Meeting Dr. Shane Dormady

Today, we went to see Dr. Shane Dormady at the El Camino Hospital Cancer Center.

The facility is pleasant and the staff are warm and nice. Dr. Dormady explains things clearly and slowly. Dad liked him instantly. It was also great to find that Dr. Dormady did not comment about the stage of the disease. When he kindly said, 'You have been in the defense mode and was suffering, now we are going to fight back", Dad almost cried. We were encouraged that he understands our frustration and was positive about our treatment options.

We decided to go with Dr. Dormady and his team. After we exited the building, we bumped into a close friend who has been treated by Dr. Dormady and highly recommended him. It was a confirmation for our decision and we are very happy about our choice.

Next Steps:

• Next Monday - Education Session (3 hours)
• Tuesday - Chemo IV (6 hours)
• Wed and Thursday - Hydration (1.5 hours each)

Treatment plan:

1. Cisplatin + Alimta + Avastin.  Two cycles of chemo, each cycle 21 days.  Meaning chemo one day (6 hours IV), two days hydration (1.5 hour IV), then break.
2. PET scan after the chemo to see if the tumors have shrunk.
3. If the chemo is effective, 2 more cycles of chemo.
4. Determine if radiation treatment is possible
5. If all goes well, use the targeted therapy for maintenance.  The doctor's experience was that the targeted therapy is more effective if the tumors are smaller.  Hence, he recommends chemo first.  This is different approach from what Dr. Tai recommends

Notes:

• Send biopsy samples for gene mutation test.  
• Dr. Dormady is 80% sure that Dad's cancer type is adenocarcinoma because Dad does not smoke and also the locations of the tumors are more centralized.  
• Dad can continue to work after chemo, travel domestically. He should not do overseas travel.
• The doctor's main worry is the many small dots shown in the CT scan. The biopsy samples were not enough to determine if every small dots are cancerous or scars. The only way to do determine is by lung surgery and remove a large chuck of lung for sample, but we don't want to do that. We will have to wait to see if the dots disappear after chemo.

- Jacqueline

Taking Advantage of "Ask A Doctor" Sessions

Upon a friend's suggestion, I went to a 'ask the doctor' session at the New Hope for cancer patients and families on Wed.  It turned out that I was one of the only two patient families present, as a result, I got to consult with the oncologist Dr. Edmond Tai for one whole hour.  Dr. Tai practiced at Palo Alto Medical Foundation with 25+ years of experience in oncology practice.

Dr. Tai's recommendation for treatment:

1. Tested for gene mutation (EGFR, ALK and KRAS) first.  If Dad's gene mutation matches one of the above, use the targeted therapy for the according type of gene mutation for effectiveness and less side effects.  
2. If gene mutation doesn't match, use chemotherapy (Carboplatin + Alimta, may be with Avastin)
3. In China and Hong Kong, even if the gene mutation doesn't match, the doctors usually start the patients on Tarceva because Asians are more responsive to Tarceva. 

http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/healthprofessional/page11

Notes:

• There are 3 grades of cancer cell in histology term.  'Poorly differentiated' means grade 3
• He commented that cancer staging system should be used only as a reference.  The system is 50 years old and was based on size and location of the tumor.  The system was designed when surgery was the only option, thus to help the doctor decide whether surgery was possible.  The staging does not take into account patients' biological characteristics, age, health condition, etc.  Also, the bio technology has advanced greatly in the past five years in the targeted therapy.  I was relieved to hear that.

- Jacqueline

Results from PET Scan

The PET scan took 3 hours and Dr. Lei came back with the results.

In our worst fears, the nodules show high metabolic activities which are indication of cancer. 

The positive thing is that there is no other abnormal metabolic activities in other parts of Dad's body including head/neck, chest wall and pleura, abdomen, pelvis, and bones / bone marrow.  Praise God!

In conclusion, Dr. Lei stated that based on his experience, the nodules are most likely tumor/cancer and recommended bronchoscopy next Tuesday to finalize the diagnosis. 

At a time like this, Dad and I found that the Bible verses and worship songs the most encouraging.  We now understand why God say His Words is life.  We play worship songs all day long to fight off the depressing thoughts. 

'For with God, nothing will be impossible'

- Jacqueline

Results from CT Scan

Dad has been coughing for a few months, the GP thought it was cough variant asthma and had prescribed various medicines including antibiotics twice, asthma inhaler, cough syrup, cortisone, etc.  Thanks to your nudging and also a sister at church, Mickie's urging, Dad went for an X ray.  Upon seeing the X ray result, the GP immediately referred us to a pulmonologist who subsequently ordered a series of tests.  

The pulmonologist showed us the CT scan image today which reveals suspicious nodules in Dad's lungs.

With the findings, there are three possible scenario:

1. Lung tumor or cancer
2. Interstitial pneumonia - Infection by fungus ( I told the doctor about the humidifier usage)- test is ordered and will take longer time to find out the result
3. Auto-immune system problem, that Dad's lung is attacking itself.  This one doctor kind of rule out because the rheumatoid arthritis index from the blood test was normal.

The doctor ordered a PET CT scan for Dad to test if the nodule is a tumor, and if the tumors have spread to other parts of his body.

The doctor tells us not to jump to conclusion before the test result is back. 

Dad has canceled his trip to Asia tomorrow.  We will focus on finding out the diagnosis and prognosis as soon as possible.  

Needless to say, we are very disappointed and sad to hear the news.  However, we remain cautiously optimistic and look up to God for strength and peace.

- Jacqueline