July 12, 2013

Not sure how much bad news I can take.
We got email from the doctor, he prefers email and you will see why.  After the scans yesterday, things are worse than we thought.
I will post some of the email here:

Cody’s scans yesterday show what we already knew about, but more of it.  There has been, as we discussed was likely to be the case, interval growth of most of his tumors, including the tumors in his lungs and his lymph nodes in the chest and the pelvis, and in the bones, as well as the appearance of new lung metastases and new lymph node metastases just below his liver.  There is a small amount of fluid accumulating in both of his lungs (pleural effusions), though they are not large enough to cause breathing problems. There is an enlarging metastasis in his pancreas. There are bony metastasis involving his ribs, sternum (breast bone), multiple vertebral bodies, and probably his right femur (thigh bone).  We will likely give him a medicine that Dr. Farooki may have already spoken with you about (Zoledronate, also known as Zometa) to try to reduce the risk of him fracturing one of his already-soft, and now weakened bones.  On PET scan, there is a finding of uncertain significance in the lower part of his colon (large intestine).   I am trying to reach our radiologist to see if there is any additional imaging that might help us learn more about what this finding represents (and if there is, we will ask Cody to come in over the weekend to have the study performed). 

Based on what we saw on yesterday’s scans, specifically the enlargement of a lymph node in his chest cavity that is pressing on his left atrium (the filling chamber that accepts blood from the lungs back into the heart before it is pumped out to the body via the left ventricle) and pulmonary veins, we called him and advised him that we did not think it safe for him to fly to Georgia – both out of concern about the safety of flying as well as out of concern that if he became unwell while out of town it would jeopardize his getting back to NYC safely other than by air ambulance.

Cody is, as I think you both understand, facing an even more difficult battle than he was faced with going into his transplant 4 years ago.  I am, nonetheless, optimistic that we can offer him treatment that will help him feel better and make his cancer better for a while, and hopefully can do so without making him too unwell.  As we discussed, the unknown variable at this time is to what degree his prior therapy will make this therapy more toxic and/or complicated to administer.  For now, we are committed to start chemo early next week immediately following his line placement;  based on the late hour at which he is scheduled to go to the Operating Room on Monday, he will start chemo on Tuesday.  We can certainly send him home with overnight hydration on Monday night to facilitate the earlier administration of chemo on Tuesday.

No words...this photo was taken about an hour ago....