PET Scan Day and The Plan Going Forward

Today we finally had our PET scan.  Those take a LONG time.  We arrived at the offices at about 12:15 and left around 3:30-ish.  Of course, I went with Maggie into the back but they kicked me out within about an hour.  So, patiently, I sat in the waiting room watching people come and go for a solid 2 hours.  Maggie said that she was in the machine so long she thought they had just forgotten about her.  But hopefully we’ll get a fantastic scan – one with NO color on it.  We won’t have any info for a little while.  We don’t actually have an appointment set to see the results but I’ve learned that I can get the results myself just by going up there.  I may not understand all of it but I can certainly get the gist pretty quickly.  So, hopefully Thursday I’ll have more to report (as my alter-ego Dr. Chris, PET Scan Examiner and Official Non-Medical Opinion Writer-Upper.)

Yesterday Dr. Loukas took a good deal of time explaining more about his “plan.”  He explained that he hopes (and expects to find) that the chemo regimen Maggie’s been on since late January has killed off the vast majority of her cancer.  But, because nature tends to be rather tenacious, it’s highly likely (or rather, guaranteed) that a few cells still remain (and by “few” I think he means hundreds of thousands – but the bitter reality is that it only takes one cancerous cell to make another tumor.)  These remaining cells are either completely resistant or just more resistant to her current chemo cocktail and, thus, more of the same chemo won’t kill them.  Thus, there’s little reason to continue the onslaught of poison.  It’s done the best job it can.

After it’s been confirmed to the best of our ability that the overwhelming majority of the cancer has been killed and the rest dormant, Dr. Loukas is going to take Maggie off chemo treatments for a while to give her a chance to rest up and let her body recover from the chemical abuse she’s been subjected to for all of 2007.  And, as Maggie quickly pointed out, to let her hair grow back.  Dr. Loukas thinks this will be about October.

Now, here’s where things get unpalatable.  Because there’s no real, quantifiable way to rid the body of all the cancer cells, the game we are playing is very serious.  The remaining cancer cells in her body will eventually wake up and start multiplying where ever they may be and create new tumors.  Then we start The Chemo Shuffle.  (And here it is – that dicey part.)  The remaining still-living cancer cells are still living because they are resistant to the chemo that we’ve been taking so far.  Those same resistant cells will start to divide making a resistant tumor.  In Apollo 13 terms, Houston, we’ve got a problem.  The chemo regimen she’s been taking (Xeloda plus CPT-11) won’t work on this (or, shudder, these) new tumors.  In other words, what has worked fantastic up until now will no longer work.  So, the next step is to find a new treatment, one that the new tumors are not resistant to.  And then we begin again.

Now, here’s some quick facts that might give you pause.  No one, except for God, knows how long it will be before a new tumor pops up.  No one knows if any other chemo recipe will work on the new tumor.  But, as I had reported before, Dr. Loukas firmly believes that since Maggie’s tumors have responded so extremely well to this particular treatment (meaning, they died, those miserable bastards) he expects that we will continue to have very positive results for follow-on treatments.  So, that’s positive but it’s just a bet.

So, after hearing about all this I asked Dr. Loukas the obvious question:  If there are a few straggling cancer cells that are resistant to the current treatment but might be killed by another cocktail, why not immediately follow up this treatment with that next deadly treatment?  Kick um’ while they’re down, I say.  Kick um’ HARD!  Good question, says Dr. Loukas, stroking my feeble but growing medical ego.  He said that I’ve touched on a philosophy of treatment.  He absolutely could give Maggie a next round.  But there are some complications, as usual:

I.  While playing the Cancer Poker, he only has a fixed number of cards he can play.  There’s only so many formulas of chemo he can work with.  And once one card is played it typically can’t be played again.  So we have to be very deliberate and careful when we play each card.

II.  A follow up, next round chemo treatment would shock Maggie’s poor body.  By taking her off of chemo she’ll have a great quality of life for as long as the tumors don’t start growing.  And, as she keeps reminding me, her hair will grow back.

III.  Current medical technology only allows doctors to detect a minimum of about 1 million cancer cells.  That’s a tumor about the size of the head of a pin.  Yeah.  Wow.  Since they can’t track any tumor smaller than that they simply have no way of knowing whether a new type of chemo is doing any good.  They’d never be able to track the death of a few hundred or a few thousand cancer cells.  So until they can track the success of the drugs they won’t use them (I suspect that refusal arises from the whole “do no harm” thing.)  And, since we only have a few cards to play (see item I. above) we have to make every single hand count.  And KNOW that it counts.

So the key here is to maximize quality of life while pushing out our time together as long as possible and hope, hope, hope, hope that any of these new cancer drugs in the pipeline will work on our side.  We just have to keep it at bay long enough.  He even called this dance “treating the cancer like a chronic illness.”  That’s much better than some other things I’ve thought about.

But for now we are headed out to a big, fancy steak dinner with Nurse Jolie and Arturo, MBA to celebrate their new jobs and our being done with the PET scan….

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