What did the PET scan show?
Steve's PET scan (taken last week) showed activity in the brain, based on how much radioactive glucose was metabolized by sections of his brain during the test. The area of the brain stem where Steve's tumor resides was black -- no activity at all. So it looks like the tumor cells that are there have died. Also, the PET scan found no other hot spots, no other areas of the brain that are harboring additional tumors.
What did the MRI show?
The MRI (taken today) showed that the tumor is stable and is slightly smaller than it was two months ago. It's difficult to say exactly how much smaller, as the tumor is not a perfect sphere. When we looked at the images side by side today, Dr. M measured diameters on each image. Looking at one cross section of the tumor, for instance, showed the tumor was 22 mm across in April and 21 mm across today. Another cross section showed that tumor was 6.9 mm across in April and 6.69 across today. All those little numbers add up to smaller mass. Woo hoo!
Dr. M explains that dead cells take up less room than live cells, so the slight shrinkage is somewhat expected.
Also, if you look at the MRI image, you can see where the tumor is slowly breaking up. In April the tumor looked denser (as indicated by the amount of white on the scan). Today the tumor looks more dissipated. That Damm Spot is on the run!
Why is the tumor dead?
1. Radiation therapy combined with chemotherapy
2. Answered prayer
3. Steve's amazingly positive attitude
If the tumor is dead, why does Steve still have symptoms?
The cells are dead, thank God, but they're still there. The brain is an amazing organ that protects our bodies very well. It is reluctant to let anything foreign in, and it is reluctant to let anything out. The tumor is a giant wound that is going to take a long time to heal. As long as the mass (and accompanying inflammation) is there, pushing around where it has no business, there is the possibility of some kind of symptom.
If the tumor is dead, why is he still taking chemotherapy?
When a brain tumor is alive, it's constantly sending off tumor cells. So while those X-rays were aimed directly for the tumor back in February and March, they couldn't reach all the rogue cancer cells running around his brain. The chemo is now chasing down those extra cells, trying to kill them. (The roaming cells are too small to show up on any kind of scan.) The goal is stop them from congregating and forming new sections of live tumor. (So much violent imagery in that paragraph!)
What about his vision?
Dr. M's office is working on a referral to a UT-SW opthamologist. We hope that there is some therapy or relief that the eye doctor can recommend for Steve's double vision, which hasn't resolved or improved since it began in January. The right eye doesn't track with the left. He's somehow able to focus out of just one eye when he needs to -- I think it's kind of a Jedi mind trick.
What about his respiratory issues?
The office is also working on a referral to a pulmonologist to address his respiratory problems. His blood oxygen level was 95-96 today -- better than 92 from two weeks ago but still not ideal. He's continuing to use an inhaler and allergy medicine for relief.
Is Steve still taking the steroid Decadron?
He had been taking 6 mg a day for the past few weeks. On Monday, he stepped down to 5 mg. Dr. M wants us to be as aggressive as possible stepping down. If this week goes well, he'll try 4 mg next week, and then 3, working down as safely and as quickly as possible.
Why is it important to reduce the Decadron?
He definitely has needed the steroid to help with the symptoms related to the swelling and the tumor. Long-term use is taking its toll on Steve's body, though. His skin has thinned, and typically minor flesh wounds are taking a long time to heal. He's been fighting thrush off and on since February. His muscles have thinned a great deal, comprimising his strength and stability. The steroid can mask signs of infection. It can cause irritability and manic behavior.
As he steps down, we'll keep a close eye on symptoms. Dr. M says we may need to allow some symptoms to come back for the sake of dropping down. So, he may need to deal with slurred speech again and/or uneven gait and/or other issues.
What about his fatigue?
Steve's body continues to cope with many challenges. The chemotherapy zaps him. The many other drugs steal energy (though some try to restore it). As his brain works on healing, the rest of his body is just worn out. Dr. M encourages him to rest when his body demands it and not to get too discouraged.
What about other symptoms?
Back in November, Steve started having frequent hiccups. They stopped after the biopsy. Now they're back. Dr. M wants us to pay attention, in the small chance they signal seizures.
He's also having tremors again on his right side, most noticeably when eating. Dr. M says the tremors are related to the Decadron and should subside as he steps off the drug.
His ears have been plugged for a while, as if he's in an airplane all the time. They look normal, though. Dr. M suggested we discuss this with the pulmonologist.
When is the next check-up with Dr. M?
We're scheduled to return July 11.
When is the next MRI?
The next planned scan is early August.
Will Steve go back to M.D. Anderson?
Our plan for now is to continue seeking scans at UT-SW during this course of treatment. If at any time we're uncomfortable with what we're hearing here or if a scan shows recurrence, we'll go back to Houston. We also plan to return at the end of this 12-18 months of chemotherapy.
What great things did Dr. M have to say about Steve?
She says that he leads the pack among her patients for having a great attitude. She marvels at how little he complains, how determined he is to get better, how focused he is on getting rid of the tumor. She says his attitude and spirit are key to his recovery.
Our thanks extends to all of you, who continue to shower us with prayer, good wishes, help around the house, meals, cards, phone calls, gifts and more. Some days I think we can just return to our "normal" life, when we didn't rely on others too often (and we could actually extend help to others), but most days I realize that your help is still so vital, that we're fighting every day and need a deep team to keep us going. Steve and I know how blessed we are that you all are fighting with us and rejoicing with us!