Answer: If you’re diagnosed a second time, you can just laugh it off.

We had a mixed bag of news today. Over the past couple of weeks, Lori has increasingly experienced more pain in her knees, femurs, lower back, shoulders and neck. She had been supplementing her pain pump with daily oral doses of morphine as well as the maximum daily allowable amounts of ibuprofen/Tylenol. Even then, she felt the pain through it all and had trouble sleeping each night.

Furthermore, she noticed a new lump in her lymph nodes under her right arm. Those nodes had previously disappeared under Eribulin chemo, so with their reemergence, we both figured the Eribulin had stopped working. When we considered the added pain, we were all but certain that the cancer had spread and was attacking everywhere with increased potency. Last Friday, Lori went to our local Dayton hospital to accomplish all of her organ/bone scans, and we both naturally expected the scan results to match the way she felt physically.

Today we drove to Indy for a follow-up with Dr. S and for further treatment depending on his analysis. First, we went to the pain clinic and had her pump output increased. Hopefully that will take care of the discomfort. When we later met with Dr S, we learned that he hadn’t yet received the transfer of the scan images from our local hospital to his IU clinic. Without the images, he couldn’t definitively say that the Eribulin was failing to work, and it looked like we’d have to wait for those to arrive before we could proceed with a new treatment plan. To pass the time, he examined Lori and confirmed that the lymph nodes did appear to have a new lump and that the right breast had a new lump as well. Remember that Lori’s primary tumor is in her left breast, and we’ve known about this small tumor growing on the right side for a couple of months now. We had assumed it was the same cancer simply spread to the other breast and kind of brushed it off as simply that. He laid out a few options for new treatments including parp inhibitors for the next phase (again assuming that the scans would show the spread of the disease). While discussing all of the next treatment options, the nurse cracked open the door, reached her arm in, and held out three papers in her hand. The scans had arrived.

Dr. Schneider took the papers and began to read them. He laughed briefly as he recognized the awkwardness of being forced to analyze them on-the-spot in front of us. Generally he accomplishes this on Sundays and then meets with his patients on Mondays armed with fore-knowledge and a well-devised plan. Fortunately, he’s comfortable with us and we are comfortable with him, so no one minded the breach of etiquette. He began to read, but after a few moments he stopped and flipped back to the front page to make sure these were actually Lori’s scans and not someone else’s. Once he confirmed they were in fact Lori’s, he had good news.

Direct quotes from the radiologist report:
– Moderate decreased uptake in the metastatic disease
– CT of the chest, small nodule on the left lower lobe on the previous study appears smaller and less apparent. The lungs are otherwise unchanged.
– Multiple ill-defined lesions throughout the liver on the previous study are much less apparent on the current study.
– The mixed osteolitic and osteoblastic bone lesions are not substantially different.

So is this good news? Overall, yes! Bottom line is that she is improving in the most important areas of her body. As a result, she can continue with Eribulin as it appears to be working very well! Now we have this pesky problem/mystery of the increased pain. Dr S. thinks that the lump in her right breast is quite possibly a new cancer that has formed. He also wants Lori to have a brain scan accomplished to see if anything is there which could be causing the sudden increase in pain.

If the new tumor is a new cancer, it may be a different type (remember the HER2 and ER types?). That would explain why the scans showed decreased metastatic activity in the areas known to be affected by the Triple Negative cells while the new cancer could still be thriving despite the chemo. If the new cancer is a different type, it would not have responded to the Eribulin chemo which targets the Triple Negative type cells. So Lori had a biopsy done of the right breast tumor, and if it’s a new and unique cancer, Dr S will tailor the treatment to suppress that type as well. If it’s HER2 or ER, it will be easy to target. Breast cancer treatment has come a long way in fighting those types.

Her brain scan will be accomplished this Wednesday here in Dayton, and we should know the results by Thursday. The results of the new tumor’s biopsy (which was accomplished today) should also be ready by the end of this week. It really doesn’t matter much what the results of the biopsy are because the overall prognosis won’t change either way. If it is indeed a different type of cancer, then the process will become more complex but not more difficult to treat overall. However, we really care about the results of the brain scan, and we want it to come back clear because…well because of course, right?

It was one year ago this month that Lori was first diagnosed. One year later, it appears she may be diagnosed all over again! This time it’s almost laughable. It has been a great year despite this attack! Every day together is a blessing. This next year, we’re going to ramp up the activity a bit. We’re planning to travel some, read and write more (Lori’s writing is really getting going), hopefully celebrate a championship in style, and just generally continue to live without fear!

Matthew 6: 19-21 – Do not store up for yourselves treasures on earth, where moth and rust destroy, and where thieves break in and steal. But store up for yourselves treasures in heaven, where neither moth nor rust destroys, and where thieves do not break in or steal; for where your treasure is, there your heart will be also.

Finally, my assignment to Wright Pat also came through, and I’ll officially be stationed here as of 30 April. I’ll be back and forth to NC a couple of times before then, but a majority of my time will be spent in Dayton with just a few weeks in NC to finalize the move and take care of out-processing.