The notes below are from the medical exam from Jack's oncologist in Santa Barbara, and are useful for giving you a starting understanding of the challenges ahead.
Jack's next doctor's appointment is Thursday with a Santa Barbara radiologist to discuss treatment plans.
UCLA visit with melanoma specialist August 25th.
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August 3, 2010
Dad had a visit with Dr. Newman to hear the finding of recent medical tests related to his metastatic melanoma. Blood LDH Serum test, Nuclear PET Scan, CT guided biopsy of abdomen (kidney area). The reason for the test is to determine the stage of the cancer. The stage will determine a suggested treatment plan.
The visit began by Dr. Newman talking directly to dad (all daughters were present in exam room). He asked dad how he felt and what he had been told by the doctors to date. Dr. Newman is a warm doctor. We all liked his professional and personal manor. Dr. Newman oversees a variety of cancer patients without specializing in anyone type.
Dr. Newman began to fill us in on the current test results. We will need to use these test as a baseline since there are not previous scans, MRI, films, etc. The progression of these specific tests will determine the rate of growth in cancer cells which determines the stage and rate of the disease (how fast it is spreading).
PET scan showed multiple hot (cancer cells) spots. Lungs, abdomen, neck lymph nodes, leg, and head outside of skull. CT guided biopsy of abdomen confirmed the diagnosis of metastatic melanoma stage IV. Topical tumor on head growing rapidly and appears to be eroding the skull bone. If this is the case, we need to stop this progression. Once the tumor gets inside the skull bone is it difficult to treat and will cause its own set of problems. A CT scan of the head will help us see if the tumor has eroded the skull bone. Dr. Newman’s office will schedule the CT as soon as possible in Santa Barbara.
Typical treatment can be radiation and/or chemotherapy. The chemotherapy used in Santa Barbara is only the FDA approved drugs, difficult to tolerate and usually not effective for melanoma. The first and important line of treatment is pain management. Dr. Newman improved upon and simplified dad’s current pain medications. Hydrocodone and time released Oxycontin are the new medications prescribed. These can be increased after time if they lose their effect. Driving is discouraged on these medications.
On exam Dr. Newman found some heart irregularities. Heart murmur and elevated heart rate were present and not believed to be an isolated episode. Dr. Newman will inform Dr. Cummins (primary care doc) of these finding and will suggest an echocardiogram and possible referral to a cardiologist.
Next step: MRI of brain to see if external head tumor has eroded the skull bone.
Dr. Newman is referring dad to a specialist at UCLA medical center. Antoni Ribas, MD and his partner Bartosz Chmielowski, MD are on the medical forefront in metastatic melanoma cases. Over the last few years they have had success with several chemotherapy drugs. These medications are only used in a trial format (unapproved by the FDA). Patients must meet a certain criteria to be enrolled in these trials. There is more than one trial available. Trial drugs are good for patients with a specific mutated gene. This gene is identified from a patient’s cancerous tissue. We can use the tissue collected in dad’s CT guided biopsy from July 20th to see if he is a possible trial candidate. There are other criteria patients must be cleared to qualify. This is why we want clearance on heart findings.
Upon leaving the office Dr. Newman’s assistant, Sandy Aguirre confirmed that she would fax dad’s necessary medical records to UCLA Dr. Ribas the same day. She will have Dr. Ribas’s office contact dad directly with an appointment. Dr. Newman let dad know the scheduled Kauai trip should not be a problem. He recommends future travel plans should include travel insurance.
Dr. Antono Ribas (310) 206-3928 aribas@mednet.ucla.edu http://www.uclahealth.org/
The very good news: MRI of brain is clear and looks ok. This is a huge positive result.
Dr. Ribas is on vacation until August 16, 2010. We are waiting for a consultation to be scheduled soon after August 22nd.
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