Friday, April 4, 2008

Wednesday visit - first major discussion on prognosis:

Wednesday visit - first major discussion on prognosis:

Email report from Brad Easton:

A gorgeous day and beautiful facility, The receptionist gave Randy 4-5 pages of questionnaires to fill out, some pretty obscure questions, but later it turns out that there is a reason for almost everything.

A nurse took his vitals and we waited in a room for about 30 minutes , a PA came in and reviewed the questionnaires and asked more specifics. Later the doc came in and asked for a brief. Doctor Wood is a surgeon and he asked what if anything had Randy been advised regarding treatment. 'Not very much' Randy replied.

The doctor took his time and explained that his expertise was surgery and staging the cancer, and ex-plained that stages 1, 2 & 3 have sub-stages of A & B. depending on how advanced the cancer is. Very professional and you get the notion this guy really knows his stuff.

He then said that Randy had lung cancer in the 3A stage. 1 being early and 4 being the worst. Not the news we were sure we would hear. 'Why?'---- because the CT and PET scans showed the N1 and N2 lymph glands were involved. So not only are the lymphs that are the closest to the lung but it has advance to the second group of lymphs. The MRI showed the brain to be clean and the PET showed that the involvement was only to the lymph and not other organs. They can do a biopsy of the lymphs to be certain but they felt it would be redundant- the films show clearly that they are involved. this Doc was well practiced at giving this speech.

3A is the most complicated to treat- because simple surgery will not tell if there are cancer cells in the other organs that we cannot see yet, or if it has spread to a third group of lymphs. It is however treatable with a curative intent. he guessed a combo of chemo first, then surgery and maybe radiation. declined to answer questions that a Cancer doc should answer. they avoid giving concrete prognosis- only stats-

he called his partner oncologist who said he could see Randy at 2 oclock- that was less than two hours from then. a very nice courtesy.

we went to lunch in shock. but Randy was still laughing and making jokes- he spoke with Rojean on the way, who had a similar diagnosis 7 years ago- she was comforting.

After Lunch a meeting with the oncologist- Doctor Renato Martins. also a guy that really gave you a good sense that he knew what he was talking about. he did his school and intern back east and then worked his way to be head of the Cancer Society for Brazil. perfect english. old school in his manner- he did an exam on Randy, listened to lungs, looked down his throat and asked for a med history. questions about family history, social support system, lifestyle.

He suggested a start on chemo before the surgery. chemo goes after everything, everywhere. so it will attack cancer sells in the body we cannot see. two courses, then a ct scan, a third course and then surgery.
between the courses doing a ct scan to see if the tumor has shrunk or grown, and to see if the lymphs are responding to the therapy. sometimes it is gone....... another course of chemo, then the surgery. Randy has what he described as a 'huge' lung capacity. the surgery will not affect his breathing capacity. all those years of talking paid off!

The chemo meds:
Cisplatin- which can cause nausea, they give meds for that. rarely it affects hearing.
Lance Armstrong took this med. it requires massive amounts of liquids to protect the kidneys. the therapy is an entire day on IV.
Alimta- same side effects
lots of patients work full time thru the chemo, most do not lose their hair.

When do we start? he advised in the next few days- he is out on vacation next week but advised Randy not to wait for his return........he made an appointment for monday, Randy will meet the other two docs in Kirkland and decide where he wants to go. if with these guys, it would be with the Cancer Care
Alliance- they have great ads and 'treat the whole person'. During Chemo he cannot allow himself to get a fever. the chemo lowers the blood count and the bacteria in mouth and gut can overtake the system.

felt like 24 hours passed in just 6. Randy is overwhelmed by all the info. questions of how long he had it were answered with guesses of 1-3 years. sometimes the cells double every 250 days or as long as 800 days.
he is worried mostly about his kids, when should he tell them? if the chemo goes well it may be they never know he is in treatment.
if the chemo goes well the surgery is more a formality- he will have beaten the cancer with chemo, but they still take the area infected out as well as the lymphs that showed infection.

hope that fills you in. i have pages of scribbled notes, forgive my grammar- just trying to get information out so Randy doesn't have to answer the same question multiple times.


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