Tuesday, September 23, 2008

The Verdict

It seems I built a little bit of suspense for today. My apologies for this post coming a little bit later than I'd intended, but I took notes while I was with Dr. Amatruda, and gapped a few things after I went back to work -- so now I'm trying to regather my thoughts and double-check my interpretation of what I believe I heard.

As an aside, I believe I have invited Dr. Korteum, Dr. Economou, and Dr. Amatruda to visit this blog.
Perhaps they can offer comments or corrections for any of my wild-eyed assertions.

So now I'll attempt to answer the question that many have had, and which I had as well. Unfortunately, now it's my turn to pretend to be the doctor and present it from the beginning.

Good or Bad or In-Between? In-between.

I've been very pleased to be receiving test results to this point that point towards the better outcomes (oh, there I go already with doctor-speak). But further tests will yield more definite prognoses. And so I'm scheduled for another couple tests, first pursuing the 'whatever' that Dr. Korteum mentioned regarding my liver.

I am scheduled for an MRI regarding the 'whatever' that made them curious. They also did another blood draw today to accompany these results. I will revisit with Dr. Amatruda after these tests have been performed.

In The Meantime...

This is my current best paraphrasing of the conversation I had with Dr. Amatruda this afternoon.

As to further evaluation, I mentioned that already. As to surgery, there is nothing to cut off at this point (but I'm still going to try to milk the "what a pain in the neck" and "ain't no skin off my back" quips).

The Breslow's depth seems to be much more significant than my earlier "location, location, location" comment. While I believe we are currently still in the process of staging, I think the current understanding is that I'm about at "Stage II, T4b: High Risk Melanoma, 4.00 mm or greater primary w/ Ulceration" -- which, if Wikipedia can be trusted (and you know I don't fully trust them), means 40-85% survival.

Let's just say that what I retain from my discussion with Dr. Amatruda is that the basic numbers are this: 50% survival after 5-10 years. (It all seems to become a numbers game once you've started playing: that there are no definite answers, merely percentages and time frames.)


Dr. Amatruda presented his assessment and recommended to me interferon to treat it. There were actually a couple of further options to consider. But the basics I took from it, as I took notes during our discussion, is that the interferon would start with one month of receiving daily (5 days a week) injections. And then the remaining 11 months in the cycle ... well, that's where the options came in.

The options I somewhat gapped, but were regarding being a guinea pig, err, test participant, in one of two unproven medical studies underway. One was with the Mayo Clinic and the other is local, if I remember correctly. There were various specifics for each, but I failed to note them. Essentially, the blood work from today will help determine which I may be better suited for, and I kinda left it at that.

I believe I noted that the interferon treatment improves the outlook by 5-10% over the duration. I'm sure I'll be getting to know the details better over the upcoming days. As will the doctors as the tests roll in.

But For Now...

I'm feeling fine. I had an appetite return recently. I need to tone down to a near standstill with the beer I love because the interferon will require it. But I have found that Busch N/A may be a reasonable substitute for the taste of real beer. Such issues are not a big deal to me, though.

So that's about what I know. Melanoma apparently tends to return, and when it does it may not be on the skin. And when it does return, it tends to be fatal. So the outcome is generally mentioned, at least from what I have been privy to, hedged in percentages quantifying 'tends' over some specified duration.


I'm okay at the moment. It's likely I won't be that way forever. In the meantime I need to do what I can to improve my odds. But this here natural born pessimist has been saying, "some people have to make up that 18%" when I was preparing myself for the worst. My odds have only gotten better. I hope to keep it that way.

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