Monday, 5:30 pm:
My parents visited N's primary surgeon, Dr P, who was slightly defensive and shocked at the spread. Ultracet has been replaced by a 25 microgram patch of Fentanyl, an opioid analgesic which is 80 times more potent than morphine, but is safer overall. The dosage, of course, has been titrated taking the potency into consideration. The prescription involved a lot of paperwork. Dr P suggested we speak with an oncologist to plan N's treatment. My mother opted out as she was very overwhelmed.
Monday, 8:30 pm:
My father and I met the oncologist. Unlike Dr P, she was not dismissive of chemotherapy (GemCarbo treatment), pointing out that N has fought her way through a major surgery with relative ease in spite of advanced cancer but underlining the fact that the therapy would, considering her age, be fraught with risk. Asked her about immunotherapy and targeted therapeutics. While aware of them, Dr S stated that her experience with these therapies were limited and mostly theoretical. However, she did acknowledge that they could be a viable alternative for N. Dr S prescribed tests to check the spread of the cancer (CT scan of the lungs, scheduled for tomorrow) as well as some blood work to exclude/confirm infection as a cause for elevated WBC levels.
Most of our questions remained unaddressed. Dr S understandably pointed out that most of them could be answered only after seeing N in person. The meeting with N is scheduled for tomorrow at 6:45 pm to evaluate whether N could be a potential candidate for chemotherapy or whether we would have to limit ourselves to alternatives/palliative care. Dr S was, surprisingly enough, more optimistic than myself on looking at the reports, though we'll wait and watch.
Tuesday
My mother maintains that she will not subject N to chemotherapy and has sourced homeopathic medicines from Delhi. I am uncomfortable giving N medicines whose constituents I am unaware of. Some may argue that homeopathic medicines are nothing but water (or whatever carrier), but I think that homeopaths in India don't really follow homeopathy as in the West, but use higher concentrations. While this may be a good thing therapeutically, I'd be more comfortable with water, as at least then, I'd be sure that nothing interacts with what she is having. Homeopaths are generally very secretive about their treatments as they compound their own formulations and that annoys me. I am tempted to send the medicine for chromatographic analysis.
Good news:
A lot of relatives came to visit N. She was very heartened and spoke at length after a long, long time. Her appetite remains poor though and she absolutely refuses solid food, though she confesses that she enjoys the smell of cooking. I think I'll buy a few books to keep N entertained. She is partial to Gulshan Nanda, though she absolutely loved Yashpal's Jhootha Sach.
Also, an update:
Have received a reply from Roche. It seems that Tecentriq is not available in India and that there are no trials of the drug underway here, either. They did refer me to an international pharmacy in Geneva, however, and listed out the protocol for importing the drug to India. Will do so if affordable.
Have not started N on any treatment (conventional or otherwise) so far, except palliative. Will have to make a decision in a few days along with N, who has been told very little of the metastasis. This makes me uncomfortable as well. If I were in her position, I'd like to know. Will need a way to break it gently, soon. I can only imagine the emotional turmoil it will cause her; after all, it devastated us when we heard. Came across a very promising article on chemotherapies in advanced bladder cancer to help us choose and understand.
7:42 pm:
Test reports out:
Creatinine: High (1.22)
Liver function tests: Normal
CRP: High (101.2)
Procalcitonin results awaited, expected 24th September.
This may mean that CT scan may need to be rescheduled...will have to modify diet (especially protein intake) as well. Will contact physician for input. Will a diuretic be started? Her feet did seem slightly swollen...
My parents visited N's primary surgeon, Dr P, who was slightly defensive and shocked at the spread. Ultracet has been replaced by a 25 microgram patch of Fentanyl, an opioid analgesic which is 80 times more potent than morphine, but is safer overall. The dosage, of course, has been titrated taking the potency into consideration. The prescription involved a lot of paperwork. Dr P suggested we speak with an oncologist to plan N's treatment. My mother opted out as she was very overwhelmed.
Monday, 8:30 pm:
My father and I met the oncologist. Unlike Dr P, she was not dismissive of chemotherapy (GemCarbo treatment), pointing out that N has fought her way through a major surgery with relative ease in spite of advanced cancer but underlining the fact that the therapy would, considering her age, be fraught with risk. Asked her about immunotherapy and targeted therapeutics. While aware of them, Dr S stated that her experience with these therapies were limited and mostly theoretical. However, she did acknowledge that they could be a viable alternative for N. Dr S prescribed tests to check the spread of the cancer (CT scan of the lungs, scheduled for tomorrow) as well as some blood work to exclude/confirm infection as a cause for elevated WBC levels.
Most of our questions remained unaddressed. Dr S understandably pointed out that most of them could be answered only after seeing N in person. The meeting with N is scheduled for tomorrow at 6:45 pm to evaluate whether N could be a potential candidate for chemotherapy or whether we would have to limit ourselves to alternatives/palliative care. Dr S was, surprisingly enough, more optimistic than myself on looking at the reports, though we'll wait and watch.
Tuesday
My mother maintains that she will not subject N to chemotherapy and has sourced homeopathic medicines from Delhi. I am uncomfortable giving N medicines whose constituents I am unaware of. Some may argue that homeopathic medicines are nothing but water (or whatever carrier), but I think that homeopaths in India don't really follow homeopathy as in the West, but use higher concentrations. While this may be a good thing therapeutically, I'd be more comfortable with water, as at least then, I'd be sure that nothing interacts with what she is having. Homeopaths are generally very secretive about their treatments as they compound their own formulations and that annoys me. I am tempted to send the medicine for chromatographic analysis.
Good news:
A lot of relatives came to visit N. She was very heartened and spoke at length after a long, long time. Her appetite remains poor though and she absolutely refuses solid food, though she confesses that she enjoys the smell of cooking. I think I'll buy a few books to keep N entertained. She is partial to Gulshan Nanda, though she absolutely loved Yashpal's Jhootha Sach.
Also, an update:
Have received a reply from Roche. It seems that Tecentriq is not available in India and that there are no trials of the drug underway here, either. They did refer me to an international pharmacy in Geneva, however, and listed out the protocol for importing the drug to India. Will do so if affordable.
Have not started N on any treatment (conventional or otherwise) so far, except palliative. Will have to make a decision in a few days along with N, who has been told very little of the metastasis. This makes me uncomfortable as well. If I were in her position, I'd like to know. Will need a way to break it gently, soon. I can only imagine the emotional turmoil it will cause her; after all, it devastated us when we heard. Came across a very promising article on chemotherapies in advanced bladder cancer to help us choose and understand.
7:42 pm:
Test reports out:
Creatinine: High (1.22)
Liver function tests: Normal
CRP: High (101.2)
Procalcitonin results awaited, expected 24th September.
This may mean that CT scan may need to be rescheduled...will have to modify diet (especially protein intake) as well. Will contact physician for input. Will a diuretic be started? Her feet did seem slightly swollen...
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