Pamela G. O'Reilly — Family Care Portal

The situation in one paragraph

Pam has two separate cancers, both being treated with curative intent. The main one is a 2.3 cm adenocarcinoma in the upper left lung, staged IIB because two nearby lymph nodes light up on PET. The second is a small, separate squamous cell carcinoma in her left arm (Stage 1), handled by orthopedic oncology on its own track. Brain MRI is clear, and genetic testing found no targetable driver mutations — which is what cleared the way for the current plan.

The plan (Dr. Vargas, Mayo — thoracic surgery)

Medications first, then surgery. Three cycles of chemo-immunotherapy (carboplatin + pemetrexed + nivolumab, one infusion every 3 weeks, ~9 weeks total) to attack microscopic spread and shrink the tumor → re-staging scans → robotic removal of the left upper lobe plus a full lymph-node dissection ~4 weeks after the last cycle → about a year of maintenance immunotherapy. No lung radiation. The arm surgery is sequenced around this. This medications-first approach is the standard of care for node-positive lung cancer, and a strong response before surgery carries an excellent long-term outlook.

Latest developments

• Treatment has started — first cycle given at Mayo; infusions continue locally at Oncology Hematology Associates in Springfield with Dr. Robert Ellis, cutting the Rochester trips dramatically.
• Aug 18 — first Springfield labs: counts are strong and stable (see Labs below). No anemia, healthy platelets, robust neutrophils — the profile of someone tolerating treatment well so far. Only flag: a mild neutrophil elevation, common after the steroid pre-medications.
• Smoke-free since mid-July, and she's been adjusting her diet to bring her blood sugar down.

The medicines, in plain language

• Carboplatin — platinum chemotherapy that damages cancer-cell DNA; dosed by kidney function, the kidney-friendlier choice given her CKD.
• Pemetrexed — chemotherapy specifically effective in her type of lung cancer; requires daily folic acid and B12 injections to blunt side effects.
• Nivolumab (Opdivo) — immunotherapy that takes the brakes off her own immune system so it can attack the tumor; active against both cancers.

What the family is tracking

• Steroid days and blood sugar — the pre-infusion steroid spikes glucose for 2–3 days each cycle; she's insulin-treated, so the steroid-day insulin plan matters.
• Blood counts between cycles — the low point comes ~7–14 days after each infusion; fever during that window is urgent (call the after-hours line).
• Thyroid — the immunotherapy commonly affects it, and she's already on thyroid medication; labs before each cycle.
• Next milestones — re-staging scans after cycle 3, then surgical scheduling with Dr. Vargas; arm surgery sequencing with Dr. Rose.

Care team

Dr. Robert Ellis — local oncology & infusions (OHA Springfield) · Dr. Deepti Behl — medical oncology, Mayo (regimen design) · Dr. Luis Tapias Vargas — thoracic surgery, Mayo (coordinating) · Dr. Peter Rose — orthopedic oncology, Mayo (arm) · Dr. Dawn Owen — radiation oncology, Mayo (not needed under current plan).

How to read this dashboard

Each card shows the latest value, its reference range (shaded band on the chart), and the full history. Gold-topped cards are the metrics that matter most during treatment. Values are drawn from the OHA report (8/18/26) and the Mayo record (6/1–6/18/26, via the 7/23 Vargas clinical note).

What we're watching, cycle to cycle

• ANC (neutrophils) — the chemo-safety number. Rough guide: <1.5 mild · <1.0 moderate (call the clinic) · <0.5 severe; fever + ANC <0.5 is an emergency (febrile neutropenia). Expect the low point ~7–14 days after each infusion.
• Hemoglobin <10 = anemia worth discussing; <8 often transfusion territory. Platelets <100 can delay treatment; <50 = bleeding precautions.
• Creatinine/kidney — she has CKD, and kidney function drives carboplatin dosing; pemetrexed is also renally cleared.
• Glucose — dexamethasone premeds spike blood sugar each cycle; she's on multiple insulins (likely LADA).

Suggested additional tests — to raise with the care team

Prepared by a separate clinical-review pass over her case. Decision-support for conversations with her physicians — not medical advice; all testing decisions belong to her care team. Confirm= likely already standard, verify it's happening · Request= worth proactively asking for · Watch= only if triggered.

1 · Thyroid

• ConfirmTSH + free T4 — nivolumab causes thyroiditis in ~10–20% of patients, and her combination therapy (levothyroxine + Cytomel) makes TSH harder to interpret. Should be on every pre-cycle panel (q3wk) and every 4–6 weeks during adjuvant immunotherapy — confirm it is, and that results are read with her Cytomel in mind.
• RequestFree T3 occasionally, given Cytomel use — especially if TSH/free T4 look discordant or symptoms change.

2 · Metabolic & insulin

• ConfirmA1c every 3 months — hers is 8.8% and steroid premeds push it higher.
• RequestA written steroid-day insulin/glucose plan (and whether a CGM is appropriate) — chemo-day steroids predictably spike glucose for 2–3 days; this often falls between oncology and endocrinology.
• RequestGAD65 antibodies + C-peptide (once, if never done) — confirms LADA vs type 2. LADA patients are insulin-deficient and more prone to steroid-induced DKA; a baseline C-peptide also helps distinguish rare immunotherapy-induced fulminant diabetes from ordinary steroid hyperglycemia.
• ConfirmCMP with creatinine/eGFR before every cycle (drives carboplatin dosing); Request a one-time cystatin C eGFR — at 74 with lower muscle mass, creatinine can overestimate kidney function.

3 · Dietary & nutritional balance

• ConfirmB12 injections (q9wk) + daily folic acid are on schedule — pemetrexed requires them to prevent severe toxicity. The single most protocol-critical item on this list.
• Request25-OH vitamin D (baseline, then annually) — osteoporosis on alendronate plus diabetes; deficiency is common and correctable.
• ConfirmAlbumin (on every CMP) as the nutrition marker; magnesium each cycle — platinum agents waste it, and it's often omitted from a basic CMP.
• WatchIron studies (ferritin, TSAT) only if hemoglobin drifts below ~11.
• RequestAlk Phos fractionation (or GGT) — her 108 is mildly high; worth asking whether it's bone vs liver origin, given osteoporosis and bisphosphonate use.

4 · Recovery & treatment monitoring

• ConfirmCBC with differential + CMP before every cycle; trend the mild neutrophilia.
• RequestAM cortisol ± ACTH if disproportionate fatigue appears, or as a pre-surgery baseline — screens for immunotherapy-induced adrenalitis/hypophysitis, whose symptoms overlap chemo side effects and are easily missed.
• RequestAsk about a baseline ECG/troponin before long-term immunotherapy; troponin + CK promptly if chest pain, breathlessness, palpitations, or muscle weakness (checkpoint-inhibitor myocarditis — rare but serious).
• ConfirmPre-op timeline — CBC, CMP, coags, type & screen, ECG, and repeat PFTs/restaging imaging ahead of the lobectomy.

5 · Hormones (other)

• RequestMorning cortisol + ACTH — the main non-thyroid endocrinopathy screen on nivolumab (one-time baseline, or if symptomatic).
• WatchSudden unexplained glucose surge on nivolumab warrants urgent ketone/C-peptide workup (rare immunotherapy-induced diabetes) — flag awareness with the team.
• Not needed: sex hormones (LH/FSH/estradiol), prolactin, or growth hormone at 74 unless hypophysitis is suspected — then endocrinology orders the full pituitary panel.

This dashboard is a family decision-support tool assembled from Pam's records. It is not medical advice and does not replace her physicians' judgment. Sources: OHA lab report 8/18/2026 (photo in this folder); Mayo clinical note, Dr. L. Tapias Vargas, 7/23/2026 (authoritative); MOK vault — Test Results & Labs. Chemistry reference ranges marked * are typical adult ranges, not lab-specific.