Monday October 17th

Hi

 

It has been a heck of a week.  We went back east and through the help of friends (both old and new) we were able to visit with Dr. Morton Coleman.  He is a wonderful man and helped us think through our options and next steps.  Combining his visit with everything we discussed with Dr. Stephen Foreman (our main doctor who we love and admire), we think we have a game plan. Unfortunately, there isn't one path to follow with guaranteed results. Rather, there are a number of choices - each with its own set of risks and rewards.

 

From everyone we met with and everything we know, the first line of attack (methotrexate and temador) was clearly the way to go. Unfortunately, Tia's cancer is resistant to this line of attack. Given that the two chemos she took are vastly different, it is likely that other chemos will also not be effective. Therefore, the second line of attack will be radiation.  Here is where the first choice must be made.

 

There are 2 main thoughts on radiation.  Whole brain radiation and IMRT (intense modulated radiation therapy - or pinpoint radiation).  The pro to doing IMRT is that it is limited to a specific part of the brain and therefore the possible damage to brain function is limited. The con to IMRT is that if there are other, undetected cancers inTia's brain, it will not irradiate them and they will continue to grow.  The pro to whole brain radiation is obviously its prophylactic effect.  The con is the possible diminution of brain function.  As Tia and I both believe the words "radiation" and "brain" should rarely, if ever, be used in the same sentence, and on advice of most of the doctors we have seen, we are opting for IMRT.  We will fly back to LA tomorrow and meet with the radiation oncologist on Wednesday with the plan of starting radiation therapy on Monday the 24th.  For those who have volunteered to help drive Tia, I will send a separate email and schedule once her times firm up later in the week.

 

After radiation, there are 3 main thoughts on the next step.  Again, there is unfortunately not one path that is both low risk and high reward.  The first path is to do nothing and just monitor Tia.  Obviously this entails no risk immediately as there is no operation, but if a cancer should reappear we have used the 2 most effective treatments (methotrexate and radiation) so we will be left with a number of less desirable alternatives.

 

The second path is to do another auto stem cell transplant.  The risk of mortality/morbidity of the operation is minimal since they are using her own stem cells and there is no risk of rejection.  The problem is that she had an auto transplant back in 2006 and obviously her stem cells have an issue as she continues to create cancers. So, we may go through the auto stem cell transplant and not decrease the likelihood of a caner reoccurring.

 

The third path is to do a mini-allo (3rd party) stem cell transplant. The risk of rejection makes this a much more dangerous procedure, but the rewards are also much greater.

 

As we do not need to make a decision on this until after radiation, we are still weighing our options but leaning toward the mini-allo transplant.

 

Through out all this, Tia has been strong. When she gets down, we chat about what we have gone through and what we have to get through. While there are lots of possible outcomes, there are 2 major ones - the cancer beats Tia or Tia beats the cancer. If the cancer were to beat Tia, then it is important for Tia to get up every day and make the most of that day with friends and family. Similarly, when we realize that Tia has beaten the cancer, then it would have been foolish for her to have wasted days fretting over something that didn't come to pass. So, again, it is important for her to get up enjoy the day with friends and family. Since, regardless of what happens, the actions for today should be the same, it is therefore our plan to make the most of everyday.

 

With that in mind we had a great week back east.  We saw dear friends for dinner on Wednesday and Thursday and a play ("Book of Mormon") on Saturday.  Rae got to join us for Thursday and Saturday (as she fit it in between travelling to Barcelona and hopefully getting an education at Penn).

 

On Saturday night we went up to our farm and had a wonderful party for lots of Tia's family and friends here yesterday. It was loads of fun even though I got demolished in football and the Brewers lost (Tia was devastated).  

 

Today we are hanging around the farm as Tia is gathering "exotic" fruits like apples and concord grapes to load up the plane tomorrow as I guess they don't have such things in the backwaters of the Pacific Palisades.  We will be home tomorrow so anyone who wants a taste of these rare delicacies can stop over and visit Tia later in the week.

 

Again, thanks for all your thoughts and emails.  They really mean a lot to Tia and all of us.

 

Jess, Tia and the girls.

 

PS - I can't help throwing out a promo for our friend Alan's movie (And They're Off) which is premiering Saturday at the arc light in Hollywood at 5pm.  Go see it when it is available!