Thank you so much for your reply Scott. She's not a close friend, she is another parent in my child's elementary school, but I am just interested in finding out whatever I can that might be of help. She's very young (40) with two young kids. As an American living in Ireland, I guess I'm a little worried about the quality of care here – I believe it is very good, but at the same time, I just wonder if there might be better access to experimental treatments or whether there are cases here where they would decide surgery isn't possible that American surgeons might be willing to take on, that kind of thing. Anyhow, really appreciate your taking the time to answer and I will probably post again when I find out more specifics! I'm thinking that if there is any chance there is benefit to having a consultation with someone in the Mayo Clinic maybe we could make that happen.