Round 2

The second half of the first cycle was on Thursday.  Due to the prior mixup with GEHA, this was going to be a Navelbine only cycle.  The pre-medicine took longer to get through than did the Navelbine.  It always makes me nervous when the nurse puts on gloves to administer the dose…just how toxic is this stuff?

Between the pre-meds and the warm blankets, it didn’t take long for Theresa’s eyes to grow heavy.  As they were preparing the dosage, the nurse brought out the Neulasta shot.  On the first round, they gave Neulasta the day after chemo and she had an appointment scheduled for Friday to receive this.  They sorted it all out and gave it to her on Thursday.

According to the billing statements, Banner UMC bills GEHA almost $25K for the Neulasta dosage, with GEHA authorizing $12K.  Since that dose has a street value equivalent to 27 ounces of platinum, I suggested we take it and run!

After the Navelbine went it, she had a similar reaction with the tumor area hurting.  And just as before, we chose to believe it was winning the fight.  Navelbine 2, IDC 0.

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The Way Forward

Tim McGraw released a song in 2004 that started with these lyrics:

“He said I was in my early 40’s, with a lot of life before me, And a moment came that stopped me on a dime.  I spent most of the next days, lookin’ at the x-rays, Talkin’ ’bout the options and talkin’ bout sweet time.  Asked him when it sank in, that this might really be the real end.  How’s it hit ya, when you get that kind of news.   Man what ya do.  And he says…”

No, Theresa did not go skydiving, or ride a bull name Fumanchu.  But she did get dressed up and take Ryan to see Kung Fu Panda 3.  As humans, we only have one way to go and

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that is forward.  There is no rewind, no reboot…No matter how much I wish there was.  The only way to proceed is to move forward.

The second Saturday of the Great Fast is the 2nd All-Souls Divine Liturgy in the Eastern church.  As Eastern Christians, we pray for those who have gone before us 5 times during the Triodion and Paschal season.  I served the Divine Liturgy this morning and standing a few feet away from the Holy Mystery of the Eucharist..Christ present in the sacramental mystery, I had so many thoughts running through my head.

I thought of a co-worker, Pete, who set out for a family beach vacation in July 2015 with his wife and 4 children…ages 18 to 8.  While driving through West Texas, the tire blew on their SUV, causing it to flip over many times.  In an instant, he lost his wife, daughter 18 and sons 14 and 11.  He and his 8 year old survived the crash.

I thought of 6 people killed in an instant by Jared Loughner in 2011.  I remembered being given the task of finding the family of Gabe Zimmerman and notifying them that he had been killed.  We had bad information on the drivers license and we finally located his residence he shared with his fiance.  Neighbors told us she was with his parents in another part of town.  We finally found the house and went inside.  There were family members all throughout the house, at least 40 people.  And I was there to confirm their worst fears.

I heard the words we sing at the end of the Great Fast pre-sanctified liturgy: “Having suffered the passion for us, Jesus Christ, Son of God, have mercy, have mercy, have mercy on us.”

I thought of a Lenten parish mission I heard several years ago when the priest uttered these words:  “We know not the date or hour”.

And finally, I thought of the words of St. John Chrysostom in his well known homily at Pascha: “O Death, where is your sting? O Hell, where is your victory?  Christ is risen, and you are overthrown.  Christ is risen and the demons are fallen.  Christ is risen, and the angels rejoice.  Christ is risen, and life reigns.  Christ is risen and not one dead remains in the grave.  For Christ, being risen from the dead, is become the first fruits of those who have fallen asleep.  To Him be glory and dominion unto ages of ages.”

What do you do when you get that kind of news?  You go forward, in faith and love.  You choose to live and enjoy all the time you have…be that many or few.  I choose to believe it will be many, blessed years.

Glory to Jesus Christ! Glory Forever!

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Pet Scan Results

As we waited for the results of the PET scan, looking over the CT and MRI results, we both feared a metastatic diagnosis.  The one beacon of hope was the conflicting results from CT and MRI.  The call finally came on Friday, February 19.

I was busy with an incident at work when Theresa called and texted me to call her.  I didn’t get the message until sometime later, so she sent me the email containing the results along with these words:

Tried to text and call.  It metastasized…liver, sternum, spine and under RIGHT arm too.  Doesn’t change course of current treatment, but does give them more cause to get the Cisplatin approved.  Also, Viscusi said that if these drugs don’t work, then a whole new set of drugs opened up as available to use because it has metastasized.

I opened the report, scanning through all the medical jargon to see a summary saying:

  1. Multiple FDG avid hepatic and osseous lesions consistent with distant metastatic disease.
  2. Large FDG avid, heterogeneous, necrotic left breast mass and FDG avid left axillary and subpectoral lymph nodes consistent with recurrent malignancy and nodal metastatic disease.  Adjacent chest wall involvement is also suspected.

How in the world do you wrap your head around this?  How did we get from good margins & no lymph node involvements, to metastatic disease while taking the prescribed therapy?

The rest of the day was a blur.

What I’ve Learned About Modern Medicine

For all of the advances that we have seen in medicine, there are still so many things that we do not have a handle on.  Doctors are not perfect;  They rely on historical odds when suggesting treatment plans and diagnosing unexpected things.  With this in mind, I thought about the previous 9 months and what we have experienced.

  • Of all breast cancers diagnosed in the United States, somewhere between 10-20 percent are triple negative.  That means that only 1 in 5 receive this diagnosis.
  • Of those treated for triple negative cancer, approximately 34 percent of patients experience a recurrence, with an average time of relapse being 2.6 years.  So, for every 100 people diagnosed in the US, approximately 20 are triple negative.  And of those 20, around 6 have a recurrence. And how many of those while on chemotheraphy?

With those two statistics, it’s easy to see why the doctors did not expect the happening in the breast to again be cancer.  Especially, while taking one of the cancer drugs commonly prescribed.

 

 

Fight 2, Round 1

We headed to the UA Cancer Center to begin the next treatment cycle.  Again, we were confronted with the insanity of insurance.  GEHA had approved the Navelbine, but not the Cisplatin.  Dr. Livingston’s nurse came to talk to us and said that they will get the Cisplatin approved, but not today.  They suggested Theresa go forward with the Navelbine and we would begin Cisplatin on the 25th.

As the infusion was winding down, she could feel a pain where the cancer was in the breast and also along her back.  We chose to believe it was the Navelbine beating the hell out of the tumor in the breast!

PET, CT and GEHA

Our insurance company, GEHA, decided to disallow the PET scan saying it was not medically necessary.  As a backup, they allowed a CT scan.  This took place on February 10.  The contrast they have you drink made Theresa sick.  Even with that, she was able to complete the scan and await the results.

That evening, Dr. Viscusi called saying that the CT scan did not show spots on the sternum or ribs, but did show something on the liver.  She said that she was going to call GEHA and get the PET scan approved.  This was the best way to determine what exactly is going on.  This was approved on February 12 and took place on February 17.

MRI and Biopsy Results

On the morning of February 9th, Theresa went for an MRI.  They did this to review the chest and stomach area.  After the MRI, Dr. Viscusi called with results from the biopsy.

To everyone’s surprise, the triple-negative cancer, first diagnosed in June 2015 has recurred.  Given the size of the tumor in the breast, I had to wonder if it ever went away.  This was a kick in the stomach.  One week prior, we met with a plastic surgeon thinking what was going on was fat necrosis.  Now, we were hearing those horrible words again.

To make matters worse, Dr. Viscusi called later that day with the results from the MRI.  The MRI showed an enlarging of the lymph nodes under the arm and in the center of the breast along with a few spots on the rib and sternum.  She suggested a PET scan take place as soon as possible and put the order in for it.

Ryan and I went off to do get haircuts, as well as some cold drinks.  As we were driving, I told him that his Mom’s cancer was still there and that there was more treatments in her future.  He hung his head a bit and when I asked him if he was ok, he said, “Yes, I’m used to this with Nana and Mom”.  What an incredible sadness came over me, hearing my 10 year old son saying he was used to cancer.  I hate it.

We met with Dr. Livingston who said that we need to get started with a new round of chemotherapy to shrink the tumor in the breast to allow for surgery.  He provided information on the drugs and advised that the course of treatment would be the same, regardless of whether or not there has been any spreading.  For this treatment, there would be 4-6 cycles of treatment.  On day 1 of the treatment cycle, there will be Cisplatin and Navelbine.  On day 8 of the treatment cycle, there will be Navelbine and on day 9, a shot of Neulasta.  After this comes a 1 week rest period and it begins again.  This was to start on February 18.

The Big Appointment

The morning first started with an appointment with reconstructive surgeon Dr. Larson.  The purpose of this appointment was to get his opinion on whether or not a reconstruction would be possible with all that was happening in the left breast.

Not one for bedside manner, he took a look and said that there appeared to be either lymphadema or inflammatory breast cancer going on.  This hit us like a sledgehammer.  How in the world could it be cancer again?  There was a successful removal of the tumor in June 2015; they had good margins; there was no evidence of further spread through the July surgery of the lymph nodes.  And for that matter, she had just finished 16 cycles of chemotherapy designed to kill it.

They quickly moved us up on the surgeon’s schedule and she performed 7 biopsies on the left breast, both skin punch and core biopsies.  Like the time in June, we were back to waiting on the results.

Dr. Viscusi also scheduled an MRI to take place to see what was going on.