March 13, 2024
Today we saw Dr. B for labs and an appointment. Both PAs were out of the office so Dr. B was left on his own and was running behind thanks to the schedulers who he said had no mercy on him. We spent a while in the office waiting so David regaled me with the fantastical exploits he had in his dreams the night before. He frequently entertains me with the most Argonautic stories from his dreams. I really need to record these. Dr. B had not seen David’s PET scan report because they are on a different charting system than the EPIC system that Piedmont uses. He took a few minutes to read it and commented that a negative scan was good, and the neuroendocrine features of the tumor could explain why the chemo wasn’t as effective as we needed it to be. Neuroendocrine tumors do not typically respond to systematic treatment. He said that after radiation, David would have more scans so the team could make a decision on the next steps. Dr. B said there was one more DNA test he could order for David’s blood that may help with where we stand. David previously qualified for genetic testing so Piedmont had already sent blood work to an outside genetics’ lab for examination. We got a detailed report back that did not indicate a genetic predisposition to this cancer at least given the limited family history we were able to provide. At the same time though, it is recommended that Sarah-Lauren will need to undergo her first colonoscopy at the age of 38. The recommendation is 10 years prior to the age David was at diagnosis. Dr B ordered DNA testing early in the Fall and that report suggested chemo drugs that may or may not be beneficial in treatment of David’s specific type of cancer according to the make-up of his cells. That information was considered when we went through chemo in the Fall of 2023. Dr. B explained that testing was not complete on the initial tumor specimen due to it being somewhat degraded, so he would recommend additional molecular testing on the tissue obtained from the liver surgery since it was a much better specimen. Dr. B said the radiation side effects tended to be worse at the end of radiation so he would see David again for more labs and to assess the side effects. He told David it sounded as if he was doing as expected. David’s labs showed his hemoglobin continues to slowly rise but it is still considered low. Liver enzymes appear to be getting back into range as we are entering week 6 of liver recovery.
