Competence in Columbia

I have a renewed faith in the world of adult medicine here in town after meeting with the oncologists today. Mike and I met with a radiation oncologist and a medical oncologist, and both were top notch. The radiation oncologist actually went over Mike’s MRI with us (a novel idea) and showed us the visual images from it. It was rather amazing to see just how big the tumor is in proportion to Mike’s brain. The medical oncologist told us based on Mike’s age and where his tumor is located, there is typically only one method of treatment for it, and that is a combination of chemotherapy and radiation. The chemotherapy is actually just a pill, so Mike would take that orally (I don’t remember the name of it, but I know it starts with the letter t) and do the radiation along with it for a prescribed number of weeks. At the end of that, they would do another MRI to see if the tumor had decreased in size. The only other option is to participate in a clinical trial. They aren’t authorized to do clinical trials here, but Duke is. He strongly encouraged us to participate in one of those if one is available. Basically, with the typical treatment, only about 20% of people are three to four years beyond their initial diagnosis. That obviously means 80% of people don’t have long-term success, so participating in a clinical trial could be more beneficial. The medical oncologist also said based on the size and location of the tumor, it does not look operable. The tumor is somewhat buried in the brain; it’s not like it’s sitting on the top edge and could just be scraped off.

I talked with Duke today, and we will be going up there on Monday. We have an appointment Monday afternoon and another Tuesday morning. We should be able to leave around noon after the Tuesday appointment. Here’s what is supposed to happen during these appointments…

Day One:
Complete a history and physical
Review pathology and most recent MRI
Answer any questions we have
Order any updated labs and/or an MRI (they may take place later that day)
Determine a plan of care

Day Two:
Meet with a social worker
Meet with a nurse educator to learn about the treatment and Duke’s team approach to care