There are good days. There are bad days. And then there are days like today, somewhere in between, when you are forced to recognize that each new day may take you round a corner that changes your perspective yet once again. We are blessed that the bulk of the past few weeks have been filled with really good days. In terms of Karen's healing things continue to get better each day. Today, however, wasn't terrible but it wasn't good either.

Dr. Prados called this afternoon because he'd had a chance to review the MRIs. When I took his call I actually didn't think that there'd be much to tell. Dr. Prados first asked how Karen's back was feeling. I thought he was just being nice, but it turns out that he was asking because after reviewing the MRIs he found a number of cancer spots on Karen's spinal cord. He thought the pain she had been experiencing in her back and thighs may have been caused by the cancer he'd just discovered there.

I don't know if this is the actual cause of her pain since the pain has totally disappeared, but regardless, I had to inform Karen of this new and disappointing news. I took her outside while the children occupied themselves with "bear and the big blue house". I wanted to speak freely without fear of little ears picking up on words and emotions that so often get misunderstood and mixed up in their young minds. I also wanted to give Karen a context in which she could respond in whatever way came naturally to her. In the end she received the news like one would expect who knows her well.

She didn't cry for herself. Tears came to her eyes when she thought about having to tell her beloved parents the bad news. No one likes to deliver news that you know will disappoint or cause fear especially when you are delivering this news to people who you desperately want to please and whose joy is so closely tied to your own. So as she asked me questions about my conversation with the doctor and heard my answers in response, tears gently rolled down her face.

The tears came not because of the additional discomfort she'd have to undergo with a more aggressive course of radiation or the additional thoughts of uncertainty that seem to attach themselves to this kind of news. The tears welled up because of the mental picture that formed in her mind of delivering this news to her parents. At that moment the first images that filled her thoughts were the sadness in her mother's face and the concern in her father's voice that would inevitably greet us on the other end of the telephone line as the news was delivered.

In the end, however, it is important for us to remember that the prognosis is basically the same as it has been since the beginning. So any sadness we feel isn't fear or dread for the future. It's just a mixture of the disappointment that anyone would feel after getting this kind of bad news mixed with some apprehension about what the radiation treatments will really be like now. The answer to the last question will be a lot clearer after our meeting with the radiation oncologist on Thursday.

What we know at this point is that Dr. Prados found between 7 and 8 cancerous "nodes" on her spine in both the thoracic and lumbar regions of her spine. He also found what he called a "sheet" of cancer on the backside of the same part of her spinal cord. All of these areas appear to be on the surface of the cord rather than in the center, which is a good thing.

This new finding changes the recommended treatment. Initially the recommendation was a focused treatment at the precise site of the tumor and we could do it now or wait. Now that the cancer is in both regions they are not recommending any kind of wait, in fact they are seriously recommending that we do the radiation treatment right away. In addition, the radiation treatment will not be a localized treatment, rather, radiation will be applied to the entire brain and spinal cord. The reason for this more aggressive approach is that now that we know that the cancer has spread the chances of microscopic cancer cells existing in other parts of the neurological system is pretty high. By radiating the entire brain and spine they will be taking any of these unseen little buggers out of commission.

Additionally, because this cancer has manifested so uniquely they are going to take some additional precautions. The first is that Dr. Prados is going to have the pathologists re-diagnose the tumor. Because it spread, which is unusual, he wants to confirm again that we are really dealing with an ependymoma. He said that the pathologists will not like this but that it is important that this get done.

Also, though he's never heard of it happening before, he wants Karen to get a CaT scan to rule out any masses other places in her body. He said that this kind of tumor is not known to spread into other areas of the body but he wants to make sure that this general understanding is verified in Karen's case.

Also, Dr Prados said that if the tumors in her spine were to start growing the first kind of symptoms would most likely be numbness in her limbs. If the tumor were allowed to progress she might experience weakness in her limbs. If the tumor were to progress to a significant degree then she might experience some motor control difficulties.

The good news is that ependymoma of the spinal cord responds just as well to radiation as ependymoma in the brain and the prognosis at this point is not much different than it was before. It just means that the radiation process will be quite a bit more exhausting and that we have some additional areas of her body to which we must now be attentive moving forward.

Thank you all for your continued prayers. Days like today are made so much easier knowing that so many people are continuing to lift Karen up in prayer.