A Monday Wrap

Mary's Oncologist apparently treated Patrick Swayze in his last months. Dr. George Fisher was on Larry King Live and here is a link to the clip. We did not learn this from Dr. Fisher, but from Mary's Radiologist in our visit with him today.

OK, so here is the wrap up. As I wrote, we met with the Surgeon, Dr. Brendan Visser, last Friday after the CT Scan had been performed. That report is down the page but if you missed it, here is a link to 'A Wonderful Friday.'

Today, we met with the Oncologist (Dr. Fisher) and later with the Radiologist (Dr. Daniel Chang). The Oncologist is recommending mild chemotherapy which means a single chemo drug administered once a week for three weeks and then a week off. Nine treatments (three months) and Mary is done. The chemo trade name is Gemzar (gemcitabine) and its use is defined in this government clearinghouse website. A more recent analysis, which mirrors almost exactly Mary's situation, was published in August this year. Here is the link. Reading this link explains why Dr. Fisher is recommending this chemo treatment. For those who don't want to dig further, here is the conclusion statement.

"CONCLUSIONS: Postoperative adjuvant gemcitabine-based chemotherapy may be a promising strategy to improve survival after surgical resection for hilar cholangiocarcinoma. A prospective randomized study should be done to confirm the results of this study."

The problem is cholangiocarcinoma is such a deadly cancer that the ability to do studies is severely hampered by the lack of survivors.

Dr. Fisher talked at length about the use of Gemzar combined with Platinol which would have been much more aggressive. His opinion is that the surgery and the radiation therapy have done the heavy lifting. As such, the objective of this next therapy is to make sure every cancerous cell is gone. He did describe Mary's cancerous material from the pathology reports and because Mary presented early (how lucky was that!) the cancer is of a form that Gemzar should work if the cancer is still present. That mirrors the August report I cited previously. He also used the R word--Mary is in Remission. That is both good and bad, of course. Good in that Mary should be back to her old self fairly quickly either during or more likely after the chemo. Bad, in that remission implies the dastardly cancer can return.

The Oncologist acknowledged, as did the Surgeon last week, that cholangiocarinoma is so rare that there is no recommended protocol or documented experience base to draw from. It is pretty much up to the docs on Mary's team.

The Radiologist, Dr Daniel Chang, wanted to know how Mary was doing and to learn a little about the fluid retention. The good doctor and his resident were in a good mood and so were we because we had already met with Dr. Fisher and had learned it would be mild chemo for only 3 months. It turns out the Surgeon was of the opinion that the radiation guys hit Mary too hard, too soon which impacted the liver to the point that is caused the bloat. In fact, Dr. Chang said Dr. Visser caught him in the hallway and had a conversation about Mary and the presumed cause. The Radiologists' experience does not include previously seeing this so they are trying to figure out if it was some other cause. The humor was flying and they said, "We are trying to figure out how to blame the surgeon but it seems we can't find a good link." I commented that the technical term used by the surgeon to describe Mary's liver was "The radiation docs cooked it." The fact is, they are all a great team and they are feeling good about Mary's recovery. I am sure they see far too many cases of all sorts that are nowhere near the positive outlook they see with Mary.

The basics are:

1. Mary's CT scan from last Friday was clean in the liver area as I reported last week. It is also clean throughout her entire abdominal cavity. Big Hooray on that news! In fact, the radiologist took the time to show us the CT scan results on a computer screen. Cool!
   
2. All of Mary's blood tests results are "nominal" which is fantastic. They told her to put salt back in the diet. And, she should continue her late afternoon protein treat. Mary did buy some Boost. Anyone want to buy 11 bottles of Boost? After the first bottle, Mary immediately switched to a protein powder in a home made smoothie. Her taste buds are re-emerging! Yeah!!
   
3. They are hoping Mary continues to get stronger over the next few weeks. Dr. Fisher said he likes his patient's self assessment to be "80% of feeling normal" before starting the chemo. Mary's self report today was "50% to 60%" so three weeks should be just perfect.
   
4. Mary does experience acid stomach which is something new for her--she rarely ever experienced it prior to all of this. The reason is that the radiation viciously attacks stomach and intestinal linings and they need more time to heal. If there is no food in her digestive tract, stomach acid will attack the damaged tissue causing heartburn.
   
5. Wine with dinner now and then and an after dinner hot tub soak would be just peachy from now on. The wine is easy (we had some tonight for our 13th anniversary) and I'll fire up the hot tub over the weekend.
   

Mary will start Gemzar on October 12 and that is another shutdown week (the last one, we are told) so I will be able to do the driving duty. The Gemzar is administered one day a week on Mondays (19th, 26th) we may need to draw upon Mary's taxi team. This time, we may need two drivers per day because the chemo is a 3 hour event. Step one is a blood draw (15 min). Step two is waiting for the blood test results (1 hour). Step three is the pharmacy mixing the goo (1 hour). Step four is the 30 minute injection (45 min with set up and all). The whole cycle takes no less than three hours. So it seems a drop off driver and pick up driver might be best. It may also me unnecessary. Some people are fine while on this weekly chemo treatment and drive themselves. We'll figure it out as we get closer.

One thing the Oncologist was very clear about is the fluidity of the chemo therapy. Each week requires a blood test and if the white count, red count, blue count (hey, I am not a doc) is below minimums, they will not administer the chemo that week. If that happens, the chemo schedule is reset. However, they indicated the 9 treatments is the goal and they'd like it done in no more than 3.5 months.