Wednesday - December 24, 2008

Lots of news, mostly bad.

Baking Soda Infusion - Judy did finish the 8 days of baking soda infusion and was sick most of the time, but felt it was worth it if it shrunk the tumors. The infusions did cause most of the back pain to go away, which was really helpful. The tumor markers went from 2,622 on Nov. 11 to 3,000 on Dec 23rd. But it is hard to tell what that really means, since they went from 1,000 to 2,622 (a 160% increase) during the prior two months that she was off chemo. In the prior two months they more than doubled and in the last 6 weeks they only increased by 15%, so maybe the infusions were helpful.

We did get the results of the Nov 25 CT scan on her abdomen and pelvis and chest and comparisons to the Jul 28 CT scan.

Liver - We learned that there was an 8 mm hypodensity within segment 6 of her liver, but that it did not increase in size and there were no new hepatic lesions. There was a mild amount of gas within the intrahepatic biliary tree within the left lobe.

Kidneys - The left kidney was not growing as fast as the right. There was a 10 mm lobulated lesion within the superior pole of the right kidney, which was unchanged. Bilateral extrarenal pelvises were present.

Pancreas - The previous 23 x14 mm hypodensity adjacent to the tail of the pancreas currently measured 15 x 10mm. The 13 mm left adrenal lesion was not changed.

Abdomen - There were numerous small lymph nodes within the retroperitoneum, celiac region and mesentery and there was also a general increase in size and number of lymph noes in these regions. The prior 15 x 8 mm left para aortic lymph node had increased to 18 x11 mm, the prior 23 x 10 mm portocaval lymph node increased to 23 x 13 mm, and the right iliac chain lymph node went from 13 x 7 mm to 17 x 9 mm.

Pelvis - There was a mild amount of free fluid within the pelvis, the uterus was filled with fluid and there was mild asymmetric thickening of the left aspect of the myometrium.

Back - Numerous blastic metastasis were again seen in the lumbar spine and pelvis. A few of these appear to have increased in size. For instance the 28 mm lesion within the L4 vertebral body previously measured 26 mm.

Heart - One mediastinal lymph node in the lower mediastinum anterior to the the descending aorta was 10.5 x 8.5 mm and is currently 12.9 x 10.3 mm.

Axillary Lymph Nodes - Many enlarged right superior and inferior axillary lymph nodes were present and increased in size.

Bones - Diffuse osseous metastatic disease involved the sternum, ribs and thorasic spine, but had not progressed since the earlier CT scan.

Blood Tests - Judy had three blood test results that were of concern to the oncologist. First, her Alkaline Phosphatase went from 298 to 961. The normal range for Alkaline Phosphatase is 39-120. Higher levels may indicate that the bile duct is blocked.

Second, her Aspartate Aminotransferase went from 80 to 131. The normal range for the Aspartate Aminotransferase is 8-35, with high levels indicating possible liver damage.

Third, her Alanine Aminotransferase went from 32 to 56. The normal range for Alanine Aminotransferase is 4-36, with higher levels indicating possible liver damage.

As a result of these significantly increased test results, the oncologist has ordered an ultrasound of her liver and scheduled it for Friday.

The last time we met with the oncologist she informed us that none of Judy's tumors were immediately threatening. So, this time I asked her what she actually expected Judy to die from. She said that it would likely either be a brain tumor or a tumor that would cause the liver to stop functioning. Based on the above test results and the absence of any indications of a brain tumor, it seems likely that a liver tumor will take her.