At least the bone marrow seems to be functioning OK now, whereas that was the problem earlier. All blood counts are normal except for mild anemia with hemoglobin of 10.6 g/dl. And all of this in the face of an absolutely normal CT scan recently except for the bone metastases. Clearly, this cancer is not imaged by CT except for the metastases in the bone. Why, when everything seemed to be going well, is the liver having problems? Sally is not taking many medications but even these few are being stopped in case they are contributing to the problem. It's not clear what the next steps will be. We will discuss with Dr. Conlon on Monday.
Thursday, April 22, 2010
I wish I could be more upbeat
This is a tough time for darling Sally. There are a lot of problems and it doesn't all make sense yet. First, the fluid in her abdomen was drained (1700 cc) and fluid in her left chest (pleural cavity) was drained 300 cc. Sally felt better for about 16 hours but the fluid reaccumulated and she is back to not being able to eat much and feeling miserable. We do not have the cytology on the fluids yet. Second, her liver function is deteriorating with abnormal enzymes, a bilirubin of 2.7 mg/dl, and a prothrombin time (INR) of 1.5. A Doppler ultrasound of her portal and hepatic venous systems does not suggest any thrombosis in those vessels. I know this won't make too much sense to many of you, but for the medical people following this, I thought I would put it in. Third, her serum sodium has been falling and is now very low at 117 mEq/L with a normal about 135. The reason for this is obscure. Renal function is normal. It may be related to the liver or an effect of the cancer (a paraneoplastic syndrome), but his would be rare for breast cancer, I think.
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Hello Sir... You seem like such a fine man, such a devoted husband, so I feel compelled to leave this note. I apologize, I don't have time at the moment to write a long, detailed explanation, but trust me when I tell you that at this point, with those symptoms, it would be best for you to take your wife to MD Anderson Cancer Center, or another "NCI-designated comprehensive cancer center" -- at least for a consultation. I think I saw that you live in the Houston area, so MD Anderson Cancer Center at the Univ of Texas in Houston is near you. Perhaps you have already tried to get in there... if so, then try again, via another department there. If in the past you attempted to get in through the breast cancer department and it didn't happen for some reason, then I recommend that you now try to get in through the liver/ gastrointestinal department -- which is actually appropriate now, since you are trying to determine what is going on with the LIVER and abdominal ascites. (They will take you in through the liver department if you make it clear that it is URGENT and the cause of the liver issue is UNknown -- in other words, that it might be due to some other cause -- maybe even some other cancer, like maybe metastasis from colon cancer? -- other than the breast cancer. Because if they are told that it is due to the breast cancer, then they will say that you have to get in through the breast cancer department there. So you need to make it clear that you need to get in through the liver department because you need their expertise to detective what is causing the liver issue. That is how we got in there.) We traveled thousands of miles from another state to get guidance from MD Anderson for my Mom, and it turned out to be DEFINITELY worth it. Ideally, try to see Dr. Curley in the liver/GI department, or Dr. Buzdar in the breast cancer department... but most important, just try to get in there, to see any doctor at M.D. Anderson. They have been the top-ranked cancer center in the nation for many years. At this point you need to err on the side of caution -- so even if you thoroughly trust your "Dr. Conlon," you need to get a second opinion from an NCI-designated comprehensive cancer center. (The list is on the National Cancer Institute's website. MD Anderson is probably the one that is closest to where you live.) Best wishes!
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