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Clinical Update as of April 29, 2012
On May 24, 2010, Jane and I returned from a fantastic ten days in Tuscany thanks to the hospitality of Luigi Migliorini. On May 26 I visited Boston Medical Center (BMC) as I had a persistent postnasal drip, what felt like blocked Eustachian tubes and a cough. Nothing remarkable was found but, as I was due to leave for Lesotho in a few days, the otolaryngology resident thought a chest film would be a good idea because of the cough. It was. That evening he called and said there was a lesion in my right upper lobe. Dr. Brian Jack, a friend, colleague and my new primary care doc, arranged a CT scan the next day. I saw Dr. Benedict Daly, chief of thoracic surgery the day after. A PET scan was negative and I had countless other tests. After a two day trip to Nigeria I returned for a lobectomy at BMC on June 18, was discharged on June 25 and had a quiet birthday dinner with Jane at a local restaurant on June 26. I am fully recovered from the surgery. Interestingly the cough was gone well before surgery and it was due to postnasal drip. Without the cough who knows how much longer I would have gone undiagnosed with ever decreasing odds for long-term survival.
When the pathology report came in, the tumor was just large enough with some involvement of the visceral pleura to make the case for adjuvant chemotherapy (Carboplatin & Taxol). The lymph nodes were all negative.
Kidney stones, found in my left kidney during my pre-op workup, were pulverized and removed with a laser on August 4 by Dr. Richard Babayan.
For those with a technical interest the path report showed: Adenocarcinoma, 3.2 cm, the tumor shows focal bronchioloalveolar and a minor papillary component. Histologic Grade: G1: Well differentiated. Visceral Pleura Invasion: present. AJCC Pathologic Staging IB (pT2a, pNo, pMo)
As the course of chemotherapy is very unpredictable, fatigue is certain and meaningful intellectual work is likely to be somewhere between difficult and impossible, I took disability leave through mid-December and did not tavel oveseas until March 2011.
Several bouts of pnemonia in 2011 led to a sinus CT scan and the edge of the scan showed smething suspicious in the brain. A supercial, small mass just to the left of mid-line between the parietal and ocicpatal lobes was idneiifed on Nov. 10, 2011. A PET scan was positive for the rt. acetblum which also showed an undispaced pathologic fracture, a small lesion at T-11 and the probable brain metastasis. Tumor in the hip was confirmed by biopsy. The brain met was treated by Cyberknife followed by 5 days of radiation to theigth hip and the Cyberkife again. This time for T-11. The cyberknife is nothing short of amazing.
In the 2nd week of January the plan was to resume chemo with carboplatin and pemetrexed (Aliimta). This failed. Patholigc fracture rt. acetabulum injcected with bone cement at MGH with a good result. Subsequently witched to Tarceva. Cerebral Leptomeningeal spread detected April 16, cord negative. Suspended Tarceva, on dexamethasone and ibuprofrefen. 10 business days of whole brsin irradiation ends May 8. I am symptom free except for mild, right, upper-medial, thigh pain.