We now have the results of the abdominal ultrasound and the echo.
The good news is that her echo (the test they did on her heart) is good – based on my understanding of reading the dictation and from what Musgrave said this morning. The pericardial effusion is minimal and nothing they’re worried about.
ECG summary for any cardio folks reading this:
Normal left ventricular cavity size.
Normal left ventricular systolic function.
Ejection Fraction = 55% (55 and up is considered normal).
The right ventricle is normal in size and function.
Mildly dilated left atrium.
Right ventricular systolic pressure is 30-35 mm Hg.*
Normal diastolic function.
Trivial to small predominantly posterior pericardial effusion of no apparent adverse hemodynamic effect.
Large left pleural effusion. (Lungs)
* She is dealing with some high blood pressure, but Dr. Musgrave said it’s not at a point where she’s worried about it yet, and she doesn’t want to add in any other drugs at this point which may alter Teresa’s kidney values. This is also why she does not want to start Teresa on HCTZ or Lasix (yet).
The bad news:
The chemo didn’t work. At all.
The tumor is growing.
After surgery but before chemo, the tumor was 11cm by 5.6cm by ? (not sure what the 3rd number was, aka 4.3″ x 2.2″). As of today, it is about 16.3 cm x 8.1cm by 16.4cm (aka 6.4″ x 3.18″ x 6.45″). THIS is what the CT called “massive”.
The pleural effusion is large, and Teresa is going to have an ultrasound-guided thoracentesis (pleural tap) to see if she has malignant ascites or if the fluid (which is in other places too) is just buildup from the Gemzar, or maybe something Thyroid related. (We didn’t have time to discuss the TSH panel, and Dr. Musgrave ordered numerous tests today. She wanted Teresa to get over to the hospital to get another unit of blood ASAP.)
Thoracentesis: using a needle to remove fluid from the pleural space for testing
Malignant ascites is bad news. It is a grave prognostic sign. Possibly worse than the prognosis for the leiomyosarcoma.
I don’t know if we’ll know anything about the results until next Tuesday when she has her next appointment with Dr. Musgrave.
If Teresa has malignant ascites, she will no longer be a candidate for surgery — mostly. Dr. Musgrave said they may be able to do palliative surgery, but there will be no way to cure/put her in remission with surgery in this situation.
So really, really, really, really hoping that this is a test we will receive good news for. She will have this procedure done around 7:30am this coming Thursday.
————————————
These are the other things that were ordered today, in addition to the thoracentesis:
Bilirubin, Direct
CBC Oncology (standard test ordered)
Cell Count and Diff, Pleural Fluid
CMP with Estimated GFR (standard test ordered)
CSF Culture with Gram Stain and Sensitivity (Don’t know when/where this is being done.)
Direct Antiglobulin Test (DAT)
Glucose
Haptoglobin
Lactate Dehydrogenase (LDH) * 2
Non-Gynecologic Cytology (Can anyone define this one? Tried to research, just got lab codes back.)
Dr. Musgrave did mention again that the gemzar may be causing HUS (see previous post for info) and that at this point, especially with Teresa’s creatinine continuing to go up, and her kidney function number continuing to go down, it would not be smart to let her have any further Gemzar.
She’ll use this and next week’s labs to see if there are continued signs of hemolysis so she can decide what to do about that.
The next regimen she is proposing for Teresa is Doxorubcin + Olaratumab. I’ve provided links to both so that you can check them out if you want to do so.
Doxorubicin can have severe cardiac side effects. It can cause dilated cardiomyopathy which can lead to congestive heart failure. If she does this, it is likely she will have many ECGs to monitor her heart. Due to this, and other side effects, and because the chemo itself is apparently red, it has been nicknamed, “red devil” and “red death”.
It also puts you at risk, even up to years later, of developing blood cancers such as leukemia.
And the risks go on.
Both drugs are more likely to cause pain (muscle and skeletal), low WBC and RBC values, nausea, vomiting, hair loss.
These are clearly both MUCH stronger than Gem/Tax.
Dr. Musgrave told she has a patient on it now who had a very large abdominal tumor and after a few treatments was able to clearly see it was decreasing in size.
If it works, hopefully unlike gemzar, the benefits will outweigh the risks.
IF she ends up on this regimen. Her current kidney issues may make it a no go from a few things I’ve read about these two drugs.
Dr. Musgrave is going to consult with Memorial Sloan Kettering first. I don’t know for certain, but it sort of sounded like if Teresa CAN have another surgery, that she might be sent to MSKCC for the operation. The doctor she first saw would be great — he’s the Chief of the Gynecology Service, a surgical oncologist, and, as I mentioned many posts ago when we first went, clearly an intelligent and innovative doctor. And he showed us that he’s very caring and personable.
Subject: Test Results & Protocol Changes We now have the results of the abdominal ultrasound and the echo.
The good news is that her echo is good – based on my understanding of reading the dictation and from what Musgrave said this morning. The pericardial effusion is minimal and nothing they’re worried about.
ECG summary:
Normal left ventricular cavity size.
Normal left ventricular systolic function.
Ejection Fraction = 55% (55 and up is considered normal).
The right ventricle is normal in size and function.
Mildly dilated left atrium.
Right ventricular systolic pressure is 30-35 mm Hg.*
Normal diastolic function.
Trivial to small predominantly posterior pericardial effusion of no apparent adverse hemodynamic effect.
Large left pleural effusion. (Lungs)
* She is dealing with some high blood pressure, but Dr. Musgrave said it’s not at a point she’s worried about it yet, and she doesn’t want to add in any other drugs at this point which may alter Teresa’s kidney values. This is also why she does not want to start Teresa on HCTZ or Lasix (yet).
The bad news:
The chemo didn’t work. At all.
The tumor is growing.
Before chemo it was 11cm by 5.6cm by ? (not sure what the 3rd number was). As of today, it is about 16.3 cm x 18.1cm by 16.4cm. THIS is what the CT called “massive”.
The pleural effusion is large, and Teresa is going to have an ultrasound-guided thoracentesis (pleural tap) to see if Teresa has malignant ascites or if the fluid (which is in other places too) is just buildup from the Gemzar, or maybe something Thyroid related. (We didn’t have time to discuss the TSH panel, and Dr. Musgrave ordered numerous tests today. She wanted Teresa to get over to the hospital to get another unit of blood ASAP.)
Malignant ascites is bad news. It is a grave prognostic sign. Possibly worse than the prognosis for the leiomyosarcoma.
I don’t know if we’ll know anything about the results until next Tuesday when she has her next appointment with Dr. Musgrave.
If Teresa has malignant ascites, she will no longer be a candidate for surgery — mostly. Dr. Musgrave said they may be able to do palliative surgery, but there will be no way to cure/put her in remission with surgery in this situation.
So really, really, really, really hoping that this is a test we will receive good news for. She will have this procedure done around 7:30am this coming Thursday.
————————————
These are the other things that were ordered today, in addition to the thoracentesis:
Bilirubin, Direct
CBC Oncology (standard test ordered)
Cell Count and Diff, Pleural Fluid
CMP with Estimated GFR (standard test ordered)
CSF Culture with Gram Stain and Sensitivity (Don’t know when/where this is being done.)
Direct Antiglobulin Test (DAT)
Glucose
Haptoglobin
Lactate Dehydrogenase (LDH) * 2
Non-Gynecologic Cytology (Can anyone define this one? Tried to research, just got lab codes back.)
Dr. Musgrave did mention again that the gemzar may be causing HUS (see previous post for info) and that at this point, especially with Teresa’s creatinine continuing to go up, and her kidney function number continuing to go down, it would not be smart to let her have any further Gemzar.
She’ll use this and next week’s labs to see if there are continued signs of hemolysis so she can decide what to do about that.
The next regimen she is proposing for Teresa is Doxorubcin + Olaratumab. I’ve provided links to both so that you can check them out if you want to do so.
Doxorubicin can have severe cardiac side effects. It can cause dilated cardiomyopathy which can lead to congestive heart failure. If she does this, it is likely she will have many ECGs to monitor her heart. Due to this, and other side effects, and because the chemo itself is apparently red, it has been nicknamed, “red devil” and “red death”.
It also puts you at risk, even up to years later, of developing blood cancers such as leukemia.
And the risks go on.
Both drugs are more likely to cause pain (muscle and skeletal), low WBC and RBC values, nausea, vomiting, hair loss, mouth sores, etc.
These are clearly both MUCH stronger than Gem/Tax.
Dr. Musgrave told us she has a patient on it now who had a very large abdominal tumor and after a few treatments was able to clearly see it was decreasing in size.
If it works, hopefully unlike gemzar, the benefits will outweigh the risks.
IF she ends up on this regimen. Her current kidney issues may make it a no go from a few things I’ve read about these two drugs.
Dr. Musgrave is going to consult with Memorial Sloan Kettering first. I don’t know for certain, but it sort of sounded like if Teresa CAN have another surgery, that she might be sent to MSKCC for the operation. The doctor she first saw would be great — he’s the Chief of the Gynecology Service, a surgical oncologist, and, as I mentioned many posts ago when we first went, clearly an intelligent and innovative doctor. And he showed us that he’s very caring and personable.
She’s also, at my request, going to ask them to send a slide to be tested for generic mutations to see if there’s any targeted drug therapy which will work for Teresa.
Summary:
- Heart Good
- Lungs – lots of fluid, will be tapped on Thursday morning to see if it’s malignant (cancerous) or not — hope, hope, hope it’s not.
- Chemo – didn’t work and caused additional problems.
- Tumor – got bigger.
- Surgery – depends on fluid tap.
- New chemo – we have potential regimen but will depend on consultation with MSKCC. And in the meantime, I’m going to see if I can get another opinion from another hospital.