I get caught up in hearing the news that I forget to ask questions.

This afternoon’s telephone update from my father was chock full of relatively good news.

First and foremost, the pathology results came back and the thing in Mom’s head is in fact lymphoma. While that in and of itself is really terrible news, it is also good news in that we’ve been told since day one that lymphoma is the most treatable of all of the possible diagnosis. So while it is really bad, it’s also pretty good.

Confusing, eh?

She had her PET scan. No word on what it told them. We’re hoping the cancer has not spread to any other organ. Fingers eternally crossed on that one.

Now, for the really good news. The steroids are successfully shrinking the tumor. Thank you steroids! I will never bad mouth Barry Bonds or Roger Clemens again! (just kidding, I’ll rip them at every possible chance)

While the steroids are just a part of the treatment, they are used to reduce the size of the tumor and thus reduce the symptoms. I consider this small success to be the first really solid good news we’ve had since she woke up dizzy on Presidents Day, Monday February 21, 2011. As some Canadian guy once said, one little victory. Right?

She is going to have an operation tomorrow to put a port somewhere into her stomach. They told my father that this was for IV treatments. After that, the chemotherapy can start on Saturday. There will be three drugs administered over a 28 day cycle. She will have to be in the hospital for the Methatrexate. We’re wondering weather or not she’ll be able to receive the other drugs on an outpatient basis.

Fingers crossed.

Monday’s commute was three hours long. Today’s was only two. I got stuck behind an accident on 93, a train on North Street in Tewksbury. (it was a loooong train) At least three buses, including one that stopped in front of the school it was heading to in order to pick up the student who lived across the street. Finally, the stupid key took five minutes to get out of the stupid ignition.

My mother has her PET scan today. I think it will be starting shortly. Let’s hope the cancer hasn’t spread. They always say that its best to catch cancer early, but we have no idea if we’re early or late or what. This might give us a clue.

Of course we still don’t have the pathology results from her biopsy, so we’re not even 100% sure it is cancer. Her doctors are all saying they are pretty sure. I think the words, “90%” have been used. Also one doctor, who hopefully does not have a gambling problem, said if he were going to place a bet he would bet it was lymphoma.

Still… 10 days… we should know for sure, right? They expect the path results today.

Fingers crossed.

Maybe I should have been a doctor… hmmmm… Or a fortune teller.

I was right about two things.

The PET scan is being done to see if the cancer has spread. Also, the chemo hasn’t started yet because they are waiting on the Pathology report from the biopsy.

I figured those were the reasons, but having my father tell me that that’s what the doctors told him makes me feel smart.

What would make me feel really smart is that I say that chemo starts Friday and it actually does.

Fingers crossed.

My mother is scheduled to have a PET scan tomorrow.

What the hell is a PET scan?

I work on an application that is designed to be used by imaging techs at hospitals. When I was in training many years ago they gave us a really nice overview of how the imaging department in an average hospital works, including the different types of machines that are used. PET scans were one of the things we covered. As I said though, that was years ago and the topic has only come up once for me since then and that was unrelated to work. That was in 2006 or 2007 I think, and it was just hearing that some one was about to have one.

(I should probably add for the record that Mass General is not using the application that I work on.)

Here’s the wikipedia article on PET scans.

I think the deal is they inject a radioactive agent into the blood stream that will be metabolized by whatever area they want to look at. In this case that must be the tumor itself. The machine then builds a 3D image that not only allows you to see the affected area, but allows you to watch it work on the radioactive agent.

Here is a snippet of the wiki article:

Applications…
Oncology: PET scanning with the tracer fluorine-18 (F-18) fluorodeoxyglucose (FDG), called FDG-PET, is widely used in clinical oncology. This tracer is a glucose analog that is taken up by glucose-using cells and phosphorylated by hexokinase (whose mitochondrial form is greatly elevated in rapidly growing malignant tumours). A typical dose of FDG used in an oncological scan is 200-400 MBq for an adult human. Because the oxygen atom which is replaced by F-18 to generate FDG is required for the next step in glucose metabolism in all cells, no further reactions occur in FDG. Furthermore, most tissues (with the notable exception of liver and kidneys) cannot remove the phosphate added by hexokinase. This means that FDG is trapped in any cell which takes it up, until it decays, since phosphorylated sugars, due to their ionic charge, cannot exit from the cell. This results in intense radiolabeling of tissues with high glucose uptake, such as the brain, the liver, and most cancers. As a result, FDG-PET can be used for diagnosis, staging, and monitoring treatment of cancers, particularly in Hodgkin’s lymphoma, non-Hodgkin lymphoma, and lung cancer. Many other types of solid tumors will be found to be very highly labeled on a case-by-case basis—a fact which becomes especially useful in searching for tumor metastasis, or for recurrence after a known highly active primary tumor is removed. Because individual PET scans are more expensive than “conventional” imaging with computed tomography (CT) and magnetic resonance imaging (MRI), expansion of FDG-PET in cost-constrained health services will depend on proper health technology assessment; this problem is a difficult one because structural and functional imaging often cannot be directly compared, as they provide different information. Oncology scans using FDG make up over 90% of all PET scans in current practice.

I wonder then, are they using this to see if the cancer has spread? I guessed that that was part of the reason they did the lumbar puncture last week. I figured if there were cancerous cells in the spinal fluid then it probably meant that the cancer was spreading. That was just a layman’s guess though, I really had no idea if that was true or not. Same with this. I have no idea exactly what they will be looking at when run this on my mother tomorrow. I really don’t care either, I just want them to come back with good news. The best news being that the first dose of chemo she expects to have today kicks the living shit out of the tumor. That would be good news.

That’s a question I’ve never considered before. I always sort of assumed that Chemotherapy was a drug in and of itself. Something called Chemo that you take in a therapeutic sense when you have cancer.

But now we’re talking about specific drugs that will be given to my mother, and how they together are called Chemotherapy. I’ve also read about some other different drugs being used for different forms of cancer. So what then does the word Chemotherapy mean?

From dictionary.com:

–noun Medicine/Medical .
the treatment of disease by means of chemicals that have a specific toxic effect upon the disease-producing microorganisms or that selectively destroy cancerous tissue.
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che·mo·ther·a·py definition
Pronunciation: /-ˈther-ə-pē/
Function: n
pl -pies ; : the use of chemical agents in the treatment or control of disease or mental disorder
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chemotherapy che·mo·ther·a·py (kē’mō-thěr’ə-pē, kěm’ō-)
n.

1.

The treatment of cancer using specific chemical agents or drugs that are selectively destructive to malignant cells and tissues.
2.

The treatment of disease using chemical agents or drugs that are selectively toxic to the causative agent of the disease, such as a virus or other microorganism.
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chemotherapy (kē’mō-thěr’ə-pē) Pronunciation Key

1.

The treatment of disease, especially cancer, using drugs that are destructive to malignant cells and tissues.
2.

The treatment of disease using chemical agents or drugs that are selectively toxic to the causative agent of the disease, such as a microorganism.
_______________
chemotherapy [(kee-moh- ther -uh-pee)]

The treatment of disease with chemicals. The term chemotherapy often refers to a kind of treatment for cancer in which chemicals are administered to destroy cancer cells.

We were told the chemotherapy would start on Monday (yesterday). It did not.

Now we’re told that the chemotherapy will start tomorrow (Wednesday). I hope so. It will be Methotrexate first. Then on Friday they will give her Rituxan, which I believe is a brand name of Rituximab.

My father told me earlier that the hospital is investigating yesterday’s adventure. I don’t think I want to see anyone get into trouble over it, but I do want them all to know that they have to keep an eye on ol’ Robbie’s mom, or she’s going to head for the front door.

I am afraid of the chemotherapy. There, I said it. I know it’s going to help her. I know it. But at the same time, it’s going to be brutal. In order for her brain to get better, the rest of her body is going to have to get sicker. Potentially, much sicker. I don’t want her to have to go through that. I just wish there was something I could do.

Jen mentioned wanting to go visit tomorrow. For that to happen she needs her own doctor’s clearance, (damn flu bug) and we need some one to watch the kids. I hate the idea of missing a night with the kids, but I hate the idea of not being there for her on the night the chemo starts.

This whole situation sucks, and I’m not even the one going through it. Somehow that makes it suck even more in my book.

Fingers crossed, for as long as it takes.

I called my father when I got home last night, just to check in and see how the few hours since last I had spoken to him had gone.

He said that Mom was an adventure.

That’s not good.

They took her across the street to Mass Eye and Ear to have her eyes checked. From what I pieced together, she has a cataract forming and they wanted to have that checked out before starting the chemo. I don’t know if there could be interactions, but based on the little bit I read about the drug I think she’s going to be taking it wouldn’t surprise me.

This, again, is pieced together from a few different sources, none of whom were actual witnesses.

At some point during the exam no one was watching my mother. So she walked out. One of the things we’re seeing a lot is that she is very often believing that she will be going home soon. Dad said at one point yesterday morning she got up and started pulling out clothes to wear home. I guess she had one of those moments during the eye exam and she just left the room to head home. In her hospital johnny. With her catheter still in.

At some point, I assume a very short time later, she realized she was lost and she called my sister in law, Mary. She said she didn’t know where she was and she was scared. Mary didn’t know that Mom had gone to Mass Eye and Ear (I guess it’s just next door to Mass General. This is Boston after all. On any given street corner if you don’t see a hospital you will probably see a college) so when Mom told her she was there she thought she was confused. She called John, who knew about the eye appointment, and he called Mass Eye and Ear’s security. As security was locking the place down, some one saw her in the lobby, complete with johnny and catheter, and correctly surmised that she probably shouldn’t have been there. Eventually, they got my mother back to where she was supposed to be.

Dad called it an adventure.

Adventures suck.

This is the wikipedia article on Methotrexate, the drug I think my mother is going to start using in her chemotherapy at some point today.

Please don’t read the list of side effects, especially the breakdown by organ. Just don’t read it.

Today is going to be a scary day. My mother is supposed to be starting chemotherapy.

I have this vague notion of what that means. Basically she takes some medication that makes her feel terribly ill while killing off the cancer cells that make up the tumor. I don’t know anything more specific than that, and most of me is afraid to find out.

If I get a chance today I will try to do a little research, but again… I’m kind of afraid to.

I think the drug in question is methotrexate. I’d read that name in a few places, and I think one of the doctors said that to my brother and sister.

I’m optimistic about the results, but I’m very afraid of the process.