Roller Coaster

This week was a long roller coaster with lots of twists, lots of turns and lots of nauseating moments.

On Tuesday, we met with Mike's oncologist, Dr. Flaherty, to discuss the news and our options. Dr. Flaherty went over the scan results, and though we already knew most of what he said, he went over everything again. True to form, I asked a ton of questions. Here are the basics: the brain MRI shows 4 to 5 lesions on the brain lining. Most of the lesions are very small with the exception of one slightly larger spot. Aside from the spots on the brain lining, the scans also show a few enlarged/diseased lymph nodes deep in the abdomen and chest.

The big concern right now is to treat the spots on the brain. Dr. Flaherty will be setting us up with a radiation oncologist at Penn to discuss possibility of brain radiation. There are two possibilities: (1) RadioSurgery/Gamma Knife, which is very high dose radiation to a targeted area. It is less invasive and it is just one day of treatment. To put it in basic terms, they zap the tumors with the radiation; or (2) Whole Brain Radiation, which is radiation to the whole head. It is a lot more difficult to tolerate and has many more side effects. The treatments will be over a few weeks.

We have no idea if Mike would be a candidate for Gamma Knife, but if he is, we are pretty sure that's the way we would want to go. Gotta keep our fingers crossed!

Using my great begging skills, I managed to get us an appointment with a famous neurosurgeon at NYU on Wednesday. We had four hours to get ready, get Penn to put Mike's scans on a CD on very short notice, which was another Herculean begging project, and get to NY. But we did it. We met with Dr. Kelly at NYU early in the afternoon. Unfortunately, the CDs that we got from Penn were of poor quality, and Dr. Kelly could not really offer us meaningful advice. Based on Dr. Kelly's review of the written reports, he did tell us that he did not think Mike would be a candidate for RadioSurgery/Gamma Knife. Another big blow. We had our hearts set on that. Dr. Kelly did tell us that Penn's radiation oncology and neurosurgery departments are top-notch, and we should feel comfortable staying there.

While the appointment at NYU did not go completely as we had hoped, the trip was not a complete waste. We walked around Fifth Ave. for a bit, bought some fun bath products, ate dinner, and used the train ride home for much needed naps!

Turns out that Dr. Kelly was right. On Friday, we met with the radiation oncologist, Dr. Lustig, at Penn. Mike is definitely not a candidate for RadioSurgery/Gamma Knife because the spots on Mike's brain lining are too small, and the disease is diffuse. So it just makes no sense to radiate a small part of the brain; instead, Mike will undergo Whole Brain Radiation (daily radiation to the whole head). The treatment will be 15 sessions, five days a week. The side effects are fatigue, possible loss of short-term memory (which actually should return with time), confusion and, of course, hair loss. Despite what I expected, Dr. Lustig was actually somewhat optimistic that the radiation could help shrink or stabilize the lesions.

Mike was also started on a high-dose steroid called Decadron to help with the radiation-induced swelling, and also reduce the headaches that Mike has been having. Decadron is a very strong steroid, which will make Mike very hungry, grumpy and wired. Dr. Lustig joked that we might need to lock the fridge!

Later that evening, Mike and I were sitting on our stairs talking. Mike looked at me and said: "Lizzy, I want you to know that I do not lose fights. I have never lost a fight, and I am not ready to lose this one. I am not scared of this radiation. I am ready. I know it will work for me. I know it in my heart. We will kick Melanoma's ass." Throughout our battle with this cancer, I have always admired Mike's unequivocal courage, unshakable strength, unbending optimism and incredible positive attitude. On this particular Friday night, I worshiped him for it.