ONCOLOGY APPOINTMENT AND PLAN

The rain continues here in Iowa. They are calling the floods in central and eastern Iowa unprecedented due to the incredible amount of water that is moving through the state. When we were in Iowa City yesterday, for Lois’ appointment with the oncologist, there were sandbags and roadblocks everywhere as they get ready for the river that runs through the city to crest next week. Although we had no difficulty getting to Iowa City, we have now learned I-80 will close tonight due to high water.

As of right now, we haven’t had any more water in the house. Thanks for praying.

Now, about the appointment with the oncologist: We really appreciated how they conducted the meeting. First, a resident Dr who works Dr Halfdanarson, met with us and made sure we had the correct information about the cancer, where its located, how it metastasizes, that its in stage four, etc. We looked at the CT Scan on the computer and, via technology, moved through the liver and could see where the three tumors are located.

We learned that if we choose the most aggressive chemo, Lois will need to finish some dental work begun in February before the first chemo treatment due to the risk of bleeding and clotting problems. (We’ve already called and have dental appointment on June 24.)

Radiation is not an option as the cancer is too widespread.

Dr Halfdanarson explained all the options and patiently answered our questions. He was hesitant to give statistics since most of the colon cancer they see at stage four is in older people. He was willing to recommend a “chemo cocktail” he predicts has a 50% chance of having any impact on the tumors in the liver and that if the chemo does have a positive impact, there is a 50% chance the tumors will shrink enough to make surgery an option.

We have chosen to proceed with a “chemo cocktail” with these main ingredients:

  • Fluorouracil which is used for colon cancer, rectal cancer, breast cancer, gastrointestinal cancer, head and neck cancer, liver cancer, and ovarian cancer.
  • Oxaliplatin which is used to treat colon or rectal cancer that has spread (metastasized), it is often given in combination with other anticancer drugs (fluorouracil and leucovorin).
  • For the second and following infusions they will add Avastin which is used for metastatic colon or rectal cancer, as part of a combination chemotherapy regimen

Although the list of possible side effects is long and scary, the Dr explained that for a patient of Lois’ age and health he expects no debilitating side effects. He currently has patients on the same regimen who come in the morning for an infusion and go back to work that same afternoon. Lois was warned to begin using skin moisturizers liberally as this “cocktail” can dry the skin; and to watch for sores on the palms of her hands and soles of her feet. Also, there could be some tingling sensation in her fingers and toes. She is to be very careful of eating or drinking anything cold for 48 hours after an infusion as that often causes a sensation which makes a patient feel as if their airway is becoming blocked.

This will all begin in Iowa City at the University Hospital on July 9 and here is the schedule:

  • 8:00 am labs – We have to leave home at 6 am to make this!
  • 9:00 am Interventional Radiology to surgically install a port in Lois’ upper right chest. After this port is installed it will be the site for all injections, infusions and blood for labs.
  • 11:15 am CT Scan to determine the baseline so that progress can be accurately measured.
  • 12:15- eat lunch after CT – her first meal since midnight
  • 1:00 pm Dr. Halfdanarson to go over all the labs and CT Scan
  • 2:00 pm chemotherapy infusion which they predict will take until 6 pm to complete. (Future infusions should only take 2 hours and we won’t have to do all the labs and scans each time.)

When we head home Lois will have a pump in a fanny pack to continue sending drugs into her system for 48 hours after which it can be disconnected by a local RN.

Two weeks later, on the 23rd, Lois will have the second infusion which will include the Avastin. There will be four infusions two weeks apart and then we will have another CT Scan and a full set of labs to determine what progress is being made. At this point they could adjust or even completely change the chemo drugs depending on what the tests show.

We asked what the possible outcomes might be:

  • Tumors might begin to shrink – if so, they would continue with the same cocktail for four more infusions. They don’t expect enough shrinkage for surgery from just four infusions.
  • Tumors might grow – if so, they would change the drugs in the cocktail and do more infusions or give us the choice to discontinue
  • Tumors might not change at all – if so, we face the difficult choices of what to try next – there aren’t many options.

This is a lot of information but we hope it helps everyone understand what we face and how to pray.

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