Bumps In the Road Part 2

In trying to keep each posting from being the size of novel, I've broken up Dan's update into two postings. (Unfortunately as you will see, it is still the size of a novel…sorry!) If you are just logging on, you'll want to read the post below first. Picking up where I left off before…..

We came home from MD Anderson feeling a bit better about things, and with some hope that the tumor in Dan's lung could be treated. It was well worth the trip. The next Monday (two days before Christmas) Dan went in for his brain scan.  He was scheduled to receive the results on January 2.  That Thursday the doctor called to tell him the cancer was back, and the second tumor had almost doubled in size in the two months since his prior scan, to 2/3 inch.  Surprisingly, I didn't get as upset as I would have expected. I think at that point we both realized that if the cancer was back in his lung, it was likely back in his brain too.  We met right away with the radiation oncologist who showed us the scans and explained what was next.  The tumor had quite a bit of swelling around it and Dan was beginning to get some mild headaches.  Dr. Smith wanted to treat the tumor with radiosurgery, because the location of the tumor was too deep for standard surgery. Radiosurgery is essentially a laser beam of radiation that targets the brain tumor and kills the cancer cells.  The goal is to be precise within a millimeter to minimize any damage to healthy brain tissue. The fact that Dan had swelling around the tumor was actually in his favor because it would push away the healthy tissue.  Side effects are minimal-possible headache, tiredness, usually no nausea.  There can sometimes be long term effects, such as loss of some feeling in limbs or other stroke like symptoms, but there is no way to know if that will happen.  Those symptoms don't typically start to arise for 3-6 months after treatment and it all depends on how much healthy tissue was damaged.  Dan got a cool astronaut type head brace/mold created and started treatment on January 30.  He had three radiosurgery treatments over two weeks which went really well.  He had a little bit of a headache a couple of days, but otherwise, had no side effects.

While all this was going on, Dr. Smith also discussed the possibility of radiation for his lung.  MSTI (Mountain States Tumor Institute-the cancer center in Boise) does not have a machine that is capable of performing radiosurgery on the body. However, its satellite site in Twin Falls (about 1 1/2-2 hours from Boise) does.  Coincidentally, Dr. Smith's father (who I will refer to from this point forward as Dr. Smith Sr.) happens to run the radiation department at the Twin Falls site.  He has 30+ years experience in radiation oncology and was one of the founding doctors at the Boise MSTI location.  When they opened the Twin Falls site, he headed down there to run it and lobbied to get a state of the art body radiation machine.  Dr. Smith had already filled his dad in on Dan's case and they both felt he was a good candidate for radiosurgery to the lung.  Two things had to happen first-Dan needed a PET scan (finally!!) and a respiratory test (to make sure there were no breathing limitations).  A PET scan is a test they use to identify "hot spots" of cancer in the body. They inject a sugar solution in the body and since cancer cells feed off of sugar, any active cells will absorb the solution and show up like bright little fire spots in the body.  You can't use a PET scan to determine cancer in the brain, heart, or liver because they all absorb the sugar regardless of if any cancer is present.  Thankfully, only the two spots in the lung that we already knew about lit up. Dan also passed his respiratory test with flying colors so an appointment was made for him in Twin Falls with Dr. Smith Sr. for a consultation/planning of lung radiosurgery. All of this (brain radiation, PET scan, respiratory scan) happened over a two week time period.

Backtracking a bit, when we found out in November that Dan's cancer might be back in his lung we decided (with a little bit of pushing by me) that we needed to take a family vacation. It was something that I had wanted to do since Dan had been feeling better, but there is always something else to get done, or go do. Needless to say, the time was upon us that we just needed to go. So we planned a trip to the Hawaiian island of Kauai for January with our good friends the Teffts. Knowing that things were uncertain, we booked with travel insurance and the understanding that we may have to put the trip on hold depending on diagnosis and treatment outcomes. Thankfully, Dr. Smith was great about working Dan's treatment schedule around our one week trip.  Dan finished his brain radiosurgery on Thursday and we left for Hawaii on Saturday.  We had a great time and it was wonderful to get away, relax, and have some family time.  The nice warm weather was a bonus!

We got home from Hawaii on Sunday and yesterday morning Dan and I headed to Twin Falls for his initial consult with Dr. Smith Sr. Things went well, we got all our questions answered and Dr. Smith seems like a really good oncologist. He treats 1-2 lung cancer patients a month and has a 92% success rate in eliminating the lung tumors.  Dr. Smith Sr. did notice a couple of additional spots near the two tumors that look suspicious so they are going to radiate those spots as well.  Dan will have 5 treatments over a 2-3 week time period (depending on scheduling availability).  Side effects should be minimal like the brain radiosurgery-tiredness, possible developing of a dry cough (usually subsides about 1 month after treatment), little to no nausea.  The doctor doesn't feel Dan will notice any effect on his breathing because his lung capacity is more than sufficient to cover the radiated tissue.  As with anything, there is the chance that the radiation could cause more damage then expected but the very slight risks are still better than not treating it, or having to go through chemo.  Dan should find out in the next couple of days what exactly his treatment schedule will look like.

So, what does that mean going forward?  Honestly, we have no idea.  Best case scenario?  The radiation kills the brain tumor and lung tumors and Dan is once again cancer free.  He has a follow up brain scan in mid February to check the status of the treated tumor. If the radiation does kill the brain tumor, Dan then becomes eligible for consideration in a MD Anderson clinical trial.  In the meantime,  he'll stay on the Tarceva and continue to monitor the existing tumors after treatment.  With radiation, it can take several months for the tumor to die.  The short term goal is just to make sure it is no longer growing.

You may be wondering why we waited so long to update everyone.  Part of the reason is that we really didn't know what exactly we were facing, and once we did, we needed time to process it.  The other issue was that all this came about right at Christmas and it seemed wrong to throw it out there with a "Merry Christmas, have a great holiday!" Now that we've had some time, and have a treatment plan, updates will be coming more regularly. I am hoping that we will once again get to point where updates aren't necessary because Dan is going great.

Many of you have asked what you can do for us and the best thing right now is to just keep praying and thinking positive thoughts over the next couple of months.  Aside from being a little tired, Dan feels pretty normal.  He is working and we are just moving forward with our everyday lives.  We are so grateful for the many blessings God has given us in the midst of this situation, and for all the wonderful friends and family that we have.   We love and appreciate each of you so much.

More to come soon,

Jen