Friday, October 30, 2009

...and the news is mixed

It was a long, long wait for a mere 25 minutes of talk with the docs. We arrived at the West Street gate of the National Cancer Institute at 7:30, as expected; we passed through security and made it up to the twelfth floor of Building 10 in plenty of time to check in. A few minutes after we got to the waiting room, Mom was called in to an exam room with several other people. A lady took her vitals, noting that Mom's blood pressure was at the high end of normal: 140/70. We went back out to the waiting room, which had filled up all of a sudden, and a few minutes later Sean arrived (he lives in DC and drove up separately).

Close to 8:30AM, we were called again and taken to an exam room, where we waited until well after 9AM before a Dr. Heery showed up. He said he was a research fellow, and asked us about how Mom's been doing. We gave him our best long-story-short version of what's been going on, relaying the history of Mom's MRSA infection and how this threw off the rhythm of her in-tandem radio- and chemotherapy. The doc asked whether Mom's condition has shown improvement since starting the Avastin; we said she seemed about the same. He performed some neuro checks on Mom and I saw that, in at least one area, Mom had improved slightly: she was able to follow the doc's moving fingertip with her eyes. Even though she kept losing track of the fingertip, this behavior was, nevertheless, a major improvement over her visit to the neurologist in August, when she was so perseverative that she was unable to follow the doc's finger at all.

Dr. Heery also checked inside Mom's mouth, where he noticed some whiteness on the tongue and in the back of the throat. This, he said, was probably thrush, a fungus often associated with steroid use (that damn Decadron again). He noticed some crackling in Mom's lungs ("rhonci," he called it), probably indicative of atelectasis-- a condition in which the lungs aren't fully inflated due to disuse. The danger here, according to the doc, was that anaerobic bacteria tend to proliferate in those parts of the lungs that receive little or no air. Solution: get Mom back to using the spirometer. I also think we need to get Mom exerting herself aerobically even more frequently than we're now doing. She spends so much of her day just sitting in front of the TV. It may be that we can also adapt some of those "airplane cardio" exercises to Mom's situation.

The doc finished his checkup and told us he'd be back with one of the attendings-- Dr. Fine or someone else. Another long wait ensued, and when the door opened again, we found ourselves face-to-face with both Dr. Heery and Dr. Iwamoto. We had met Dr. Iwamoto during our very first visit to NCI, way back on May 6, two days after Mom's birthday. He came with two poster-sized MRI flimsies, each containing dozens of slice-images of Mom's brain, all laid out in neat rows.

The news about Mom was, as it turned out, mixed. The good news was that the Avastin had had a positive effect on the first two tumors. You'll recall that the first tumor had been partially debulked; the second tumor, by contrast, had had time to grow to about the same size as the first tumor (pre-debulking), but had been partially killed by the radiotherapy. Well, both of these tumors now show significant shrinkage.

The bad news, though, was that the third, most recent mass was unaffected by the Avastin, and had in fact grown. I asked whether the Avastin might prove effective against this tumor in the future; the doc thought that would be unlikely. Instead, he recommended that we begin a regimen of carboplatin, to be administered via IV, like the Avastin, but every 28 days, not every 14.

Calendar-wise, then, the plan goes like this: Mom will have another four infusions of Avastin, along with two infusions of carboplatin, before she gets her next MRI. That's another eight weeks' treatment, which takes us into-- what?-- late December, I think. The docs also recommend, as Dr. Meister did, that we get Mom into speech therapy. Dr. Heery's feeling, after doing his neuro checks, was that Mom probably has something to say, but needs help in saying it. This dovetails with our intuition that "she's still in there." She is still in there; we see it in her eyes and in her gestures every day.

So the docs sent us home with advice to call Dr. Meister (who's been in charge of Mom's chemotherapy, including Avastin) to arrange the in-tandem carboplatin/Avastin infusion, to inform him that Mom has been given a thrush prescription, and to see about finding a speech therapist/pathologist.

Right now, I'm too tired and drained to write anything more, but one obvious question for me is whether I'll be able to find work, given what we now know. Since we haven't established that Mom's condition has stabilized, this may not be possible. Leaving Dad to take care of Mom alone is unthinkable. I have no clue as to the third tumor's growth rate; all we know at this time is that it probably doesn't respond to Avastin because its "biology" is somehow different, whatever that means. Not a good time for me to be absent.


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