In Test, Zaps To Spine Help 2 Stroke Survivors Move Arms - Mr Validity
The end of life journey for my mother. Mom was healthy all her life (no colds, ate healthy, dressed appropriately in various seasons to not get sick, etc.) On Jan 17th, the nightmare began when I took mom to ER because of breathing problems. After her admission to the ER I was told that it "might be ovarian and breast cancer". WOW, I could not believe what I was told. Mom also had showed the ER docs a mass (light green color that had grown outside her belly button/on her stomach - exposed). This was the mass - mom did not share this with me but daughter knows she is very sick and dying. The ER docs ask me if I had seen this (and i had not); Mom even told the onocologists that "the secret" is out - and now moving forward, Mom was admitted to the hospital at Vanderbilt University-Nashville and she stayed there for 10 days; when released, she went home. On the 7th day at home, one morning, Mom had been up all night and told me later that she had a pain in her left leg like her leg was turning/twisting in knots and she immediately had me taken her to the ER room. Again she was admitted to hospital for several days (cancer had spreaded a lot); we met with oncologists team and her pcp and the oncologists wanted to start chemo. Before we could begin first round of chemo, Mom started throwing up blood and blood came out of her urine and stool (she had to be admitted to intensive care). I never forget, it was my birthday, Feb 14th, and when I arrived to visit her, she acknowledged my birthday and wished me happy birthday. During the entire cancer process, mom was alert but mom did not eat one bit of food from day one until she died. Mom's memory also started to go; when I got all the medical bills in the end, I found out they had ran some serious tests on my mother; they only told me the basics; cancer, prognosis and that was all. Mom just would not eat; all mom wanted was water, ice and that was all during the entire 2-month process. Mom was in and out of nursing homes because it was only me and my mom at home. See mom moved in with me because prior to the cancer she had a stroke 1 -1/2 years ago. When Mom had the stroke, the same hospital Vanderbilt ran all types of tests and I now wonder why wasn't this cancer detected then? After her stroke, the docs told her she had recovered very well and was doing good. My mother, a fighter, had ask help to get back on her feet with Dad's death 10 years ago of skin cancer, so it was just my Mom and I. Anyway, to get to the final part of this story, the oncologists and her pcp recommended a nursing home so someone could be with mom 24/7. The prognosis in the end was with chemo 1 to 1/2 years and without chemo 6 months or less. We did get one round of chemo in but that was all. The pcp doctor told me "everytime we fix something on your Mom, somethings else breaks." The pcp doc kept me well informed of Mom's condition everyday until the end. The hospital removed lots of fluid from Mom's body twice (the fluid removed filled 2 large bottles, she told me it really hurt). But Mom was doing anything to live. My mother and I know she wanted to live because she told me one day, no one wants to die. Mom's feet swelled very badly but her breathing and spirits were good until she went into the last 2 nursing homes. When I had the final friday talk with Mom and her pcp, we were told, there was nothing else they could do and recommended hospices. In my mind, I knew it was a matter of time to spend with mom. When she arrived at her final nursing home, a lady told me to spend as much time with my Mom as I could. Mom had a strange request the day before she died. She asked I bring her a bell, a back scratcher, and a yellow sheet/table cloth (so she would not get anything dirty). Also on the day before she died, I went to see her and she kept staring at a mirror to her left and then staring down the hall to the right. I asked her if she was ok and she said, "Yes, I am ok". The next day, Mom passed away in her sleep at 71. She died at 7:25 am. The death journey lasted approximately 2 months. Looking back from all of this, I remember one thing that could have "possibly" prevented all of this. Back in 1976, when mom went to her pcp, they told her she had a small tumor. Nothing was ever said or done after she was told this. Mom also told me that she thought because she had a large stomach and always wore big clothes that she just thought she had a big gut. Mom said to me she always thought she was a very healthy person. Ii had to deal with losing my mother all by myself. I had her cremated because I wanted to kill the cancer once and for all because the cancer took my mother quickly and swiftly. To end my story, I want to say anyone diagnosed with ovarian / breast cancer, this is a death sentence. It is a quick and swift death sentence. Mom was bedridden during the entire process and had to have a decatheter to use the bathroom. She tried to be strong but the cancer did not allow my mother to be strong. All mom kept telling me was "I am very tired". Mom was so much of a fighter that several months before she was diagnosed, she continued to go to the NFL Titan football games; she told me she was tired and went but never complained to me about her health. Mom told me she did not want me to worrry. That was Mom. Ovarian cancer is a silent killer; one can be healthy as a horse, have no health ailments and overnight get diagnosed and die quickly. I miss my mother so very much; I love her but I know that I will see my mother again one day.
In test, zaps to spine help 2 stroke survivors move arms - Mr Validity
By Gregory D. Pawelski, husbandIntroduction:This is an account of my wife's treatment for recurring ovarian cancer. Her cancer treatment varied tremendously depending on which hospital she attended and the type of treatments given at our local hospital were responsible for her final tumor recurrences and her depressed quality of life in her last years.When she first got ovarian cancer in 1972, it was treated in San Diego, post-operatively with Chlorambucil. This is one of the slowest acting and least toxic of the oral drugs, which allows the immune system to regenerate during the process. The cancer recurred in 1996 on her diaphragm and was removed at the Fox Chase Cancer Center.It is commonplace to give the same treatment to a recurrence as was given for the original tumor(s). However, our hometown hospital in Pennsylvania gave her a 'hard and fast' drug combination of Taxol and Carboplatin. This suppresses the immune system, which can allow tumors to grow and can weaken the blood-brain barrier, potentially inviting cancer cells into the central nervous system.Sure enough, the cancer turned up in her cerebellum in 1998, and was removed at the Hershey Medical Center. Our local home town hospital then treated her with Whole Brain Radiation. Literature suggests that this can result in permanent side effects such as dementia and memory loss in 90% of patients over 60. My wife was 66. Hershey suggested treatment with focal radiation to the local tumor bed. Scans to check for a possible spinal tumor were also suggested but never fully carried out.In 1999, three tumors were found on her spine and were eradicated. In the end, my wife died of the effects of Taxol and Carboplatin, which may have caused the cerebellum tumors, and the terrible effects of Whole Brain Radiation, which further scans revealed had caused extensive damage to her brain. Ann's Medical History:In 1972, my wife had been diagnosed with ovarian cancer, when she presented with a left DVT (deep vein thrombosis) and pulmonary embolism at a hospital in San Diego, CA. DVT is not uncommon in patients with ovarian cancer (it may be a presenting sign). Workup which was triggered by this presentation revealed that she did have an ovarian carcinoma for which she was cured with total abdominal hysterectomy and Chlorambucil (Leukeren) treatment. This postoperative chemotherapy drug was among the slowest acting and least toxic of the alkylating agents (well tolerated oral-dose drugs). By giving chemotherapy more often, at lower doses, it can prevent the regrowth of blood vessels that feed tumors. Depression of the immune system is slow and reversible, allowing it to regenerate and contribute to healing. A malfunctioning immune system can fail to stop the growth of cancer cells. When caught at this earliest stage, ovarian cancer has a good prognosis. At Stage I, ovarian cancer has a five-year survival rate of around 93%. She went twenty-four years before experiencing any recurrent ovarian cancer. During the early 90's in Reading, Pa., she underwent a laparotomy (a surgical procedure which involves opening the abdominal cavity for examination) as a followup and this did not reveal any evidence of recurrent carcinoma. This is supposed to be the most certain way of diagnosing ovarian cancer and assessing the extent of cancer spread (metastasis). However, negative second-look patients have a 50% chance of disease recurrence anyway. For the most part, her group of oncologists relied almost entirely on the CA 125 tumor marker (a blood test done to assess the amount of an antibody that recognizes an antigen in ovarian tumor cells). The rate of "false positives" makes it inadequate for use "by itself" for screening of high-risk patients. It should be supplemented with transvaginal ultrasonography and a rectovaginal pelvic exam all done at the same time.Metastatic Recurrence and Treatment:It was our family doctor that found her first metastatic recurrence to her diaphragm in 1996 (not the medical oncologists at our local home town hospital). She was having dry coughing spells at first but then she began having a mucus discharge, which eventually was bloody. A chest xray and Cat Scan had shown a lesion inside her diaphragm. That recurrent ovarian cancer was surgically excised at Fox Chase Cancer Center. It was a metastatic transdiaphragmatic tumor from the original ovarian cancer (1972), with attachment to the lung and other midline structures of the chest. Parts of those structures were surgically resected (the diaphragm is a common site for ovarian metastatic recurrence). The thoracic surgical oncologist left us with the knowledge that a second place an ovarian metastasis possibly could occur maybe the Central Nervous System (CNS) like the brain and/or the spine. It is very rare for ovarian cancer cells to metastisize to the CNS. In fact, up until 1994 there have been only 67 well documented cases in medical literature. A multi-institutional study of 4027 ovarian cancer patients over 30 years identified only 32 cases while an autopsy study of ovarian cancer reported an incidence of 0.9%. The surgeon at Fox Chase did not feel that further treatment with chemotherapy was indicated. However, the ideas of our local home town Medical Oncologists were different from the Thoracic Surgical Oncologist who excised the tumor from her diaphragm. My wife received postoperative chemotherapy by these medical oncologists, seven months after having that metastatic tumor surgically excised. She did not have any cancer tumor markers indicate any cancer within her system. Some tumors send out microscopic outposts while most do not. However, medical oncologists cannot tell which ones do, so they want to give chemotherapy in nearly every case. The type of chemotherapy she received was the hit fast, hit hard type combination chemotherapy of Taxol with Carboplatin (second-line chemotherapy). It is usually given in big doses, with breaks of several weeks between doses to let the body try to recover (or else it can kill a patient). Patients who develop recurrent ovarian cancer more than 6 months after first-line chemotherapy (in my wife's case, 24 years), can experience another remission following treatment with the identical first-line chemotherapy that was previously used (in her case, Chlorambucil). It has not been shown that platinum-based combination therapy is superior to single agent alkylator therapy. No substantial benefit has been found in giving ovarian cancer patients second-line chemotherapy. Clinicians have found that the toxic effects of this treatment can cause a lower quality of life for these patients. Plus, the late stage of "recurrent ovarian cancer" makes the combination chemotherapy of Taxol & Carboplatin drug resistent to cancer cells and suppresses the immune system, making it possible new tumors to grow because the patient has been rendered unable to resist them. In recent years the incidence of central nervous system (CNS) metastasis has increased. Unfortunately, some chemotherapeutic agents can weaken the blood-brain barrier (BBB) transiently and allow CNS seeding. Taxol & Carboplatin are two of the drugs that violate the blood-brain barrier (dose dependent). In essence, it breaks down, damages the blood-brain barrier (BBB) to invite microscopic cancer cells into the CNS. A NCI observational study in 1995 reported experience in their clinic where recurrent systemic disease occurred in all patients for which they received dose intense paclitaxel (Taxol) therapy. Brain metastasis was the only site of disease recurrence, presenting with headache, dizziness, unsteady gait, nausea and vomiting. It was our family doctor that found her second metastatic recurrence to her cerebellum in 1998 (not the medical oncologists at our local home town hospital). She was presenting with headache, dizziness, unsteady gait, nausea and vomiting. A large (3.5cm) solitary cerebellar brain tumor was found via enchanced Cat Scan (later confirmed by an enhanced MRI). The tumor was excised from her brain by a Neurosurgeon at Hershey Medical Center. Histologic features were consistent with metastatic papillary adenocarcinoma with extensive necrosis from the ovary. The Neurosurgeon stated that he was 99% successful and felt that she should go back to our local home town hospital and receive focal radiation to the local tumor bed (which is 2cm beyond the periphery of the excised tumor site). The treatment protocol recommended for brain metastases of large solitary tumors exceeding 2cm in diameter is surgical resection followed by 5 fractions of local radiation to the tumor bed. At the same time, she should receive an MRI of the spine because of suspicions of either another tumor, on her spine or a herniated disc, causing her leg problems. However, the ideas of our local home town Radiation Oncologist were different from the Neurosurgeon who excised the tumor from her brain. The Radiation Oncologist took it upon himself to give my wife 5 fractions of focal radiation to the local tumor bed, plus 20 fractions of Whole Brain Radiation over a 35 day period. The risk of neurotoxicity from Whole Brain Radiation is not insignificant and this approach is not indicated in all patients with a solitary brain metastases, particularly when platinum drugs lower the tolerance of the CNS to radiation. Literature of the early and mid-80's on morbidity of Whole Brain Radiation, is flooded with papers reporting long-term side effects, such as dementia, memory loss, radiation induced necrosis, leukoencephalopathy, in up to 50% of two year survivors. Whole Brain Radiation Therapy has been recognized to cause considerable permanent side effects in patients over 60 years of age. The side effects from WBR Therapy affect up to 90% of patients in this age group. My wife was 66 years of age while receiving Whole Brain Radiation Therapy. During radiation treatment, my wife received an Unenhanced MRI to the spine that showed a 1cm lesion. Instead of performing an Enhanced MRI to the spine or a Triple Phase Bone Scan to further evaluate, our local home town hospital performed a Regular Bone Scan that showed normal bone imaging. However, a Regular Bone Scan cannot distinguish what a lesion represents and cannot differentiate between a tumor, an infection or a fracture (a Triple Phase Bone Scan may occasionally be helpful in determining benign from malignant lesions). Enhanced (contrast) agents increase the sensitivity, conspicuity and accuracy of an exam. The agent most commonly used is Gadolinium. The proper medical protocol for all Brain and Spinal MRI's for metastatic diseases is Enhanced with contrast (today, it is the Pet Scan). An Enhanced MRI was not performed and the Radiation Oncologist told us the lesion was nothing and not to worry about it. He also ignored my complaints about her having seizures during radiation therapy. Nine months later, my wife was admitted to our local home town hospital during the Memorial Day Weekend of 1999, for a week of testing and evaluation for unexplained falls and light-headiness. After two weeks of failing to find out what was wrong with her, I took her by ambulance to Hershey Medical Center for proper medical treatment. At Hershey Medical Center, we found out by a medical onocologist and a neurologist that she had Leptomeningeal Carcinomatous (remember the undiagnose tumor of nine months prior, not further evaluated?). An Enhanced MRI showed now three (3) metastatic tumors on her spine. Spinal metastases can grow into adjacent structures, such as into the meninges from the spine. The largest of these tumors grew into the meninges on the spine into the spinal fluid, hence Leptomeningeal Carcinomatous. This was confirmed by a spinal tap. With the damage already done to her by our local home town hospital, the doctors at Hershey Medical (in order to save her life or at least give her some time) had to administer Intrathecal Methotrexate along with systemic radiation to the spine (Admitted June 19,1999). When both therapies are performed at the same time it doubles the theraputic dosages of each therapy (increasing the neuro-toxic effects on the brain). However, the cancer cells were eradicated completely from her central nervous system by this protocol. Ever since the second spinal tap at Hershey (when methotrexate was already being administered), all of her spinal taps were negative for 10 consecutive times up until January 14, 2000. A Whole Body Bone Scan (November 3, 1999) indicated that the skeletal system demonstrated normal uptake and an Enhanced Brain MRI (November 3, 1999) showed no new areas of abnormal enhancement.Adverse Side Effects of Treatments:My first experience with the side effects of combination chemotherapy and whole brain radiation was when she was at Hershey Medical Center in 1999. The doctors showed me the Enhanced Brain MRI from her previous year's cerebellum excision and the one done in 1999. The scans showed the progressive deteriation of her white matter (white matter disease). Late delayed effects, occuring several months to many years later, are classified into diffuse white-matter injury, radiation-induced arteriopathy & stroke, and late delayed Radiation Necrosis. These reactions are due to changes in the white matter and death of brain tissue caused by radiation-damaged blood vessels. This clinical syndrome generally occurs 6 months to 2 years after radiation therapy. Symptoms include decreased intellect, memory impairment, confusion, personality changes and alteration of the normal function of the area irradiated (all symptoms my wife had over the past year).Radiation Necrosis can be fatal! It causes pathological changes that impair vascular integrity. Delayed radiation injuries result in increased tissue pressure from edema, vascular injury leading to infarction (stroke), damage to endothelial cells and fibrinoid necrosis of small arteries and arterioles. My wife suffered a stroke to the left basal ganlia area of the brain in January 2000, confirmed by an enhanced MRI.My wife had developed necrotizing l