Pamela Smith (Olean, N.Y.)

DSRCT Diagnosed 11/95 at age 35 - Passed Away 8/6/01

http://home.earthlink.net/~drdubious/pamela_history.htm

www.DSRCT.org

Pamela's Herbal & Nutritional Therapy

(Dosage in mg.) 9:30 AM Breakfast 10:30 AM 11:30 AM Lunch 2:30 PM 3:30 PM 5:30 PM Dinner 9:30 PM 10:30 PM 11:30 PM

Therapeutic

                       
Astragalus      

1350

     

1350

     

1350

Coenzyme Q-10      

100

     

100

     

100

Devil's Claw      

1500

     

1500

     

1500

Essiac Tea (2 oz.) X           X    

X

   
Garlic  

2500

   

2500

     

2500

     
Maitaki    

1000

   

1000

   

1000

 

1000

 
Red Clover    

1000

   

1000

   

1000

 

1000

 
Shark Cartilage      

2500

     

2500

     

2500

Special Formula #1      

1000

     

1000

     

1000

Cleansing

                       
Dandelion

1500

         

1500

   

1500

   
Milk Thistle

600

         

600

   

600

   
Nettle

1500

         

1500

   

1500

   

Nutritional

                       
Acidophilus  

1000

   

1000

     

1000

     
Adrenal extract  

150

   

150

     

150

     
Beta-Carotine        

15

     

15

     
Calcium  

2400

   

2400

     

2400

     
Chamomile  

350

   

350

     

350

     
Chromium        

.2

     

.2

     
Ginger  

1000

   

500

     

500

     
Ginko Biloba  

100

   

100

     

100

     
Ginsing  

2000

   

1000

             
Multi-Vitamin  

1 Cap

                   
PABA

500

500

Pituitary extract  

35

   

35

     

35

     
Spirulina  

1500

   

1500

     

1500

     
Thymus extract  

140

   

140

     

140

     
Thyroid extract  

50

   

50

     

50

     
Vitamin C  

2000

   

2000

     

2000

     
Digestive enzyme  

800

   

800

     

800

   

From Pamela's web page

Pamela's story began late in the Spring of 1995. We originally thought she had a hernia or fibroid cyst when she felt a mass in her abdomen. After seeing an ultrasound, her gynecologist sent her to Dr. David Marchetti in Buffalo, a gynecological oncologist. Because of her age (35) and lack of other symptoms, Dr. Marchetti was almost certain it was a cyst. A week later he opened her up and found a grapefruit-sized tumor. He had never seen anything like it, but the pathologists at his hospital came up with the dsrct diagnosis very quickly, to their credit. Very fortunately, Pamela had only a small number of isolated tumors which had not metastasized. This was very unusual, from what we have since learned about the disease. By the time this tumor is usually discovered, it has spread throughout the abdominal cavity.

We did a lot of research for the next month and talked to Dr. Brian Kushner at Kettering (among many other doctors). He had a protocol, called P-6, which was designed to address aggressive small-cell tumors like dsrct. His work was not overly encouraging and, we felt, inconclusive. On the other hand, there was evidence of some response (he claimed 50-75%, but that included corpses with complete remission in their autopsies). After questioning Dr. Kushner and convincing him to send her his latest research report, Pamela was still doubtful about P-6. On the other hand, he seemed to be the only game in town. She decided to wait and see if the surgery had removed all of the disease. If the tumor returned, we would give P-6 further consideration.

In December, 1995, a CT scan was performed, which was generally clear, but a few faint shadows appeared which were considered possible fluid accumulations (we found out otherwise later). There were also several small spots (less than 3mm) in the liver. Dr. Kushner was certain these spots were metastatic lesions and wanted us to come to New York and do a liver biopsy. Dr. Marchetti, on the other hand, was very doubtful of cancer in that area and discouraged a biopsy attempt. He figured Pamela would just end up with chopped liver and little useful information, predicting that the liver spots would turn out to be benign. We went with the conservative approach.

In January, a laparoscopy showed several small tumors recurring near the area of the earlier surgery. A CT showed no change in the size of the liver spots. It seemed P-6 was the next logical step. We decided against going to New York. Our doctor expressed a lot of doubt about the effectiveness of high-dose chemotherapy in general. Pamela was very uncomfortable with the idea. We finally decided to "do our own thing" and modify the Kushner protocol by using "lower" doses of the same drugs. This was a relative reduction, in that P-6 uses extremely high levels so that even our so-called reduced levels were well above "recommended" concentrations. Our doctor felt that if this combination of drugs was going to work on a specific patient, it would probably work at less than mega-doses. This was based on his experience with female cancers, personal research and, I think, his intuition.

Pamela began treatment on February 9th. After three courses of this modified regimen using 3-day infusions of Cytoxan, Adriamycin and Vincristine (CAV). Pamela had another CAT scan on April 15th. This showed two fluid-like shadows near the cecum and the right kidney. A biopsy of the cecum appeared to be scar-tissue of tumor origin. A second surgery was performed to remove the two masses. The cecum proved to be all scar tissue while the tumor near the kidney had a small number of active cells deep within the mass. The other small tumors seen during the laparoscopy in January had disappeared completely. 

We were pretty encouraged, but Dr. Kushner advised repeating two courses of CAV at the highest possible doses. We agreed to the first one, but at the last minute, our doctor cut back the Cytoxan by about 20%. Then, before the second repeat course (the fifth in total), Pamela was having precognitive dreams and experiencing numerous strange syncronocities. It was all too much, so she wanted to cut back the last dose. By this point, our doctor was pushing for one final high dose, but he must have been dreaming too, because on the morning of her admission, he changed all the orders to reduced levels. As it turned out, it was a very good thing she didn't have the extreme dose, because upon returning home, she caught chicken pox for the second time in her life (she had a severe case during childhood). Since the high doses can push white counts down to 300-500, this might have been fatal. As it was, she got pretty sick and had an infection, but has recovered with only a small scar on her cheek. She took Acyclovir toward the end, and this seemed to help. A CAT scan done on June 13th was clear.

Now began phase two of the protocol: three courses consisting of 5-day infusions of VP-16 and ifosfomide over 21-28 day cycles. We started on July 8th. Again, at slightly reduced doses. It should be noted, again, that these reduced dosages were relative to the P-6 protocol. They were still above the pharmaceutically recommended maximum doses. Fortunately, Pamela had no major side effects and escaped blood and platelet transfusions. She was adamant about avoiding blood transfusions from the beginning and believes this may be one reason she had a better response. We have a theoretical basis for this, but none of the doctors buy it.

The third treatment of phase two on September 9th marked the end of the official P-6 as we had modified it. Ironically, although we had opted for lowered doses, the two extra CAV sessions probably resulted in equal or higher cumulative doses than the original protocol called for. We managed to take a short family vacation at the end of August, just before school. This was a much-needed break. The mediport, which resides under the skin, was a major benefit during this break, as throughout the entire treatment period. It allowed Pamela to swim and bathe unhindered at all times. She could have a pretty "normal" life between sessions and not have to worry about infections and constant wound-cleaning. Anyone who has had to suffer with an "external" access knows what a hassle it can be.

In addition to this "conventional" treatment, Pamela took every herb and vitamin thought to have the slightest effect on cancer, including Essiac tea, shark cartilage and Maitake mushroom. An outline of our herbal/nutritional "protocol" follows this history. She also received chakra alignments, psychic healings, prayers and magic. She was on more "prayer chains" than we knew about at the time. We figured if you throw everything at the wall, maybe something would stick. Keeping an open mind seemed very important, especially since we were asking as much from our doctor.

Now we needed to see where we stood. We discussed diagnostic alternatives, including blood tests, imaging and laparoscopy. Dr. Marchetti was open to the idea of a PET (Positron Emission Tomography) scan because he had recently seen some positive reports on the procedure. So we scheduled a test. The result was what we wanted to hear: "no evidence of disease or metastatic progression."

The dilemma now was what to do next. Having very good apparent response, we didn't want to drop the ball early. But the "expert" recommendations of Bone Marrow Transplant and full abdominal radiation seemed far too extreme. We consulted with a doctor at Roswell Park Cancer Institute, a pediatric oncologist who we had spoken to in 1995. He was very nice, but didn't add much. He suggested going the BMT/radiation route. Dr. Marchetti was very dubious about radiation in particular and not very keen on BMT either. We had pretty much ruled-out radiation back in December and nixed it for good now. Pamela did have her bone marrow harvested at the end of June "just is case." But we felt the BMT was not justified at this point. We are believers in the theory that immunity is a significant factor in any recovery and we didn't want to compromise her system just when it might be needed the most.

About this time we found Dave Denault via the internet and learned about a Dr. Sugarbaker (Washington, D.C.) and his treatment involving intraperitoneal chemotherapy. We had independently discussed the intraperitoneal idea with Dr. Marchetti earlier in the treatment. It seemed kind of logical that direct infusion to the intraperitoneal cavity might help get the chemo into areas of poor blood flow. It was also during these discussions that we brought up the idea of using DMSO (dimethyl sulfoxide) as a solvent for the chemo to improve penetration. I remembered hearing about DMSO 30 years ago in college as being a unique agent able to penetrate skin and carry soluble materials with it. Dr. Marchetti was noncommittal on the DMSO part, but since he had previously used intraperitoneal administrations himself, this approach was given a green light.

We talked with Dr. Sugarbaker's office over the phone a couple of times and they mailed a copy of his protocol. This method called for surgical removal of all peritoneal tissue and any other "unnecessary" organs, followed by bathing the open abdominal cavity with heated chemotherapeutic agents. Finally, tubes are left in the cavity for several days through which additional chemo is pumped in and then drained out. Pretty radical. From our perspective, this all seemed a little too much like the BMT/radiation ideas which we had rejected as being too harsh.

Further discussions with Dr. Marchetti led us to the idea of infusing "normal" doses of the P-6 phase-two drugs through a peritoneal port in Pamela's abdomen. Rather than trying to drain the stuff back out, we would let the fluids be absorbed back into the body. This procedure would be repeated three times.

On November 2, 1996, exactly one year after the initial discovery, Pamela had a "second look" surgery to visually explore the abdominal cavity. Everything looked clean and a "wash" of the area showed no evidence of malignant cells.

Intraperitoneal chemotherapy began on November 8, 1996. It was difficult and painful. By now Pamela was finding it nearly impossible to accept the needle insertions to her mediport. She has always hated needles and never got used to them during this ordeal. The pre-flight ritual had evolved into a double dose of Marinol on the way to the hospital, followed by 3mg of lorazepam and a final 10 mg shot of morphine. After the morphine soaked in for a few minutes, lidocaine was injected around the port site to numb the area. Then she'd let them put in the needles. Now there were two instead of one. And to make matters worse, the intraperitoneal port failed the first time out. They ended up inserting a temporary tube (a "pigtail") via a guided CT scan.

Even with Zofran, Marinol and lorazepam, Pamela was too sick to take anything by mouth during the treatments and vomited frequently. We learned by this time that a full 24 hours of hydration after the end of chemo was necessary to prevent problems at home. Whenever we violated this rule, Pamela would end up very weak and dehydrated. One time she needed to be readmitted to the hospital locally. Another time, a visiting nurse started an IV at home. Even at home, she would have difficulty drinking water for a few days post chemo. Luckily, she would snap back very quickly and within a week start to be her normal self again. But each session brought her to a new, lower level and it became more difficult to recover. Amazingly, she still managed to avoid blood and platelet transfusions. She did receive neupogen shots for 6 to 10 days after each treatment until the DMSO was started.

Two more intraperitoneal courses (#'s 10 & 11 total) followed on December 6th and January 27, 1997. The 2nd required another "pigtail" insertion, because we still couldn't get the abdominal port to work. Finally, on the 3rd course, Dr. Marchetti had to put in a whole new port because the radiologist was unable to insert the "pigtail."

On February 2nd, Pamela had to be readmitted to our local hospital for dehydration and severe abdominal pain. A couple days of IV's and she was back home again.

Since Pamela went through all the trouble of an additional surgical procedure to insert another intraperitoneal port, Dr. Marchetti suggested that we might want to go on and do yet another three courses. We said yes, but on the condition that DMSO could be included. I suggested the idea again after the 2nd look surgery but he wanted to finish the "standard" protocol first. He said we could think about that later, when we were done with the current program. He was probably thinking at the time that we would finish the whole treatment with just 3 intraperitoneal courses, so that he wouldn't have to deal with the DMSO at all. But Pandora's box was opened and we weren't about to shut it now.

During the Month of February we did the planning for the incorporation of DMSO. This ended up becoming a major challenge. Dr. Marchetti was willing to do it, but very little clinical information existed on the use of DMSO with chemotherapy in humans. There were some very interesting and encouraging articles on rats, though. The stuff is very safe and, in fact, is used to store human blood cells for bone marrow transplants. We did a lot of research & came in contact with Dr. Stanley Jacob (http://www.dmso.org) who has done pioneering work with DMSO. He gave us a lot of encouragement and talked to our doctor about dosage. We also talked to a research pharmacist in California who had encountered a few cases where DMSO had been mixed with chemo drugs.

On February 20, 1997 Pamela had her first intraperitoneal treatment with DMSO dissolved in VP-16. Simultaneously, Ifosfomide was administered IV. The observable response was quite remarkable. Pamela's toxicity during the course of treatment was markedly diminished. Even more significant, her recovery after chemo was noticeable improved. Particularly her white count, which only dropped to 2200 in the days following treatment when they had previously fallen to 1000 or lower. She only needed 3 days of neupogen before it shot back up to 15,000. And this was after 11 earlier courses of intense, immune-depressing treatments. We have no way to evaluate the primary goal of the DMSO use, since there is no control or DSRCT blood tests to run. But the dramatic reduction in standard side effects of chemotherapy was reason enough to recommend it. We would certainly do it again. We only wish we had been able to incorporate the DMSO in the earlier treatments. The only negative side effect was the strong smell of garlic. Dr. Marchetti didn't visit in the room very long during these treatments.

Pamela's final intraperitoneal+DMSO treatment was given in May , 1997. Blood tests and CT scan done in June were all clear. Another CT scan was done in September, which also read normal and a PET scan done on November 28, 1997 came back good and negative.

Now it's just a waiting game and periodic testing. We keep our fingers crossed and the Essiac tea flowing. Dr. Marchetti is very optimistic about Pamela's outlook. We know we can't rest for several years, at least, but no matter what happens, Pamela has been very fortunate in her amazing response and wonderful medical support. She must also be given personal credit for an amazing strength of will and character. It also didn't hurt that that her blood and immune system must have been built by the same people who put together the "Terminator." No one can believe she went through all this without blood transfusions.

Update: 6/8/98   Pamela had a CT done in April. The report was normal with the exception of an apparent cyst on her ovary. The doctor does not believe this to be a problem. We will check this again by ultrasound in July.

Update: 10/16/98   In the beginning of July, an ultrasound was performed which showed a significant growth in the size of the object near the ovary. Pamela was thrown into a severe state of anxiety, fearing the worst outcomes of DSRCT recurrence or a secondary ovarian tumor. Surgery was scheduled within two weeks and that time passed in agonizing apprehension. Finally on July 17th, surgery was performed to examine and remove the ovarian growth. In anticipation, we had contacted, courtesy of David Denault, a doctor at the University of Michigan. He is experimenting with certain tumor vaccines and agreed to accept a sample of Pamela's tumor, if one was found, in an attempt to produce DSRCT-specific immune agent that could be re-injected back into Pamela. But Lady Luck and whatever other powers there may be smiled on us once again: the mysterious growth around the ovaries turned out to be a cyst after all. A Complete hysterectomy was performed to reduce the risk of other reproductive cancers in the future and Pamela returned home within a week.

We are now back to the waiting game with a CT scheduled for November. Pamela has recovered from surgery, feels very good and is regaining much of her strength. We are attempting to bring our lives back into a normal mode and love every minute of precious life we have to share with one another.

Update: 12/31/98   Pamela's CT scan was performed at the end of November and the report was negative: no evidence of metastatic disease. Again, we are thankful and relieved. Good fortune still shines.

 Update: 8/4/99   Another CT scan was performed at the end of April. The report was negative. Pamela's health is good and no other problems have developed. 

Update: 12/17/99   Another CT scan was performed on November 24, 1999. The report was negative.

Our biggest continuing stress is the recurring cycle of anxiety between, and leading up to, each new scan. Perhaps if we can continue to get good reports for another year, we will eventually learn to relax. In the mean time, we enjoy our lives and try not to dwell on it. 

Update: 04/22/2000  Everything still going well. Pamela is scheduled for PET, CAT and bone scans in the next few weeks. We hope they will continue to prove negative. 

Update: 08/20/2000  It is with great dismay that I must update with bad news at this time. Pamela's April scans were delayed when a travel opportunity developed and it was not until after her return that we were able to reschedule. On June 29th a full-body CT scan was performed. The analysis was generally normal except for a questionable image near the start of the small bowel. The first radiologist thought it might be a "bowel loop", but also proposed the possibility of recurrent tumor. After a consultation with Dr. Marchetti and his radiologist, an MRI was ordered. Dr. Marchetti felt strongly that it was a recurrence. The MRI done on July 25th confirmed our worst fears: a 4cm by 6cm mass was visualized near the Porta Hepata of the liver. Pamela was shaken, but not entirely surprised, especially after hearing about all the other dsrct cases over the last few years and their poor outcomes. An immediate surgical consultation was arranged with Dr. Constantine Karacusus of the Millard Fillmore Hospital in Buffalo. Dr. Karacusus is a surgical oncologist, like Dr. Marchetti, but his specialty is in sarcomas. Dr. Marchetti recommended him highly and our research indicated that he is one of the foremost surgeons in the Western New York area, if not the country. We found many journal articles that he has written or participated in. He is also a research scientist. Surgery was scheduled for Monday, August 7th. The operation lasted over 8 hours, but doctor Karacusus was unable to resect the entire tumor. It had entwined itself within the venous area of the Porta Hepata and approximately 70% of it was impossible to remove. In anticipation of the surgical conformation, we made arrangements to have the tumor tested for sensitivity, resistance and possible production of a vaccine. Dr. Marchetti believes that since more than 3 years have elapsed since complete remission, the original drugs of the P6 protocol should remain effective. This thinking has been bolstered by the results of the sensitivity tests which showed the highest tumor cell kill rates with the CAV combination of drugs (Cytoxan, Adriamycin, Vincristine). We therefore have decided to proceed with another round of P6, or at least the start of it, depending upon Pamela's tolerance. Because of the recurrence, we feel we must do more or something different that t he first time. To that end, we have convinced Dr. Marchetti to disolved the Cytoxan portion of the P6 in a solution of DMOS (dimethyl sulfoxide - see reference above). This agent was not used with the original course, and the research we have seen indicated that the inclusion of DMSO may enhance the cytotoxic properties of the the chemotherapeutic agents and reduce the adverse side effects, We noticed the reduced toxicity during the use of DMSO with the intraperitoneal chemo given to Pamela the first time. We will follow the P6 program as completely as possible and upon its conclusion,we will have dr. Karakusus's scientist attempted to produce a vaccine form the preserved tumor and Pamela's blood. We are also investigating several clinical trials of some interesting new drugs and may try to get Pamela enrolled in one of them, As disappointing and depressing as all this is, Pamela' has not given up hope. Nor have I. We will continue to push forward against this difficult disease and hope to achieve a final cure. 

Update: 08/27/2000  Pamela entered the hospital again on August 24th to begin a modified repeat of the P6 protocol. This time we are using Cytoxan dissolved in a 10% solution of DMSO along with the 3-day infusion of Vincristine. For now Adriamycin is being left out due to cardiac toxicity, There is maximum lifetime dosage limit to this drug and Pamela is very near that limit. We did not use DMSO with the CAV drugs the first time around, so this treatment will be significantly different, aside from the lack of Adriamycin. We plan to use the the other two drugs in the P6 as we did before, via I.V. and intraperitoneal infusion, also along with DMSO. So far, Pamela seems to be tolerating the chemo pretty well, although she was hit with severe nausea tonight. We are increasing the I.V. Zofran to compensate. Hopefully, she will be able to continue the program to its conclusion. 

Update: 08/29/2000  Returned home on the Monday afternoon. Weak from her first round of chemo, but recovering quickly. 

Update: 11/15/2000   Pamela has now completed 3 rounds of our very-modified P6 protocol. The last two included continuous infusions of DMSO throughout the treatment period at a rate of 75ml per 6 hour Cytoxan dose and 1ml/hr over the remaining 3 days of Vincristine. The most noticeable effect of this process has been the reduction in side-effects. So far, no blood or platelet transfusions have been needed and Pamela's lowest white count has stayed above 1400. This compares with a drop to as low as 600 during her previous treatments without the DMSO. Her last CT scan showed no change in the tumor, but because of the limitations of this technology, we do not know if the areas visualized represent living tumor cells or scar tissue. There has been no progression of disease. In 1996, similar CT results ended up being dead tissue when biopsied. We are hoping it is the case this time. We expect to have a PET scan done soon which may clarify the issue.

We are also following up with our other doctor on the possibility of custom vaccine being made from a piece of the last tumor removed. They are optimistic that it can be done and are waiting for completion of chemotherapy to begin this phase of treatment. 

Update: 07/15/2001   I apologize to the many people who have emailed me for an update of Pamela's condition. The last 8 months have been very difficult and, frankly, I have not been up to the task. As I write these words, Pamela is home in bed. She has stopped all treatments and entered a Hospice program as of this past Wednesday, July 11.

Because the three courses of P6 had no effect on the tumor (confirmed by a PET scan) Dr. Marchetti, after consulting with Dr. Kushner, suggested trying Taxol and Cisplatin. We were doubtful about the efficacy of taxol, in particular, because we knew of no other patients who had responded to this drug. However, the sensitivity tests indicated that Pamela's unique individual tumor might react, so we went ahead, now running out of ideas. We still wanted to try the vaccine as well as the Androgen blockers, as proposed by Dr. Fine at Columbia. However, the general consensus was that these treatments were more appropriate as consolidation measures after the tumor had been substantially reduced by some conventional treatment. We were hoping for a full or partial remission which could be followed by blockers and/or vaccine. This was never to be. After three courses of Taxol/Cisplatin during January, February and March of 2001, the tumor still showed no signs of change. To complicate matters, Pamela's Liver became blocked in December 2000 and a stent was inserted between this organ and the bowel. Later, the stent itself became blocked and had to be reinserted. We took a vacation to the Caribbean in April and upon our return tried one last ditch chemo. This time we used Hexalene, an oral drug, taken at home, which showed great promise in the earliest sensitivity test done back in 1995. Low side effects were promised, but we found the Hexalene to be one the harshest drugs Pamela ever took. She was wiped out for two weeks after the first round. Upon our return from vacation, she tried another cycle, only to be stopped early by the extreme toxicity. In hindsight, I guess we should have stopped after the first dose and gone on to something else, like CPT-11, but it's easy to say that after the fact. By this time, In late May, Pamela had become very very weak and sick. She was eating nothing and drinking very little. Eventually, I had to put her in the hospital for feeding and rehydration. It ended up becoming a 3 week stay. By this time, her stent had become blocked yet again and her poor liver function precluded any further chemo until it could be reopened. Pamela's blood chemistry was now very poor and her red blood cell status extremely low. After all these years, it became necessary to accept a blood transfusion. The first attempt ended in failure due to an immediate and severe reaction to whole blood. A second attempted using Benedril and steroids also failed. Finally, on June 12, they succeeded in transfusing 2 units of washed, leukocyte-free, red blood cells. This got her counts up to about 50% of normal. Later, 3 more units were transfused, just prior to her 3rd stent procedure. This was done on June 26th at Buffalo General Hospital in Buffalo, NY. The procedure was successful but it was followed by a plasma transfusion. I had reservations about more unfiltered blood products, but the "experts' assured me that problems were unlikely. Well, problems there were. On that way home from Buffalo, Pamela began feeling restless and ill. That night she was extremely restless and the following morning began to experience general body pain. I finally had to call an ambulance and have her admitted to the local hospital for a possible transfusion reaction. There she stayed for 4 more days and came home Monday, July 2, weak as a kitten. For the next two weeks she was completely bed-ridden and sometimes delirious. She was put on Hyper alimentation for nutrition and water and stayed on it until this past Sunday, July 8. The new stent made no significant improvement to her liver function and after waiting more than a week for results, we came to the conclusion that no further progress was possible. The decision was made to abandon all treatment, enter Hospice and try to make Pamela as comfortable as possible. This is where we are now.

We could torture ourselves with "what-ifs", But overall, I am comfortable that we did everything that was reasonably possible. As far as I know, Pamela is one of the longest living survivors of DSRCT, being in her 6th year now. She has had quite a bit of time and a good quality of life during most of her ordeal, and this was our primary focus, not just "life" at any cost. Others underwent far more extreme and debilitating treatments yet fared no better.

Thank you to everyone who has written to us with support and encouragement and I hope we have been of some help to others. Although this is not the happy ending we prayed for, Pamela's long survival will hopefully be an inspiration to many and we all know things are changing fast in this field. Perhaps a cure is just around the corner. Pamela is not gone yet, and she may still surprise us.

Just live, look to the future and keep fighting.

Someday, this too shall pass.

Pamela passed away on Monday, August 6, 2001.

There is really nothing more to say. We've all seen this last entry too many times.

 

 

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