We continue to be blessed by the thoughts and support of our friends. God 's mercy is evident.

3/21/2009 Pam continued to suffer abdominal pain and lack of appetite and energy this week. She had chemo on the 19th and learned her CA 125 marker was 205, down from 234 several weeks ago. Every decrease leads us to believe the chemo is being effective in neutralizing the cancer. On the other hand, abdominal fluid was retained and 5.5 liters (approximately 11 pounds) were drained yesterday. (The last drainage occurred on February 6th, when more than 7 liters were removed.) The effect of the drainage on Pam's outlook was immediate-she ate well, remained active all day, and spent a lot of time on the phone.

Pam is fully engaged in the music programs for Easter. She worked with the children's bell choir and the Sanctuary Choir on Wednesday. She gathers all her strength and energies to work with the music ministry, which is her passion.

We continue to be uplifted by the frequent expressions of encouragement and support by our friends for Pam's comfort through this ordeal and hope for continued effective cancer treatments.

Bless you, all!

3/14/2009 After a particularly miserable week of abdominal discomfort, Pam felt much better after chemo and meeting with her doctor yesterday. She gained only two pounds ( a far cry from the 15 pounds of fluid in the past) since her last weigh-in and Dr. Iannotti gave his okay for a two week hiatus from chemotherapy before Easter. Pam's blood work showed no signs of anemia and she was so positive about the report that she enjoyed her first real meal at a restaurant in weeks.

Her schedule calls for chemo on March 20th and 27th, then a break from chemo until April 14th. This will certainly make her more comfortable in working with her choirs during Holy Week and relief from the tedious chemo treatments.

As we prepare for Easter, Pam and I are encouraged and strengthened in spirit from all the thoughts, prayers, and messages from our friends in our church, our community and around the country. God bless you!

3/10/2009 Pam had chemo last Friday (3/6) and everything went well. Her blood count was good and she showed no signs of anemia. The effects of the chemo treatment last about two days before Pam starts to feel good. Despite feeling a lack of energy on Sunday, she directed the sanctuary choir and looked relaxed and radiant. She does need to rest more frequently and is generally tired of the chemo routine. Maybe Pam will be able to take a short break in chemo treatments after completing this round in several weeks.

We thank all our friends for continued support and encouragement.

2/27/2009 This has been a successful week for Pam. Even after fighting a bladder infection, Pam worked with the children's vocal and bell choirs and the adult bells. She held up well and had no symptoms of dizziness or vertigo. Pam also has not gained any accumulation of abdominal fluid. It has been nearly three weeks since nearly 7.5 liters of fluid were drained. This is a good sign that perhaps the lymph nodes are permitting natural drainage regardless of the cancer cells. Finally, Pam had chemo today and her hemoglobin count is fairly steady. She has a bit more energy each day.

We believe the power of your prayers and best wishes has brought Pam to this point where she is able to fight the cancer and enjoy some quality of life. Bless you all!

2/17/2009 Since Pam had chemotherapy last Friday, she has gone from feeling really well to feeling miserable with stomach pain, vertigo and little appetite. Today, however, she learned her cancer marker, the CA125, decreased to 234 from 298. This is great news and it is the second straight decrease in the score. We have no explanation for the decrease but we believe it is a sign the chemotherapy is working. Pam's doctor seemed very pleased with this result.

Pam is looking forward to working with the children at church tomorrow. We thank you all for your prayers and continuous support for Pam's health.

2/13/2009 Pam had her first chemo since consulting at Sloan-Kettering. After considerable evaluation of Pam's cancer condition with Sloan Kettering and Pam, Pam's doctor recommended continued chemotherapy with Gemsar, the same chemical infused over the last eight treatments.
If Avastin were used at this time to starve the cancer cells along the abdominal wall, drainage of any accumulated fluid in the abdominal area would be extremely risky and could result in perforations in the intestines. Since Pam was drained of over 7 liters of fluid a week ago, the possibility of continued fluid accumulations is possible. Consequently, Dr. Iannotti will be prepared to treat this condition without extreme risk should it become necessary.

Pam's cancer is not concentrated in one location, so the Gemsar is designed to treat the upper GI area , as well as the uterine area. If this does not work, an alternative plan is ready. Gemsar seems to be the chemical which provides Pam the most comfort after infusion, despite the fluid accumulations. We remain encouraged that the CA 125 marker went down last time and a recent cytology report of the drained fluid showed no cancer cells.

Pam continues working around the cancer and keeping active as much as possible. She still experiences periods of weakness and lack of energy and does well to tolerate and overcome those symptoms.

We really are encouraged that Dr. Iannotti's assessment of Pam's treatment plans are consistent with those suggested by Sloan Kettering. The most effective factor in helping Pam is the support, love, and encouragement provided by friends, family, and the faithful members of our church.

2/5/09 Pam's oncologist will start her on avastin on Thursday, February 12th. As we learned in New York, avastin is an anti-body that attacks cancerous cells. In Pam's case, the cancerous cells around the lymphatic system will be attacked and allow fluid to pass through the peritoneum and prevent the bloating in the abdomen. It seems that avastin has not been prescribed locally for ovarian cancer due to possible restrictions imposed by the drug manufacturer. Dr. Iannotti is seeking to overcome these restrictions and clear the use of the drug with the manufacturer and verify insurance coverage. We are still awaiting the pathologist's review of the liver biopsy tissues to verify the type of cancer diagnosis.

Pam is scheduled to have the abdominal fluid drained tomorrow. This will happen if her blood test for clotting is satisfactory and that has not been a problem previously.

We are more confident in the potential success of this new treatment than we were after our consultation in New York. We also strongly believe your prayers, thoughts and wishes have led
to this next step in beating this disease. God bless you all!

2/2/2009 Pam consulted at Sloan Kettering today and met with a knowledgeable oncologist. The doctor agreed the treatment plan set up by Dr. Iannotti was the proper plan and that the right sequence of chemicals presented. Since the bloating and buildup of abdominal fluid has returned, the conclusion is the chemo is not working, regardless of the cancer marker results. The recommended plan of action is to stop the current chemo and attack the ascites, the swelling, with a chemical known as avastin. Avastin would be ingested every two weeks and Pam would take cytoxin daily. There are side effects, but if the ascites is destroyed, the swelling will go down, Pam's appetite and strength will return and she will live somewhat more normally.

The pathologists are working on the assessment of the biopsies Pam has had to confirm the type of cancer she has, ovarian or something else. The basic plan to attack the ascites will probably not change, however, since Pam has an apparent chemo resistant cancer.

The trip was worthwhile and we will return home on the 3rd. We thank you for your prayers and and support each day as we learn how to cope with this disease.

1/29/2009 This week was supposed to be a time for Pam to relax for the trip to Sloan Kettering; however, it was a trying time. She was unable to work with the children or the Treasure Coast Community Singers. Aside from the effects of the chemotherapy (lack of energy, lack of appetite, edema), Pam has been coughing constantly the past few days. She felt she was catching a cold and I thought the cause was associated with the dust and air pollutants from the current work in the house. Her doctor told her today she has thrush. We have no idea how she contracted that disease, but she will be taking more medication for it.

The encouraging news for Pam today came in the form of test results. Her hemoglobin count was up a bit from last week and it was high enough for her doctor to decide she did not need blood transfusions before our trip. This was a relief for Pam! The real lack of energy had been compounded by the thrush and not the low hemoglobin.

We will leave Saturday morning to visit Dave's brother, who is vacationing from the Ohio winter at a timeshare on Singer Island. Our flight to New York leaves Sunday morning. The appointment at Sloan Kettering is at 3:30 p.m. on Monday. We plan to return home on Tuesday the 3rd. The hospital checked in with Pam today and all the necessary records have been received in New York. Her doctor is extremely supportive of this second opinion and Pam feels he wants to get the best opinion and diagnosis possible.

Your blessings, prayers and unfailing support have helped us immensely. We thank you and God bless you!

1-20-2009 Pam received wonderful news from her doctor that her most recent cancer marker score was 298, down from 360. She was so excited, she burst into tears at the news. It looks like she will have only one more chemo session before the second opinion evaluation at Sloan-Kettering. This schedule will help Pam relax a bit before the trip north.

Bless you all for your prayers, encouragement and support.

1-16-2009 The past ten days have been a struggle for Pam, as she experienced many periods of abdominal pain, anemia and lack of appetite. She underwent chemo treatments on January 9th and today and two others are scheduled before her consultation in New York. Pam was at her familiar enthusiastic self when she worked with the children's choir and the adult choir on the 14th.
She was able to overcome her discomfort doing what she loves. It is a fact the anemia and lack of energy greatly affect her activities, yet Pam maintains a positive outlook.

We are comforted by the many prayers, calls, cards, and visits from our friends in this community and from around the country. Your expressions of faith, encouragement and support are powerful sources of confidence that the cancer will be overcome. Bless you, all!

1-6-2009 Pam's abdominal area was drained of 5.5 liters of fluid yesterday. That is a quick way to lose more than 10 pounds, yet Pam is doing much better than she has over the past few days.
She is looking forward to her February 2nd consultation with the doctor at Memorial Sloan Kettering. This will be a preliminary visit to permit a second opinion as to the nature of the cancer and treatment plans. We do not know how long the assessment will take, but we will only be at the clinic that one day. We will make as many followup trips to New York as necessary to implement more effective means to fight the cancer.

Thank you for all your prayers and support. Pam feels strong enough to resume working with the children's choir this week. She is certainly a woman of faith and optimism.

1-3-09 Pam had her fourth chemo treatment in this round of eight yesterday. Although her hemoglobin count was marginally low, her doctor gave the okay for treatment. The next procedure will take place on the 5th when the fluid accumulation in Pam's abdominal area will be drained. This was not unexpected because her doctor indicated the effectiveness of this chemical in killing the cancer cells in the lymphatic system may not be properly evaluated until near the end of the current treatment plan.

Pam's doctor has scheduled a referral to Memorial Sloan Kettering Cancer Center in New York City for February 2nd. We have an appointment with a medical oncologist specializing in gynecological cancers. Pam's cancer has been categorized as uterine cancer for purposes of the referral for further tests and evaluation.

Pam's spirit has been uplifted by all the kind and supportive letters, cards, and prayers from our friends-those that we know personally and those who know us through others. She has done extremely well in maintaining a positive outlook while dealing with pain and lack of energy. Thank you for your love and continuous encouragement.