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Summary as of January 10, 2009
Sandy has been diagnosed with stage IV metastatic cancer in the bone. It appeared in some of the thoracic and lumbar vertebrae. Fortunately the cancer is not seen anywhere else in her body. She will start daily radiation therapy on January 15th. She will also be starting chemotherapy at a date to be determined following a deep bone biopsy on January 14th. Following a series of medical exams, CT scans, MRIs, blood chemistry tests and consultation with a number of physicians, Sandy is very optimistic and confident that this latest medical setback can be managed successfully for a long time.
On December 29th Sandy went to see her Primary Care Physician complaining of back pain extending from her lower back down her left leg with additional discomfort in the middle of her back extending upward into the neck region. After an exam and a thorough review of her medical history, the Doctor ordered an MRI for January 5th. That same evening the Doctor personally called with the results of the MRI that he “didn’t like the looks of”. He described what he thought to be metastatic lesions at the 11th Thoracic (T11) and 5th Lumber (L5) vertebrae resulting in mild compression and deformation of the vertebrae to the extent of impingement on adjacent nerves which likely was the cause of her pain and discomfort. Dr. Timmerman immediately ordered the first of what was to become a long series of tests, examinations and consultations.
On January 6th Sandy was seen in the office of a Neurosurgeon at Methodist Hospital. This was a consultation to gather health history and talk about possible surgical treatment depending on the diagnosis. (It was concluded from the results of subsequent testing that neurosurgical treatment would not be a viable option.)
On January 8th Sandy had CT scans of the lumbar, chest, abdomen and pelvis regions. These scans show no evidence of pathological processes in the chest, abdomen or pelvis but did correlate to the MRI done on January 5th showing a bony metastatic disease. Specifically, these CT scans show metastatic disease to the T11 and M5 vertebrae with at least mild compression of both of them and slight anterolisthesis of L4 upon L5. Also seen is a slightly inhomogeneous appearance of some of the remainder of the lumbar vertebral bodies likely reflecting additional metastatic disease. No definite soft-tissue metastases are seen to the chest, abdomen or pelvis.
On the morning of January 9th Sandy met with the Medical Oncologist at which time he explained the findings of the MRI and CT scans and presented possible radiation and chemotherapy treatment modes going forward. The Oncologist also ordered another MRI which was done the same morning in advance of a second meeting with the Radiation Oncologist early that afternoon. The results of the second MRI revealed no new surprises.
On the afternoon of January 9th, Sandy met with the Radiation Oncologist at which time he collected additional medical history, presented the plan for radiation therapy and answered questions about her disease etiology, diagnostic techniques, interpretation of diagnostic imaging, treatment objectives, treatment duration, expected treatment outcome and medications that would be available to prevent or minimize side effects of radiation. The Doctor expressed a high degree of confidence that radiation therapy would effectively destroy the cancer cells in the vertebrae and eliminate her pain. This echoed the prognosis made earlier by the Medical Oncologist. The Radiation Therapy Nurses spent considerable time with Sandy collecting detailed personal and medical information, explaining the radiation therapy process, touring the facilities, completing radiation planning and body marking, and walking her through a simulated treatment cycle.
Sandy is scheduled for a deep bone biopsy on January 14th. Biopsy results will be reviewed with the Oncologists to make any needed adjustments in radiation therapy and to devise a plan for chemotherapy. In the interim Sandy will decide whether or not to seek a second opinion on any aspect of the diagnosis or prescribed treatments.
As she heads into the last phase of diagnostics and into the initial treatment phase, Sandy has a very positive attitude, expresses confidence in her health care providers, and is optimistic about treatment success and long-term survival.