Saturday, April 18, 2009

What's Up With the Doc 51? - Forecast Partly Cloudy with a Touch of Orthopedics

Just remember that partly cloudy means mostly sunny. Our visit to Dana-Farber Tuesday was really a wonderful thing. The thoracic oncologist agreed that it is time to stop cytotoxic chemotherapy and that it is not likely to be a useful treatment modality in the future for me. He also reminded us that, while I have this cancer in a lot of places, I don't have a lot of it and none in any life-threatening locations (near major vessels, compromising my breathing, etc.) and that the biology of the cancer is just different in nonsmokers than in smokers. It tends to be much more indolent (I love that word) and that he wouldn't expect me to really feel any systemic effects from this cancer next week, next month or for MANY MONTHS. He feels they can be leisurely in evaluating my tissue for those oddball genetic mutations (which is good, because they don't exactly know where that tissue is right now) and if I've got one of them then we can go the clinical trial route. He admitted that treatment options are more difficult if I don't have one of those mutations, but pointed out that there are still a couple of small-molecule inhibitors of the VEGF receptor tyrosine kinase, such as sunitinib and sorafenib, that have shown efficacy in my type of cancer and those would be reasonable options to consider.

So I get a big old break from systemic treatment for the cancer after 13 continuous months of feeling like crap because of whatever treatment I'm on and I am really, really looking forward to feeling good for a while.

Which takes me to the touch of orthopedics. When my left hip metastasis first showed up early last month my orthopedic surgeon was adamant that I needed to do SOMETHING about it because it was structurally threatening and I would be in a world of hurt if I fractured through it. After much cross consultation we decided to go forward with the chemotherapy, hoping that that would shrink the mass and make it less threatening. Tuesday's scan showed that that did not happen and the oncologist Tuesday was even more adamant than the orthopedic surgeon had been that I need to do something about the hip right now, BEFORE it fractures. While radiation therapy would be an option if pain were the issue, it probably won't provide the structural stability necessary to prevent fracture and allow continued normal activity. So I'm likely to wind up with a partial hip replacement in the very near future. No fun, but the technology is very good these days and people recover very quickly so we probably just need to get on with it.

I consider all of this to be very positive for me and my family and I am so grateful for all the good thoughts and prayers that you have all offered on my behalf. A very good friend of mine is very seriously ill in the ICU right now and if you could divert some thoughts and prayers in Ann's direction for a while I would very much appreciate it.

Good thoughts also to Hannah's volleyball team and I'll let you all know when I know something more concrete on the orthopedic side.


1 comment:

Catharine said...

Lisa -

Sending good thoughts your way and to Ann and Hannah.