Friday, September 7, 2007

Chronology of Bradley's Treatment, Part 4

8/30/05 Dr Sausville
The first four rounds of chemo were the “induction rounds”. The initial staging tests were run again to see how the cancer was responding to chemo.

9/01/05 CT Scan of chest, neck and abdomen

9/06/05 PET Scan, CT of lungs
Test results from first four rounds showed great improvement. Big sigh of relief, as any indications of active tumors at this point would be really bad news. The decision was made to proceed with local control, removing the primary site.

First visit to Dr Garofalo, the radiology oncologist. He recommended radiation after surgery. I asked if the radiation would be targeted and he said there was no need for that.

9/12/05 Appt with surgeon Dr Krasna was cancelled as he’s out of the country. This caused a 2 week delay.

Appointment with the surgeon Dr Krasna. The plan was to remove most of the rib that was the primary site and part of the two surrounding ribs along with muscle between the ribs in order to achieve wide margins. The latest PET didn’t show any tumor activity in that lung anymore, but he’d check it out and remove tissue as needed.

Dr Sausville
Surgery was almost a month away, so Dr S recommended we go ahead with round #5. Bradley had already had his lifetime max of Doxyrubicin and would start receiving Etoposide.

Chemo #5 IE

Pre-surgical tests
10/18/05 Pulmonary function test, echocardiogram
10/21/05 Chest X-Ray and appointment with Dr Sausville
10/24/05 MRI
10/25/05 Stress test

11/02/05 Surgery Hospitalized through 11/09/05 (7 days)
Bradley came through surgery with flying colors! The surgeon had to remove more of the 6th rib that was the primary site than originally planned, which meant he also had to take more of the ribs above and below that rib (ribs 5 and 7) to achieve wide margins. The good news is that he found virtually no evidence of tumor in the lung. He'd been concerned there would at least one significant spot in the lung, where there had been a fairly large tumor at diagnosis, or that they would find additional metastases from the bone that would require removal of some lung. There was none of that. He did find 3 small spots in chest wall and diaphragm, which he removed and put clips in, but there wasn't removal of a significant amount of muscle. If pathology found these spots to be active (they could be anything, not necessarily related to cancer), the clips would serve as markers for targeted radiation later. Labs would be done on the bone to ensure there’s no active tumor in the removed bones; results can take a few weeks to get back.

We did have some bumps on the non-surgical side. We arrived at the hospital VERY early, around 6 AM and didn't leave until after 8 PM that night. We'd been there for over 14 hours and Bradley still hadn't been moved to a post-op area where we could see him. The nurse said he might not be available for visits before morning, and said we might as well go home and get some rest. Unfortunately, Bradley did wake up during the night and was very upset that we weren't there. He said that the surgical staff was unresponsive and didn't listen to his complaints of pain, thus failing to notice that the pump that was supposed to be delivering on-demand pain meds wasn't working. My husband was livid. Bradley was 19 and they were treating him as an adult in terms of privacy and final say on medical decisions. We shouldn't have HAD to spend the night to make sure he was taken care of properly, esp after being advised to go home. Now we realize that once we left the Cancer institute side of the hospital, we were in a whole new world. The staff in the cancer clinic and infusion center were great people, attentive to detail and compassionate. On the other side of the "big city hospital" some staff could be apathetic and inconsiderate and it was more important that Bradley have a family member present to advocate for him.

11/11/05 Dr Sausville
We were still waiting for the results of biopsy on samples taken during surgery, due later this week. Dr S filled us in on some details. If the biopsy of tissue from chest wall was cancerous, radiation would likely occur before the end of chemo; otherwise, it could wait until the end. Since the left lung was found to be so healthy, there MIGHT not be the need for low level radiation of the whole lung after chemo as originally planned. They’d modify the chemo cocktail to reduce toxicity for any chemo given during radiation. Bradley wanted to go to San Antonio, where his girlfriend was, but agreed to stay in MD through radiation. We hoped to make sure he was on the home stretch as far as the remaining rounds of chemo before he left.

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