Candy had a great weekend.  There was very little sickness and loss of energy.  I hate that her co-pay on the anti-nausea drugs are $350 per month, but her happiness makes it worth it.


GREAT NEWS
There is also great news to be had!  CA-125 is a protein that is found at levels in most ovarian cancer cells that are elevated compared to normal cells. CA-125 is produced on the surface of cells and is released in the blood stream.  A CA-125 test result of greater than 35 U/ml is generally accepted as being elevated.  Before the surgery 2 months ago, Candy had an CA-125 test result exceeding 250+ U/ml.  The test was performed again last week.  Despite the cancer having two months since surgery and debunking yielded a test result of only 30 U/ml.  These results make me extremely happy.


DINNERS
Debbie Defoe has graciously offered to coordinate some dinners for us.  She is planning on delivering/having delivered on Tuesdays and Thursdays while Candy is in Chemo.  Please contact her at Mrsjdefoe@aol.com or text her at (727) 504-3876


HAIR CUTS!

Today Candy and Sarah visited Carmella at alpha and omega.  I greatly appreciate her accommodating her after we had to after cancel last week due to her surgery being more significant than expected.  After a lengthy discussion we all felt that it would be easier emotionally for Candy to go into chemo with significantly less hair to lose (when that day does come).  I must say, looking at how beautiful she looks with this short hair, she is going to be adorable with or without hair.

Well things have been going smoothly.  Just a little update for everyone.  Candy went in Monday for some minor day surgery.  The port in her abdomen was removed and they installed an IV port in her upper chest. She has been sore, but overall in great spirits.

Today was the start of chemo.  We have opted to go with the GOG 252 study and were randomized for Arm I (more on this below).  This is an IV chemo which will require us to have chemo every seven days. Currently our schedule is the 17th and the 22nd as the 24th is Thanksgiving.

I am very excited that she is such great great spirits and I hope that they last.  We have had no nausea (yet) and am told that by Sunday she should be pretty wiped out and sleeping.

Thank you to everyone for your continued support and prayers.

DMS

I would like to first apologize in the delay in this (lengthy) blog post. What now lies ahead are three potential courses of treatment, and sub levels of treatment within the three main categories.  We must decide which one to take.  This treatment must not only allow us to beat this cancer, but can get us into the twenty percentile of stage III-C ovarian cancer patients whom survive long than five years.  As you all know I come from the real estate industry, not the medical field, so this is all the result of a self taught crash course and research.  I would greatly appreciate feedback and any comments.


Treatment Main Categories:

1. Avastin (Bevacizumba Injection) - Avastin is a biological agent which is used in conjunction with standard chemo drugs (as explained in options 2 and 3 below).  Avastin is already approved to treat lung, colon, kidney and brain cancers.  The drug will not help Candy fight the cancer, but has been shown to prolong the time she will remain in remission.  The drug is currently part of a 3 armed clinical trial study (GOG-252) by the National Clinical institute.  Candy has the opportunity to be a patient in this clinical trial and will be placed in one of the following three arms of the study at random.  At the current time, I feel that Arms I and II of the Avastin trial look very promising, I need more help understanding Arm III.
•  Arm I: (What I am calling the Japanese Dose Dense IV Study) - This regiment is was set forth by a 2009 GOG study which proved that more frequent doses of Paclitaxel through IV gave the patient an additional 28 months of survival when vs to a standard IV treatment of Paclitaxel every 21 days.  
• Patients receive Paclitaxel IV over 1 hour on days 1, 8, and 15 and Carboplatin IV over 30 minutes on day 1. Patients also receive Bevacizumba IV over 30-90 minutes on day 1 in courses 2-6. Treatment repeats every 21 days for 6 courses.  This route will require more frequent trips to the hospital, and will likely be harder on Candy.
• Arm II: (What I call The Standard IP Treatment) - This arm is based on the findings of the 2006 IP study listed in #3 below which makes the case that Carboplatin placed through a port at a higher concentration every 21 days gives patients on average 16 months longer than traditional IV (#2 below)
• Patients receive paclitaxel as in arm I and Carboplatin intraperitoneally (IP) on day 1. Patients also receive bevacizumab as in arm I. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone as in arm I.
• Arm III (The arm I really don't understand) - Can someone please tell me why this arm is in the study, what studies have shown that the delivery of Paclitaxel over 3 hours vs 1 hour is more beneficial and why Cisplatin (not Carboplatin) is used on the following day?
• Patients receive paclitaxel IV over 3 hours on day 1, cisplatin IP on day 2, and paclitaxel IP on day 8. Patients also receive bevacizumab as in arm I. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone as in arm I.
2. Intravenous (IV) Treatment (Recommended by Moffitt Cancer Center) - The injection of paclitaxel and carboplatin, the most common drugs used to fight Ovarian Cancer, will flow through the blood stream and the body to attack the cancer cells.  Based on Candy's condition, the overall median survival rate if approximately 37 months.  Moffitt recommends this course of action because Candy had a bowel perforation after her first surgery and she was forced to have a colostomy.  The advanced scar tissue on the bowel and in her system would be damaged by IP treatment and can lead to future quality of living problems.  However, we have been told as there are currently no large nodules on Candy's colon since the last surgery, this is a VERY minimal risk.  What do you think?
3. Intraperitoneal (IP) Treatment - According to a 2006 New England Journal of Medicine article (thanks to Jill for getting me the full text) patients with advanced ovarian cancer whom receive the standard chemo drugs, paclitaxel and carboplatin through a port placed in the abdomen as opposed to through an IV live on average 16 months longer.  The theory is by flooding the abdominal cavity with these drugs, they attack the cancer directly and "This route allows the escalation of the dose of chemotherapy to a level that is not possible to achieve safely with intravenous drug administration."  The higher levels of chemo and more frequent sessions of chemo result in "a reduced quality of life during the therapy and shortly after its completion, but there was a return to baseline one year after completion". 

Does anyone know of any studies performed which determine the effectiveness of carboplatin vs cisplatin when administered via IP?  As of the 2006 NEJM article it was still debatable.


I greatly appreciate everyone's input in helping us keep informed and making the right decision.


David M. Scherer

I wanted to let everyone know that we are doing well and in the recovery time between surgery and chemo.  Candy gained a pound last week!!  Thank you to everyone for your well wishes, flowers, cards and dinners!

Tomorrow I should be wrapping up a huge blog post which will discuss treatment options and some of the questions and challenges we face.  I would greatly appreciate everyone checking in, passing the article around and helping us be informed enough to make a tough, life changing decision.

David

After two long weeks we are busting out of this joint!  A huge thanks to such a great staff at Bayfront for helping us through this.

Candy moved to soft foods today!  First time she has had REAL FOOD since Sunday the 11th of this month.  She was ecstatic!  We hope she gets out of the hospital Sunday or Monday.

Candy has had a good, but tiring day.  We have already walked three times!  They have also taken out her NG tube, catheter and jp drain.  We also got moved to full liquids including pudding and yogurt! 

We hope to bust out of this joint by Sunday or Monday!

I'd like to remind everyone that they are welcome to come to Bayfront and see Candy.  After the first surgery I had tried to only have visitors on the good days, of which there few.  I have had a change of heart, I hope people can make i She is still in the hospital, and we unfortunately not yet have a timeline for when she will be released.

Please call me (727.753.9879) to set up a visiting time and get the room number.

Some things to be aware of since when visiting:

1. I park in the east parking deck.  The nursing station on her floor will validate your parking.  If not, it is $0.50 per hour, $4 max, cash only.
2. She currently is on a dopamine based IV drug. She can be a bit "loopy" and might forget some things/say some random things.
3. She has an NG tube right now to pump her stomach every few hours, not the most becoming of things, please don't let it's appearance make you think less of her sense of fashion!
4. She has not yet been released to drink, and I don't mean mimosas, she can't even have water.  It breaks my heart as she is so desperate she will often try and sneak a sip in.  Drinking water will slow her treatment as it leads to more liquid pumped out of her stomach and a longer time off of clear liquids and food.  Please don't let her drink water.
5. Please encourage her to walk and practice her breathing exercises.  Walking will help keep fluid out of her lungs, wards off pneumonia and awakens her bowels.  This means progress!
6. Please no stories of _____ who had cancer and had _____ done.  I want to hear them as I want to learn more about treatments and our options, but Candy gets so anxious she had to get a shot of Ativan last time this was brought up.

I hope that everyone will get a chance to visit either the hospital or at home once she is released.  

I received a copy of my Candy's pathology reports.  Before I have meetings with Doctors I would like to better understand what I am looking at.  Can anyone with some experience in these matters sit down with me and review these?

Thank you,

DMS

Candy is out of surgery. It was a little over 3 hours long. She had a perforation in her bowel..... Fortunately it seems we caught it early and the was not a great deal of seepage into the abdominal cavity. She will be in ICU for 24 to 48 hours. Thank you all for your support, calls ands prayers.

I would like to ask everyone for (yet another) prayer request today.  It has been a roller coaster week in the hospital.  Today we learned that Candy has a perforation in her bowel which has been leaking since surgery.  She will be undergoing emergency surgery once an operating room opens up.

Thank you,

DMS

Team Candy is walking the One Step Closer to the Cure 5k this weekend.  Join us!  When registering be sure to add "Team Candy" in the "Running with team or in honor/memory of:" section.

When

Saturday September 24, 2011 from 7:30 AM to 12:15 PM EDT 

Where

Albert Whitted Park

480 Bayshore Drive SE
St. Petersburg, FL 33701

I am pulling the night shift at the hospital tonight.  Candy is doing well.  She started on solids for dinner again tonight (mashed potatoes, yum!).  Unfortunately she is in quite a bit of pain, but that is to be expected given the extent of her surgery.  It looks like they are going to extend her stay till Tuesday or Wednesday until her pain is at a controllable level and she is eating more solids.
DMS

We are moving to room 677 at some point tonight.  We are not quite ready for visitors yet.  Two steps forward, one step back.  Today was a step back unfortunately.  Her stomach is still upset but I hope by tomorrow all will be better!

David

Mommy is snoring :)  She will KILL me when she finds out that I published this, but I am just so happy that she is finally sleeping.  She had a rough night with lots of pain and nausea.  I am sitting at the foot of her bed looking for jobs on the laptop and she let out the cutest little snore... just one then she stopped.  Made me smile :)

These people are AWESOME!

Candy is doing well, I am amazed by the amount of support she is getting from so many good friends.  You may have noticed I did not updated this site yesterday.  I was a bit busy and really thought it could go 24 hours with out a "Candy Update", I did not want to bother everyone with details.  Boy was I wrong.  My phone and email lit up with questions and people wanting to get updated! It really is amazing

She has spiked a bit of a fever this morning, but it has not passed the 101 mark at which the hospital will start taking action to combat.  Bayfront has been nothing short of amazing to us yesterday.  I greatly appreciate how kind and attentive the dayshift nurses are.  I know it's not an easy job, but they seem happy doing it.

DMS

Candy is doing well today.  Her temperature dropped and they took her off the major post surgery drugs.

Last week she asked that I change the color of the website.  Though she naturally loves pink, teal is the color of the Celma Mastry Ovarian Cancer Foundation.  Candy was a founding member and a the former executive director of the foundation.  She asked that I change the color of the site to bring attention to the cause and asks that everyone consider either making a donation, start a team for their annual 5K "One Step Closer to the Cure" or help support someone whom is planning on walking for the cure.  The event is September 24th.  She asked that I start a team (we are working on witty names still).  Feel free to email me at david.scherer@gmail.com if you want to walk this event on Candy's team with me!

David

Candy is out of surgery.  The official diagnosis is Stage III Malignant Ovarian cancer.  She had a port installed for the upcoming chemo and will be in the Hospital till Sunday or Monday.

If would would like to visit, please give me a call at 727.753.9879 or email me at david.scherer@gmail.com.  I would prefer to have a steady stream of people over the coming week(s) and not everyone crowded in the hospital room tomorrow.

Thank you all for your thoughts and prayers over this past week.

David.

They took her back at 5pm.. Wish us luck!

She was not allowed to
wear her tiara :(

Candy was admitted into pre-op at 10:30 today for a 2:30 surgery.  It's 4pm and we are still waiting, should be soon though. I understand that her Oncologist has a reputation for being extremely thorough and appreciate that he is taking his time on the other patients as he will on my Mother.  I will admit as his first surgery started at 7:30am, I am worried about fatigue and the staff's condition to perform a major surgery on my mother.  It is a 4-6 hour surgery and 12 hours is a long time to be standing in an operating room.

Candy's bible study group and friends will be visiting our new home tomorrow, Monday September 12th to meet and pray with her for her surgery on Tuesday.  The ladies (and gentlemen) will gather at 7pm and all are welcome to join us.  If you can't be here in person please join us in prayer around 7:15pm wherever you may be.  I know that prayer is very important to my mother and she is walking in faith.

Our new address is:

4849 Queen Palm Terrace NE in Placido Bayou

You will need to let the guard gate know you are going to visit Candy Scherer and he will let you through.

Thank you all,

David

About two months ago Candy purchased a lovely new home and has been doing some modifications before the big move.  All was normal and this Friday was going to be just another move.  Given all we have learned this past week and now a move?  Talk about bad timing!  The good news is my mom gets to be queen bee and direct everyone around! Which side of the room do you want your 19th century armoire again ma'am?  I had to keep nagging her to sit down and rest, but if nothing else, the move has been a great distraction from the elephant in the room.

 It felt like a scene from Tom Hank's the money pit.  The place is close to completion, but not 100%.  At one point this afternoon we had two plumbing vans five pickup trucks (electrician, carpenter, cabinet people, Bright House Networks and my dad's), two moving trucks and the IKEA delivery van and the Merry Maid car.  The street was blocked with all the going ons.

I really want to thank so many people with your warm wishes and help today.  Mrs. Crookston and Mrs. Strickland both brought lunch over for us, it was a feast!  Goodall Bros was also amazing, they helped pack (we only started last night), move and went above and beyond.  At one point my mom was executing a new will and we need another witness; Chris Goodall happily sat down from his job and helped out.  I am confident that we are not going to need it, but it's good to know that it is in place.

We are wrapping up for the day, I'm off to set up the TV for a nice relaxing night on the couch with Mom and the family.  I can not express how thankful we are for all the caring messages and prayers which have been bestowed upon us this past week.  We truly appreciate it.

David

For those of you whom are not aware, please offer up your support and prayers for our very much loved friend and mother who was diagnosed on Tuesday with advanced ovarian cancer.  I have created this blog to inform those who care about her as to her condition and help her get support from those near and far.

At the current time she has been diagnosed with stage III or IV cancer (they do not give a determination until post-op).  She will undergo significant surgery next Tuesday September 12th.  Please keep her in your thoughts and prayers in the week to come.  I will update this blog as we get further information.

Thank you,

David M. Scherer