Thursday, October 29, 2009

Status Update

Bumping that 4th C-E by 2 weeks messed up other scheduled scans and appointments a bit. My followup MRI was eventually moved to Oct 14th. Dr. Close, the doctor who performed the embolizations, wanted to meet with me that same day to discuss the results.

I was done with the MRI a little after 9, and Angie wanted to be there for the consultation with Dr. Close. It's usually a 10-minute drive from home to Suburban Imaging, so I thought I had plenty of time to get Angie and return by the appointment time of 10. As it turned out, I pushed it a little too close and Angie was still asleep when I got home. She arrived separately in time to meet with Dr. Close, but needed to bring Heather with her.

Dr. Close showed that the tumors in my liver were shrinking, which was good news. But the fourth C-E also ended up producing a fair amount of infarction in the right lobe. This means that normal, healthy liver got killed as well. On its own this isn't terrible -- it will regenerate.

But somewhere in this time I had gotten a fever that went to about 102.5. Shortly after the C-E procedures, I am supposed to go to the ER if I get to 100.5. But this was four weeks later. I started monitoring the fever a little more closely prior to the 102.5, and when it got there, I called Minnesota Oncology. Of course I was told to go to the ER.

In the ER they took some blood to check for the flu, since that had started popping up about that time, but the cultures turned out negative. I don't remember the time frame all that well, but the upshot is that I ended up monitoring my temperature a lot more frequently. And I was able to discern activities that tended to increase my odds of bumping up a fever. I kept the fever business in check, but it took until just recently to really seem to break it. I think the fever has been a response to the infarction.

Again, I forget a bit the order of events, but I think the fever was before meeting with Dr. Close. Near the end of the visit, Angie had to tend to Heather, so I was by myself when I left Dr. Close's office. He left me with the impression that there was more information forthcoming, and asked me to call later in the day.

When I called, Dr. Close said that in the MRI he thought he had seen indication of the cancer spreading to bone, to my ribs. I had already been trying to schedule another PET/CT to get the "big picture" on where things might have spread. This news left me with something to expect regarding that scan.

I had the PET/CT on the 23rd, and today when I met with Dr. Amatruda I got those results. He informed me that the results showed that I have metastasis on 2nd(?) thoracic vertebra(?). I was fairly distracted during much of the rest of the visit, dwelling on this result. I boiled things down a couple of times: "If we hadn't had the progression to the bone, if it was just the liver tumors shrinking, it would have been a good news day, right?" "Yes." And, "I'd heard that when it gets to the bone, that's pretty much it." "Well, with melanoma it's not all that different from tumors on the liver." I found this comforting in its own way.

Regarding the progression to the verterbra, Dr. Tom examined me a bit. I haven't really had any pain in my back that I thought was of notice. Given this, he was leaning against using radiation to treat this, but it is something he will consider with the radiation treatment folks.

I was finally able to focus a bit as Dr. Amatruda again presented my treatment options.
We're going to check on my eligibility for the experimental treatment or Avastin, my first and second choices, and then go from there. Wel'll see where things go.

But I've been feeling fairly good lately. Thankfully the pain after this 4th C-E hasn't been as bad as the 3rd. Still, it has been a pretty long recovery time. The fevers and infarction complicated things a bit. My appetite was not very keen much of the time since #4, but I think things are returning to a normal. Yesterday I had 3 meals and had a fairly productive full day at work.

So that's about where things stand.

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