Tuesday, February 12, 2008

02.12.2008 - Results & The Next Steps

02.12.2008 was a long day. I checked into radiology at 0800 hours and then had a MRI a short time later. After that, I had to have a Pulmonary Function Test (PFT) which was to assess how my lungs were doing. Evidently, some of the chemotherapy drugs can adversely affect the lungs. I asked the respiratory therapist if the testing would be similar to what I had to do annually as a firefighter in order to wear a SCBA (Self Contained Breathing Apparatus) and she said it was different. Well, after doing the whole testing process, I found it to be quite similar to the pulmonary testing that I had to do as a firefighter. There were a lot of deep breaths and then rapid and forceful exhalations.

Next, I went to see the neurooncologist and he reviewed the MRI scans and the PFT results. My lungs were great. The MRI scans showed that there was still some residual tumor remaining in my brain. This was to be expected. My neurosurgeon told me that he was able to remove about 90% of the tumor or so. The residual tumor tissue was kind of like a ring around the healthy brain tissue around the cavity where the other tumor tissue was resected in October. The doctor didn't think that any growth had occurred since the surgery and I didn't think any had either looking at the scans.

It was next to impossible to use the MRI scans taken right after surgery as a baseline because the MRI was unable to discern tumor tissue from blood, debris, scar tissue, and other liquids occupying the cavity. Now, things have cleared out significantly. The scans taken today will form the new baseline. We may do a future scan that will include spectroscopy. I learned that spectroscopy is a MRI scan that involves detailed analysis of the substances that make up what is in the cavity. The main issue of whether or not this can be done is if the insurance will pay for it. Having spectroscopy done costs significantly more than just a regular MRI with and without contrast.

Now that we know that the tumor is responding to treatment, the next step is to continue treatment. The radiation part is over. The chemotherapy will still continue. The tested my blood levels and found that all is well with my blood. They were very impressed at how my immune system was functioning. The chemo agents often knock down the immune system, but I have learned that my immune system recovers well from the agents I have been subjected to so far.

I started the first day of a three day intensive IV chemo program. I received a chemo agent over a four hour period and then will have it again on Wednesday and Thursday. So far, I feel no side effects whatsoever from it. I will also take the oral chemo drug that I took during radiation for the next five nights.

There won't be that much more chemotherapy involved because the body can only take so much of it and needs to have rest periods. Chemotherapy agents are toxic and while the goal is to poison the cancer, the body needs to have time to recover from those agents as well. The doctor advised that the new and latest focus in oncology is what he referred to as "biologicals." The drugs he referred to are all antiangiogenesis agents. That means that they inhibit the growth of new blood vessels in the tumor tissue. If the tumor can't produce new blood vessels to feed itself, it will not be able to grow. The side effects are minimal with the biologic agents and occur rarely.

Most of the future therapy will be oral agents, so I can take them at home instead of sitting in the doctor's office for many hours at a time. I learned today that the treatment plan may last up to three years with all involved. I was surprised to learn that because it seems like they spring new information on the treatment plan on me each time I see them. I asked the chemotherapy nurse why I only received bits of information at a time and the plan kept expanding more and more each time they shared it with me.

She told me that since they don't know how each patient will respond to the different treatments (how they will tolerate different drugs and how the tumor will respond to the drugs), they don't want to elaborate on this multi-year plan when hardly any of it may actually happen. In addition, going over that much information early on can be overwhelming. I could understand both of these points. However, I still like to know what is going to take place and I like to know all of it, rather than bits and pieces.

I considered today one of good news. I didn't want to see any new growth or activity with the tumor. This is a high grade glioma and no new growth or activity is what is sought.

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