A Fresh Beginning- Part 1 - August 25, 2010

Yesterday marked what seems to be a new beginning in Pete's battle against sarcoma.

Monday afternoon he received a call from Dr. R's office. Pete had notified them that he had obtained the slides of his initial biopsy as they had requested. True to their word, they responded almost immediately with an appointment time of 9 AM Tuesday morning.

We were up and on the road just shortly after 6. There was a report of problems with commuter trains on the LIRR and that this may result in heavy traffic delays as people turned to their cars to make the trip to work and not chance having to face train rerouting problems. As it turned out, our drive into the city went smoothly.

Dr. R had been affiliated with St. Vincent Cancer Center until the hospital abruptly closed in April. Many of the physicians and services were transferred to Beth Israel Hospital, so that's were we were headed. The drive up was much easier than going to MSKCC. This trip was done with Mapquest directions in hand. We exited the NJ Tpk at Exit 14, through the Holland Tunnel, and only had to navigate about 2 miles of Manhattan streets. We arrived at our destination around 7:45, well ahead of the appointment time.

Pete announced himself at the concierge desk and despite the early arrival, he was taken in for blood work. That completed, he had barely seated himself in the waiting area when we were escorted to Radiology. He had been instructed to fast in preparation for a possible CT scan, but after responding to a few questions posed by the receptionist, a call was placed to Dr. R. Within minutes, Dr. R's Physician Assistant came in, introduced herself, and spoke with us briefly, and then told us she would be back after she had spoken with Dr. R.

Minutes later she returned with Dr. R and the two of them escorted us to Dr. R's office, chatting comfortably about more than just medical issues and putting both Pete and I at total ease. I didn't look at the time, but I would guess that it wasn't much later than about 8:15 or so.

After talking with Pete and I, posing questions about Pete's medical history and making copious notes, Dr. R pulled up the scans that Pete had brought, one after the other. He encouraged Pete and I to view them along with him as he scrolled through, pointing out tumors, blood vessels, muscles and explaining concerns about locations and treatments. He was so unlike the doctors at MSKCC, where I had felt a mere observer. Dr. R's approach encouraged us to become active participants in Pete's healthcare.

Pete had brought slides of the initial core needle biopsy performed in December 2008. Dr. R placed each slide under the microscope and explained what he saw. Unfortunately, he did not feel that these slides were adequate for him to provide a thorough assessment and directed Pete to secure slides of the original tumor resected from his arm by Dr. S at MSKCC in January 2009. He shared his concern about one of the margins noted in the surgical report as being insufficient. It was listed as 0.1 cm when conventional surgical wisdom recommends a considerably wider margin.

He did a physical exam of Pete and sent us into an examining room where a nurse came and recorded Pete's vitals. He changed the originally expected CT scan to a PET/CT and were told we would meet with Dr. R to go over the results following its completion. It was about 10:30 when we left his office giving us about an hour and half until the scan appointment time of 12 noon.

They were prompt about taking Pete in for the scan which lasted until about 2 :30. We walked back to Dr. R's office and after a brief wait were called in to meet with him once more. Again, he invited both of us to view the results of this scan, pointing out areas he was most interested in checking, and explaining and interpreting what we were looking at on the screen.

In closing, he shared his treatment plan for Pete based on the information he had, but cautioned that he may modify certain parts following a re-examination of the scans and after he has the opportunity to view the slides of the actual tumor biopsy which Pete will get from MSKCC.

So what does Dr. R recommend? For one, he feels the close margin of the original resection presents increased possibility for recurrence at the site. He would have recommended post-operative radiation immediately following surgery, but assured us that radiation performed on the site at this time will offer some protection against recurrence. The large tumor in his upper left lung, the one that is causing the pain, would also receive radiation along with high dose chemo, most likely Ifosfomide with the possible addition of another agent, to encourage tumor shrinkage, followed by surgical removal and recommended a thoracic surgeon with whom he has worked closely. He advised that the surgery will probably require the removal of 2-3 ribs to be replaced by a plastic mesh, but more on that later.

He is taking an aggressive approach in this battle and though he is not promising it will be easy, it does give more hope than the doctor at MSKCC seemed to be offering.