Weighing Risks vs. Benefits

Our appointment with the oncologist was very different than we'd expected. Mentally prepared to begin chemo, we were just waiting to get a start date, but the doctor has put off the decision for another two weeks.

The first reason being that Mom's recovery has been much more complicated than anyone expected. She wasn't expected to "bounce back," but at four weeks out they didn't foresee her having gone through all she has. She needs to be at her strongest starting chemo, and she's even admitted that her legs have gotten noticeably weaker in the past month, not to mention the persistent diarrhea, random nausea, lack of appetite, weight loss, and insomnia.

The second reason is that the chemotherapeutic drug they feel would be most beneficial to Mom is very nephrotoxic (mean to the kidneys), and seeing as she only has one, we need to take extra special care of "Lil' Lefty." If that kidney were to fail, it would mean undergoing dialysis indefinitely, unless the damage could be undone or she could be transplanted with a donor kidney.

For all intensive purposes, her borders were clean of cancer cells when the tissue was examined by a pathologist under the microscope, and so administering chemo would be prophylactic, or extra insurance. However the cancer they did find was highly aggressive and has the potential to metastasize, or spread to other parts of the body.

So the massive question at hand is whether to subject Mom and Lil Lefty to chemo without having scientific evidence of remaining cancer cells, when Lil Lefty has already had her fair share of issues, or to watch, wait, and play defensively.

To watch and wait would mean Mom would undergo CT scans at least every three months to check for tumor growth, and have her labs and symptoms monitored very closely.

There is no right answer. If she had two kidneys, chemo would be a no-brainer, but considering she only has one, and there is no active cancer that they can see right now, it's a hard decision to make.

Dr. D. communicated with her colleagues at Sloan-Kettering in NYC, and since very few studies have been done in cases such as Mom's, they feel postponing the decision for another two weeks would be wise as well.

As of today, her stool sample is negative for c.diff, although we'll need at least two more to really be sure. Her diarrhea comes and goes from day to day, and she has to take a pill for nausea about once daily (although needed none today). Her creatinine (which measures kidney function) is high (1.5, and the normal high is 1.2), which could indicate the the Lil Lefty is still a tad stressed, or that she's simply dehydrated. The good news is that she's had no left-sided flank pain, which is a bonus.

The other issue at play (cause why not make things super complicated) is that her blood pressure was 170/100 today. Considering our kidneys regulate fluid volume and your blood pressure, well then we need to get that blood pressure down, keep Lil Lefty from working over-time, and make sure she's below 130/80 before anything happens, especially chemo.

Our spirits were clearly down when we left Dr. D's, but we talked our way through it. The plan for now is to eat plenty of nutritious foods, suck down massive quantities of water, take several walks daily and go up and down the stairs three times a day, PRAY that the new Ambien gives Mom a good night's sleep, re-start some old BP meds she was on before surgery, keep a daily log of BP readings, and get rested and strong.

Regardless of whether chemo is in our future or not, Mom needs to be in her best health ever. As Coco said to me once, "flies can't live in a dirty kitchen," so cancer is less likely to come back if Mom keeps healthy and strong.

We are going to communicate with Dana Farber Cancer Institute (DFCI) in Boston because we'd been seen there a few times before, and Dr. D completely agreed that educating ourselves by speaking with a few experts will provide us with the most complete picture.

A week from today we'll bring in more lovely samples to the cancer center, and then the following Tuesday we have another appointment with Dr. D to re-assess how Mom's doing and revisit our options.

Our day ended on a good note, after a delicious Salmon dinner accompanied by my brilliant-chef-Uncle Eric's healthy rice mixture and my grandfather's famous steamed-to-death-veggie-mush, we had some good laughs watching Little Miss Sunshine. Mom's now under her new electric blanket (thank you Susan, HH guru), happily awaiting the Ambien to kick in.

Needless to say it has been a long, emotional day, but tomorrow will be new and filled with fresh perspective renewed cancer-fighting energy!