4/10/2010 -Our visit to the Mayo Clinic in Jacksonville enabled us to review all of Pam's treatments and test results. The doctor was thorough, spent a lot time with us and seemed genuinely concerned for Pam and her condition. Regardless of the source of the tumor, which apparently was the gall bladder and bile duct, the chemotherapy treatments administered over the past two years were the ones that would have prescribed if the origin had been identified in the first place. The six different chemo treatment protocols Pam received were systemic to the whole abdominal area. It seems the cancer was rejecting the treatments that science and research have shown to be effective. The conclusion is that the treatments were consistent with the information made available through the various test results. The tumors are so wide spread that any surgery or radiation is not possible, and this decision is consistent with earlier conclusions regarding surgery.The tumor is pressing against Pam's stomach which is causing her lack of appetite and feeling of fullness after a small amount of food.

The Mayo oncologist spoke briefly about some options that may be available, as follows: hormone therapy, oral chemotherapy, a feeding tube, and use of the drug avastin that starves cancer cells of oxygen. He will have discussed these options with Pam's local oncologist when we meet on Monday, April 12th. Meanwhile, Pam is struggling with pain management, lack of energy, and poor mobility.

We thank God for your prayers, concern and support.

4-6-2010 Pam had a wonderful Easter when all our children and 7 of 8 grandchildren and relatives brought food, cooked food, and ate food most of the afternoon. There were a lot of games and activities for everyone. By afternoon's end, all were sated with food and fellowship. It was a grand day.

As we prepare to go to the Mayo Clinic for Thursday's appointment, we have been truly blessed by the prayers and comforting words from our friends and family. We believe God has a treatment plan for Pam.

4/2/2010 We finally have the results of the tests of Pam's recent liver biopsy that were conducted by a lab in Arizona. The report indicated the primary tumor site is the gallbladder, while the specimen site was the liver. These tests were conducted because no definitive primary site had been established. Some of the treatment agents associated with this type of tumor have already been administered without success. We also had hoped for a DNA micro-array but the test could not be performed due to insufficient tumor present in the specimen.

The test specimens will also be evaluated by the pathology clinic at the Mayo Clinic in Jacksonville. We do hope our visit to the Mayo Clinic on April 8th will result in a thorough review and an effective treatment plan. We canceled our planned trip to the Moffitt Cancer Center G-I department in favor of the Mayo Clinic.

Pam's oncologist seemed to be in favor of the cutting-edge lab work that we just received. This was a real comfort to us.

Meanwhile, Pam is experiencing problems with appetite, energy and nearly constant pain. She has been unable to participate in the Easter music programs this week, but will make every effort to sing on Easter.

We treasure your prayers and blessings and wish you a Happy Easter.

3/22/2010- Pam struggled with constant abdominal pain, lack of appetite, lack of energy and dwindling hope for feeling better. None of her medications worked as planned, even after new pain medications were prescribed. We expect the hear the results of the last biopsy this week. Other tissue specimens will be submitted to Moffitt and the Mayo Clinic in advance of our appointments in April. These events will be a measure of progress toward seeking an alternative treatment to the chemotherapy, especially in view of the seemingly long period of time to hear about the biopsy.

Pam had a period of time todaywith no pain and awoke from a nap well refreshed. Although pain patches were prescribed today, she had not applied one before her nap. I believe Pam's outlook for relief has been refreshed.

Please bear in mind that all your prayers and support have helped us endure the effects of this cancer and give us encouragement for daily living.

March 14, 2010 This week has just flown by. Pam has been blessed with visits by friends she has had for more than 15 years. Traditionally, Pam and three friends try to meet at least annually for fun and fellowship. This year Sally and her husband Dan from the Atlanta area took time on their anniversary trip to spend two nights here. Later in the week, Ann and Bennie flew in from Dallas and New Orleans, respectively, to spend nearly three days of just "hanging out." Time was spent at the beach, at the restaurant, at the concert, and just doing nothing other than being together and having a grand time. Pam says everyone is so comfortable with each other that they just pick up where they left off, no matter how long it has been since they've been together. Of course, Pam had a wonderful experience although she is very tired. Above all, she is very happy and thankful for devoted friends from the past.

Pam has an appointment with a GI oncologist at the Moffitt Cancer Center in Tampa scheduled for April 8th. Before that date was confirmed, we arranged a visit to the Mayo Clinic in Jacksonville to seek a treatment plan for April 8th. We will sort out this scheduling dilemma this week.

Thank you for your prayers and unfailing support as we look for the next step in dealing with the cancer and its effects.

3-5-2010 Pam met with a Moffitt Cancer Center physician in the GYN clinic in a followup to her May 2009 visit. In comparing pathology reports from June 2009 and February 2010, we learned that the reports focused more on cancer cells in the bile duct in the liver than cancer cells in the ovaries. In view of all the chemotherapy treatments with no consistent measurable results, the doctor believes that a diagnosis of cancer of unknown primary is appropriate. Pam will be referred to a medical oncologist in the Moffitt GI Department for review and evaluation of GI tract adenocarcinomas and possible diagnosis of cholangiocarcinoma (bile duct cancer). We were unable to speak to any member of the medical staff in the GI Department or anyone familiar with phase I clinical trials.

The visit to Moffitt did not meet our expectations,, but we must now be more assertive and diligent in seeking test results and comparative analyses.

Your prayers and blessings have brought us comfort and hope. We remain optimistic for a treatment that will make Pam more comfortable.

2-26-2010 Pam has not received a report from the biopsy of the tumor on her liver. Tissue specimens will be analyzed by a lab for molecular structure which may lead to another form of treatment.

Meanwhile, Pam will visit Moffitt Cancer Center in Tampa next week to promote assignment to a cancer trial which features treatment with avastin. We considered treatment with avastin last year, but opted to continue with chemotherapy. Now that chemo has not been successful we will look at an alternative treatment. Avastin works by blocking blood flow to the cancer cells, but there are potentially dangerous side effects in the intestinal area. It apparently has not been used extensively for cancer of unknown primary.

Pam continues to deal with abdominal pains, and lack of energy and appetite with courage and hope. She did very well on a trip to Orlando for a visit with my brother and his wife. The opportunity to travel for fun really appealed to Pam.

We ask you continue to pray for healing. May God bless you all!