A lesson in expectations management...

Well, Nat and I were joined by my mom, Nancy, for today's scheduled chemo treatment.  I should start with a little back ground on the procedures associated with the chemo process.
First I check in at the desk.  They then call me back for a quick evaluation of my weight, blood pressure, pulse and oxygen levels.  Then I go back to the infusion area.  It is a nice, open room with lots of windows for natural light.  I take a seat in the nice recliner where the nurse begins a process to access my port.  A port is a permanent access point that is implanted in my right chest under the skin that has a hose that continues under the skin up and over the clavicle and then down through the neck into the jugular vein.  It is much easier than a typical needle access in the arm, but it also prevents the toxic effects to the smaller veins in the arm.  Once accessed, all the nausea meds and chemo drugs are hung on the IV stand and delivered via the hose.   Then I sit for 4 hours.  Nat is there the whole time supporting me, taking calls of support and posting to the blog.  There might be some time to cross stitch.
During this time, I have a slot scheduled with the medical oncologist.  During this visit he asks how I feel and if I have any questions, etc.    For today's visit, there was a bit of apprehension because we would discuss the results of yesterdays MRI scans.  Today, we jumped right into a discussion on the scans.  Honestly, our oncologist was a bit hesitant and we sensed it.  The results were not at all what we expected or hoped for.   He indicated that the scans showed no reduction in the size of the tumors.  In fact, it was possible that they increased in size a millimeter or 2, but that increase could easily be error or bias in the way tumors are measured and the difference in the scan being conducted in Omaha and Utah.  The bottom line was that the tumors are basically stable, but the chemotherapy is not effective.
This is where the expectations management lesson enters.  I (we) should have known that little effect of the chemo was a possibility.
Now I am going to step back a couple of months to the pathology and assessment just after the first emergency surgery.   Originally, the tumor pathology was declared mid-grade, or the higher level of a low-grade cancer.   Low grade indicates a slow growing, not very aggressive tumor or cancer.  A high grade cancer is fast growing and aggressive in nature.  Since I had an emergency surgery and the tumor pathology was "mid" grade, we were uncertain as to what the next steps might be.     At this point in time, we began interviewing and consulting surgical oncologists.  These are surgeons that will "debulk" by surgical methods also known as the MOAS, or the Mother of all Surgeries.  Based on these interviews, all but one surgeon suggested that the best course of action would be to start a regimen of chemotherapy.  The basis for this decision is that, 1) I just had major surgery and another immediate surgery was not needed and I needed time to recover, 2) time was on my side since the grade was thought not to be really aggressive even though pathology was labeling as a "mid grade" cancer.  Since it was "mid" grade and all manifestations thus far were that it was pretty slow growing, it was determined that time was not of the essence and we could try the chemo.  Generally, chemotherapy is ineffective on Low Grade tumors and chemotherapy is highly effective on High Grade tumors.
Fast forward to today.   We thought, hoped and prayed that chemo was reducing my tumors.   It didnt.  I should have known and expected this as a possibility.
So for the positive spin.  The fact that chemo was not at all effective may suggest that I do indeed have a Low Grade cancer remaining in my gut.  Surgery sooner than later is now my course of action. Nat and I will try to decide in the next day or 2 as to the city and surgeon to pursue for the surgery.
For those that know me, I am all about the positive.  I see this as a blessing and  positive answer to our prayers.  Please don't take this all as bad news, as it is not.
Thanks to all my family, friends and acquaintances for all the prayers, thoughts, love and support for me and especially for the support to Natalie and the kids.

Nate