Dr. Ryan Merkow, and a Plan I Can See

Today I met Dr. Ryan Merkow at University of Chicago Medicine, and I walked away feeling like the road ahead has real shape to it and reinforced what my care team hybrid from multiple health care systems has told me. My case is unique to me, I’ve had eyes from the best of my local hospital systems - Powers Health, Northwest Cancer Centers, University of Chicago and even my fourth opinion from Dana Farber in Boston. We are doing what is best to systematically attack it all, now we get more specific starting with building plans and windows in to the future that could turn in to doors.

Before the appointment I put together an infographic to help me organize my questions and keep the conversation focused (I do this now for every new consult, it keeps my brain from turning into TV static). Dr. Merkow was so kind and loved it as I was able to share it on the screen, see below. He said the only thing he would change on the whole thing was that I needed to remove his hair. 😄 Noted, doctor. Consider it fixed for version two.

👨‍⚕️ Who is Dr. Merkow

Dr. Ryan Merkow is a surgical oncologist and hepato-pancreato-biliary (HPB) surgeon at University of Chicago Medicine. He is an Associate Professor of Surgery, Vice Chair of Quality and Safety, and Director of Surgical Cancer Quality and Informatics at the UChicago Comprehensive Cancer Center. He did his residency at UChicago and his HPB and surgical oncology fellowship at Memorial Sloan Kettering in New York, which is where he learned the hepatic artery infusion (HAI) pump program he now leads here in Chicago. His clinical focus is colorectal liver metastases, HAI pumps, complex liver surgery, and pancreatic cancer. Knowing his experience at Sloan Kettering, this makes me even more confident that he’s my guy!

🔗 Read more about Dr. Merkow:

- UChicago Medicine profile: https://www.uchicagomedicine.org/find-a-physician/physician/ryan-merkow
- Department of Surgery faculty page: https://surgery.uchicago.edu/faculty/ryan-merkow
- HAI Pump program at UChicago (he leads it): https://www.uchicagomedicine.org/cancer/types-treatments/hepatic-artery-infusion-pump
- Google Scholar publications: https://scholar.google.com/citations?user=fQIOSg8AAAAJ

🧠 How he thinks about my case

He walked me through his framework in three buckets.

🩸 Pattern and extent of disease. Cancer spreads three ways: through the bloodstream (which is why the liver is usually the first stop), through lymph nodes (nearby ones come out with surgery, distant ones count as truly metastatic), and by shedding into the peritoneum. On my imaging he sees bulky disease on both sides of the liver, but nothing outside the liver except the primary. That puts me in what he called the "liver-dominant, liver-only" bucket of metastatic colorectal cancer, which is a meaningful category because it keeps the most options on the table.

🧬 Tumor genetics. Every solid tumor gets tested for mutations that guide drug choice, targeted therapy, and prognosis. I just received more results from the test taken with Guardant and it’s very promising.

⏱️ Timelines and response to therapy. He said this one "ties for first place." How fast the disease appeared, and how it responds to chemo, tells them the biology of what they are actually fighting. Hard to say when it started but I had not one but two Galleri Grail blood tests that scan for over 100 active cancer markers and BOTH turned up clear - one in 2022 when my mom was diagnosed and the second in 2024 when my mom died. Both are very expensive tests and should never be relied on as a sole scan, the gold standard is the colonoscopy for colon cancer. Don’t ever skip one for these new tests as they can lead to false negatives and false confidence. Also, they moved the minimum age for colonoscopies to 45 because there is a huge boost in number of cancer cases. My kids will need their tests even earlier due to this family history.

📋 What Dr Merkow is recommending right now

💧 Stay the course on FOLFIRINOX with Dr. Shergill's team at UChicago and Dr. Sidani from Northwest Cancer Centers. My tumor markers are coming down and the disease is responding, so we do not change a thing. We really need that liver to show UNDER 70% active disease and it’s not there which leads to next point…

🚪 The HAI pump is on the table for later, not now. There is a rule of thumb that if the liver is 70 percent or more tumor, the pump does more harm than good. The whole goal right now is to shrink the disease enough to make the pump a safe, realistic option. I anticipate we will do another 4-5 chemo rounds before our next scans.

⏸️ Transplant and removing the primary were discussed at a high level, and deferred. Any surgery means pausing chemo, and he does not want to interrupt something that is working so that is why it’s not an option TODAY.

🤝 The team has been talking to each other and that was obvious. I am now connected to Dr. Merkow MyChart, and he will loop in Dr. Shergill (med onc, UChicago) and Dr. Shogan (colorectal, UChicago) so we are all on the same page from what we discussed today.

💛 The line I am holding onto

He told me, "take it one step at a time. The big picture can be so anxiety-provoking. You are on the right path right now, and we will see what the next step shows us. You are doing all the right things." - one day at a time. Since GoGo is a long term goal oriented person this is the hardest thing. I once attended a Tony Robbins event and heard him warn against “chunking” all the work it will take to get out of a mess. I need to stay in the present and keep focused on healing. I am going to write that on something and stare at it. Maybe lipstick on my bathroom mirror.

One step at a time. Chemo is working. Team is aligned. The pump is a door, not a decision. And apparently my next infographic needs a bald edit. 😄

Speaking of bald, I still have portions of my hair and have decided to keep it until I can’t take it anymore. In the mean time I introduce to you my first of many new looks - Check out my hat hair!