Week One of Treatment

This really comes in two parts. Part one is getting some more diagnostics done and the insertion of the port-a-cath while part two was the administration of the first round of chemotherapy.

On Tuesday, Tim had a series of CT scans, a bone scan, a spinal tap, and a bone marrow aspirate taken. All of this to look for any possibility of spreading of the tumor cells. The short story is all of this turned out negative. The bad side is that Tim reacts poorly to spinal taps. The previous spinal tap which was used to conduct the myelogram to look at the syrinx caused him to not be able to keep any food down for a week. In the previous case, he had a conflict of instructions to lay down but keep the head elevated so as not to let the contrast medium get to the brain. He lost some spinal fluid out the hole. This makes one dehydrated and he wasn't able to do much about it. He couldn't get fluids into his system. In the week one case, he felt a lot better the day after all the tests but in retrospect, he should have stayed on his back and let the hole heal over. He started to feel nauseous and then threw up Wednesday evening through the following day of his admission to the hospital for chemo.

The bone scan involves injecting a gamma ray emitter that finds it way into the bones so that under a radiation scanner the bones literally light up. After several minutes integrating the emissions, the machine paints an image of the skeleton. They look for really bright spots which would indicate rapid bio processes which would imply cancer cells. None were found.

The CT scans are looking for high activity and a contrast medium is used. Again, none were found. They are looking for cells in the spinal fluid and bone marrow and no cancer cells were found there.

The port-a-cath also got inserted. This device provides a direct line into the jugular vein which then can be accessed via a needle poke through the skin and into the device. It is located on the upper chest and avoids having to establish IV lines each time drugs need to be administered. There is also a cream that gets applied about an hour before use that numbs the area so he doesn't even really feel the needle poke. The only bad thing is that they have to flush the system out and use heparin and saline to do that which causes a metallic taste in the mouth.

So on to part two. He got admitted on Thursday for chemo and also to make him comfortable by getting fluids pumped in and getting anti-nausea drugs.

This helped a lot and he was able to eat some while in the hospital. But, when we got home Friday night, he was back to being nauseous and essentially wasn't able to eat or drink anything for the weekend. This was pretty bleak and initially we could not really tell if the nausea was from the spinal tap or the chemo. In the end we think it was the spinal tap and so we'll wait for the next chemo admission to see what happens.

The protocol he is on includes three chemo drugs administered on weeks 1, 4, 7, and 10 with one of those drugs administered on weeks 2, 3, 5, 6, 8, and 9. This pattern then changes on week 11 if he stays in the clinical trial. One of the two additional drugs adminsitered every three weeks is the nasty one and the subject of the clinical trail. Not being on the trail, this drug continues to be administered every three weeks. We'll have to see his reaction and go from there.

The reason for the hospital admission is also to allow the introduction of massive amounts of fluid to keep the one nasty chemo drug from affecting the bladder lining. As a result, Tim has to get up every 90 minutes or so to pee and that has to be measured and tested each time. They end up looking for blood in the urine and finding none after 24 hours or so, they let him come home.

Anti-nausea drugs are still needed at this point and the ones they use now-a-days are really a seratonin blocker. The stomach says throw up, but the brain doesn't get the signal. There are a number of them and like meds for migraines one has to find the right one that works for the individual. Because we were dealing with the spinal tap issues, we're not sure at this point what drug works or not. Again, we'll find out on week 4.

--bob