Posting From the Raleigh Family

Dear Friends of the Vanca Family,

As most of you know, our friend, George Vanca, died this last Thursday after struggling with pancreatic cancer.  The good news is that George is now at peace and in the presence of our Lord Jesus.  And those who share George's hope will meet again.

George is survived by his wife, Donna, daughter, Hanna, and son, Matthew.  On account of the medical expenses George has incurred, the costs of his burial, and the loss of his income, his family has some financial needs.  Because of these needs, I am reaching out to George's friends to ask for donations in lieu of flowers or other gifts.

I have confirmed with George's bank that checks made payable to "The Vanca Family" can be deposited into a savings account George used and can be accessed by Donna for the family's expenses.  You can mail a check to my office at the following address and I will deposit your checks into George's account.

Ken Raleigh
Hedman Partners CPAs
27441 Tourney Road, Suite 200
Valencia, CA  91355

Memorial Service

Dear Family and Friends,
The past few days have been so painful, and difficult. We are so appreciative of  the love and support we have received. I know George would be honored by the faithfulness demonstrated by his friends and colleges, and the kindness that has been extended to myself and the children.

Services to honor George will be held:

Monday November, 21, 2011
11:00 AM
Grace Baptist Church
22833 Copper Hill Drive
Santa Clarita, Ca

Graveside Service
Eternal Valley Memorial Park
Newhall, Ca

Reception to follow at the home of
Jan and Jeff Bernards

*Address and directions will be available at the service



*In Lieu of Flowers a fund is being set up for the Vanca Children. You may contact Ken Raleigh for information and details at 4raleighs@gmail.com

Proverbs 3: 5-6

Today at 1:30 in the afternoon our Lord directed George's path home.
He was pain free, peaceful, and surrounded by Hanna, Matthew and myself.

The past few days the Lord has been preparing him, and I know he was touched by the love from all of you.

As soon as we have details regarding the service it will be posted.

~Donna

Home Sweet Home!

Friday Night Update

George has now been here at UCLA for a week. Dr. W along with the Palliative care team have been successful in getting George's pain under control. He continues to have fluid issues with swollen leg & feet. Today he received another blood transfusion, and medication to help shift some of his fluid. He has been tired, and frequently falls asleep during visits. He took a slow walk down the hall to help increase his lung expansion, get his legs moving.
We have had many decisions to make regarding his care, with our main goal being his comfort. It is apparent to the Doctors, and us that the growth of the tumor has increased. It is felt that his care will be focused on comfort when he is discharged Saturday.
~Donna

Sunday Update

George started the day uncomfortable again, and so the rate of his continues Dilaudid drip was increased. His Red Blood Cell count has also dropped, and so he received another unit of blood. He is feeling a little better now getting settled in for the night. We don't have the exact time for the nerve block procedure yet, however I'll tweet when we know.
George was encouraged by the support he received today, but tired. Thanks to Chris for taking the early shift, and helping me out today.
~Donna

Saturday Update

George was unable to get the nerve block today. The GI doctor was available however, the unavailability of the Anesthesiologist was the issue. The GI Doctor will attempt to get it coordinated for Sunday however, we were told it may not happen until Monday. Until the block is done, George will continue on the PCA to control his pain.
The Ultrasound was done, and they did find a clot in Georges lower left leg. He was started on a Heparin drip for now, and will be changed to a drug that us given by injection when he goes home.
Our prayer is for good pain control and that the block can be done Sunday.

~Donna

Pain......

George has had a dramatic increase in pain this last week. He has been unable to find a position that is comfortable to sleep. On Thurday night he was up all night, and by morning not only was he still in pain (even with medication) his feet were swollen. After informing Dr. W it was decided he would be admitted for pain control, and to rule out any clots in the lower legs.
Last night after the first dose of IV pain medication he was feeling much more comfortable. I came home late and her was feeling very loopy and tried form the meds. His night was not pain free, and were still working on adjustments of the dose to achieve comfort.
The plan is for him to be transported over to UCLA's main Hospital in Westwood to undergo a
procedure done that blocks the nerves surrounding the Pancreases. The block is done via endoscopic scope so he will be out for the procedure. As of a few minutes ago we are still waiting for a time, as he is being added on to the schedule. He is also having an ultrasound on the legs to check for any clots.
I will update later today after the procedure. George appreciates all the messages, but please understand that he is so out of it from the pain medications that responding to text or
messages is just not possible. I'm sure Sunday or Monday will be better.

~Donna

TPN

George has now been receiving the TPN for almost a week, and we are starting to get into a routine. He is never ready to be hooked up in the evening, and looks forward to being disconnected every morning.
For the most part I have been handling most of the process everyday, and we are grateful to have a few  nurse friends who have offered to help out. Thanks to Diane V. (friend and fellow CHLA RN), who came to  prepare the TPN and connect him the other night while I was at work. It is very comforting knowing we have such great support close by.
We continue with the goal of weight gain for George, and more energy.

Resting and Waiting

On Monday afternoon we met with George's oncologist. It was decided that George needed to get more rest and nutritional support before considering additional chemo options. The stent is working, however, but George is limited to a soft diet for now. His weight loss in the hospital was significant, and we will be adding TPN to his regiment to help add calories. The process will take another day or so to set up, but he should start by the end of the week. We will meet with Dr.Wainberg again in two weeks to further discuss if the clinical trail in an option.

Stent Placement

We were thrilled that the Stent placement went well. Yesterday was a long day as George was the last case to be done, but once we were given the word that the stent was placed it was worth the wait for endoscopic Doctor. George was back in his room by 9:00 PM, and felt encouraged for the first time in days. Dr. T was not the one doing the procedure, but he came to observe and give me the good news. We are so fortunate to have him on our case. Thanks to Suzanne and Kim for waiting with me, it helps to have a distraction.
George is doing good today, just tired. We are so thankful to be here at UCLA, however when you are at a teaching hospital the Doctors arrive very early for rounds. Today the first Doctor knocked at the door at 4:45 AM, and then Dr. Tomlinson's surgical team arrived at 6:00 AM. George only received about 3 hours sleep, so he's napping now as I write this. I stayed last night here with him, and found it so odd to be the patients family member, and not the nurse. It gives me new insight into how my patients families feel when the Doctors arrive so early and just flip on the lights. We are Glad to have such good care, but I know George will get more sleep when he's back home.
The plan will be to advance from the clear liquid diet he is on now to soft solids later today. If he is able to handle his meals well he will be discharged Thursday morning.

Thank you for all the prayers, and encouraging emails. We feel so grateful for the support.

~Donna

Quick Update

Sorry it took me so long to get more details posted. Thursday we ended up in the ER at UCLA, not a great way to spend your Birthday (George turned 51 Thursday). He was having increased abdominal discomfort, and we needed him to be assessed. The ER attending had a CT done so they could see what was causing the distention. George had been scheduled to have an outpatient CT done on Friday to check the progress of the Chemo treatment and re-staging. The CT showed that the primary tumor in the Pancreas was pushing on the part of the small bowel that is directly below the stomach. The stomach was unable to empty, and allow food passage. The blockage in not complete so some liquids were slowly passing, but not much. The obstruction needs to be resolved, so the surgical team was consulted. George spent the next several hours having his
stomach drained (I'll spare you the details) but not a fun night. The surgical team contacted Dr. T our surgical oncologist, and George was admitted in the middle of the night. I will not go into details, but between 12 and 4 AM I was on the phone with the ER attending as our primary medical group was giving UCLA a difficult time with approving the admission. They wanted us transferred out of UCLA. Clearly our Medical group has system issues with documentation, and can't see that we were granted treatment with the UCLA oncology department. Friday I spent another full day of phone calls, dealing with the medical group as they had a hard time understanding the obstruction was related to the cancer, I was in no mood to be messed with after only getting 2 hours of sleep. The end result is that after they spoke with
Dr. T it was clear that they are unable to provide the car, and procedure needed so they approved for George to stay at UCLA.


The plan is as follows; George will be limited to small amounts of liquids to taken by mouth for the next few days, he will need have a procedure in which a Stent is placed in the upper small intestine to open the obstruction. Dr. T is not sure the stent will work, but this will
be the least invasive way to open the obstruction. UCLA has a GI doctor that specializes is this type of procedure, it is done with the scope. If the procedue in not successful Dr. T will need to do a surgical procedure to bypass the obstruction. The stent placement will be done on Tuesday, and George will stay in the hospital until then to allow his bowel to rest, and receive IV hydration.
Yesterday was not an easy day as Dr. T also shared that the CT showed the cancer cells have spread to several areas in the Liver. We will meet with our primary oncologist on Monday to
talked more about this, and what our treatment plan will be.
Please pray for that the stent placement is successful on Tuesday, and recovery goes well. George will most likely be in the hospital until next Thursday. You may send him a message at his email gmvanca@aol.com if you wish. He may not be up to responding to all his messages and text, but he reads them all :)

~Donna

Hiccups Resolved

Well I'm glad to report that Georges Hiccups have resolved. Thank you to our friend Lisa G (who is not only a friend, but a former oncology nurse as well). She was kind enough to pass on some information related to Hiccups and Cancer patients. We feel is was the Zofran George takes for nausa that was the cause. The day they started he had been given a great deal of Zofran due to the nausea he was experiencing during Chemo. The hiccups have now stopped but the nausea continues. He has a few different things he takes, but it has really wiped him out.
Thanks also to Georges Uncle Roy who always calls at the right time with words of encouragement.
Please pray that he is able to eat, and get enough calories in each day as he's having difficulty doing that right now.

~Donna

Quiet Week

This past week was the first of two off weeks from Chemo for George. I wish I could say he feels great, and is enjoying the off week but, that is just not the case. He has been very tired and just feels drained. He does have one odd, and annoying symptom that we continue to search the cause of. He has hiccups that last for hours at a time. They frequently start at night, and keep him from sleeping. Just when we think they are gone, they start up again. Very odd and kinda disruptive as far as sleep goes.
The plan will be to have a CT next week and then hopefully we will have results by September 26, and know if we continue the treatment plan or make a change.
We appreciate all the prayers and help these past several months. Please continue to pray that the treatment is effective and the scan results are good.

Frustrating Morning

Today George is on Day 8 of cycle #3. Sleeping at night has been difficult for George, and last night was no exceptions. He actually fell asleep pretty well, only to be awaken at 1:30 AM with the ringing of the doorbell. After rushing to the front door, and realizing no one was in sight, we concluded it was just teens being rude. The hard part was that then we couldn't go back to sleep. As morning came George was so tired from the lack of sleep, and frustrated knowing he had a long day of Chemo ahead. We discovered as Matthew was leaving for school that our car and house had been egged in the middle of the night. I felt overwhelmed at the task of cleaning up this mess, getting the car cleaned off, and having a deadline to get down to UCLA. After a few phone calls, and the help of our neighbors Chris and Kelly we got it all cleaned up. Sadly we were not the only house on the block that had been hit.
We headed down to UCLA for the Chemo. His counts were pretty good, and even know George felt so lousy the Chemo was started. It was decided would get some extra fluids via IV to help flush out the Chemo, and keep him hydrated.
We are now done with 3 complete cycles of the Chemo. You may have noticed that I wrote out the exact way the Doctor counts the cycle. Each cycle is really 21 days during which he gets Chemo on day #1 and #8. So Chemo is day 1 then again day 8 then 7 days off starting the next cycle after day 21 is complete.
This time we will end up with an extra week off. The plan for now is that George have a repeat CT scan to see the progress, and start Cycle # 4 around September 26.
We will let you know when that is scheduled.

Blood Transfusion Today

Today George is here at UCLA for day 1 of Chemo cycle #3. We just found out his Red Blood Cell count is low so in order to get the Chemo he must first receive a Blood transfusion. This is just a bump in the road,however, one George was hoping to avoid.
He has been very tired this past week,so now we know why. He will still receive Chemo so we can stay on track with treatments.
Hoping that after they give him the pre-medications he will be able to nap a bit during the infusion.
I'll keep you posted on how it all goes.
~Donna

Better Week

George has now completed four cycles of the new Chemo regiment. This last Monday he just barely made counts to get the chemo, so we are grateful that he received the Neulasta injection last Tuesday. I don't think I had shared that the original plan to take daily Neupogen injections was put on hold due to the very large co-payment the injections would cost. Neupogen is one of the those drugs that when given inpatient it's covered 100%, but given at home it is very costly. The Neulasta is given in the infusion center so it is covered, but it can only be given when you have at least 14 days before the next dose of Chemo and it takes about three days before it "kicks in".  It is basically like a long acting Neupogen that increases the Neutrophil (white blood cell) counts.

Having two weeks of back-to-back chemo has been hard, but these past few days George is feeling a little stronger and now looks forward to this "off week", with NO chemo!  Additionally, he's now taking natural products, Green Smoothie's, and other supplements.  Thank you to Hazel, who has been bringing smoothie's to our door every morning, as well as, coconut's, and other healthful "alternatives."
A special thanks to Pastor Dan Fetters, for arranging a meeting with all of the Elders at our church, who prayed over us this past Wednesday evening...

We celebrate our 14th Wedding Anniversary this coming Tuesday. This year, we look at our marriage, our family, and our friendships, through a whole different perspective of love, appreciation, and gratitude.
~Donna

A Rough Week

So the Stent placement didn't go as smoothly as we had hoped. Last Monday was the longest day. We were one of the first patients to arrive at the procedure unit at UCLA, and the very last to be discharged Monday night. We even heard one of the nurses say to another "Are they still here?" Believe me, we were glad to get back on the 405 and get back home. The procedue was more painful going through the Liver route, with a needle, then the surgeon had led on it would be. George was awake for the entire 45 minute procedure and one of the nurses forgot to give him a second dose of a pain med. George had discomfort for several days and is still sore at the site. On Wednesday, he started having symptoms that were indicating the Stent may have been plugged. We rushed off to our local urgent care to get labs, and then waited for the decision from the UCLA Doctors. It was decided to go ahead and plan to have the procedure re-done to open up the Stent, if needed. Friday we headed back, after all the approvals were obtained, and had the blood work repeated. George's symptoms had gone away and we very prayerful that the Lab's would show that the procedure was not needed. Finally, at 2:30, it was confirmed that everything looked good, and the Stent was working. George was on a gurney, wearing a gown, IV's in his arm and ready for surgery when they said we could go home. What a roller coast we were on...

we have been taking it easy this weekend, and George is resting and eating as much as he can.


Monday will be cycle 3 of the new Chemo. George is glad to be moving on getting a full dose of the Chemo, but it wasn't much of a "week off" for him.



Our prayer is that his blood counts stay high so he will have no delays in the Chemo cycle's.

~Donna

Friday Update

We are down at UCLA again today to have lab work done, and see the Doctor that placed the Stent. We won't get the Lab results back until about 1:30 PM so I'll update then.

~Donna

Day 8 of Cycle #1 of New Chemo

My apologies for not posting sooner. The past week, or so, we have been focused on watching Georges temp, and recuperating from the first round of the new drugs. The main symptom George experienced from the new drugs was overwhelming fatigue. The first few days it was hard for him to even get out of bed. Mid week he spiked a fever, and it was decided he would start another round of Cipro. He really dislikes the way the Cipro makes him feel, but it has kept him home and out of the hospital so that is good.
We also found out that next Monday, August 1st, the Stent will be replaced. The procedue will be at UCLA done by endoscopy. It's out-patient and he will be the first case that morning.

As I'm typing this, Dr. Wainberg came to say that Georges WBC is too low for him to get both Chemo's today. He is concerned that his counts will go even lower so he will get one Chemo today, and a daily Neupogen injection at home for the next six days.

By the way, next week will be an off week for Chemo due to the Stent replacement on August 1.

~ Donna

Staying Home

George has been doing better, and his temperature has stayed in a range that the Doctor is comfortable with, so he's letting him continue treatment at home. He will continue taking his antibiotics for the next 10 days, and if all is well he will get Chemo next Monday.
The Stent still needs to be changed, and Dr. Wainberg is working on the details for that endoscopic procedure.
We will keep you posted.

~Donna

Monday's Chemo Postponed

Yesterday didn't turn out as planned. We had a busy weekend, and George was tired upon starting the day. At 7:00 am, while getting ready to head out the door, George said he was cold, and started shaking. Not a good sign, so we checked his temp right away and it was 101.8. We decided to go ahead and head down to UCLA as we knew they could access the Port, draw labs and call the Dr for us. The fever continued low grade even after Tylenol, so when the Labs came back with elevated an White Blood Count George's oncologist suspected infection. The most likely cause is the Stent, as George's Liver enzymes were slightly elevated compared to two weeks ago. The goal is to avoid Hospitalization so we spent the rest of the day in the infusion center getting some extra hydration with fluids through the Port. The Dr. also started an oral antibiotic to start working on the infection. Dr. Wainberg decided that if the fevers stopped within the first 24 hours of starting the antibiotics we could continue treatment at home. The plan today is to keep checking his temp, if it goes back over 101 George will be admitted to UCLA for several days for IV antibiotics. At Noon today it went to the lowest point of 98.5 so we shall see.
We will still need to deal with the Stent issue. When the Stent was placed we were told it was temporary with an average length of time to be 3-4 months. It was placed in February so we have gotten 4 months out of it so no surprise it needs to be replaced. After the infection is treated we will get it swapped out as an outpatient procedure. If George does end up inpatient for antibiotics we will do it prior to being discharged.

For all of you here in LA you know that this weekend the 405 is being closed down from Friday night till Monday morning. UCLA sits right in that part of the closure and getting in and out will be a challenge. Our Dr's goal is to get us in and out by Friday afternoon so this will not be a problem. This weekend is also a very busy one for Donna at work, as CHLA is moving into a brand new Hospital Building. All the patients will be moved Sunday to the new units; months have been spent planning out this process. Our prayer is that George will respond to the Oral antibiotics and be able to recover at home. We will be taking it very easy the next few days and through the weekend so George's body has a chance to heal. Dr. Wainberg is still hopeful that George can receive the new Chemo next week if all goes well.

I'll post again later today as to the status of the fevers.

~Donna

More Details

The CT scan results were hard to hear. The primary tumor in the Pancreas has only decreased slightly in size, and as Dr. Wainberg put it, "The chemo regiment didn't do the job needed to make surgery an option". The CT scan also showed two new sites in the liver that look concerning. They are too small to confirm as cancer, however, it looks like they are. These areas are not causing any liver issues at this point, but they completely change the goal of our treatment.
The plan now is to start a different Chemo of two new drug's and do another CT scan after a few cycles. Dr. Wainberg was very honest in saying that the very aggressive chemo that George has been taking is not beneficial to continue, and we need to see if the tumor will respond to a different regiment.  It will start on July 11 and be each week for two weeks and then one week off.
Dr. Wainberg is also going to look into the option of a Clinical Trial.  The goal is to decrease the size of the primary tumor, as well as, slow down or prevent, any further spreading.
Please pray that the new chemo drug will be effective and that we are on the right track.  Also, that we will be able to be a part of any Clinical Trial's that would be of benefit.  Thank you.
~Donna

Waiting for Results

Just wanted to give a quick update on today's plans. We meet with Dr. Wainberg in the early afternoon down at UCLA to get the CT scan results. My goal is to send out a Tweet when we're done, and have any news to share. So if you're following me on Twitter you will hear then or check the blog later today for a more complete update.
We appreciate all the Prayer's and support during this last week, as the wait has not been easy.

~Donna

Good Counts!

Today we had our Chemo appointment a bit later then usual, I guess we're on summer mode. I brought the Laptop with us, so I'm posting now as George is receiving his first of three chemo meds.

The good news to report is that the Neulasta injection really helped after the last cycle. George's Labs came back looking very good!  His ANC was 4.1, this means that the Neulasta helped his bone marrow produce healthy white blood cells that fight infection. We also closely watch his Liver Enzymes which help us know if the Stent is still functioning. All his Enzyme levels, including Bilirubin, are well within the normal range and looking good. The news of the good Lab results is very encouraging to us today; now we just need to wait for the CT results.

CT Scan Friday

I know the delay for a CT seems like a long time to wait, but we have been making good use of this time. The goal this past week was "Family Time" and "Eating Well", although the weight is just not coming back.
The CT scan is scheduled for Friday, late afternoon, around 4:15. Due to it being late in the day, we are still scheduled to have cycle # 5 of Chemo this Monday. We already know that Dr. Wainberg is not available on Monday to review the CT result with us, however we're hopeful that we will not have to wait until June 27th (our next appt with Dr. Wainberg), to get the results.
Please keep George in your prayers during this test. It's our prayer that the results will show the tumor is responding to the chemo and decreasing in size and position.

~Donna

Frustrating News

We received word yesterday afternoon that UCLA was having an issue in getting the CT scan approved. After many phone calls, it was apparent that the original person that sent us our approval letter from Anthem Blue Cross was incorrect in stating all treatment was covered. She omitted the fact that we would need to seek more approvals for imaging such as CT scans. The same information was incorrectly given to the UCLA staff that works on these issues, as they were not told of the procedure that needed to be followed. The result is a delay in getting the scan. Already today we have had many phone calls back and forth to get the issue resolved. It's very frustrating that I have to spend time dealing with issues such as this, but apparently Anthem feels our time is better spent this way.
We are hoping it is all resolved soon and that the scan will be re-scheduled in a timely manor. We will keep you posted.
~Donna

New Drug

Cycle # 4 has gone well. George was given a new drug for the nausea and it really seems to have worked. It is call "Emend" and it's given for only three days. The first day, he didn't feel it made any change as he still needed to get an extra does of Zofran the day of chemo. However, the second day he felt pretty good and was able to eat. His major symptom the second and third day was overwhelming fatigue. He was even able to gain a few pounds this last week, so that was great. He has been laying low and trying to rest as much as he can. We had a quick visit from Donna's uncle Bill who is in town from North Carolina. It was a good visit, and we're glad it worked out as he may not be out again for awhile.
Today we will return to UCLA to get the injection of Neulasta. It is a longer acting form of Neupogen and will help George's bone marrow produce more Neutrophils. Our goal to keep his counts up, and prevent any infections.

George is scheduled to have his follow-up CT scan on Tuesday. The scan will show us what progress has been made on the tumor after 4 rounds of Chemo. We don't know when we will get the results of the scan, but were hoping by the end of the week, if not sooner.

The kids will be out of school for summer break by the end of the week (Hanna already ended on May, 26) and, we are hoping that George has a good "off chemo" period, and we can spend some good family time together.

I'll post again after the scan.

~Donna

Cycle # 4

First thing Thursday morning we will head down to UCLA for Cycle # 4. It has been nice to have this extra week for George to regain a little strength. His eating has been a bit better this past week, however the weight gain just didn't happen. He didn't loose any weight, so we are happy with that; it's all about finding the positive and moving forward.
The only change in the plan is that this coming Monday we will go back into the infusion center to get an injection that will help keep his White Blood Cell count up into it's healthy range. If all goes well we go back the following day, Tuesday, for the first CT scan post the start of Chemo.
I'll Tweet after we get his blood counts back and start the chemo., Thursday.

~Donna

NET/30, INC. Garage Sale!

For the past few months, George's colleague's at NET/30, INC., have been collecting items and saving them for a garage sale to be held on our behalf.
Recently, Lianne has made several trips to our house, all the way from Thousand Oaks, to pick up additional items, for the sale.
This past Friday, Lianne, Karen, Lana, Nelly and Shelley spent Friday afternoon, and evening, preparing for Saturday's sale. 
Lianne hosted the event at her house. She and husband Dave made dinner for the group, provided sleeping accommodations and geared up for the big day.
Lianne placed an ad in the paper and posted signs throughout the neighborhood.  She set a dollar goal and achieved that exact amount!
We want to thank everyone at NET/30 for their generosity.  Jo-Ann, Becky, Beth, Lisa, Debi and Robin were also big contributors to this day.

Lana, Nelly and Shelley
"The Night Before the Garage Sale."

   



Lianne, Lana, Shelley and Karen
"The Day of the Sale".

                              
Thank you for your overwhelming support!

~Donna

"A Simple Gift"

I have wanted to share this for the past few weeks, and got a little side tracked with George's recent Hospital stay. We received a package just prior to Mothers Day, from one of Georges faithful friends and colleague Lianne. She had made a beautiful card for Mothers Day, and stated that the enclosed gift was for Donna to wear because it's pretty, and for George to read so he can be reminded to "Never Give Up".

It's a "Simple Gift" that "Means a lot"

Thank You Lianne!

Catching Up...

I'm going to attempt to catch everyone up on the events of this past week or so. On Monday May 9th chemo went well for George. His blood counts were good, with the exception of  low potassium (but easily corrected with a supplement) so no hold up with cycle # 3. We had Susan again as our nurse. Not sure if I have mentioned this but she is a down to business nurse. She knows her stuff, and is very efficient. She is not really the warm and fuzzy type but she knows what George needs and gets the job done. She happened to be in charge last week, but still took George as a patient. The infusion center was very busy, and our first "Chair" where we were placed was not the best. Susan was able to move us into a window seat half way into the infusion, which was more private and comfortable. It was nice because Rick V. came on his lunch hour to hang with George and give me a break for a bit.
Dr. Wainberg and Dr. Chung (The fellow) rounded and were both pleased with how well George has handled the chemo. He stated "You have been handling this particular toxic Chemo about as good as anyone I've ever seen." George felt good upon hearing this.
Dr. Wainberg decided to give George an extra week off chemo to help re-gain his strength and some weight. We will get cycle # 4 on June 2nd. That week is Memorial day and the infusion center is closed Monday so we decided on a Thursday appointment. Dr. Wainberg will be doing another high resolution CT scan after cycle # 4 to measure the progress of the Tumor. We just found out the date will be June 7th. We scheduled Cycle # 5 although that might change depending on the CT results.
George had seemed to be doing better this round. He has been able to keep food down easier, and with fewer trips to the bathroom. His overall fatigue level is his biggest problem at the moment.
Many have asked if he's losing his hair. Well he still has hair, it's just thinning quite a bit. My friend Leanne, who cuts my hair, came to the house, and cut George's. She didn't buzz it off completely, but trimmed it real short.

On Thursday May 12th I had been at work all day, and I came home to find George in bed with no energy to eat. My Friend Jan delivered a wonderful meal (Thank you Jan!), when I headed up stairs to bring George food, I found him under the covers telling me is was very cold. Took his temp, and sure enough he had a low grade fever. Took it again and it was at the mark that meant "Call the Doctor" so that's what we did. We headed to the ER, and started the long process of getting admitted and started on Antibiotics. George stayed in the Hospital until last Monday night, and was very happy to get back home.
The last few days have gone well; he continues on antibiotics taken orally for another 5 days. His strength is getting better each day, and he is able to eat and even gained back a few pounds. The plan is to get Cycle 4 on June, 2nd along with the drug Neupogen. I failed to mention that he received Neupogen after being admitted to the Hospital to increase his Neutrophil count. From now on Dr. Wainberg will give it to him on his Chemo infusion day.
George is looking forward to the extra week off, and getting his strength back. Thank you to everyone who helped us with the kids during his Hospital stay. The Finn family, and the Stewart's, for the last minute overnight stay with the kids. Shelli for staying the weekend and spoiling the kids. Diane for making sure Hanna got home from school and Andy and Kari M. for the large stack of reading material. All of the emails, texts and calls have kept George encouraged while he was in isolation for four days and feeling very much alone.
We are grateful to all of you!

~Donna
(Sorry for the long post)

Hospital Stay

Well it's been a long night, so this is just a quick update. George developed a fever last night so our oncologist had us go to local ER to get started on antibiotics. It turned out to be longer process than thought to get them started, and treated as our oncologist had hoped that is a story for another post. He is now admitted and will stay for a few days to get the antibiotics via IV. It was a long night, and George is very tired, so for now we need to limit the visitors. His counts are low so his risk for infection is high, another good reason to limit the visitors. You may send him emails (gets them all on his iPhone) and I will update the blog later today via twitter as to how he is doing.
If you don't have his email here it is:
gmvanca@aol.com

~Donna

Difficult Days

 I wish I could tell you that George bounced back from this cycle quicker, however that is just not the case. It has not been until the past few days that he has really been up and going. The fatigue, and general weekness has really set in. The stomach issues still come and go, with today being the best for handeling all his meals. We appreciate all the help this past week, and expecially the all the food that has so graciously been delivered. The kids had a great time hanging out with Cousin Dan last weekend, they went to see the movie "Soul Surfer" and really liked it. George and I will wait for it to come out on DVD, we hear it is very inspiring.
Our goal these next few days will be to once again get as many calories into George as we can. I'll update again on the weekend to let you know how he does.

~Donna

Cycle # 2 Done

Today George finished up the 48 infusion, and his Port was de-accessed. His symptoms set in a bit quicker this time, and from day 1 he was feeling the side effects. The Doctor changed up one of his medications to help his stomach, and he received an extra dose of the Zofran during his infusion on Monday. So far the new med is helping, but he is just very tired and run down.
Tuesday Donna had a meeting at work that just couldn't be avoided, and we were grateful for all the help we received to get through the day. Carolyn D. came to the house with food in hand, and kept George company late morning. Rick and Diane V, and Kim H., came in the late afternoon so the "Nurses" could check on the pump and be sure George was eating and staying hydrated. What would we do without our own personal staff of nurses!! Thanks guys for all the help  :)
Today has been a nice quiet day, and George was able to nap a bit in the afternoon. His stomach gives him issues on and off, and a few mouth sores have developed so he continues on the medications around the clock. He was glad to have the CADD pump removed, and we are hoping for a good nights sleep for a change.

~Donna

Preparing For Cycle # 2

The last three days George has felt the best since starting the chemo, but not completely symptom free. It appears that his week off chemo is going to be a bit more of a struggle than we had hoped, and take a bit longer to feel somewhat normal. George needs to be cautious about being exposed to a large amount of people so he stayed home rather than attend some of our normal Easter events. His longtime friend Rick V came by today for a visit while Donna and the kids visited her Parents.

Tonight we prepare for the second cycle, and our prayers are as follows:

•  For a safe drive, with minimal traffic
•  That Georges Blood counts are favorable, and will meet the criteria for Chemo
•  That we have Susan again for a Nurse
•  That the Doctors have some good recommendations to handle the symptom's better this round.

I'll Tweet  when Chemo is a go after we get the lab's back in the morning.
~Donna

Handling Chemo.

This past week was an exhausting one, but George has done well. The Doctors and our chemo nurse prepared George for how he would likely feel in the immediate days following the chemo infusion. He had all the classic symptoms they said he would, just like clock-work, and now we're in the up swing mode. Last Tuesday he was feeling OK, just tried and with slight nausea. On Wednesday night the symptoms really set in, and a few tough days followed . George was given medicine to help with the nausea, but it doesn't take it completely away. He is now doing better, just extremely fatigued. We have had a quiet weekend, and are looking forward to the start of next week. This will be the "Off" chemo week, so George is hoping to tackle some things on his "to do" list.
On Sunday, George's cousin Dan will be over to help entertain the kids, and be sure that George is eating and drinking enough while I head into work to get some hours in. How grateful we are for all the help that has been offered. 

Our Specific Prayer request is:
That George is able to handle the Chemo treatments well, and is able to eat enough in order to gain back some weight.
That words of encouragement continue to come in, as we stay focused on the fact that we can win!!

~Donna

A Long.....Day of Chemo.

Day one of chemo is done, and it was a bit longer then expected. It was a busy day in the infusion center so getting the Port accessed and lab's checked (all blood work needs to be done prior to the chemo being infused), took longer then expected. Our nurse also had a great deal of information to cover with us on our first day so the chemo meds didn't start until close to noon. The infusions took about 4 1/2 hours total then they placed the last one on a pump (It's a CADD pump) that will stay on for the next 48 hours. We will go back this Wednesday afternoon to have it discontinued, and for a nurse to check to see if George is staying hydrated and tolerating the first round. We had a very good nurse today, and the good news is she always works Mondays so we will have her again for the second round in two weeks.

George did very well today, and his Nurse Susan was able to give him some tips on what to expect. We also saw Dr. Wainberg and went over a few more details. His plan at the moment is to give George four cycles of this combination of Chemo, and then repeat the CT scan to measure the mass.  On a lighter note, Dr. T  happened to walk by outside the building and saw us in the infusion center through the window as George was sitting in his chair getting chemo.  Dr. T stopped, smiled, and waved at us.  It was a light and spontaneous moment.

As I already stated, it was a long day, and the next infusion should go more quickly. We couldn't have done it without a few helping hands; our friends and neighbors the Finns took Matthew to and from school, Diane  picked up Hanna and checked on the kids later in the afternoon when it was determined that we wouldn't be home in time for dinner, for Jan who so graciously brought dinner over for us and for Lianne for leaving us a "Surprise Package" on our back door. The package was a delivery from George's work company  NET/30, INC. It was the most creative toy, a "Vanca Van" filled with photo's, well wishes, and generous contributions from each of George's colleagues. I just had to show you a photo so you could get the visual.

~Donna

Treatment Starts!

We've had a quiet week, with no Doctor appointments, and good family time as Hanna and Matthew were home for Spring Break. We were even able to get a visit in to Disneyland with the kids. We are so glad that Aunt Suzanne, Tara and Shelli could join us to take George's place on the rides. George did well, but found it exhausting with all the walking and had to rest often.

We will head down to UCLA in the morning to start George's first Chemo Treatment. He will get two infusions administered during the day, and the third will be placed on a portable pump to run for 48 hours. We will return home later in the day after meeting with Dr. Wainberg. We will need to go back on Wednesday to have the infusion stopped and his Port-a-Cath de-accessed. This will be our new routine every other week.
George is set to keep his mind distracted during the infusion; he has his podcasts ready and his quotes in hand. Becky and Jo-Ann came to visit this week, and gave him some very encouraging sayings to focus on: "Never, Never, Never, Never Quit", by Wintston Churchill and "If You're Going Through Hell, Keep Going," also by Churchill.  They also supplied him with a Bible verse that happens to be one of his all-time favorites: "Trust in the Lord With All Your Heart; and Lean Not Unto Your Own Understanding.  In All Your Ways Acknowledge Him, and He Shall Direct Your Paths."  Proverbs 3:5-6.
I will update the Blog Monday Evening...
~Donna

Port Placement and Chemo Schedule

It has been quite a week; we prayed that the doors at UCLA would open up their tight schedule to accomodate us and they did. This week we feel like we have made a great deal of  progress in moving toward getting treatment started. Not only did we get the appointment with Dr.Wainberg moved up, (it was yesterday instead of next week), but the beauty of our Surgeon and Oncologist Team having a great working relationship has really benefited us. Just as Dr. Wainberg said he would schedule the Port-A-Cath Placement, our Surgeon walked down the hall past our room. The two Doctors talked right then and there and within minutes they were conferencing with us about the instalation of the Port and Chemo schedule. Dr. Tomlinsons staff arranged for it to be done right away, and here we sit today, Friday, with the Port in place, and one more thing checked off the list.  George was in surgery today for about an hour.

Dr. Wainberg wants to do George's infusion on Mondays due to the amount and types of drugs he will be getting.  George will be given 3 different drugs.  Two will be given over a few hours in the infusion center at UCLA and the third will be infused over 48 hours via a pump that he will go home with. We will then return on the following Wednesday afternoon to have the pump disconnected and the line de-accessed. The chemo will be given every two weeks. This course will continue for 2-3 months and then a CT scan will be done to check the Tumor and see what response has been achieved.   Dr. Wainberg was very frank with us and said  cancer of the pancreas is a tough area of the body to treat and chemo doesn't always work.

Some have asked why we are waiting until April 11 to start. The chemo start date was set prior to knowing exactly what day the Port placement would be. When it was decided that Dr. Tomlinson could make room to do the Port today, the Infusion center was already arranged for the 11th, and due to the 48 hour infusion of the one drug, keeping the Monday/Wednesday schedule works best. This will give George time to adjust and heal from the placement of the Port and be ready on the the 11th.

George is feeling sore tonight in the upper right chest, but that is to be expected. It was a long day, and he did well.

We realize that many of you are out of state, but for those of you who have asked, and who live locally, our good friend Lori Raleigh is going to coordinate meals.  If you are interested in helping out, please email her at: 4raleighs@gmail.com  

Thank you!

~Donna

Oncologist Appointment

Many of you have heard that our appointment has been moved up to Thursday morning. We need to be at UCLA by 7:30 AM tomorrow. This will be our first consultation with the actual Oncologist who will be managing George's care. We expect that the "Treatment Plan" will be outlined for us, and we will know more about the actually type of chemo, and when it will start, after the appointment.
Many of you have graciously offered to bring us meals, and so many already have, and we are very appreciative for that. We decided to hold off on getting any regular meal schedule started until we knew what the treatment plan would be. We have a friend who will be arranging this so that we can get a few meals each week during treatment. I will keep you posted when this is set-up.  Thank you.
~Donna

On Our Way to UCLA!

Word came in today from Anthem Blue Cross that they had reviewed our appeal and had accepted our petition to go to UCLA!  We are now approved to meet with an Oncologist and start treatment.  Our goal is to meet with him as soon as possible this coming week.  We don't know when George will start chemo., but the oncologist already has all of our records and is up-to-date as he works in conjunction with Dr. T.  They are all part of the same Pancreatic Team. This is the best news we have had since receiving the "bad news," in February. 

From now on, we can concentrate on fighting this illness, rather than fighting our insurance company. That battle is over and we can now focus on the real issue at hand.

Thank you for your love and support and especially to those working behind the scenes who had a key role in getting this approval.  How can we adequately thank you....

With love and gratitude,
~Donna

Immediate Request Needed

We just received a phone call from our medical group denying our request to seek treatment from the Oncologist at UCLA. We had a phone conversation earlier today from the surgeon, that is with the our medical group, in which he shared that the medical group believes it is not standard treatment to provide chemotherapy in hopes of shrinking the tumor to a point of it becoming resectable. The fact that out medical group is not on the cutting edge is exactly why we are seeking treatment elsewhere. With this forwarning I had already contacted Anthem Blue Cross to find out the procedure for filing a grievance if the denial came. What I didn't know at the time, was that just 15 minutes later I would be using this process.  The Medical group feels we should use their oncologist.  A few facts to share:

1. Our medical group currently has just ONE oncologist who handles all cancer patients for Santa Clarita and the San Fernando Valley.
2. This Doctor is obviously overworked and limited on resources.
3. This Dr has no area of speciality, and offers only "Standard Treatment" and has personally stated that he feels there has been no chemo. improved in the last 20 Years.
4. He has a history of being a poor communicator with patients and family members.
5. He offered us NO HOPE!!

How could anyone think that this is the person who should be managing George's care...

So, I immediately called Anthem Blue Cross and filed a grievance about the decision. I was blessed by getting a Rep on the phone named Mindy, who was compassionate and took down every detail I shared with her. She wrote up the grievance letter, and has submitted it as an expedited case. I ask that everyone please pray for the people that make this decision. Pray that they want to help us give George a chance at the best treatment we can get him.
The process could take a little as 72 hours or as long as 30 days, however that will depend on the expedited status. They know that we can't wait 30 days, however legally she had to tell us that.
I will also share that I'm also looking into the process of how and when we can change our medical group. I already know that this can't be done immediately, but down the road it might be an option.
Needless to say it has been an emotional day, and I now rest it in God's hands. I can't tell you how grateful we are for all the Prayer Warriors we have.
~Donna

No Need for the CT

Today we received a call from Dr. Tomlinson with the news that he was actually able to get our original scan uploaded into a computer at UCLA which gave him a clear reading. He consulted with another Doctor and Radiologist, and it was obvious to them that the mass is encasing the Portal Vein. This would mean that at this time Dr. Tomlinson would not be able to remove the mass through surgery. The plan will be to start Chemo first, under the care of a UCLA oncologist, and a follow-up CT scan will be done at a later time. That future time will  be determined by the Oncologist and could be in six months, or more, depending on how the tumor responds to the chemo. It will also depend on how well George reacts to the chemo. We will have more details after meeting with the Oncologist, and know more about the treatment. At this time we don't know when any of this will happen as we still await approval from our insurance.
The paperwork has been started, but we were told we may not hear anything until this coming Monday.
Our goal right now is to get George strong ,and in a good state to start chemo. He has lost about 22 lbs. since January so we need to bulk him up. Were keeping busy doing all the important things that one puts off, and of course, helping Suzanne (George's Sister), on a limited basis, to manage their Dad's care.
We are grateful to our friend Andrea, and her love of photography, who was able to get us an up-to date family photo to place on the blog.
~Donna

Some Potentially Encouraging News

Dr. T., from UCLA, called us Saturday evening at 7:00.  He said he was looking at additional scans that had previously been taken of George and that he was now not ruling out surgery at this time.  He said the quality of the scans was not good, but upon closer study he felt things looked better than he originally felt when we met with him last Thursday.
Dr. T. will be working on our insurance approval to get us in immediately for the high imaging scans of the pancreas that will be more specific to that area.  At that time, he will know for sure if surgery is an option or not.  We're hoping that the scans will be no later than this coming week.
In any case, if surgery is found to be a possibility, at least we have more options to choose from in the not too distant future.
~ Donna

Meeting with Dr. Tomlinson

Our Morning at UCLA was long, but we feel encouraged after meeting with Dr. Tomlinson. First I must say he and his staff were very kind and helpful. He spent almost an hour with us going over the treatment options available for Pancreatic Cancer. The main thing that we discussed was the fact that Surgery will not benefit George at this point, and chemo will be the first step. The option of Surgery is not closed, but it will be reevaluated after it is seen how the tumor respondes to the chemo. The Pancreatic team that Dr. Tomlinson presented George's case to all agreed that the CT done at Henry Mayo is lacking in quality and needs to be redone on a higher quality machine to get a proper reading and staging. UCLA started working right away on the paperwork and request to have the CT approved by our insurance and scheduled. We talked a great deal about the chemo option, and were told that many types are available. Most encouraging was the fact that Dr. Tomlinson said that if "Plan A" stops working or George doesn't tolerate it, we will move to "Plan B" and when that stops we move to "Plan C" and so on. He must have listed 3-4 different drugs that have been effective in shrinking pancreatic tumors. We know this will not be easy, and we may have very difficult days ahead, but he said George is young and healthy and can do this!

We talked about the possibility of the tumor shrinking enough to be resected at a point down the road. Dr. Tomlinson said if and when he feels that benefit outways the risk of the Surgery then he will offer that option. It is major surgery and not without very serious risk. Dr. Tomlinson had just preformed the Whipple Procedure yesterday on a patient, and has another scheduled for Friday morning. We feel he is very qualified, and knows what is resectable or not.
Next, we will be waiting  for the call to say the CT approval is in, and then set the date to get it done. We will then request approval to allow chemo treatment to be done by an oncology doctor that works with the Pancreatic Team.
Sorry for the delay in getting this information updated, but it's been a very long day...
Good night,
~Donna

Wednesday Night Update

We feel blessed that so many of you have contacted us regarding our appointment Thursday morning at UCLA. We could not begin to properly thank each and every one of you for the love and support that has been poured out on our entire family. The friends that have made sure our family is well fed, and the kids transported to school or to church events, has been so greatly appreciated.  The cards, email's, texts, visits and overall help, are such an encouragement to both of us.
My mom is here tonight, and will manage the morning routine with Hanna and Matthew so we can hit the 405 first thing. Our appointment is at 10:00 AM so prayer around that time is requested. We will most likely not have information to share with you until the afternoon, but we will be updating the blog upon our return.  Thank you!  Love, George and Donna.

UCLA is all set

Wednesday was spent making, and taking, many phone calls. Early in the morning I sent an e-mail with the results of the Endoscopic Ultrasound to the doctor that I had made contact with at UCLA. Within an hour,  Dr.Tomlinson personally called me on my cell. We went over a few of the medical details about Georges case, and he wants to see George next week. He is presently in Texas, presenting at a medical conference but is eager to see what he can do for us. He will be presenting George's case to his team next Thursday morning, and will meet with us a few hours later. The team consists of other Surgeons, GI doctors, Oncologists and a Radiologist. They will all give their impression and recommendations for treatment options. We could not have asked for a better team, and know that it is worth the wait. We also know that Surgery at this moment may not be the best treatment plan so Dr. Tomlinson is working on getting us connected with an oncologist. We may even see one that very same day, but that is not confirmed.  I Fed Ex'd all of George's records to him so we shall see what next week holds.

~Donna

Discouraging News

Late Tuesday afternoon we met with the surgeon from Facey, our medical group. He was very compassionate toward our situation and spent a great amount of time educating us on the Pancreas and the areas involved. His professional opinion is that George's mass is not resectable. He based this on the fact of the encasement of the portal-vein, even though no obvious invasion is seen there it's very close. This was not the news we wanted to hear, and not the battle I was prepared to fight. The surgeon admitted that he is not a Pancreatic surgical specialist, and told us he would give us a referral to UCLA. He made a few calls right then, and received the approval. We are clear to make the appointments. I will be working on that today, and keep you posted as to the next step.
The surgeon gave us a great deal to think about regarding treatment, and offered to help us in anyway if needed.

Endoscopic Ultrasound

The preliminary results are very encouraging, and a bit of good news in a bad situation. The GI Doctor that did the procedure feels that the Mass is "borderline resectable" and it will be the surgeon's final call. They could see that there is encasement of the portal vein-superior mesenteric vein, but no invasion. They were also able to biopsy the lympth node in the area of the mass. The pathologist looked at four different areas and they all appeared clean and no cancer present. It was sent to the lab for a second and final look prior to making the result final, but it looks good.

The GI doctor feels it will take a skilled surgeon and is advocating that we seek a consultation with the UCLA Pancreatic Surgical Team. He was so kind, and even gave me his personal cell number so that we could have the surgeon call him. We have been so fortunate to have one of my colleague's connect us with an Oncology surgeon at UCLA and will now request again our medical group give us the referal.

What is Next:
We meet today with a surgeon from Facey, and have the required consultation in which I will state the case that our group surgeon is not qualified to do the surgery needed. This is a "Hoop" that we have to jump through, but I'm prepared with all my questions and facts. My prayer is that the surgeon reconizes his limitations, and quickly agrees to start the paperwork. I have been corresponding with the surgeon at UCLA, via email, over this past week so I'm confident that once the approval comes in we will move along fast. We also have a contact at USC so we will not rule out any of our options at this point. We will post again tonight as to the results of today's appointment.

Thank you to everyone who was praying and thinking about us yesterday during the procedure, and to Tara and Lianne who helped distract me during the very long wait.

~Donna

Monday's Procedure

Monday morning at 10:00 AM. George will have the Endoscopic Ultrasound at Providence Saint Joseph Medical Center in Burbank. The Procedure will give the Surgeon a clear picture in determining if George is eligible for the Whipple procedure or not. It should also give them the ability to give us a "Staging" of the Cancer. We will then be meeting with the first Surgeon on Tuesday afternoon, who is part of our Medical group. We already know that we will be asking for a referral to another outside Surgeon to seek the treatment based on the complexity of the surgery. Please pray that this continues to move along without delay.

The Need to Blog

Dear Family and Friends:
During the past week it has become very difficult to keep up with all the emails and text messages. I was grateful to have so many of you concerned and wanting updates, yet feeling overwhelmed trying to get the information out.  We decided to follow the recommendations of many of you to create this blog and post as many updates as we could. Sometimes it will be me doing the updates and at times George (he is a far better writer than I), so here goes...

Recap of the past two weeks:

2/6-      Just as the Superbowl starts George's Primary care doctor calls to say his liver enzymes are elevated. He had done routine blood work the week before in preparation for a check-up that next day. He did tell the Doctor he was itchy.

2/7-    He has all the lab's repeated, with added tests, and in a few days we see the enzymes are even higher.

2/10-  We are sent for an Ultrasound of the Liver, the Doctor felt he may have a gallstone blocking a
duct. No stone is seen, in fact the tech just noted some fatty areas and we were told this would not cause the elevation. George continued to have severe itching and started on medication to help rid the Liver of any toxin's that could be the cause. All the blood work was negative for any viral cause and the enzymes remained high. 

2/14- Enzymes levels were tested again, Donna worked that day and upon returning home could see that George started having yellowing of the eye's, skin, and periods of chills.

2/15- We waited for the Doctors call, and felt we needed to be more aggressive in finding the cause. When the call came we were both on the line, and before Donna could ask for more to be done we were told the enzymes were still high and we needed to go the the ER immediately. Family came to help with the kids and our friend Rick V. met us in the ER. After a long night George was admitted for a full workup with a Liver specialist.

2/16- The GI/Liver Specialist had  more blood work, and requested an MRI. That afternoon we were told the news that a Mass was seen on the head of the Pancreas. They then did a CT to see a more detail view and confirm that it was a solid mass and what area's were involved. They could see it was blocking the ducts that bile and enzymes excrete from, and he would need to have a stent placed in the ducts the next day to open this up. It was a day filled with tears and anxiety as we shared the news with family and close friends. The Liver Specialist warned us that due to the size it was unlikely benign.

2/17-  The call came in that this was a solid mass and is 4 cm by 4 cm. We would need the stent right away and a Surgical evaluation to determined if a resection (removal) could be done or not. The surgery to remove it is a highly specialized procedure called a "Whipple" and is not always possible. Several friends and family came, and at one point George had 3 RN's at his bedside (Donna's fellow colleague's) when he went in for the ERCP with stent placement. The procedure was only about 45 minutes and the Doctor was able to share with Donna photo's that were taken. It was clear that an area just outside the pancreatic duct was already ulcerated and the tissue looked like the presence of cancer. You could see the mass is pushing the ducts closed, and narrowing was present.

2/18- The comfirmation came that the tissue just outside the Pancreas was postive for Adenocarcinoma. We know that this is the same type of Cancer cell that George's Mother passed away from over 20 years ago.

2/19- George was released from the hospital and the jouney for more outpatient procedures, and Doctor consultations, begins.