Time Out

Here is Gavin McCrea, my ace catcher heading for the dugout.

News from Aunt Charlene in Denver:

After our consult with Dr. Tony Reid, an oncologist at UCSD, on March 6th, our clear vision of the ‘next steps’ in Val’s treatment plan became a bit ‘snowy’. It certainly isn’t the first time during this journey that we have received ‘conflicting’ information on what the best plan of action would be! Dr. Reid’s recommendation was to stay the course with the current chemotherapy regimen as it appeared to be effective in keeping the cancer stable. He suggested that any of the three ‘interventional radiology’ procedures we were considering, Sir-Spheres, Chemo-embolization, or Intra-arterial Chemotherapy, were not appropriate at this point in time. This information seemed to us in direct conflict with the input from Dr. Steven Rose, a colleague of Dr. Reid’s at UCSD, who specializes in these interventional radiology procedures. So, needless to say, we left this appointment with many ‘new’ questions in our mind.

In the meantime, Val continued to struggle with maintaining her weight, her energy, and her ability to maintain life as ‘normal’ as possible. She continues on the intravenous nutrition to augment weight management and to increase her energy level. All of the chemo drugs along with the pain medications take their ‘toll’ on the gastric system, and though they are effectively keeping the cancer under control, they are definitely contributing to the loss of appetite, and low energy levels.

So what next???

As we have so many other times during this journey, we consulted with Dr. Nick Nissen, the liver surgeon and specialist at Cedar-Sinai Hospital, to help us understand and clarify the ‘snow’ on our screen. Prior to speaking with Dr. Nissen, we sent him the most recent CT and PET scans, so he could review these and compare them to earlier scans. The first and ‘most significant’ point that Dr. Nissen made was that the PET scan indicated that the overall tumor activity was under control…….and that the cancer is stable…..great news! He further suggested that we consider giving her body a one or two month ‘time-out’ from chemo to regain strength, weight, and to increase her energy level. His other recommendation was to manage the pain medication, which can contribute to the ‘gastric’ problems and dehydration, by taking only what is necessary to handle the pain, and no more. During this ‘time-out’, we will monitor the tumor activity closely, so we do not allow any growth or increase in quantity, by having a CAT scan done after one month. Our objective during this time is to increase Val’s weight, decrease the ‘impact’ of the drugs on her entire system, and increase her overall strength.

As it relates to Sir-Spheres or any of the other interventional radiology procedures, Dr. Nissen felt that due to the increased risk of infection, particularly cholangitis, with any arterial therapy that impacts the blood supply to the liver, the evaluation to perform a procedure such as this should be delayed until after the chemo break. Val would be at an ‘increased’ risk of infection unless her body is strong enough to fight it off. We will continue to keep this option ‘open’, and will re-evaluate in a month or two.

So the direction in the near future is now clearer……thank you Dr. Nissen! Val will begin her chemo ‘time-out’ this week, she will get another CAT scan on Wednesday, and consult with Dr. Lenz and Dr. Sue Hanks at USC this week. On April 2nd, Val will undergo her three month stent replacement procedure with Dr. Simon Lo, and we will re-evaluate the plan mid to late April.

In the meantime, Val, eat, eat, eat……. drink fluids often, get out in the sunshine and walk, and most of all, enjoy your upcoming ‘family vacation’ on the beach with Jeff and family, Julie and family, Paul and your mom and dad!

You are always on my mind,

Charlene