More Tests

After more dealings with another annoying medical office, including a receptionist who did not know that scheduling these tests was urgent, Mom's schedule this week includes:

1. meeting with the Radio Oncologist on Tuesday 12/20
2. Another PET Scan on Wednesday 12/21
3. Bonescan on Thursday 12/22

Then next week, while Dr. Koletsky is on vacation, Mom is supposed to meet with his nurse with whom he will be in contact. Supposedly she might possibly start treatments then.

I left a message for Dr. Koletsky and he called me back so I could clarify what the protocol will be, since he will be out of town.

He called me back and told me that he would be making his recommendations regarding the Chemo and the Radio Oncologist who would create a plan that incorporates radiation. He said test have shown that a combination of the two, dual therapy, works better than doing them in tandem.

Most likely therapy will be at lower doses but more often, meaning three days per week, rather than one week in three. The goal is to use as high doses as possible without side effects. I asked how sever side-effects would be and he noted that they now prescribe drugs to keep the nausea of the chemo in check. Ultimately though everyone reacts differently and mom will be monitored regularly.

Radiation too might have side effects. The nurse will go over all of it with Mom on Tuesday.

He suggested radiation would probably start on Monday, rather than Friday followed by two days off. Thus possible radiation on Monday and an appointment with Koletsky's top assistant on Tuesday as well radiation and again on Wednesday.

Again, this is all dependent on the PET scan results and the bone scan results which won't be in until Thurs or Fri.

That's it or now. Now we wait. Again.

Joshua

Oncologist in Florida

Mom is at Dr. Koletsky's office right now. The Dr. just called me to update me on their discussion. Basically, he will order a bone scan and an additional PET scan (if insurance will pay for it) and reveiw them with a radio-therapist and create a treatment plan by next week. Treatments will also start next week (he goes on vacation the following week.)

He reiterated the two areas of concern were the tumor in the lung as well as the hip area.

He suggested that the treatment would most likely be radiation with a mild dose of chemo, but the additional tests and consultation will dictate the exact plan.

PET Scan report & First Visit to an Oncologist

Phil drove Mom to New Haven and I met them at Dr. Sam Bobrow's office at The Father McGiverny Cancer Center at St. Raphael's Hospital.

After much additional wrangling with Dr Gerardi's assistant, Dr. Bobrow's office managed to get her to send the PET Scan report. Dr Bobrow interpreted the report for us.

He noted that the scan confirmed that Mom has Non small cell lung cancer, advanced stage IIIA, which means that it has spread outside the lung into the lymph nodes. There may be two additional areas of concern, in which case it would be a Stage IIIB.

In addition to the large mass in her lung and adjacent lymph nodes, the PET scan indicated there may be additional tumors in the lower posterior pelvis, but it is uncertain whether it is in the left sacroiliac area or whether it is in the lymph nodes immediately adjacent to the bone. Additionally, the report notes that there is a second area in the left hip region, most likely in the bone. The other area is in the lymph nodes is in the right supraclavicular, which appeared to be the collarbone area.

The Dr. emphasized that the only way to tell whether the cancer was in the bone was with an additional bone scan that her Dr. in Florida would order. Which brings us to Florida.

Dr. Bobrow suggested she get going and see an oncologist there. The Florida oncologist will determine treatment and when she returns in the Spring, we can deal with transferring primary care up here. Mom had the name of one oncologist, Dr Koletsky, in Boca and Dr. bobrow gave us the name of Dr. Neil Friedman, in Lake Worth (561-439-4682).

He knows and recommended them both, since they both spent time at Yale. Today, Mom called Koletsky and with Dr. Bobrow's help, made an appointment to see him next Thursday, Dec 15 at 9:00 a.m.

Finally Some Reports

Turns out Dr Gerardi's assistant never faxed the reports she said she would. On Monday she finally siad that she mailed mom a release form "early last week." Talk about a pathetic excuse for not doing her job. Mom told her to fax the release. She did, mom signed it. Phil picked up the reports and faxed them all to Dr. Bobrow (who he noted was listed as one of the top oncologists by Connecticut Magazine, the Bible when it comes to choosing the right oncologist).

This note just in from Phil along with the copy of the reports:

After much wrangling and general unpleasantness with one of the worst human
beings to ever be employed by a medical office (and that's saying something),
here are Mom's reports. No PET scan yet, should have by tomorrow.
She has an appointment tomorrow in New Haven with Dr. Samuel Bobrow at St
Raphael. Keep in touch.

So Mom will stay at Phil's tonight and go to Dr Bobrow's in the morning. Stay tuned for results. Same Bat Time. Same Bat Channel.

Joshua

PET Scan and Oncologist Visit Updates

Mom went for her PET Scan yesterday and although the place had scheduled her for Saturday and she confirmed with the front desk after her MRI on Wednesday that she would be in on Saturday, the lab was closed when mom showed up.

So we assume she is on for the scan at the originally scheduled time fo 12:45 on Monday and she will have to cancel/reschedule her first visit with Dr. Joel Silver.

Cousin Michael is still waiting for a fax of the Pathology report as am I. Dr. Gerardi's staff is severly lacking in the customer service area as tomorrow will be one week since we requested the information.

Joshua

Oncologist Appointments

So far, Mom has appointments to see 2 oncologists.

1. Dr Joel S. Silver - receommended by Dr Gerardi and her own physician. Based at St Francis Hospital in Hartford. Specializes in Hematology, Internal medicine, and Oncology. Ass't Prof at UConn Med School. Been practicing for 21 years. Appointment is this Monday, Dec 5, at 12:30. Phil will bring her.
2. Dr. Samuel N. Bobrow - referred by Shep Nuland. Based at St Raphael Hospital in new Haven.Specializes in Internal Medicine and Oncology. Assoc Clinical Prof at Yale Med School. Been practicing 37 years. Appointment is Wednesday, Dec 7 at 9am. Phil or I will bring her.

Dr Bobrow's office said he will need faxed (203-867-5422) to him the following so that he can reveiw it before Wed morning:

1. Pathology Report
2. X-Ray and Cat Scan Reports (bring films)
3. MRI Report
4. Bronchoscopy Report
5. PET Scan Report

Bobrows office is located in teh Father Mcgivern Cancer Center at St Raphaels Hospital. Entrance is on George St between Sherman and Orchard. After entering building his office is the last and only door on the left. (sounds to me like it might be the first as well).

Joshua

Research: Expectations Can Help Healing

Nov 29, 9:40 AM EST
Research: Expectations Can Help Healing
By LAURAN NEERGAARD AP Medical Writer

WASHINGTON (AP) -- Your medicine really could work better if your doctor talks it up before handing over the prescription. Research is showing the power of expectations, that they have physical - not just psychological - effects on your health.
Scientists can measure the resulting changes in the brain, from the release of natural painkilling chemicals to alterations in how neurons fire.

Among the most provocative findings: New research suggests that once Alzheimer's disease robs someone of the ability to expect that a proven painkiller will help them, it doesn't work nearly as well.

It's a new spin on the so-called placebo effect - and it begs the question of how to harness this power and thus enhance treatment benefits for patients.

"Your expectations can have profound impacts on your brain and your health," says Columbia University neuroscientist Tor Wager.

"There is not a single placebo effect, but many placebo effects," that differ by illness, adds Dr. Fabrizio Benedetti of Italy's University of Torino Medical School, who is studying those effects in patients with Alzheimer's, Parkinson's disease and pain.

The placebo effect is infamous from studies of new medications: Scientists often given either an experimental drug or a dummy pill to patients and see how they fare. Frequently, those taking the fake feel better, too, for a while, making it more difficult to tease out the medication's true effects.

Doctors have long thought the placebo effect was psychological.

Now scientists are amassing the first direct evidence that the placebo effect actually is physical, and that expecting benefit can trigger the same neurological pathways of healing as real medication does. Among them:

1. University of Michigan scientists injected the jaws of healthy young men with salt water to cause painful pressure, while PET scans measured the impact in their brains. During one scan, the men were told they were getting a pain reliever, actually a placebo.Their brains immediately released more endorphins - chemicals that act as natural painkillers by blocking the transmission of pain signals between nerve cells - and the men felt better. To return to pre-placebo pain levels, scientists had to increase the salt-water pressure."Our brain really is on drugs when we get a placebo," says co-researcher
   
2. Christian Stohler, now at the University of Maryland. More remarkable, some especially strong placebo responders suggest "many brains can actually stimulate that (pain-relief) system more."Italy's Benedetti gave Parkinson's patients a placebo and measured the electrical activity of individual nerve cells in a movement-controlling part of the brain. Those neurons quieted down, a decrease in firing of about 40 percent that correlated with a reduction in patients' muscle rigidity - they moved more easily.
   
3. To further prove the power of belief, Benedetti hooked pain patients to a computerized morphine injection system. Sometimes the computer administered a dose without them knowing it; sometimes a nurse pretended to give it. The morphine was up to 50 percent more effective when patients knew it was coming.
5. Likewise, Parkinson's patients moved much better when they were told that doctors had turned on a pacemaker-like implant in their brains, which blocks tremors, than when it was turned on covertly.
   

But in a similar experiment with Alzheimer's patients suffering pain, Benedetti found no difference between covert or expected dosing. The results are preliminary, he cautioned a meeting of the Society for Neuroscience last month. But it appears that because Alzheimer's robs patients of the cognitive ability to expect a benefit, they need higher doses of painkillers to get as much relief as non-demented patients.

Placebos aren't a substitute for real medicine. But the research suggests maybe doctors should try to manipulate patients' treatment expectations, for at least some hard-to-treat conditions.

"The bigger question is how do we capitalize on the placebo effect," said Dr. Helen Mayberg of Emory University, whose studies suggest some antidepressants have a "placebo-plus" activity in the brain. "There may be a phenomenon we all have access to."