Dad Having Spinal Compression - 1264959

Thanks for the links, Jim. I guess what has sort of got me puzzled is that all the tumors seemed to shrink when on therapy, but in these 6 weeks off therapy, the spinal mets appear to be the only ones growing.

As far as treatment, the neurosurgeon thinks he can operate on the tumor causing the compression, notwithstanding the other mets that have developed. I'm concerned that we're setting ourselves up for, lack of a better term, a "whack a mole" situation. My dad isn't thrilled about the idea of the surgery (in fact, he hasn't been thrilled about doing any of the treatments so far) and I'm trying to respect his wishes while at the same time trying to keep him with us for as long as possible (which, I realize might be two conflicting goals). So, I have two questions:

1) Is spinal cord compression a good reason to operate in the context of Stage IV disease; and
2) Assuming we go ahead with surgery, what sort of recovery time / affect on quality of life are we looking at ?

Thanks,

Seth

Please disregard the above post -- the final decision has been made not to operate, as there are too many spots. Thanks,

Seth

Dr. West-

You kind words are greatly appreciated. For what it's worth, especially in light of reading the part about cancer being able to do anything, I've expected the worst but hoped for the best all along. I guess that's my defense mechanism, and it's unfortunate that in this instance, with respect to rapid growth, my expectation came to fruition. As someone who likes control myself, cancer seems to be better than anything at reinforcing how little control we have.

Best,

Seth

Judy,

Thank you for your kind words. They are much appreciated.

Seth

Hi Janine,

Thank you for your thoughts. As an update, I'm not entirely how accurate the information my mom has been passing along -- she has horrible anxiety and and gets easily overwhelmed by medical information given to her. Unfortunately, I am about 2 hours away from UCSF and was unable to make the trip this week. I, however, was able to read some of the discharge instructions online and they specifically said "there was concern for nerve compression. You had a scan of your back which did not show spinal injury." So, I sincerely hope I did not convey an overly dire situation when it might not be so. In any event, my wife and I will be going to my dad's appointment on Tuesday and I will update with exactly what is going on. Again, I appreciate everyone's kind words.

Best,

Seth

Oh, and as to hospice -- it is my hope that he accepts hospice at home when the time comes; the last thing I want is to wait too long and let him suffer unnecessarily.

Seth

So, I was able to speak to my dad's oncologist today to get a better understanding of where we're at :

It looks as though the C-7 tumor has grown such that it is causing pain, but it is not pressing on the spinal cord. The rib tumor also has grow, but is asymptomatic. The primary lung tumor is stable. The multiple other lesions on the spine shown on the spinal MRI are indeterminate, as the PET/CT did not show increased metabolism in these spots. In the workup of my dad's leg weakness, an MRI was done, and several (I'm not sure how many) small (less than 1 cm) brain lesions were found, but the doctor was confident they were not causing any symptoms (due to lack of evidence of swelling) and were not an immediate concern. Of concern, however, my dad stopped eating on Friday for 24 hours and then was admitted to the hospital yesterday after being extremely weak (unable to get of bed). According to the doctor, it is unclear if it the cancer, the pain, late effects of chemo or all three causing the weakness / loss of appetite. The original plan was to radiate the C-7 spot and then hopefully go on to Alimta. However, while they're pretty confident the radiation will help with the pain, they are unsure whether it will help with the weakness / loss of appetite. I don't want my dad to suffer through a futile treatment, but at the same time I don't want to place him in hospice when we have a chance to improve his quality of life while he's still with us. He seems to be leaning toward radiation. So, I guess right now we're taking it day by day (his radiation is scheduled to start Wednesday).

Best,

Seth

I knew I had a question to ask:)

My dad was prescribed tramadol (50 mg as needed) one day before his rapid decline in performance status. Is it in the realm of the possibility that the tramadol precipitated his decline?

Thanks,

Seth

Thanks Jim and Dr. West for the responses. My dad was released from the hospital on Wednesday and is doing much better. Honestly, when I went to visit him on Monday, having read the post about what to expect when someone is dying, I couldn't help but think the death process had begun -- he seemed totally out of it (I believe delerium is the term that the doctors used), and wasn't eating much. However, by the next morning he was much better, and in the past few days he is back to his new normal of generalized weakness, but complete coherence and able to get around, albeit slowly. Radiation began yesterday, so we're hoping it can help with some of his symptoms, at the very least we hope it will relieve the neck pain.

With respect to the tramadol, I can't help but thinking it precipitated this by causing a loss of appetite, which caused extreme fatigue, thereby creating a vicious cycle. I may be wrong, but there seems to be no other explanation for his 180 turn around other than the discontinuation of the tramadol.

Best,

Seth

Thanks Dr. West. We're all glad he's doing better as well.