Sunday, June 21, 2009

Happy Fathers Day!

We just want to wish everyone a Happy Father's Day. Dave wants to thank everyone for taking the time to visit, help out, call, and pray for him throughout the last few weeks. Please continue to pray for him to be able to receive his treatments this week and that his tumor will respond to those treatments. It has been a very good Father's Day for him today and he hopes that all of you have also had a great one as well.
Remember, we can do all things through Christ who Strengthens us.
Much Love.

Thursday, June 18, 2009

Additional Information about the Golf Tournament

New number for Steve Watts at the golf course. 801.407.3030

Also, donation accounts have been set up at Central Bank and Bank of Utah in the name of "David K Palfreyman Cancer Donation Account".

Tuesday, June 16, 2009

Dave's Treatments --

1. Nexavar – a pill to stop the growth of the tumor
2. Radiation – the typical radiation treatment
3. Therasphere – a new form of direct radiation (it will be concentrated in the tumor)

Dave started the Nexavar last Thursday. He has had only a few side affects. He has had some itching and a dry throat and mouth. He also has been very tired from this medication. He goes in and out of phases where he feels really energized and phases where he feels really tired. I feel like it’s a good sign that some days he has a lot of energy.

When they start the radiation treatment, it will be full blast. They will use the highest dose that they can to attack the tumors on the lymph nodes. I will let you know more about this soon.

Dave will hopefully start the Therasphere next Tuesday. First, it is necessary to find out if his blood vessels in and around the liver are in tact or if they are damaged. Today he went in for a mapping procedure to find that out. This procedure is much like the treatment itself except that the doctor injected a dye (rather than the radiation) today. (Details about this treatment are listed on the posting “Therasphere Treatment Postponed”) The doctor can see where the dye goes and that will let him know if it will be safe for Dave to have the Therasphere treatment. If the blood vessels are damaged, the dye will go into his lungs and GI Tract. If that happens, the dye won’t hurt him, but the radiation from the Therasphere would so they won’t do the procedure. The nurse told Kaylene that if he is not a candidate for the Therasphere treatment the doctor would call with another treatment plan. It will be a week or two before we know the results from the mapping procedure. However, he will be scheduled for treatment as soon as the results come in.The mapping went well. I thought he would be tired and ‘out of it’ tonight, but he is awake and alert. The doctor told him that he needs to be up and walking around more. They want to make sure he doesn’t end up with a blood clot. He went for a brief walk around the house and out onto the porch this evening with his sweetheart.

Thursday, June 11, 2009

Golf Tournament for Dave

Dave has helped so many people throughout his life. He is very blessed to have so many close friends who have offered their prayers and support.

Dave’s type of cancer is rare, and the procedures he will require are expensive and they will affect him so that he will be unable to work. To help ease the financial burden brought about by his circumstances, there will be a golf tournament fundraiser on July 1st. The details are below.

Date: July 1
Registration Check in: 7-8 am
Tee Off: 8 am
Location: Talon’s Cove

Please contact Steve Watts to sign-up.
Phone: 801.472.0965

We will have a catered luncheon with entertainment following the tournament.

Donations of $75 are encouraged to participate. However, donations of any amount to participate will be received with gratitude. All proceeds will go to Dave.

Please feel free to forward this to anyone who knows and loves Dave.

Dave’s family would like to express our deepest gratitude to all of our friends and family members who have been and will continue to be so supportive to Dave. Thank you! You are in our prayers daily.

Therasphere Treatment Postponed

With the Therasphere treatment, comes a risk. (That is the treatment where the doctor places a catheter in his leg and runs it up the Femoral Artery and into the Hepatic Artery. Once that takes place, the radioactive material, encased in tiny glass spheres, will flow in through the blood vessels and into the tumor and start to attack it.) If Dave’s blood vessels in the liver are damaged, it is possible that the radiation spheres will travel into his lungs and GI Tract. That would create a very dangerous situation for Dave. However, if his blood vessels are all in tact and healthy, the procedure will work just fine. Fortunately, there is a procedure called ‘mapping’ that will enable the doctor to know if the blood vessels are damaged or not. They will not do the Therasphere treatment until they get the results from the mapping and know that it is safe to do. Dave’s mapping appointment is on Tuesday June 16. It will take one week before they can actually do the Therasphere treatment. It won’t start until at least Tuesday June 23.

Dave’s medication(Nexavar) came today. He started it this afternoon.

On another note, the surgeon, Dr. Ott called Tuesday afternoon and said that if it hadn’t been for the cancer in the lymph nodes, he would have operated on Dave this week and pulled the tumor on the liver out. He said he is confident that he could do it and although it would be a long procedure and long recovery, Dave would have been fine. Dr. Ott also said that if the radiation cleans out the cancer in the lymph nodes, he will go ahead and operate. That is really positive news for our family! Dave really needs the operation. The doctors have told us it is the only way to cure this type of cancer. Keep praying that the radiation will go well on the lymph nodes and that the main tumor on the liver will be able to come out! Thanks for your love and support.

Monday, June 8, 2009

Treatments! ... Finally

Dave had a biopsy done on the swollen lymph nodes this morning. Then he met with Dr. Watson who specializes in Liver Therapy. Kaylene says that the first appointment was very grim. One of the lymph nodes has a cancerous tumor that is 6 cm on one side. (That is half the size of the tumor on his liver.) The doctor that gave the results of the biopsy was very matter-of-fact. Kaylene said that it was horrible to sit through that explanation. On the flip side, Dr. Watson was very positive. He came in and said that he will treat this cancer very aggressively and that they will get started right away. There are three different treatments that they will use. One is a pill called Nexavar. That will help keep the tumor from growing. With the tumor being so big, the Nexavar won’t shrink the tumor. The second treatment will be radiation on the lymph nodes. They have ordered the stuff to start radiation within the next week. The third treatment will be a new type of radiation therapy that is more concentrated on a specific spot. This is called Therasphere. Dr. Watson is the only doctor in Utah who uses Theraspehere. We are very fortunate to have been able to meet with him. Dr. Watson wants to start treatment within a week from today. (Hopefully Wed/Thurs) Here is the website that explains this new treatment option.

Brief Explanation of Therasphere:
The doctor will make a small incision into Dave’s leg (I believe in his thigh) and place a catheter into the Femoral Artery. He will use fluoroscopy which is the technology that allows the doctor to see the images as he guides the catheter up the Femoral Artery and into the Hepatic Artery. The liver has two main arteries. One of them, the Hepatic Artery, supplies blood to this type of tumor. Once the catheter is in the Hepatic Artery, the doctor will inject millions of tiny glass spheres filled with radioactive material. Those spheres will travel along the blood stream and attack the tumor from the inside. There will be minimal (if any) damage done to the healthy tissue near the tumor. The half-life of this material is approximately 64 hours. This means that after 64 hours only half of the original amount of material will be left in his system. After 4 half lives of this material (256 hours or 10.5 days) the radiation levels will be undetectable (basically out of his system).

The Side Affects:
Each of these treatments will be done outpatient. For the radiation and Therasphere, Dave will go in to the hospital for a few hours and then come home and likely go right to bed. There are side affects to these treatments but right now it seems the biggest one is fatigue. He will be very tired. With the Nexavar he may get a rash and his feet may swell up. Fortunately, increased nausea, pain, and discomfort are not likely.

Friday, June 5, 2009

"An apple a day keeps the doctor away."

If only it were that easy. Actually Dave is very blessed to have scheduled appointments with some VERY good doctors.

We don’t know anything new just yet. We anticipate a lot of new information and progress over the next few days. Dave has an appointment today at 4 pm with Dr. Wallentine, who is an Oncologist at Utah Valley Regional Medical Center. I believe is the best that they have. Dave also has an appointment on Monday with Dr. Watson who does “Liver Treatment” in relation to cancer and diseases. I am not sure what that means, but I will find out. Prior to that appointment Dave will have a biopsy done to find out what is going on with the swollen lymph nodes. Tuesday they have an appointment with Dr. Ott who is a surgeon. He should tell us what specifically needs to happen for Dave to have surgery. We are hoping that these doctors will get him started on some sort of treatment plan right away. Please help us by praying for this. Please also know that you are all in our prayers of gratitude for the many loving friends and family members that Dave is blessed to know.

Dave had a rough day yesterday. He had a high fever, was nauseated, exhausted, and had difficulty eating. (This is different from earlier this week when he was feeling alert and comfortable. His wife Kaylene, and daughters Amber and Julia, are taking really good care of him. He is in good hands. Dave says he feels much better today and has much more energy.

After speaking with some close friends this morning, his spirits are higher. Dave spoke with Ellen Matthiais Porter who was in the Young Ambassador’s with him at BYU many years ago. He also spoke with Mike Westfall who is a former mission companion in the Germany, Central mission which is in Dusseldorff. Dave expressed to me that his spirits were really low this morning but after speaking with those good friends, he feels a great deal better. Dave really appreciates all of the comments and phone calls. They have helped keep him hopeful.

Wednesday, June 3, 2009

Larry King and Seagulls

When I started typing this, we were patiently awaiting a phone call from the Utah Valley Region Medical Center’s Tumor Board. We just received a call from them. They met today but did not discuss Dave’s case. Evidently his surgeon thought the oncologist would be taking the records to the board, and the oncologist thought the surgeon was taking care of that. It fell through the cracks. Since the Huntsman Board already looked through his case, we aren’t as concerned as we may have been otherwise. At any rate, we don’t have any more news than that. So,I thought I would share some of the positive experiences that our family has had during this trial.

Dave is long-time friends with Shawn Engemann King. Shawn is married to Larry King. Shawn’s dad called her and talked to her about Dave’s illness. Shawn was so upset, as are many of our family and friends, and she called Dave. Shawn and Larry were at Wrigley Field in Chicago for the Dodger’s/Cub’s game. Shawn called right before Larry was to sing during the seventh inning stretch. She told Dave that they were praying for him and that Larry was going to dedicate the song (for the seventh inning stretch) to Dave. As Larry got to the end of his song and was about to dedicate the song to Dave, the cameras switched to center field where a flock of seagulls had landed right in the middle of the game. They landed for just a moment and then took off in one entire flock. Dave and his oldest son Matt were watching this game. Just as the seagulls flew in, Matt said, “That’s the sign of a Utah miracle.”

For those of you who may not know, the pioneers who crossed the plains and settled in Utah experienced miracle with seagulls. This is the story according to
“The seagull is Utah's state bird. This is because of a miracle that occurred in 1848. That spring the crops were invaded by crickets.
After numerous prayers and pleadings to God, the sky was darkened by thousands of seagulls. They came, they ate the crickets, they vomited them up, then they gobbled up more, and the crops were saved. The birds' intention was to kill crickets rather than to feed them selves.
The Seagull Monument in Salt Lake City is an ever lasing reminder of these days of darkness and light.”
Dave notes that, “The interesting thing about this is that there is no food for the seagulls in the middle of the field. They didn’t land to eat, they just landed and then rose up in the sky.”
Our family looks at this as a reminder that God can perform great miracles. But we must remember the scripture in Ether 12:12. “For if there be no faith among the children of men God can do no miracle among them; wherefore, he showed not himself until after their faith.”
Thank you for your faith and prayers. It has helped us to continue to have faith.

Tuesday, June 2, 2009

Cain and Abel

One of Dave’s doctors or nurses has referred to Dave’s liver as Cain versus Abel. One side of his liver is healthy and strong and the other side has this ugly tumor that is trying so hard to kill off the other side. And the battle continues.

The Huntsman Cancer Institute has a Tumor Board that meets every Tuesday. (An explanation of the Tumor Board is given on the posting Dave’s Story.) Dr. Sorenson from the Tumor Board called today with the results. Keep in mind, there will be bad news, but there will also be good news. Our family is clinging to the good news! It keeps us fighting and keeps Dave strong!

First, Dave’s insurance doesn’t cover the Huntsman Cancer Institute and so he will not be receiving treatment from them but they did meet to discuss his case. They are not suggesting surgery at this point. (For anyone unaware, we have been fasting and praying for surgery. That would have been the best option.) He can’t have surgery because the tumor is so big. If they remove the tumor, his liver might not sustain his body. The national standard for liver transplants states that the tumor must be less than 8 cm. Dave’s is 12 cm on one side. They can not remove the tumor or do a liver transplant at this point.

Since Dave will not be receiving treatment from (HCI), Dr. Sorenson has referred Dave to some doctors in Salt Lake City that we have already heard great things about. Dr. Watson is an Oncologist who specializes in “Liver Directed Therapy”. At this point I am not entirely sure what that means. (As we understand it, they will be trying to strengthen the healthy side of his liver and attempt to shrink the tumor on the right side. When I find out what exactly that is, I will put more information.) Dr. Mark Ott is a surgeon who we have heard wonderful things about.

Dr. Sorenson(from Huntsman) sent Dave’s medical records to both Dr. Ott and Dr. Watson and requested that they call Kaylene within the hour to set up an appointment with Dave. Both called quickly and Dave has an appointment with Dr. Watson(the Oncologist) on Monday afternoon and one with Dr. Ott(the Surgeon) on Tuesday afternoon. Both appointments are next week. Dr. Ott has already reviewed his records and wants a biopsy done on the lymph nodes. (As it turns out he has two that are swollen.) Dave will go in for a biopsy on Monday morning.

Monday- Biopsy on the lymph nodes and appointment with Dr. Watson(Oncologist)
Tuesday- Appointment with Dr. Ott(Surgeon)

Also: There is a Tumor Board that will meet tomorrow (Wednesday) at Utah Valley Regional Medical Center (where Dave was last week). Dave will also get an appointment with his Oncologist from that Tumor Board. His name is Dr. Wallentine.

The Good News:
1. There is something to be said about not getting into the Huntsman Cancer Institute. Since they are a research facility, they don’t allow their patients to have any outside treatment options because they need to have controlled situations for their research. Since we won’t be taking Dave there, he has a lot of treatment options to look at.
2. The tumor is growing very fast. Since the cells are dividing so quickly, they are not very strong and should be easy to kill. We are hoping that the liver therapy will kill enough cells and that they will be able to shrink the tumor enough to operate. I have to think that is the reason that Dr. Sorenson said they were not going to recommend surgery and yet he still referred us to a surgeon.
Keep praying and sending him your love. He’s a fighter and we will fight our way through this. Thanks again for the love and support.

Monday, June 1, 2009

Dave's Story

This contains details about how Dave found out about his cancer. If you have any questions about anything in here, please message Kelly Palfreyman(Dave's daughter-in-law) on facebook. We will continue to post updates as we get them! Thanks for your love and support!

Before the Hospital

Dave has been sick for a few months. He has had respiratory problems (including pneumonia last year) and stomach problems (including vomiting). For a few weeks prior to being admitted to the hospital, Dave’s vomiting had gotten worse but was not in any kind of pain.

Dave had gone in to see his dermatologist, Dr. Jensen, about a lesion on his arm on Wednesday May 20. Dr. Jensen noticed that Dave had lost a significant amount of weight and wasn’t looking healthy so they started talking about it. (On a side note, Dr. Jensen is a long time personal friend who used to work in the ER.) So Dr. Jensen started making calls to get Dave in to have an ultrasound that afternoon.

They called Thursday with the results from the ultrasound. They showed that his gallbladder was not functioning properly and there was a mass the size of a baseball on the right lower lobe of his liver. That same day, Dave went in with Dr. Jensen to have his lungs x-rayed to see if the tumor had spread to his lungs.

Dave went in for a CT scan on Friday which confirmed the mass on the liver and that his gallbladder was not functioning. Then he scheduled a liver biopsy for Tuesday morning (due to Monday being Memorial Day). At this point Dave was still not feeling any pain just discomfort and nausea. Dr. Jensen had given Dave medication to help with the discomfort and to help him sleep.

By Sunday Dave was in a lot of pain (in the ribs next to his liver) and experienced severe vomiting. Dave also had a high fever so he was taken into the ER that night at 8 pm.

At Utah Valley Regional Medical Center (Sunday May 24-Monday June 1)

Dave’s wife Kaylene took him to the emergency room on Sunday night at 8 pm. They started I.V. fluids and gave him Dilloted for the pain. When the doctor came in he felt around Dave’s abdomen to find the location of the pain. For some reason Dave was feeling more pain in the lower part of his abdomen. As a result, the ER doctor was concerned about Dave’s appendix bursting. Another CT scan showed that Dave’s appendix had not burst and we were back to square one.

On Monday, Dave had a Hyda -test done on his gallbladder. This is a test where they inject the gallbladder with a dye and watch what the gallbladder does with it. This shows them how high the gallbladder is functioning. They continued to give him medication for pain and nausea. The liver biopsy was still scheduled for Tuesday when the doctors were back in town.

Typically when patients are in the hospital for an extended period of time, they are given blood thinners since they lay in bed all day. However, the liver is an organ that bleeds a lot. So doing a biopsy after he’d had blood thinners was not an option. The biopsy was postponed until Wednesday morning. (As a side note, his nurse was in tears and very apologetic.)
Wednesday morning, Dave had the biopsy done. The results general take 1-3 days to come back. Dave’s took two days. Wednesday at 4 pm, Dave’s doctor started him on antibiotics. Over the next few days his fever went down and his strength started to return.

The results came back on Friday. Dave had been prepped for surgery before the results came back. At that point the best option was to remove the gallbladder and the tumor. The right lower lobe of the liver could be taken out because that part of the liver will regenerate itself. The results came back that the tumor was cancerous and a better look at the tumor showed that it was actually the size of a softball. The doctors were concerned that the mass might be too big for them to take it out. If they take out too much of his liver it won’t be able to sustain his body. At this point on Friday the doctors explained the options were to operate and take out the mass (if they can without killing him) or to do a full liver transplant. They came in Friday evening and said that a transplant would no longer be an option. The national standard for a transplant includes a qualifier. The tumor on the liver can’t be larger than 8 cm. Dave’s tumor is 12 cm on one side. On another note, Dave has a swollen lymph node in or around the portal vein (the vein that leads to his liver). The doctors aren’t sure why it is swollen but they say it is most likely cancer. We aren’t sure what that means for Dave just yet, but that is a low priority compared to the tumor.

Dave stayed at the hospital until he could tolerate and keep his food down and his oxygen level went back up to the mid 90’s. They transitioned him onto oral antibiotics and oral pain medication. Dave came home this afternoon Monday June 1.

Options for Dave as of Monday June 1

At this point Dave has a few options. The best option is for him to have surgery. However, at this time he is not eligible for surgery because of the size of his tumor. There are medications that can shrink the tumor or freeze it so it won’t grow. If they can shrink it enough, they could take the tumor out. Or, if they can shrink it down to 8 cm then he would be eligible for a transplant. Shrinking the tumor to 8 cm is not impossible, but not likely. However, every person’s body is different.

The Huntsman Cancer Institute at the University of Utah has a Tumor Board that meets every Tuesday morning at 12:30. The Tumor Board is composed of a number of expert Oncologists and Cancer Surgeons who spend time looking through rare cases and try to come up with treatment options. Thanks to some of Dave’s close friends, the Tumor Board has agreed to review Dave’s medical records. Kaylene and Matt (Dave’s son) will be taking Dave’s medical records up first thing tomorrow morning and the board will meet at 12:30.

Dave has a rare form of liver cancer. Generally liver cancer is secondary which means that it starts somewhere else and spreads to the liver. Dave’s liver cancer is primary which means that it started in his liver. Fortunately it doesn’t seem to have spread. His organs (except the gallbladder) are fully functional. The doctors are surprised that the rest of Dave’s liver is also functioning at full capacity given the size of his tumor. They are also surprised that he has this kind of cancer at all. Generally this kind of cancer is found in third world countries in drug abusers, alcoholics, and people infected with hepatitis. They have no idea why he has it or where it came from. For those of you who live out of state or may be otherwise unaware, the University of Utah Huntsman Cancer Institute is a research school and is dedicated to making life saving discoveries. While they don’t know much about this type of cancer, we are confident that getting Dave in at the Huntsman Cancer Institute will be his best option. We are very interested to see what they do with the information.

If you have any questions please message Kelly Palfreyman on facebook. Also, Dave has a facebook group "Friends and Family for Dave Palfreyman". If you are not a member of that group and would like to be, please search and join or message Kelly Palfreyman and she will invite you.

Dave wants to express his thanks to the many friends and visitors who have helped out in any way, and he is happy to report that his spirits are high, most in part because of the great love and many prayers of you, his close friends and our incredible family.

Thanks for your continued prayers and support. We need our Utah miracle, and we can’t do it without all of you.