Tuesday, September 8, 2015
Cycle #5. Tolerating the dose reduction. Tolerating chemotherapy well. Liver enzymes continue to improve. He has mild nausea from the chemotherapy which is being controlled with Zofran. Return in 2 weeks for cycle #6.
Monday, September 21, 2015
Cycle #6. Tolerating chemotherapy well. He was advised to remain active and continue his routine medications. Mike had a 5 mm ulcer on the left side of his tongue. He was advised to use soda bicarbonate as a mouth rinse. He is to also add nystatin for this ulcer. Return in 2 weeks for reassessment and a CEA.
Monday, October 5, 2015
Cycle #7. Tolerated the last cycle reasonably well. Mike did report that he did have around 8 episodes of diarrhea with some minor abdominal cramping the day after the last infusion which resolved without any intervention. No blood or mucus in the stools and no nausea or vomiting. No issues with fever or chills. After starting the nystatin swish and swallow for mucositis, the lesions cleared after 2 days. Cycle #7 was initiated. Imodium as needed for diarrhea if this becomes an issue. Restart the mystatin should any further mouth sores develop. A CEA was drawn at this visit to be reviewed at the next visit.
Monday, October 19, 2015
Cycle #8. CEA 274.3. No toxicity from treatment. Performance status has improved. Return in 2 weeks for Cycle #9.
Monday, November 2, 2015
Cycle #9. Some pus was extracted along the gumline. There may be some periodontal disease along the left lower molar. Given Penicillin VK 500 to take for the abscessed tooth. If no improvement, Mike was instructed to seek a dental consult. Continue the bicarbonate mouth rinse. Given cycle #9. Return in 2 weeks for Cycle #10.
Monday, November 16, 2015
Cycle #10. Occasional mild, intermittent nausea. No oral ulcers noted. Abnormal molar loos improved. Does have a follow up scheduled with the dentist. Return in 2 weeks for cycle #11.
Monday, November 30, 2015
Cycle #11. Since last visit, Mike developed an upper respiratory infection with postnasal drip, sore throat, right ear pressure, and rhinorrhea over the past 4 days. Mike has been taking Vitamin C to help resolve the infection. He has been to the dentist where he was told his gingiva has receded and have become very sensitive. Nasal mucous positive for erythema and congestion. Oral mucus clear. No lesions or ulcers. Gingiva of the anterior teeth of the lower jaw noted to be receded - no bone visualized.
Proceed with Folfiri cycle 11. The Avastin is withheld from the infusion due to the gingival recession and tenderness in the mouth. Osteonecrosis of the jaw is a concern with Avastin. However this was not noted on his exam today. Mike was advised that manipulation of the gums while on chemotherapy is contraindicated. Symptomatic care was encouraged. Mike was also informed that large amounts of vitamin C can interfere with chemotherapy mechanism of action and possibly decrease effectiveness. Mike was instructed not t take more than 500 ng daily of vitamin C. He was to contact the office if he developed progressive respiratory symptoms or fever. He is return in 2 weeks for a complete blood count, chemistry profile, and hepatic function test prior to reassessment for cycle #12.
Monday, December 14, 2015
Cycle #12. No ulcers noted. Sinus infection improved with a Z-pak. Irritation of the gumline noted in the anterior jaw in the area of the incisors. Recommended that Mike use biotin mouth rinse. The Avastin is still held. Proceed with #12 FOLFIRI at 30% dose reduction. Return in 2 weeks for potential FOLFIRI. CEA and a CT scan of the chest, abdoment, and pelvis to be done to reassess his disease.
Monday, December 21, 2015 CT SCAN
Multiple bilateral pulmonary nodule consistent with metastatic disease. However, there has been a definite decrease in size of the numerous lower lobe nodules compared to the prior exam. Multiple hepatic lesions present consistent with metastatic disease. These are also decreased in size compared to the previous study.No new suspicious signs of metastatic disease currently identified.
Monday, December 28, 2015
Cycle #13. Scans indicated good partial response and CEA is also improved. Continue biotin mouth rinse, Hold further Avastin because of the gum recession and lower jaw pain. Proceed with Cycle #13 at 30% dose reduction because of prior toxicity. After 3 further cycles, repeat CEA will be done.
