End of Week # 3 - We're Home...

It seems as though events on Wednesday and Thursday all ran together with the pace quickening, and the decisions ever more difficult...

We started at 7AM Wednesday with an MRI of Sally's brain to get a clearer picture of the cancer involvement there. At 11AM we had our consultation with Dr Weber, the orthopaedic oncologist. Ron and Sue joined us for this consultation. We gathered around the Doctor's computer screen to have a look at Sally's hip bone ( The big bone which includes your pelvis), to observed the location of the cancer, and receive the analysis from Dr Weber, as to the cause of Sally's pain. The cancer is in the bone directly above the hip/leg joint. Whenever Sally sits, or walks, pressure is put on this weakened area creating the pain. Dr Weber prescribed a walker and cane to assist Sally when she walks, and instructed her to limit the amount of weight she places on the leg. Dr Weber indicated that it will require 4 - 6 weeks for the bone to recover. Following that appointment we went to the rehab center where Sally was fitted with the walker and cane, and given a brief session on appropriate use of the equipment.

Next, we hurried to our 2PM consultation with the Radiology Doctor to review the results of the brain MRI and hear about recommended therapies. Sally's brother Allen, and sister Flo, joined Ron, Sue, Sally and me for this consultation. Dr Hales, a Resident Radiologist, who has been with us through the previous radiation treatments went over the findings and recommended treatments. As we gathered around the doctor's screen this time, we were greatly saddened at what appeared before us. Numerous clusters of cancer cells forming tumors in various locations of Sally's brain appeared on the screen. Dr Hales explained that each tumor represented millions of cells, and that there was probably an equally large number of cancer cells floating around in her brain that just hadn't clumped together yet into tumors. The recommendation to do a full brain radiation required a decision from Sally and I that we did not feel prepared to make. Although Dr Hales indicated that the results would be positive, he acknowledged, that only Sally's Medical Oncologist, Dr Rudin, could tell her how this fit with her wishes in the overall treatment of her lung cancer. Our meeting ended without any resolution for treatment, and Sally proceeded on to the 4Th radiation treatment of her vertebrae.

I'll just add a small note here regarding Sally's instructions to Dr Rudin relative to the boundaries of acceptable treatment. Sally has told Dr Rudin that she is willing for treatment that will help her maintain her quality of life, but does not want any treatment that simply prolongs life. When Dr Rudin called on Monday to inform us of the findings in Sally's brain, she again discussed these wishes with him. He assured her that he would not recommend anything that violated her wishes.

As we were preparing to leave after Sally's radiation treatment, my cell phone rang, and it was Dr Rudin calling. He asked where we were, and if he could join us for a bit. Of course, we welcomed his offer, and soon found ourselves in a private room with him.. Dr Rudin and Sally sat quietly talking together as the rest of us stood by listening in on their conversation. Dr Rudin quietly explaining that this treatment, although a bit severe, was in line with her wishes, and was intended to reduce the possibilities of the cancer spreading in the brain, causing more serious neurological disorders. Sally questioning whether the treatment was just for the purpose of extending life, and Dr Rudin answering that if Sally had the brain treatment, that he still would pursue the medical treatment he initially described to support her quality of life. He indicated that he felt that there was a good possibility that she would respond well to the new medical treatment as she did to the Tarceva treatment. Our meeting ended with Dr Rudin encouraging Sally to take the treatment, saying that she could choose anywhere along the way to end the therapy, and that he would provide the necessary hospice treatment to accompany her wishes. Sally tentatively agreed to consider the treatment, but indicated that she and I would need time to make the final decision.

It is hard for me to describe how intensely sad this moment was for us.. It was obvious that it was equally sad for Dr Rudin as he and Sally talked quietly together. At one point Sally lightened the moment by exclaiming to Dr. Rudin, " I don't now how you do this from day to day!!!"

Sue brought our supper for Wednesday evening. She and Ron prepared the meal for all 6 of us.. Soon everybody was on their way home, and Sally was exhausted. Before going to bed we both spoke again of the treatment, agreeing that we should proceed. We left the final decision until morning, so that each of us could settle the matter for ourselves.

Thursday morning Sally initiated our discussion again regarding the treatment. She spoke of proceeding, and I agreed. In the afternoon we met again with Dr Hales to indicate our acceptance of the treatment. Dan and Kate joined us for this meeting. At that meeting, Dan asked if the Tarceva effectively treated this problem in Sally's brain. Dr Hales said that he couldn't answer, but that no traditional medical cancer treatment (chemotherapy) has any affect within the brain. Our bodies have a firewall in the blood supply to the brain which prevents the treatment from entering the brain. As a result, radiation is the only therapy for cancer in the brain. After our consultation, Sally was taken into the prep-room to complete the preparatory steps for her treatment. Dr Hales recommended a few days break, so scheduled this treatment to begin Tuesday March 18Th.

Sally completed her fifth and last radiation treatment for the vertebrae, and got to "ring the bell" outside of the treatment room - indicating the completion of treatment for the cancer in her bones.

Dan and Kate were preparing supper, but as Sally and I left the hospital, I told Sally that we had one more difficult decision for today. Did she think we could go home this evening?

After supper with Dan and Kate, we packed and headed home - - arriving at 9PM.. A little extra pain medication made the trip pleasant for Sally..

We'll pick up with more news next Wednesday. For now, Sally and I wish to thank you all for your kind thoughts and support.