Quick update (Thursday 25 Nov)

Mum had the PET scan on Thursday. It was a little painful for her having to lay stationary on her back for such a long period of time but at least it is over and this will provide a lot of information on locations of any cancers so the treatment plan can be finalised (or a lot closer).

Mum is hoping to get the results on Thursday at her next Hematology appointment.

Another consultation, another step forward

Mum met with the Hemotalogists again. The theme of this consultation was getting a little more information on the matters that we discussed at the last consultation. We met with Dr Wright who is a registrar. This means he is higher in the chain than a resident and has selected his speciality (apparently residents do a bit of everything until they choose). We were also joined by Dr. Mollee later in the appointment who is a consultant (or qualified specialist). He was excellent in the information he provided us.

So we talked through the tests that were coming up and the things that need to be finalised before the decision is made on the treatment plan. Things discussed were:

- The lung nodule is not expected to be cancer, but just a complication from the surgery that will not cause any issues. It will be monitored but nothing is expected of it.

- Mum has an slight enlargement of the lymphnode in her neck. It was at the upper end of normal size when it came through in the scan. It is likely just that it was fighting some form of infection at the time of the scan and they will biopsy it to be safe. This test will be scheduled after the PET scan that is being planned.

- Mum is going in for an untrasound to look at the breast tissue on Monday 22 November 2010. Again, this is expected to be nothing and no one is worried about this but better safe than sorry.

- Mum is scheduled for a PET scan on 25 November 2010 which will identify areas of cancer with more precision than previous scans. This has to be performed at the Royal Brisbane Hospital as the PA does not have a PET scanner. In this scan a radioactive tracer is injected into Mum's body that is attracted to metabolically active areas, including the brain, heart, kidneys and areas of cancer. This has to be performed before the lymph gland biopsy the tracer would be attracted to the puncture point of the biopsy so would result in a positive result for her lymph gland whether is was cancerous or not.

- The results of the PET scan will assist in identifying areas of cancer in Mum's body to help rule out melanoma (which would influence cancer treatments).

- Mum has been scheduled in for a dental appointment which is required before her bone hardening treatment (Zometa) as when you are on this drug, any tooth extraction is a high risk procedure so they check your teeth before they start the treatment. This is scheduled for 3 December 2010.

- Mum's protein levels have not changed since she first went into hospital which suggests the disease has not progressed measurably (which is good).

- A heart ultrasound is scheduled for 14 December (to make sure Mum's heart is healthy enough for one of the proposed treatments).

So pending the outcome of the above tests, the treatment options are:

- Zometa (this will be administered in any case as a bone hardening treatment to counter the bone destruction experienced with multiple myeloma)

- Thalidomide will be included in the plan as an anti-cancer treatment

- The main decision is whether to go with low dose chemo or the more invasive stem cell transplant. The transplant involves killing all bone marrow (healthy and cancerous) and reintroducing bone marrow through stem cells. The benefits are longer term control of the cancer than the low dose chemo (which would be administered regularly). The downsides are the 2 months after the chemo where recovery from the treatment includes all of the normal chemotherapy side effects, including infections due to a depleted immune system. The first 10 days are hard, and the remainder of the 2 months are better as the patient gradually improves.

- Mum's response to either primary treatment options will not be known until they are tried so a decision will have to be made soon which will be based on a combination of what Mum's body can handle (based on the results of the tests above) and also what Mum actually wants to do.

One thing we did find out which was quite a shock is that without treatment, myeloma patients have a 6 - 9 month life expectancy. When I found this out I was quite shocked and challenged the doctors as to why the treatment plan was taking so long and why all of the tests were not scheduled. They took this concern on board and to their credit had all of the tests booked within a week. We are on track now and at the next consultation on 2 December I am expecting that a treatment plan will be decided on (or close to being able to at least).