Cancer versus Chemo Fight Set for January 16

A lot happened on Friday, January 6 and very quickly.  The day started out slow and ended in a flurry of activity.  Both Mario and Sherry got up later than normal.  Mario as usual had Cheerios with milk in a plastic cup.  Mr. FOG suggested an egg, toast and fruit to make his breakfast more complete.  This was accepted.

Mr. FOG sometimes offers , but generally leaves Sherry alone in her food choices. She makes much better choices than Mario and does not need Mr. FOG’s input.  She likely had her Greek yogurt.

Both Lord and Nurse went to work  most of the morning on their computers to keep their employers happy and the pay checks coming in.  Mario had a couple of conference calls.  Mr. FOG was in his room working studying cancers, backgrounds of doctors, etc. 

On the agenda today is another doctor’s appointment.  It is probably the one that we should have had yesterday, but yesterday’s appointment was also helpful --so no regrets—since we learned a bit about what radiation oncology can and can’t do for Mario.  As you may recall, the radiation oncologist we saw yesterday facilitated the appointment we have today with a hematology oncologist.  But before we get to this, it might be good to discuss the history of this cancer saga.

Timeline

We are now at about week 12 of this odyssey.  Below is my best recollection of what happened and when.  Mario and Sherry know best the first eight weeks of this saga, since Mr. FOG was in Asheville.  In any event these first 8 weeks were mainly a blur of pain, increasing impairment of motor skills, ineffective injections, three different doctors, misdiagnoses, etc. trying to determine why a healthy 35 year old man, with no  injury or prior history of back or leg pain issues was having severe leg pain and motor skills issue.   In hindsight as usual, the answer is clearer. But this was not an easy diagnosis of a rare condition.

Dates	What Was Going on	Comments
Week 0	The Wedding.	A good time was had by all.
Week 1	Drive home and Honey moon	Symptoms begin but very slowly.  A slight discomfort, a little odd walk, etc
Week 2	Back to Work	Pain begins but not too bad
Week 3	Back to Work	Pain increases, Mario sees primary care doctor injections given
Week 4	Back to Work	Pain continues, more injections, pain pills
Week 5	Back to Work	Pain continues, motor skills affected
Week 6	Thanksgiving	Mr. FOG sees Mario, Sherry and the Duffys.  Mario is limping and in pain but goes fishing.
Week 7	Back to Work	Pain is still there
Week 8	Spinal Surgery Planned	Mario gets pre spinal surgery tests, tumor found
Week 9	Diagnosis of Schwannoma	Spinal surgery cancelled.  Decide to go to Miami for tumor operation with specailist.  More pre-operative tests
Week 10	Miami Surgery (12/21)	Mario and Dad go to Miami, More pre-operative tests.  Surgery, Find that tumor is likely malignant.  Biopsy taken.  Lots of tears
Week 11	Christmas, Recovery from Surgery and Drive Home	A blue Christmas, Nurse Sherry arrives, Miami hotels, Filling prescriptions, Aunt Julia, St. Simmons Island and Family, A Gator Hope Chest, Drive home Cleopatra-style in our Honda Element turned into an ambulance
Week 12	Atlanta Doctors, Tests, and Chemo decision	New Years break, Mr. FOG starts his new job,  more doctors, and a treatment decision is made
Week 13	Pre-Chemo Tests	To be written
Week 14	Chemo Begins (1/16)	To be written

A Decision

Events during our afternoon visit with the Atlanta hematology oncologist moved quickly, and perhaps rightfully so.  The Lord was making the decision.  Nurse and Butler were in agreement.  The trio decided to go forward with chemotherapy and the sooner the better. 

Chemotherapy protocols (the mix, frequency, and strength of the medicines/poisons given) is fairly standard for the cancer being treated.  Stated differently, the chemotherapy received would probably vary little from one hospital to another.  An exception to this would be if one is in a clinical trial.   While Mario’s results may be better at a hospital having more experience on Ewing Sarcomas, there are drawbacks.  The biggest one is that it is rare cancer, so while there is research there was no clear place that had an "expertise" on this cancer.  Also, It would be difficult to get chemo therapy at the Mayo Clinic in Rochester, Minnesota or Cleveland Clinic in Ohio or Sloan-Kettering in New York and still maintain a normal life.  Nor is there any real assurance that going toone of these facilites would in fact be better or any different treatment than what Piedmont Hospital would provide.  For sure we would have lost another couple of weeks following up on these options.  Time is an important factor for us.  The oncologist confirmed what Jane, Mario's Mom had said, Ewing's Sarcoma is a fast growing cancer.

Mr. FOG’s friend is being treated at Piedmont, went for a consult visit to the Anderson Cancer Center in Houston, a world leader in cancer treatment.  During her visit she found that the treatment she was getting in Atlanta for her lung cancer was the same treatment she would get at Houston.  Hence it made no sense to leave home for the same treatment she was getting at home.

Mario and Sherry have a support base in Atlanta.  Besides getting a paycheck, having a near normal work and social life as possible should help Mario (and Sherry) deal with the many challenges ahead. 

The oncology practice selected is affiliated with Piedmont Hospital and is the one used by Mr. FOG’s friend of who is battling lung cancer.  The practice is also a part of the hospital system of Mario’s Atlanta neurosurgeon.  While the oncologist treating Mr. FOG’s friend was highly recommended, he was not the one with whom the radiation oncologist had been able to set us up with.  Our hematology oncologist did her residency at the Winship Cancer Center at Emory.  This is the center that had two oncologists that had done some work on Ewing Sarcomas identified by one of Sherry’s friends, a cancer survivor.  A special thanks to her.  Although Mario decided to get treatment at Piedmont and not Winship, the information she provided helped us.  Mario’s oncologist had already discussed his case, since it is rare, with one of the Emory (Winship) specialists recommended by Sherry’s friend.  Thanks.  Also we are not locked in to this choice, if we find something better.

Mr. FOG was more concerned about time.  Too much time had already elapsed and we needed to attack the cancer quickly.  It is only getting stronger and making Mario’s recovery of his motor skills more difficult.  Or least this is what Mr. FOG believes.  More searching would probably not give us a better decision, but delaying would likely risk having a favorable outcome. 

For the most part Mr. FOG kept his mouth shut during the appointment, only asking a couple of questions to see if the oncologist was worthy.  There was no need for him to talk, Mario did well on his own.  Funny how we still think of our children as when they were small and not all grown up. 

Mr. FOG liked Mario’s oncologist, a young but not too young, Asian American woman. Mr. FOG observed that with only 24 hours lead time she had studied Mario’s case before our appointment; was familiar with Ewing’s sarcoma, knowing the difference between an EES and PNET; consulted with the senior oncologist in the same group used by Mr. FOG’s friend; and had already contacted her colleagues at Emory having a background or research interest on Ewing’s Sarcoma.  She also asked about for any clinical studies that Emory may have, but there were none.  In Mr. FOG’s opinion she passed her job interview with high marks and will do her best and work hard in Mario’s behalf

Mr. FOG foolishly did get involved discussing the date that the chemotherapy should start and lost sight of priorities.  Fortunately Hot Lips Houlihan was there, and true to her character stepped into the fray. Mario wanted to minimize the impact on his work schedule and start chemo on a Thursday.  Mr. FOG and Mario had previously discussed this, reasoning that this might be better for him since the worst symptoms would happen over the weekend while he was at home.  Mr. FOG was lured into this argument, but fortunately Nurse Sherry was there with the obvious, “the treatment should start as soon as possible.  Mario’s health is more important than work.”  That simple true statement settled the matter.  As we know more how the chemo affects Mario the day that it is given can be adjusted so that the impact to his work is minimized..

While the trio is not happy about what will come ahead and the changes to their lives, especially Mario, they are comfortable with the decision.  Mr. FOG will try his best to balance Mario’s health needs with work, and other commitments of the couple.  However, sometimes when the tire hits road you got to make hard choices and Mario’s health comes first. 

West Piedmont, as the building is called since it is west (and also north) of Piedmont Hospital, is well situated for Mario and Sherry. The facilites are almost spa-like and patients have nice vies of the city, telivision and other comforts while receiving chemotherapy (really poisons). The facility is at the intersection of Howell Mill Road and I-75 for those of you who know Atlanta and convenient to the work places of the couple and their home on Vinings Mountain.  Likewise for those of you with a military interest, since this will likely be a long war and not a quick battle, having short reliable supply lines between home, work sites and cancer  treatment center is important to keep morale up and keep our cancer warriors strong during a long campaign.   

Many, many more things were learned during this visit but these will have to wait and will be shared soon. 

The day ended with Sherry and Mario having a nice evening at home with close friends.   Although tempted by the food, Mr. FOG decided it best to leave for the weekend so that the newlyweds could have their own space.

 Mr. FOG also needed his own downtime and will be staying at a friend’s house in Atlanta.  The friend is out of town, but Mr. FOG will have a feline, named Bess to attend to.  She is an elderly cat and perhaps Dame Bess is a more appropriate name should Mr. FOG need to embellish his resume. Lord Mario, Dame Bess, perhaps Queen Elizabeth is next?????  We need to show progress on our resume.