Talk with the doctor

About 7:30 PM Thursday, Dr. Vinod Ravi and nurse practitioner Sue came to see Cheryl and gave us the opportunity to ask questions. It was Tuesday afternoon when we last saw Dr. Ravi (Sue came earlier today) and a lot had happened since then. Following is a summary of the questions and answers.

Have the pathology results determined the exact type of sarcoma? No. It is not urgent since we decided to proceed with the first round of chemo without knowing the exact type. If we had decided to wait for the exact type then it would have been urgent. The exact type will be important when deciding the approach for the second round of chemo at the end of three weeks. Dr. Ravi said one of the world's best sarcoma pathologists is doing the work.

Were the tests that have been done planned from the beginning or has Cheryl's condition caused him to order more tests? All the tests so far are part of a comprehensive evaluation of Cheryl's condition at the start of treatment. They are to identify all the problems at the beginning and serve as a baseline for comparison when progress is checked at the end of six weeks.

Have the tests shown anything different than what we knew before coming to Houston? Dr. Ravi has not reviewed the bone scan yet. The only thing new from the other tests is a compression fracture in vertabra C2 in her neck. There are several possible causes and he does not know if this is related to the cancer. He did not seem concerned, it is just part of documenting her initial condition.

Is Cheryl's reaction to the chemo drugs typical? (This was a repeat of the questions to Sue this afternoon) Dr. Ravi reminded us that when we talked about the planned chemo, he had told us about two areas he would be watching for. First was problems with the kidneys. This has gone well and the kidneys are doing great. The second was "neurological effects." This side effect can cause "mood changes, depression, confusion, hallucinations, nervousness, difficulty sleeping, dizziness, drowsiness, clumsiness, difficulty walking, or restlessness." Cheryl has experienced quite a few of these but it is all within normal parameters and is most likely completely reversible as she recovers during the next two weeks (although there are rare exceptions).

Does Cheryl's tolerance to the chemo so far mean she won't be able to continue such high doses in the future? It will be up to her. Once she has recovered and before another round he will discuss with her if she wants to continue. Medically, based on her tolerance so far, it would be possible. But it will be up to Cheryl if she thinks the benefit is worth the cost. Dr. Ravi will be there to help her understand the options, but the final decision is up to Cheryl.

In case your interested, the drugs being used are:

1. Ifosfamide in combination with Mesna
2. Doxorubicin

We will keep you updated as we learn more. Ron