Monday, May 14, 2012

Result Day

So, today we got the results of Steve's CAT scan and MRI.  I have secretly been VERY worried about the MRI as Steve has been having headaches for about 10 days now.  Melanoma spreading to the brain is very common.  I am happy to report that the MRI was clear!  No melanoma in the brain!  Yay!  In regards to the CAT scan.  It was pretty much exactly what we expected to see.  There were NO new growths!  But, the CAT scan did not show much shrinkage of the tumors that he already has.  Some people may read this and take this as bad news, but it isn't actually all that bad.  Of course, who wouldn't want the CAT scan to suddenly show no tumors?  But realistically, we knew that was not really going to be the case.  A-I can still feel the tumor on the lymph node (although it has shrank drastically since December), and B-They have told us many times that the tumor on the adrenal gland shows necrosis (dead cells).  Necrosis may sound good, it's dying cancer cells right?  Well, it can be a sign that the treatment is working, or it can be a sign that the tumor is so big that it is suffocating itself.  So, parts of the tumor are still alive and parts of it are dead.  There is really no way for us to know without doing surgery and/or another biopsy.  So, what's next??

Steve has been doing biochemo which consists of 3 chemos and 2 immunotherapies.  The maximum they will do of this treatment is 6 rounds.  Steve has completed 4 rounds.  Not every person's body can tolerate the full 6 rounds.  That seems to be the case with Steve.  Even though they dropped one of the chemos from his last round of biochemo, his counts were still critically low after this last treatment.  His levels have still not completely returned to normal (although they should be back to normal by the end of the week).  So, Dr. Kim would like to stop the biochemo.  Bittersweet.....It has prevented the melanoma from spreading, but it also causes Steve so much pain, fatigue, etc. When you have stage 4 melanoma, surgery is usually NOT an option.  The reason being, they are afraid that they are giving you unnecessary risks.  Every surgery poses a risk in any situation, then on top of that, the cancer could spread during recovery.  Why would you risk the cancer spreading if it appears to be stable?  Well, generally most people with Stage 4 cancer have a lot more tumors already.  Although Steve is stage 4, he only has a few tumors, the largest being the adrenal mass.  I suggested to the nurse and the PA when talking with them before Dr. Kim come in that we stop the biochemo, do surgery to remove the adrenal mass, and then continue with some sort of treatment.  Both the nurse and PA kinda shot this down since it is not standard practice in Stage 4 treatment.  However, when Dr. Kim came in, he mentioned it before I even had a chance to!  He is going to have a meeting with the surgery and melanoma team on Monday and they will decide if they want to do surgery.  Since the melanoma is so under control (or appears to be) and Steve still has the biochemo drugs in his system, if the surgery team agrees to do the surgery, he will have surgery to remove the adrenal mass as early as next week, or the following week.  If they do not agree to do surgery, he will probably start a clinical trial, or Zelboraf which is a drug that only people with the BRAF mutation can take (Steve has this mutation). Read more about Zelboraf here: ttp://www.zelboraf.com/patient/about/work/index.html   If he does have surgery, this is likely the drug he will start as early as 2-3 days after surgery.  The good news is none of the new drugs that he will take are chemos.  They are all immunotherapies.  Immunotherapy drugs do not mess with your hemoglobin, platelets, white blood cell counts, etc.  So, those days are behind us for now!!  Steve's hemoglobin is still low.  The doctor wants Steve to have a redraw on Wednesday and see if the hemoglobin comes back up on it's own.  If not, he will most likely have a whole blood transfusion on Thursday.

So, at this point we just sit and wait a bit.  Steve's numbers will likely climb back up on their own this week. Then we will find out late Monday or early Tuesday if the surgery/melanoma team have decided to go forward with the surgery or not.  If not, we have a follow up in 4 weeks with Dr. Kim and will discuss with him which drug that Steve will move forward with.  Regardless, our life for now should "semi" get back to normal soon.  Steve should start feeling good and not feeling so fatigued and sick all of the time.  His white blood cell counts should stay up, so we should be able to get out and about more, maybe take the kids on a vacation or two this summer, hang out with our friends more, etc. No more week long stays in the hospital (with the exception of possible surgery and some of the clinical trials).  The other drugs that he may take Yervoy is an outpatient 1 day treatment every 3 weeks, and Zelboraf is a pill....no need for hospital stays!

Thanks again for everyone's prayers, well wishes, positive thoughts, calls, texts, messages, cards, etc, etc, etc.  We appreciate each and every one of you for investing yourself into this journey with us!


4 comments:

  1. Jennifer

    Thanks for all your updates! We will continue our prayers for Steve and the rest of the family.

    Love you all,
    Uncle Ray and Veronica

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  2. Thank you for the prayers! We love you both!

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  3. Praise the Lord! Great to hear the good news about the MRI--no cancer in the brain! Steve, sounds like it's time for your body to rest and revive itself--go slow. (Jennifer, you need to rest up also) Isaiah 40:31 "But those who trust in the Lord will find new strength. They will soar high on wings like eagles. They will run and not grow weary. They will walk and not faint." We love you'll and are constantly in our thoughts and prayers! Uncle Tim and Aunt Robin

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  4. Thanks Uncle Tim and Aunt Robin, we love you!

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