The oncology docs here at MVH told us that her liver will not get better. It is not functioning well, and each day the liver/blood numbers are getting worse. They also don’t have any further lines of treatment to recommend for her cancer. I checked with Dr. S, and he concurs that there are no more traditional chemo or FDA approved drugs for her. However, Dr S would be willing to prescribe an immunotherapy drug, but he wants her organs to be functioning well before he gives it to her. The immunotherapies are known to wreak havoc on the body so I agree it would be rough to try that at this time. Also, he needs to see Lori in person to do an analysis so he can feel right about a prescription. We are definitely in no shape to travel to Indy, and he already said she’s in no condition to get the immunotherapy now anyhow.
He and Dr Marinella agree that it would be ok to continue with the Xeloda in hopes that it will take hold and start to fight back the advance of the cancer cells. But there’s not much hope there medically. If that chemo was going to work, it would have done so in her first cycle. I did see some signs that it might have worked, so I won’t give up on it yet.
She is in pretty bad shape overall. The signs of liver trouble are ever-increasing. Her shoulders are bony and her face/skull is becoming sunken with a sickly sort of appearance. Her eyes are yellow with jaundice. She’s barely able to communicate, and half of the time it’s just mumbling about something incoherent. It’s amazing though, because she can still pray and hear prayer so well. Although her liver is failing fast, the rest of her body is strong. Her kidneys, heart, lungs, etc are all fine so I think it’s unlikely that death is imminent. It’s hard to put a number against that but the predictions range from days to weeks if she continues to digress.
OK so every doctor who meets with us throughout the day has encouraged us to talk to hospice and to consider a transfer. Here’s my philosophy (and Lori’s too) on how we approach that kind of decision (remember we’ve been here and done this before!) :
First of all, if we’re going down, we’re going down fighting. That means that if there’s a treatment available, we’ll try it until the end or until it’s doing more harm than there is potential for good. So for chemo, we’ll continue on Xeloda likely until the end. If the side effects are too much to bare, then we’ll stop. Pretty simple. It’s our only medical hope of treating the cause of the liver failure (cancer). We’ll also always pray and believe that God can heal Lori until the last breath. Just days following her diagnosis, she told me that she believes God can heal her and that she won’t stop believing all the way until the end.
Secondly, I’m only going to transition to hospice if the advantages of hospice outweigh the disadvantages of leaving the hospital’s full-time care. The main things I was concerned with were the loss of daily blood work/analysis and whether or not we could continue the Xeloda. I had a long meeting with a hospice rep today, and I’m satisfied that they can meet/exceed everything we’re receiving in the hospital, but I had lingering concerns about the bloodwork and Xeloda questions. The rep had to go back and research, and she returned a couple hours later with news that they would make an exception for Lori and run regular bookwork analysis (they usually don’t do that more than once per week if at all). Also, Xeloda is on the list of approved chemotherapy so there’s a winner.
The advantages to transitioning to hospice are that the docs there are said to be the best at pain control. I heard about many of their techniques, and they told me about one in particular that sounds good. They use a drug that controls the pain well but doesn’t cause much drowsiness. The trade-off is that it’s hard on the respiratory system so hospitals and doctors don’t typically use it. Hospice nurses are specially trained to administer the drug while monitoring the symptoms of the side effects. They tweak the dosage until they find the right balance. Also, Hospice of Dayton is a huge operation. They have a large inpatient facility that they say is extremely nice and designed around comfort for the patient and the family.
It’s sad to be making this transition, but there are more pros than cons. So, we’ll stay in this hospital one more night, and unless I change my mind before tomorrow morning, we’ll sign on with Hospice around 9am. That should set us up for transport to the inpatient facility on Wilmington Pike by noon or so.