This update has a lot to report and some technical details, so apologies in advance.  I had my scans a week early due to my new medical oncologist going on vacation. I am glad to know he takes care of himself by going on vacation because I certainly want to know that the expert following my treatment is well-rested.  

My scans showed some mixed results, which seems to be the "norm" for me.  The melanoma has not moved into any organs and my brain is normal.  Dr. B was happy to see that the lymph node on the right side of my neck that they had been using for the TVEC injections was "too normal to inject any further"-meaning it has shrunk back to a normal size and there is not likely any more cancer in that lymph node.  In addition, all the upper body nodes continue to decrease in size, which means the TVEC did the job of calling out my T-Cells to fight the melanoma up there.  Unfortunately, the lower body (pelvic) area has increased in activity since the last scans.  

What this means is that my immune system is fighting the melanoma, but not everywhere at the same time.  Sadly, the lymph nodes in my lower body which are large enough to inject, are also very deep, so not candidates for TVEC.  

Dr. G recommends I start a new treatment plan next week.  Instead of the Pembro IV drug I have been receiving since my recurrence, I will go back on the "cousin" immunotherapy drug to the Pembrolizumab, which is Nivolumab. Nivolumab was the drug I received for a year after my initial diagnosis to help my body fight off the melanoma for almost 2 years with no side-effects. In addition to the Nivolumab, I will also receive 4 doses of Ipilimumab, another immunotherapy drug to partner with the Nivo.  The goal is to make sure my T-Cells identify and go after the melanoma.  Those two immunotherapy drugs are called Immune Checkpoint Inhibitors and their job is to erase any barriers the melanoma tries to put up, keeping the T-cells from recognizing them as "bad guys".  Dr. G says to think of the T-Cells as the FBI (specialized police), the melanoma as having "diplomatic immunity" (hey, I'm a bad guy, but you really can't come after me) and the Immunotherapy drugs as the means to remove the diplomatic immunity so the FBI T-Cells can go after the melanoma bad guys. 

The additional drug, (Ipi for short) has the same potential side-effects as all the other immunotherapy drugs I've had.  I could have any experience from no side effects-to mild-to severe. I'm praying my experience will be a similar response as to the other IV immunotherapy drugs.  

We definitely prefer all good news from scans, but we continue to trust in God's perfect timing and the lessons He teaches us, even in the middle of challenges He allows.  He always proves Himself faithful, no matter what.

God is our refuge and strength, A very present help in trouble. Therefore we will not fear, though the earth should change And though the mountains slip into the heart of the sea; Though its waters roar and foam, Though the mountains quake at its swelling pride. Selah.

~Psalms 46:1-3 NASB

Thanks for joining us on this journey!

Praise God for:

• All my treatment for the foreseeable future will be at the Layton hospital, so no commute to Salt Lake.
• Many options for melanoma treatment-there is another immunotherapy drug they expect to be FDA approved by March!
• Great medical team.
• Small blessing of the addition of a mirror to "see out" during the MRI.

Pray for:

• My relationships with the Layton infusion nurses and staff, since I will be there every 3 weeks for the next few months. 
• God's continued peace and my contentment.
• Pain management.  The enlarged lymph nodes are close to nerves, and are causing some pain. Pray for peace and perseverance and that God will use the immunotherapy to shrink them so they aren't causing pain.
• No fatigue due to low iron.  They are watching my iron levels closely-my January iron deposit (IV iron infusion) seems to be wearing off.  My body has iron available, but still seems to have difficulty absorbing it.  Yes, I am eating LOTS of foods to assist absorption...my body just doesn't cooperate in this area. 
• If it's God's will, that He would eradicate every cancer cell with my immunotherapy treatment.
• God to be glorified in everything that is going on.