Pam's Scan Results and What Follows

It was very unusual not to hear promptly from the Oncologist about Pam's CT scan. He has always been on top of these things. The report was finally posted on MyChart on Friday last. The report found small lesions in the lungs that have remained stable in size and number. The Liver mets continued to shrink and some thickening in the colon within the rectosigmid region. We had hoped that the lung mets would be gone and were disappointed about that. We were happy that the liver mets continued to shrink. The treatments are working.

We did labs on Saturday and the results began popping up on MyChart. Blood work looks good. CEA came up on Sunday and had creeped up from 81.7 a month ago to 98.3. This was upsetting. It had been on a steady decline since the first reading of 1298 in February. Pam dreaded doing any more chemo. I told her that she should prepare for chemo on Monday as it was likely.

We put together a list of questions for the oncologist visit Monday morning. I had questions about what other treatments may be available, ie. surgery, radio frequency ablation, radiation, etc. Our oncologist has never spoken of any of these options other than to say surgery is not an option. His reports have always stated that care is palliative.

We prepared for the worst and met with the Doc. He wasn't aware that the scan had been completed. It turns out that he NP had ordered the scan and it was not in his feed. He apologized for us not being notified and urged us to call his office if such a thing happened in the future. Again, he is always on top of these things and informs us promptly.

Paraphrasing and in summary, he said that the lung mets may be remaing scar tissue or dead cancer from the treatments. He is going to order a PET scan. Maybe the insurance won't reject this request like they did the last one.

He was happy with the liver mets continuing to shrink. He brought up radio frequency ablation, HAI Hepatic Artery Infusion, and SIRT Selective Internal Radiation Therapy to address the liver mets. He will be in contact with the specialists to see what they have to say about treatments for Pam.

I brought up a surgical resection of the colon to remove the primary tumor. He said that the colon was thickening but functional, no blockages. He said that removing the tumor doesn't change the outcome. Although I think I know what he means, he has never told us what the expected outcome is. We did learn that from our second opinion in March; mean survival for stage 4 colon cancer is 30 months. Pam really doesn't want to do surgery at this point. She feels so awful so often.

We discussed metronomic chemo and didn't get to far because of all of these other options being on the table and the lead time to setting them up. Then it was off to infusion 13; Folfir with Avastin and 5FU. He said that it was getting to the point that she needed a break from chemo.

Pam started feeling poorly with the avastin and slept through a lot of the infusions. After the infusion was finished she got up to use the bathroom. She was a little swimmy in the head and her knees were weak. We noticed that sometimes her knees don't work properly during the three day infusion period; they won't lock but almost hyperextend when she walks. It is usually the right leg but this time it was both. She has a knee brace that she uses during infusion to support the knee but we forgot to bring it - she was feeling good going to the infusion. I had to help her during the walk.

After pump connection she went to stand up and got pretty dizzy. I asked the  infusion nurse to check her pulse02. We left one time with her at 91 and I didn't want that to happen again. The nurse decided to do all the vitals and they all looked good other than BP systolic higher than normal at 158.

The Oncologist arrived quickly and checked her out. I can't praise him enough. He is the only one in the practice that I see regularly checking up on his infusion patients in the infusion center. He asked her if she had eaten anything and again mentioned getting a break from the chemo.

They had her lay back for a while and brought her some chicken soup and gingerale to give her blood sugar a boost. It was all off diet for her but under the circumstances I encouraged her to eat and drink it all. About a half hour later the dizziness was mostly gone and I took her to the car in a wheel chair.

She walked in strong carrying her cane and had to get a ride out... But without the chemo...

Once home she walked around, OK for chemo day. She slept a few hours, spent some time on the Ereada mat, had a little supplemental oxygen, and felt a little better. She did not have much in the way of sick stomach although swallowing was uncomfortable, as it usually is.

I sent the labs, CT Scan report, and a summary of the visit to the ND and Integrative Oncologist. We have a visit with one of her PCPs, Vitamin C IV and hyperbaric 02, and energy healing on Thursday and Friday.

At this point we are awaiting to learn what lays ahead for us. The rest of the year is an unknown for now. I will post about what treatments are offered.

I have a question about surgery. Our oncologist said that it won't change the outcome. I don't understand how not removing the tumorous colon won't be beneficial to the body, lower the tumor load, and let the immune system attack a smaller force rather than fight a general multifront war.  I would be grateful to hear from others who have been through this.

My other concern is about whether or not a colostmy would be permanent or temporary. I have read enough to know that either way it is a lifestyle change. I don't think I will be satisfied until I have a surgical oncologist review the case and get an opinion. Pam has already had at least five non-cancer related surgeries already and is not warmed up to the idea.

Dan