Today we had another Spa visit.  Mary, Maggie’s mom, accompanied Maggie since I was in class.  All went fine.  Dr. Loukas and Maggie had a nice visit.  Now she’s back here at the house sleeping.  As is par, we’re in for about four days of crappy, wrapping up just in time for her to leave for MD Anderson on Sunday.

At MD Anderson, we want The Wizards to tell us two things: 1)  if the new chemo regimen is working, 2) is she eligible now for surgery to remove the tumors in her liver.  To answer those questions, she’ll get another CT scan.  Lookout, CT machine, here she comes! (She and that machine have a history together… it performs the CT scan and Maggie shows her love by throwing up on it.)

The results of this scan are important.  Remember when I mentioned the game we are playing – the decision to stay at the table as long as possible vs. go all in for a win?    Back in October we decided go for broke and play to win.  Well, this is when we get to see what cards we were dealt.  And, unfortunately, in this game there’s not much bluffing.  You either get good cards or you fold.

Dr. Loukas was very insistent today that, if the scans lead Dr. Curly to believe that she’s ready for any type of surgery then we absolutely, positively must insist that they not schedule the surgery without first performing a PET scan.  See, a CT scan will just show us the tumors in the liver – basically a rough snapshot of what she looks like from the inside (See Peek At What’s Inside Maggie for an example.)  However, a PET scan will show current cellular activity by way of highlighting radioactive sugar uptake – a fancy way of saying “where any active cancer is.”  Surgery to remove the tumors in her liver without removing any active cancer elsewhere on her body would be like de-fleaing the carpet without de-fleaing the dog.  Except more painful… and more expensive.

Dr. Loukas said that, for this entire treatment, he’s really kicked up the dosage to full strength.  Maggie has shown remarkable resilience to the side-effects and, thus, has allowed him to push the envelope to maximize our chances for success.  However, being aggressive is a double-edged sword.  FOLFOX, the oxaliplatin chemo regimen she’s on, has a maximum toxicity that a body can withstand.  Typically, that maximum level of toxicity comes at about the six-month mark.  We are in month four of the new treatment but because he’s turned the dosage up to eleven, he fears that we’ll hit that mark sooner.  And that’s bad.  Thus, when she comes back, if there hasn’t been dramatic improvement in the tumors then he’s going do dial it down quite a bit to hopefully enable her to continue on this treatment as long as possible.  What do we do when we hit maximum toxicity, you ask?  Good question.  We’ll find out soon enough, I suppose, but I’ll bet it’s not all cotton candy and slip-n-slides.*
* Attributed to Weston Norton, 1/21/08, People Management class

Maggie leaves Sunday for her appointment.  Sunday is blood work.  Monday is the CT scan.  Tuesday is the appointment with Dr. Eng in which I’m sure she’ll tell Maggie how the scans look.  And Wednesday is the appointment with Dr. Curly.

I told my professor today that next Tuesday I’ll need to leave my phone on during class.  He was very understanding.  I certainly appreciate his willingness to bend the rules for me for this occasion.  School’s important and all but this….  It doesn’t even compare.