Wednesday, January 7, 2015
Well Mike and I made it safely into New York City with out any difficulties. We left after work last night. We arrived in the city around 9:30, found a parking garage located right under our hotel, checked into Doubletree Hotel, and were both in bed by 10:00. We thought we would venture around the city a little bit in the morning before Mike's appointment. The room was very nice and the beds so comfortable. The weather that night and the next day were predicted to be very cold, I guess due to us both working all day, the three hour drive, the comfortable bed, warmth of the room, the room darkening curtains, and not being on a too busy street, we were able to have a good, sound sleep. Mike is one to not sleep in. On the weekends he is up anywhere between 3:00 & 5:00 AM. However, he did not wake up until 8:50 AM. His appointment was at 10:00 AM. We rushed to get around and, therefore, were unable to site see before his appointment.
We walked the two blocks from the hotel to the hospital. This outpatient center does not stand out as a regular hospital. We were standing on the street trying to locate the address when I turned around to ask a gentleman for help and discover the hospital's logo on his jacket. We were standing right in front of the entrance. We went inside and took the elevator to the 5th floor where we were greeted by a very friendly receptionist. She gave us paperwork to complete. While I was completing the paperwork, They took Mike to get his temperature, blood pressure, height, and weight. We were then taken to an examination room about an hour later. Dr, Veach same into the room and stated he had reviewed Mike's records, but wanted to hear Mike's telling of his journey thus far. He then did a brief exam and did some strength testing. He told us he heard a drop in Mike's heart beat which he called atrial arthymia. After that, he asked Mike - "what is it that you want from me". Mike told him that his oncologist suggested seeing an oncologist who specialized in the type of cancer that Mike has.
Here are the options that he gave to Mike:
1) He could continue with the Folfox that he has already had (two rounds). He stated the pro for this treatment would be that Mike would know what to expect from it. The con was that the tumors have already experienced this drug so the response to this "cocktail" of drugs goes down to a 30% chance of working. This treatment would also have an accumulative toxicity.
2) He could try Irinatecan (AKA Camptosa). This drug is classified as a plant alkaloid. The pro to this would be that the cancer has not experienced this drug. He stated it would be the most aggressive with the best chance of working for him and that there was no dose limiting toxicity. The con to this drug is that it can cause diarrhea. This occurs in less than 30% of patients who receive it. This drug is given by infusion over 90 minutes.
3) KRAS testing. This is done using tissue from the liver biopsy. It can tell you what to use. I still do not quite understand this so I will explain it using information I obtained off the internet.
This test detects specific mutations in the KRAS gene in the DNA of cancer cells & tissue. The presence of mutations may indicate that certain drugs may not be effective in treatment the
cancer.
With this testing, Dr. Veach suggested a drug, Erbitux, which has been approved for treatment of patients whose colorectal cancer has spread to other parts of the body, Only patients whose tumors have a KRAS mutation negative gene (commonly known as "wild type" and whose tumors have a protein called Epidermal Growth Factor Receptor (EGFR) should receive this. The con to this drug is that is causes skin problems such as an acne like rash, skin drying and cracking. The acne/rash would then have to be treated with steroids.
4) Experimental treatment.
They could take a new biopsy of the liver to test for mutations to see what the tumors need to grow. They would then somehow stop giving the tumor what it needs. They would look for molecular abnormalities.
Immunotheraphy which is not a treatment of cancer itself, This use the body's own immune system to help fight the cancer, It stimulates the body's own immune system to work harder to attack the cancer cells.. It "takes the breaks off the immune system and lets it loose on the cancer while shutting off immune support". The immune system is reved up. It can also attack the good cells and make antibodies against itself. If this would happen, then they would stop the drug that is boosting the immune system and give the patient steroids. This would have to be done at Sloan Kettering.
Since Mike is "asymptomatic", Dr. Veach stated he would not recommend any experimental treatment.
Dr. Veach then sent Mike up to the 7th floor to have an EKG to document what he heard when listening to his heart. By this time it was 11:45. The transporter told us that the EKG was scheduled for 1:00 but he would take us up there and have us check in. He said that maybe they could get him in earlier. We checked in and they told us to have a seat. They came right out for Mike and took him back for this testing. Before I could send an email to my and Mike's coworkers, Mike was back with the print out in his hand to take back down to Dr, Veach. The doctor said it show the "drop" and gave Mike the print out to bring home to have it to compare to any previous EKGs that Mike may have had done for prior surgeries. He stated it was not really anything to be concerned about nor something for which he would need medication. It was just something our family doctor could watch.
So we left Sloan Kettering with this information. I knew Mike was anxious about getting out of New York City before there was any major traffic. I asked him if he wanted to eat lunch there or drive out of the city and get something to eat along the way. He decided to eat there. We did not, however, take time to find a different or special place to eat in the city. We saw a guy walking carrying a Subway bag so we asked him if there was one close by. We went there for lunch and then headed back to the hotel to pick up our bags that we had put in storage. We called ahead to the parking garage so they could get our car ready to be picked up. We had the parking validated by the hotel and we started our journey home from 51st Street around 1:00 PM.
Mike concentrated on the driving while I kept an eye on our directions and obstacles up ahead in our lane. We followed the GPS and headed out of New York City unscathed and without any problems. We encounterd a couple of snow squalls on Interstate 80 on the way home. There have been some recent major accidents on this interstate due to snow squalls, I told Mike that if it got bad, we were going to pull over and not try to continue in that. Luckily we did not have to do that. We drove straight to our dog groomer's house who had kept our 3 dogs while we were away and made it back home around 5:30 PM.
It was a quick trip in and out of New York City. We did what we went there for and will bring that information back to Mike's oncologist and decide on how to proceed from here.
