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.