Bumps In the Road

When I last left you in early November I had promised that a one year anniversary/reflection on the year's events would be coming. And I had in fact begun to write that blog. During those two weeks as I wrote, reflected, edited, and reflected some more, Dan had his usual (every 3 months) chest CT. No big deal-things were going well. We went in to see his medical oncologist for the results on November 20 (One year to the day from his surgery) expecting to breeze in and breeze out with another follow up appointment set for 3 months down the road. The doctor walked in and matter of fact stated "something showed up in your lung on the scan".  I felt like I had just been sucker punched in the gut. In retrospect, we should have expected it. Dan's brain scan the month before had picked up some activity in the second tumor (previous blog post) but we truly were still hoping/praying that it was just a brain bleed and nothing serious. Still, Dan was feeling fine and there were no symptoms. The doctor wouldn't come right out and say that the cancer was back. He said there were a couple of suspicious spots and that it was possible that it could be some scar tissue that had broken loose. Dan asked what was the next step and was advised that we just wait a couple months, stay on his chemo pill, come back in two months for another chest scan and decide what to do then. When pressed for more info, the doctor said that if in January it was determined that the cancer was back, chemo would be the next step. The doctor wished us a happy holiday (yeah right) and in a matter of 10 minutes, the appointment was done. We were devastated, and I began to panic. No way were we going to sit back and wait to see what happened over the next two months. I turned to Dan (and on the verge of begging) told him he was going to call MD Anderson in Houston that day. It was time for a second opinion, and thankfully he agreed. He called, had his records sent that afternoon, and by the end of the week we had an appointment with a thoracic (lung/neck) oncologist there in two weeks.

In mid December Dan and I flew down to Houston for his appointment. MD Anderson is an impressive facility. If you've never been down in that area, the campus in unbelievable. The sheer number of medical facilities is overwhelming. Every type of specialty medical care is within a few miles radius along with a hotel zone that rivals the hotels circling any major airport/destination. When you receive your appointment packet, you are given specific parking/lobby/elevator information depending on what doctor you are seeing. When we arrived I understood why-there are 10 elevators to choose from. Each goes to its own wing. They had probably at least a dozen volunteer greeters in the main lobby to help you find your way.  It is a well oiled machine! Once checked in, Dan met with the Fellow that was working with his assigned oncologist Dr. Glisson. Both her and Dr. Glisson's knowledge of Dan's case was unbelievable. They knew every detail of what Dan had been diagnosed with, treated, results of all his scans, side effects, etc. We received a lot of useful information about the drug he is on (Tarceva) which explained some issues Dan was experiencing. They also explained that typically Tarceva is only effective for 10 months (which I had read), but that even with a recurrence of the cancer, they don't take patients off the drug. Through clinical trials they have found that staying on it keeps the tumor(s) growing at a slower rate, and can sometimes keep additional tumors from developing. MD Anderson also has a couple of clinical trials in which they are testing new drugs, in combination with the Tarceva, to increase the effectiveness. Right now they are showing a 50% success rate in stopping any additional growth in tumors. The biggest piece of information that we received was the confirmation from Dr. Glisson that it was in fact, not one but two, tumors in Dan's lung. The tumors were in the same spot where the initial tumor had been. The frustrating thing about that was Dr. Glisson called Dan's oncologist here in Boise and he agreed that it was cancer. Why didn't he just tell us that instead of telling us it "might" be scar tissue?  However, Dr. Glisson suggested that the tumors could be treated with radiation instead of chemotherapy, since he had no other occurrence of cancer. That was the first that radiation had been mentioned for the lung and we suddenly had some hope. The side effects for radiation are much less severe than chemo. The next issue was to determine what exactly was going on in Dan's brain, because if you have any active brain metastases, you are not eligible for participation in a clinical trial. Since Dan was already scheduled for a brain scan the next week in Boise, Dr. Glisson sent us home to follow up with Dan's radiation oncologist, Dr. Smith. Once we knew the results of that test, we could make a plan.