Surgery

Marshall got through the MRI last night and this moning the doctors came by to tell him he had another tumor wrapped around the spine, this time in the lumbar area.

More teams of doctors have now come to see us, all with the same prognosis -- he is pretty much out of options.  

Then Dr. Flaig, the oncologist, came to see Marshall.  He told us that the MRI showed that the cancer metastases in the bones have not really changed, they have remained stable.  But the tumor wrapped around the lumbar spine is problematic because it is growing so aggressively.  Marshall no sooner recovers from one surgery than there's more cancer and another surgery opportunity.

Dr. Flaig said there are two ways to go.  The one he clearly recommended was going into hospice.  The other way is to be aggressive and have the surgery to remove the tumor around the lumbar spine, then get two weeks of radiation and then go back on Zytiga to see if he will respond to Zytiga for a second time.  I asked him about another drug that's out there called Xtandi and he said he has had two patients in the past two weeks who were on Xtandi and who had seizures and really hurt themelves.  He said he is very hesitant to put Marshall on Xtandi but if the Zytiga didn't work and if Marshall still wanted to be aggressive he might try it.

Dr. Flaig said that (1) the cancer is very aggressive; and (2) the Zytiga only works the second time around in 30% of men.  He clearly thought the aggressive way to go would be very tough for Marshall to handle.

Marshall asked Dr. Flaig how much time he has left. Dr. Flaig said that if he goes into hospice he has "long months" to go, maybe 6 to 10.  If he went the aggressive route and had the surgery/radiation and IF the Zytiga works, he might have as much as a year to even two years.   

So Marshall has decided to have the surgery and radiation and give the Zytiga a try.  The surgery will be this afternoon.  Poor Marshall, he hasn't had anything to eat or drink (except ice chips) in two days because they don't want him to eat before surgery and they weren't sure if or when the surgery would be.  He is starving.

I have the hotel room until Friday and then I'm not sure what I will do.  The hotel is $200 a night and it's silly to pay that kind of money when I'll spend most time here at the hospital.  So depending on how the surgery goes I may either just move into the hospital room with him or I may go home for a day or two and then come back.

After the last surgery it seems to me he was released pretty quickly, like after three or four days, and I thought they sent him to the nursing home for rehab.  But I've been reminded that that wasn't the case.  He came straight home (the nursing home situation was at another time).  So I am assuming that will be the case this time, too.  I can see that our CNA (Gina) will have her work cut out for her! because I will definitely be able to uss the help.