November 11, 2010

happy to be wrong

I have a near pathological need to be right.  You can ask my son.  He keeps a running tally of the number of times I've been wrong.  I think I get it from my dad.  If you ask him if he's ever been wrong, he replies, "Once.  I thought I was wrong but it turns out I was right."  As a result, when I start to draw conclusions, I usually have a pretty strong degree of confidence in their accuracy.  So it was with my brother's progression.

My brother has been suffering miserably of late.  He's lost 40 pounds, his pain levels were increasing dramatically and has difficulty even walking.  Not what one wants to see from a cancer patient.  But he was confident that the primary tumors were behaving.  In his words, he said 
"my gut instinct tells me they are stable. Don't ask me why I think that...I just have a feeling. The rest of my body: that's another story."

Pain is usually one of the most reliable prognosticators for progression of cancer.  But visceral sensation in the chest is just not that precise.  Just think of a heart attack.  It often feels like pain in the shoulder or arm, not the chest.  And when my brother's primary tumor shrank upwards of 60ish percent with chemo, he never felt any difference in his chest.  My fear was that he wouldn't be able to discern a 30-40% increase in the primary tumor.  It'd still be smaller than it was originally.  So when he was telling me of his immense and growing pain in his shoulder and hips, I grew troubled.  I figured the primary tumor would fly under his pain radar.  I inferred that if the tumors in his hips were growing, then most likely the ones in his chest were, too.

Today, we got the preliminary results of the PET and CT scans.  It was a mixed bag but I've never been more relieved to have been wrong in my life.  The primary was mostly stable (there was one small ancillary growth near the primary).  The bony metastases in his hip and leg bones, however, were growing.  My brother...well, I'm not sure how he feels about it.  Me?  I breathed a big sigh of relief, which I know sounds odd but here's my reason.  If the primary had grown, because of its location near the lungs and great vessels of the heart, it would be life threatening, plain and simple.  The tumors in his hips and legs, though, are not trivial.  The risk of a fracture is real and dangerous.  A fracture would require major surgery.  The bony tumors have absolutely impaired his quality of life and my heart aches to see him in such pain.  It impairs his mobility and morphine just doesn't work that well on bone pain.  But a tumor invading the hip bone does not carry the risk of a tumor invading the lungs or aorta.  And that's why I am greatly relieved.

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