Diagnosis & First Steps

Mom has had a persistent cough for a couple of months. She went for xrays at Buckland Hills Imaging a few weeks ago and then, on Nov 11, she had a CAT Scan done at the same place. Her pulminary specialist, Dr. Girardi sent her for a bronchoscopy on 11/21 and on Wednesday Nov 23, the day before Thanksgiving, he called her to ask her to come in for the results. She insisted on hearing it over the phone, at which point he told her the tumor was malignant. They scheduled an appointment for the day after the holiday.

Rebecca and I brought her in for the appointment, armed with some questions from WebMD that cousin Henry had emailed. Having three of us there allowed us each to deal with the emotional aspects of the news while still getting as much information as we could. I tried to take detailed notes, as I will continue to try to do, and will share the information here so friends and family can keep up to date with what is going on.

Dr Girardi was guarded in teh information he shared at first, nioting that hwe was not trying to be evasive. Rebecca let him know that whether he was trying to or not, indeed he was being evasive. Part of the issue was that he did not have all the answers, and part of teh issue appeared to be his desire not to hit us with too much bad news at once.

The Dr. noted that we will know much more after an MRI and a PET scan, which will show if and to where the cancer has spread. Both are scheduled during the coming week. Dr. Girardi informed us that Mom's lung cancer was probably an adino carcinoma in a more advanced stage. Given the size and location, he suggested that it was most likely not operable and chemotherapy would be the probable treatment.

He continued by showing us the X-rays and CAT scans. The tumor is 4-5 centimeters (1.5-2 inches) in diameter and is against the left wall of her right lung, pressing up against the bronchial tube. He noted the cancer is probably in stage 3, indicating his still unconfirmed belief that teh cancer has left teh lung and entered the lymph nodes as well.

The compression of the bronchial tube by the tumor is the cause of her cough. Thus, while he gave her some cough medicine, it is clear the only way to alleviate the cough will be to reduce the size of the tumor.

Dr. Girardi noted that the he thought the goal of the chemotherpay would be to shrink the size of the tumor. Given Mom's parkinsons disease, he did not believe that radiaton therapy would be combined with the chemo. He did not believe it could be eliminated. His prescription for now and throughout her treatments is threefold:

1. Eat well
2. Get plenty of rest
3. Be as active as possible.

Although he suggested that it might be better not to go to Florida, and to stay in CT where Phil, Beck, and I can see her more often and provide support, after much discussion Mom decided that going to Florida will probably be the best plan. It will allow her to exercise and to get out when she is able to do so. In Florida she will have the best support system, with Mort far enough away from his buusiness that he won't feel compelled to work, her sister, Sis, living in the same complex, and Mort's niece, Nehama, living nearby. Since Phil and I are working out of our homes, we will be able to spend a week or so at a time in Florida as needed as well.

The current plan is to see an oncologist and get a second opinion in Boston, New Haven, or NY before going to Florida and starting treatment.

So the first step, other than the two tests scheduled for this week, will be to settle on the appropriate oncologist. Dr. Girardi noted that mom's physician usually refers to Dr. Joel Silver.

My doctor friend in NY, Paula, suggested that the main purpose of a consult at Sloan Kettering would be to see if there were any appropriate clinical trials for mom to participate in as well as to review any recommended course of treatment. She noted that Yale would be a much more convenient place, provide the same high standard of care, and that they might possibly be doing the same or similar trials. I have a call in to friend, Dr. Sherwin Nuland, to see who he recommends as the best oncologist in New Haven.

Cousin Michael Yaffe, and his wife Sung Yun are both cancer speicalists in Boston. They happened to be in Farmington, CT visiting Sun Yin's parents for the holiday weekend and were kind enough to stop by Phil's house on Sunday. The next post will detail their comments.