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[cancer] A visit with the oncologist - Lakeshore
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Jay Lake
Date: 2009-06-13 19:24
Subject: [cancer] A visit with the oncologist
Security: Public
Tags:calendula, cancer, health, personal
Had another doctor's appointment Friday, calendula_witch came with. Oncologist this time; a smart, capable doctor just a few years older than me. She walked through the facts of my case, and the ambiguities. Though her emphasis was quite different from my surgeon's, all the underlying issues were identical. She did show us the CT and PET scans on a monitor, including the relatively prominent liver hotspot.

The oncologist had a fabulous Marcus Welby thing going on — very understated, comforting, comfortable. This contrasts with my surgeon's rather earnest bluntness, which I think I prefer. But the facts still remain about the irregularities in the lymph, the lung spot, and the liver spots. She doesn't seem very concerned about the lung, focusing on the alternate explanations for the lung spot.

Unlike my surgeon, the oncologist is not fully confident that we're going to chemo (and she is the oncologist), but she also didn't have any alternate theories to cancer for what was going on in my liver. She said, well maybe it's just a structural feature. I pointed out it wasn't on last year's scans, and she acknowledged that.

We also discussed chemo at some length. I would have FOLFOX in two three month courses with a break in the middle for imaging. I'd also be on regular imaging as a long term followup, for some years at a minimum. There's another drug in the mix, Avastin, that impairs the growth of blood cells in tumors. ETA: paulhaines advises I have my medication notes mixed up, that the cold side effect is from the oxaliplatin component of the FOLFOX: it has the odd side effect of making the patient radically cold-sensitive. As she said, don't put your hands in the freezer or drink anything chilled.

The oncologist did say that any appearance of cancer after a surgical resection triggers chemo, that we don't have to prove it's in the lymph via tumor detection to do that.

She very strongly prefers to wait and re-image in order to look at growth on the liver and lungs, and re-check the lymph. She felt four months might be better, but two months would be acceptable. I asked what other tests would be appropriate, and this is where the one significant new element emerged. She said an MRI would allow us to evaluate the liver differently, and might reveal new information either confirming cancer or making it less likely.

So I have an MRI the morning of on Thursday, 6/25 before calendula_witch and I light out for Iron Springs. The oncologist will contact me after the MRI to discuss the results, and we'll either go to a mid-July CT scan from that, or if we've confirmed the cancer, we're go to a consult and map out the treatment plans. If I can humanly manage it, I'm going to take the MRI scans with me to the second opinion on 6/30.

We also discussed the timing and advisability of the liver re-sectioning, but she didn't shed any new light on that. It all comes down to resolving the ambiguities about what's going on in my liver, and to a lesser degree, my lung.

So, except for the MRI and some details about chemo, no real news. Like I said, different spin, but we're still on the watch-and-wait plan for a little while longer.

I'll try to write a catch up note tomorrow on my emotional journey of late.

Originally published at jlake.com.

Post A Comment | 17 Comments | | Link






melissajm
User: melissajm
Date: 2009-06-14 03:58 (UTC)
Subject: (no subject)
:fingers still crossed for you:
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karenjunker
User: karenjunker
Date: 2009-06-14 04:50 (UTC)
Subject: (no subject)
It's a testament to your professionalism that you'd keep Iron Springs on the agenda with all else you have to deal with that week. You're a real trouper! (or is it trooper?) Anyhow, we'll be looking forward to seeing you there...
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scarlettina: Hug 2
User: scarlettina
Date: 2009-06-14 05:32 (UTC)
Subject: (no subject)
Keyword:Hug 2
Keeping you in my thoughts, babe.
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e_bourne
User: e_bourne
Date: 2009-06-14 06:30 (UTC)
Subject: (no subject)
Waiting for answers is deeply frustrating. I am particularly bad at it, so you have my sympathy. My hope is that it is resolved positively as quickly as possible.
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biomekanic
User: biomekanic
Date: 2009-06-14 07:00 (UTC)
Subject: (no subject)
Best of luck.

I think you've had an MRI before haven't you? If not, be forewarned they are loud. I've been front row at heavy metal concerts and not felt anything that loud. Thankfully they have headphones, but still I wasn't prepared for the intensity of it.
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Leslie Claire Walker
User: lesliewalker
Date: 2009-06-14 15:14 (UTC)
Subject: (no subject)
Wishing for the best.
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Alley
User: alleypat
Date: 2009-06-14 16:08 (UTC)
Subject: (no subject)
*** hugs *** Jay
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cj_ruby
User: cj_ruby
Date: 2009-06-14 18:06 (UTC)
Subject: (no subject)
Jay, were you on chemo after your surgery last year?
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Jay Lake
User: jaylake
Date: 2009-06-14 18:08 (UTC)
Subject: (no subject)
No, I was not. At the time it was seen as a clean surgical cure. Good margins, no cancer in the 13 lymph nodes removed, etc.
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Jay Lake
User: jaylake
Date: 2009-06-15 02:41 (UTC)
Subject: (no subject)
Thank you. That may become highly relevant.
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kara_gnome
User: kara_gnome
Date: 2009-06-15 01:42 (UTC)
Subject: (no subject)
It sounds as if you were very comfortable and in good hands. It's interesting about the chemo, and I hope it works out well re Thursday.

It's hard waiting and trying to prepare; it seems so surreal to be going through this again.
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Paul Haines
User: paulhaines
Date: 2009-06-15 04:04 (UTC)
Subject: (no subject)
Avastin had very little side effects for me, and very little for most people in my chemo lounge. It's a monoclonal antibody that destroys the blood vessels feeding the tumours, and not a chemo, so it's relatively focused and doesn't effect your entire body.

Oxaliplatin (sp?) is the chemo commonly combined with FOLFOX (5FU) that gives the extremities problems, particularly with cold. I wore gloves, scarves and hats when I ventured outside, sometimes gloves on inside, especially in the morning. The tips of my fingers are still slightly numb (it's been over 12 months since my last dose of Oxaliplatin) and my feet are still affected badly. (It feels like they glow at nighttime). Lost my sense of balance for a while when the side-effects were at their worst as I couldn't really feel my feet.

Oxail and 5FU are the most common and most effective chemo treatment for bowel cancer. I had 6 months of it after surgery. But, unluckily, it didn't work for me. I never lost my hair either.
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Jay Lake
User: jaylake
Date: 2009-06-15 11:37 (UTC)
Subject: (no subject)
Whoops. Note taking error. Have corrected. Thank you for the update, and for the continued insight into your experience.
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farmgirl1146
User: farmgirl1146
Date: 2009-06-15 05:53 (UTC)
Subject: (no subject)
You may get the MRIs on a CD. I got my x-rays that way a couple of weeks ago. They were savable with GIMP, and one is on FB. So save them yourself, too.
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User: xjenavivex
Date: 2009-06-15 18:59 (UTC)
Subject: (no subject)
This wait and see bit now, with the new spin does it feel any more positive?
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