They went into extra innings in NY....

The embolization was more difficult than expected. Half of the liver was embolized. In four weeks a scan will determine how successful the procedure was. At that time, the radiologist will also determine when to embolize the other half.

Hap is currently battling side effects this evening...nausea, high blood pressure, sweats and pain. The doctors and nurses are working hard to get him comfortable. As of 8:30PM, he is still in recovery. After he is stable they will move him to his own room to be monitored.

Thank you all for keeping Hap and his family in your thoughts today.

Hap met with the radiologist today who will perform the liver embolization on October 28. The liver tumors are throughout the liver; therefore
the embolization will be in two parts. On October 28, half the liver will be embolized where, as the doctor said she will get “the biggest bang for the buck”.

The progress will be monitored with scans. In 1-2 months, she will embolize the other half. This is a long term management plan that hopes to starve the tumors.

The radiologist will also get a better image of the pelvic mass to determine if an embolization can be done there in the future. She needs to check the vessels, blood supply going to this mass and how close nerves are to this mass.

Hap received a long term ocetreotide injection today to suppress the symptoms he is having from the release of hormones from the carcinoid tumors.

Hap will be in the hospital for 3 days to be monitored and to manage the pain (thank goodness for pain management pumps!)

Please continue to pray for Hap as he begins this difficult journey.

Top of the second....game plan

It was a long first inning, but Hap has reviewed the plays with his team and he's ready to swing for the fences.

The treotide scan showed no additional tumors, so Hap received confirmation that the carcinoid is only in the liver, pelvic mass and some lymph nodes.

After weighing all the options, the team decided to start with an embolization to the liver tumors and chemo to target the pelvic mass in order to avoid the risks involved with surgery at this time.

In preparation, today Hap received a short term treotide injection to make sure he would not have any allergic reactions.

Next week, Hap will receive a long term treotide injection to suppress the release of hormones from the carcinoid tumors.

The embolization will take place on October 28th.

Chemo treatments will begin soon after and last approximately two months.

Following that, Hap will receive another scan to evaluate the changes and progress made.

"The difference between the impossible and the possible lies in a person's determination." ....Tommy Lasorda

Hap had the rectal ultrasound and it was determined that the pelvic mass is not attached to the rectal wall; therefore, a biopsy was not needed.

The latest CAT scan showed that there’s been no change in the pelvic mass since the scan 7 weeks ago.

Hap is scheduled for a treotide (nuclear) scan on Monday and Tuesday to see if there are any other carcinoid tumors.

Then Hap and Mary will return to Sloan on Wednesday for the results. Hap’s doctor will also give her decision about the surgery
to remove the pelvic mass and lymph nodes, as well as the procedure for the liver.

Hap was thrown a curve ball today...

Hap's doctor called in a colon and rectal surgeon to evaluate the pelvic mass, which has been identified as a carcinoid.

The surgeon determined that the carcinoid has spread to some lymph nodes above the pelvic tumor.

Hap had another CAT scan today to find out if the liver tumors and the pelvic tumor have changed in the past 7 weeks. (results to follow next week)

Hap will have a rectal ultrasound and a biopsy of the rectal wall tomorrow back at Sloan.

Based on those results and the CAT scan from today, both doctors will collaborate on the best procedures for Hap. The ideas shared today include:

• the doctors remove the pelvic mass in conjunction with the determined liver procedure
• or they shrink the pelvic tumor first before surgery along with a procedure on the liver

The doctors anticipate having a decision by early next week...it is truly a "team" effort.

Hap will meet with the doctor on Wednesday to get the biopsy results. In the meantime, Jeff and Rick are in town to spend some quality time with Hap. ....the state police are on standby