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AnnieRSA

AnnieRSA - Hello from South Africa

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Hello all. I am posting this on behalf of my mom who has been diagnosed with lung cancer this morning :(

She is 58 years old and has never once smoked a cigarette in her life. Yet this morning we got the most saddening news that our dear mother is now a victim.

She is married to the kindest, most loving man, husband, friend and father. She has two sons (I am the elder) and a daughter (the youngest, our baby:) ).

Our family hails from India and we have a lot of relatives in India, the USA, and some other countries too.

My intention is to share her story and explore the various treatment options available as well as to derive as much inspiration and hope from everyone's experience, love and support.

Best regards to everyone

Chris

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Sorry to hear about that. Has a stage (I, II, III, IV) and/or specific type (adenocarcinoma, squamous cell, large cell, small cell, ...) been determined yet?

BTW, East Asian never-smoker women with the adenocarcinoma type of lung cancer have something like an 70%-75% chance of having EGFR-driven cancer, and it may be similar in India. (That might be more due to behavioral and cultural factors and exposures than genes, but it's not known.) That can be useful because if it were EGFR-driven cancer, then if it progressed to a stage where it might be considered incurable (usually in Stage IV where it's spread far from the original site), an EGFR inhibitor like Tarceva (erlotinib) or Iressa (gefitinib) might have a good chance (something like 85%+ odds) of controlling EGFR-driven cancer for a number of months. EGFR status is determine by doing a gene mutation test on a biopsy sample. Other useful mutations (more likely in never-smokers) are ALK, ROS1, and a new one is emerging from the research called RET, though these are increasingly rare.

Best hopes,

Craig in PA (USA)

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Hello and thank you Craig. We have not yet heard definite results and are expecting this tomorrow. I am currently away on work and only return to them on Friday. My brother and sister are currently with my parents.

I have asked that they collect and send as much information from the doctors so we can send it to friends and relatives to get second opinions and treatment options.

We hail from south India. So we are trying to get her there for either radioactive or otherwise Ayurvedic treatment.

The doctor said that the infection is spread all over her lungs and not just a single tumor. Hence surgery will not work. He also mentioned there is a possibility it has spread to her liver too.

Today has been an incredibly taxing day on all of us, including the extended family. Everyone has been calling and in tears all day. This being a first of its kind in the family, and especially since she is a never-smoker, we are all rather confused and (should I say) feel betrayed?

We are trusting in God to show us His best will.

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AnnieRSA,

If it has spread widely within both lungs, there's a good chance it's considered Stage IV. I'd assume that given her age, never-smoker status, gender, and ethnic background, there's a fair chance that she's got an adenocarcinoma, and then maybe the EGFR mutation.

In the USA, a couple of not-for-profit organizations here estimate 15% to 18% of lung cancer is found in never-smokers (different %'s depending on which data they use). One of them believes it is 20% in women (10% in men). It is shame there is so much misperception in the world where most people assume that only smokers get lung cancer when, in reality, all people are at risk even if they seem to have no risk factors. I personally speculate that even if tobacco never existed a large portion of smokers who have lung cancer probably would have gotten it anyway.

Best hopes,

Craig in PA

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Thank you Craig.

What doesn't add up is that she had a complete check up done last year November and the doctors said there was absolutely nothing wrong with her barring her frequent tension.

Around three months ago she started coughing and it kept getting worse. That is when she consulted a doctor and went on several cough remedies as well as asthma related medication.

What made things worse is she suddenly lost a lot of weight and was simultaneously diagnosed with type 2 diabetes. Her diabetic count was at 24 (whereas it should be below 8). With insulin and hospital care, it has now dropped within the 10 to 12 range but still not fully stable.

We have asked the doctor for the results to be sent to us but I now hear that he only will send the results to other doctors valid email addresses.

Does anyone know any doctors who could perhaps have a look and suggest what can be done?

We have also enquired about Ayurvedic treatment in India which they say cannot be done if we have already started with radiation therapy.

We have scheduled for her to be flown to the city where we (her children) are currently residing so that we can have constant access to her everyday. The hospital there has scheduled treatment to begin on the 29th November.

Please do let us know if there are any precautions and necessary steps to be taken to help her in absolutely any way.

Thank you again for reading and wish you the best regards.

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Unfortunately, it is not unusual for a never-smoker to be told there is nothing serious wrong and then be diagnosed with lung cancer. For example, I was told my x-ray showed no tumor yet a CT scan showed a 6 cm tumor and at least a little spread to all the lobes of both lungs.

Either diabetes or cancer can cause weight loss, but not always. I had no weight loss. I am surprised to hear she has both diabetes and lung cancer, if understood you correctly. I wonder if there is any connection.

There are many doctors who would be glad to see a patient and offer a 2nd opinion. I don't know any who would do that without seeing the patient, although I think I recall a service that would remotely review and comment on medical records for a big fee. I don't remember who it was, but they had no specialists who focused exclusively on lung cancer.

For what it's worth, I am not a believer in promoted remedies that have not yet been proven to be effective in credible clinical trials, regardless how many centuries they have been practiced. If I can't read the research and see it isn't flawed, I assume I can't rely on promoters' claims. I'm also cautious to avoid things that might unknowingly interfere with my medical treatments while I'm getting them. Of course there are many people in India who disagree with my point of view.

Best hopes,

Craig in PA

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Chris - I just wanted to welcome you to this forum and tell you how sorry I am that you had reason to find us. Unfortunately Craig is right, and delayed diagnosis is a very common problem with this disease. It's even worse among nonsmokers, but it happens as well to people who smoke or used to smoke. I can't imagine what a shock the diagnosis must have been to your family. It is obvious your mother will be well cared by for all of you. There is a web site - www.cancergrace.org - where you can ask questions and a doctor will respond. Of course they can only answer questions in a general sort of way, and not suggesting a specific treatment for a particular patient. But it is still a very very helpful site and it has lots of the most up-to-date information on new therapies and research. I would encourage you to check it out.

I think this initial stage is the most frightening part of this journey. Once you know more details, and have a specifid treatment plan in place things get a bit easier. Your mother is young and has a loving family - so she has much going for her.

Please keep us posted on how all of you are doing. I will be keeping your family in my prayers.

Diane

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Yes Craig she has been diagnosed with both diabetes and now the lung cancer.

We are still awaiting the doctor to send reports. There is a renowned cancer specialist doctor in India called Dr. Gangadharan. We are going to ask him as well to review the report and findings.

Below is a link to a case study of someone that did Ayurvedic treatment and healed. Don't know how much everyone will agree or disagree.

http://www.pbhrfindia.org/index.php/cur ... asestudy-2

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Thank you Diane. Yes it is a grueling period in all of our lives. The big problem is that nobody really has what it takes to tell us to our face what will happen or what the exactly details are. And I have never been fond of sugar coated details.

I have checked out the cancergrace website just a little last night. Will post questions and queries as well as read up some more today after work.

Thank you again for the response. It means a lot to me and the family. Take care Diane!

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If i am not mistaken, the doctors have diagnosed stage IV adenocarcinoma as predicted. See report extracts.

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The doctors seem to have given up already and say its not gonna help much to take her to India.

However what I have heard is the healthcare in India is much more advanced and there are several more knowledgeable doctors there.

The second reason they give us not to take her to India is because the pressure difference on the plane could cause air to enter her lung through the cut they made for the biopsy. So now I am more confused.

Has anyone got any experience regarding traveling (8 hours to Dubai and then another 4 hours to India) by air under similar circumstances?

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I flew without problems with one lung during chemo, but NOT immediately after biopsy. That might be a good question for the doctors at cancergrace. Did they indicate how long until they thought it was safe for your Mom to fly? As I believe Craig already mentioned, adenocarcinoma is one of the most common nonsmall cell lung cancers diagnosed, particularly among never smokers. I imagine they will be testing the tissue for mutatioins in order to pinpoint the best treatment option. If you feel the doctors are simply giving up on your mother, you definitely should get other opinions. Although there may not be a cure yet, there are many new treatments, especially for some of the genetic mutations, that enable people to live with lung cancer almost as a chronic disease, as well as many clinical trials. Your mother's age is in her favor, and so is her family's determination to find her the best care. I believe a positive attitude is also a very important component.

Keep us posted.

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Wow Diane. I appreciate the insight. You are right. My brother was in tears following his chat with the doctors today. But there is absolutely nothing the doctors can say that will push our faith away. God is above all things and he can heal anything. I pray for each of you on this forum now because I was foolish thinking such things won't happen to us. And here it is, eating away at my dearest mommyluv when it could have challenged me instead. I hate it!!!

But I am doing my best to keep everyone's morale up high. She is not nearly ready to go anywhere and we won't allow that. Infact my sister sent me a photo today and she's looking even better and healthier than when I last saw her two days ago. Surely that's cause for celebration and not grief!

Following your advice, I will ask the doctors about the travel story again. In the meanwhile we are getting the reports to as many doctors as we can.

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Wow Diane. I appreciate the insight. You are right. My brother was in tears following his chat with the doctors today. But there is absolutely nothing the doctors can say that will push our faith away. God is above all things and he can heal anything. I pray for each of you on this forum now because I was foolish thinking such things won't happen to us. And here it is, eating away at my dearest mommyluv when it could have challenged me instead. I hate it!!!

But I am doing my best to keep everyone's morale up high. She is not nearly ready to go anywhere and we won't allow that. Infact my sister sent me a photo today and she's looking even better and healthier than when I last saw her two days ago. Surely that's cause for celebration and not grief!

Following your advice, I will ask the doctors about the travel story again. In the meanwhile we are getting the reports to as many doctors as we can.

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AnnieRSA,

I can't see anything in that report that suggests it is Stage IV. That seems to be a histology report describing what is seen under a microscope and some test to determine if it is cancer and what type.

I see they looked at samples from two lobes -- upper & lower -- so that has me guessing they might be referring to biopsy samples from the two lobes of the left lung, is that correct?

I think it is possible to have cancer spread from one lobe to an adjacent one and not be classified as stage IV, but I'm no doctor and can't guess your mom's stage. Spread to lymph nodes is part of the staging calculation, but if she has what I think she has, she might not have any detectable spread to lymph nodes.

(BTW, the right lung has 3 lobes -- upper, middle, & lower, while the left lung is divided into just 2 lobes; that's why I guessed this biopsy focused on the left lobe's two lobes.)

From that report, it looks like they suspect it might be the mucinous BAC (bronchioloalveolar carcinoma) subtype of adenocarcinoma. I have m-BAC too so I can tell you some of the good and bad about that subtype, although your Mom's cancer is probably a variation driven by a different mutation than the very rare one driving mine so there can be some differences.

One of good things about m-BAC is that it often (not always) grows more slowly than an average adenocarcinoma. Mine grows at about half the normal speed, and that gave me time for testing that gave me a new treatment track I wouldn't otherwise have had. It also is usually likely to stay confined to the lungs and not very likely to spread other organs, bones, brain, etc. m-BAC can sometimes change as it cosolidates and then start behaving more invasively and aggressively, but let's hope that doesn't happen. (I'm not expecting that in my own case.)

One of the bad things about m-BAC is that it has often already spread undetectably to distant lobes and it can take a sharp-eyed oncologist or radiologist who is experienced with m-BAC to notice evidence of it over there in a CT scan. (If it has a slow metabolism, it probably won't show up on a PET scan except where it's consolidated into a tumor mass.) In those distant locations it might look like just a GGO (ground glass opacity) "haze" or cloudiness. Most of my m-BAC was and still is that cloudiness, and some is too hard for me to see on my CT scans but an expert can using better viewing software.

That was my situation -- already spread to both lungs, although it took an expert with more experience than my local doctor to see it and interpret it correctly, saving me from surgery that wouldn't have helped me and would have left me worse off.

If it's still in one lung, they might be hopeful it could be III still and they'd try chemo first. If her doctos are saying that surgery is not an option, it is probably at least stage III and maybe they are suspecting it is IV.

I think you said her doctors sound like they've given up on your Mom, but do you mean that they don't expect any treatment they try will extend her life, or do you just mean they know the odds of cure are so small that they don't want to offer any false hope? If they know their field well, there should be hope of extending her life a while (at least until proven otherwise).

One of the bad things about m-BAC is that there are anecodotal stories suggesting the odds of traditional cytotoxic chemo (poisons) working well on it may be lower than with regular, faster-metabolism adenocarcinoma. Such anecdotes can mislead some doctors into having low expecations for what can be expected from treating m-BAC patients. But such anecdotes are no better than individual case reports -- isolated examples are not reliable indicators of what a good clinical trial with lots of patients would really see. So we don't know if it really has different odds. I do know that some drugs (e.g., Alimta) do sometimes turn out to be useful to some m-BAC patients for a while, but patients vary.

However, some m-BAC has a useful driving mutation like the EGFR I mentioned before (or ALK or mine which is ROS1), and something like that makes sense to try if the cancer reaches a point where the doctors consider it incurable. (An inhibitor drug for a driving mutation doesn't eradicate the cancer, it just inhibits it from acting badly; in contrast chemo has a chance of eradicating the cancer, although it's a small chance in late-stage cancer.)

My local ocologist was delighted when a referral to a distant expert came back saying I had a useful driving mutation, and even more delighted to see the dramatic improvement I got on the drug very quickly. I think he was expecting only a bad downhill hard road for me with a lifespan of 2 years or so, but instead my clock has been turned back and the expiration date stamped on my butt is too fuzzy to read anymore.

BTW, I know an m-BAC patient who has lasted 7 years since diagnosis so far (and she's been through all the hard stuff along the way -- surgery, chemo, 1st generation mutation-targed drug, and 2nd gen experimental mutation-targeted drug. And although the median time to progression for an EGFR-driven lung cancer on Tarceva (or Iressa) is only a number of months (9-10 months?), I've heard of lucky cases where someone is still alive after 7 or more years on the drug for that. That's pretty good given they only gave it to Stage IV patients.

From what I hear, India offers most of the advanced medicine that can has been approved elsewhere, sometimes with a lag for the newer treatments (and not as many experimental drugs). India also offers traditional remedies that I haven't seen any clinical trials on. (I mean no trials involving dozens and then hundreds of patients to prove something works for a significant portion of them, and then try to find out who specifically benefits from what, with result published in critically-reviewed medical journals.) Given all the people in the world who promote things that aren't really effective, I can't rely on anything that isn't supported by credible published clinical research trials (or trials-in-progress). It's not worth 000 my life on something without any proof that it should work in me, not when there's something with proven odds of success available. That's my personal opinion and that of most medical doctors; it might one reason her doctors discourage the idea of traveling to India for approaches not grounded in medical research -- if there had been a proven miracle treatment available there for years, her doctors would already know about it, would have proven it in other trials, and would be using it.

On the other hand, I'll speculate some doctors in India might be a little more on top of the latest lung cancer research from the USA and Asia than most in South Africa. But if what your Mom needs next is an EGFR test, then she should be able to get that done in South Africa or wherever she is.

Re: air travel when one's lungs after surgery might have an issue with the air pressure, you might try to reach out to http://inspire.com/squanch for her thoughts on that. I think she was prevented from traveling for a while for that reason, but I think she's able to fly now.

Best hopes,

Craig

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Wow. Thank you Craig. That's another mouthful of info to digest. But I'm working at it.

Yes the left lung was the one they did the biopsy on.here are the result documents. With X-ray results before removing and after removing the drain tube.

What worries me is the detection of some spread in the pancreas.

We asked why not surgically remove it but the doc said in her case he can't do that. Any idea why?

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post-54915-141270979758_thumb.jpg

post-54915-141270979759_thumb.jpg

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In the meanwhile the doctor has approved her for travel as soon as she feels upto it.

I'm shopping online for a portable oxygen concentrator (POC) so she can take it everywhere. I'm assuming this is a basic necessity with her condition until she is fully cured. Found the Philips EverGo (by Respironics). Does anyone know if that's a good option or recommend any other/better one?

Another thing that came up today is the availability of a local plant called the "cancer bush" which several people have used successfully. Including a friends uncle and aunt. So we are investigating about that and homeo treatment for now until the doctors have a better indication on what to proceed with.

Another thing to note is a distant cousin of mine was diagnosed with final stage 4 of lung cancer and he is literally 90% cured by this doctor we were referred to only by taking medication and no radiation/chemo.

I may be wrong in many things but only stating my feelings and thoughts. Please feel free to correct me as necessary. Thank you to all for reading :) Be Blessed!

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AnnieRSA,

The additional reports make the picture sound more confusing. The abdominal CT report suggests the contradictory possibility that pancreatic cancer might be the origin of what seemed like lung cancer (i.e., if true, it would mean the cancer in the lungs is not lung cancer but metastatic pancreatic cancer). In contrast, the lung biopsy seems to say lung adenocarinoma, not pancreatic. I cannot sort out a diagnostic question like that; her doctors will need to tell you.

It sounds like it is also possible that there's pancreatic adenocarcinoma cancer (independent of the lung cancer or as the cause of the cancer in the lungs), but it might require a biopsy of that pancreatic tissue to determine if it is or isn't. I don't know enough about pancreatic cancer to say much about that subject. But I can tell you that lung adenocarcinoma is not the same thing as pancreatic adenocarcinoma and treatment probably differs. (I think, though, that pancreatic adenocacinoma is more likely to be driven by a not-so-useful KRAS mutation instead of the useful EGFR mutation seen in some lung cancer adenocarcinomas.)

BTW, if cancer had spread from an origin ("primary") in the lungs to form metastatic lesions in the pancreas, that would suggest it is more like a regular adenocarcinoma (or mucinous adenocarcinoma) and not very much like mucinous BAC since m-BAC isn't likely to jump to other organs like that.

So I'm becoming a bit confused by the conflicting data. Your mother's doctors may need to sort out what is really going on before you'd have a good idea of how to treat her. Is it lung cancer? Pancreatic cancer? Has one spread to the other location, or are both independant primary cancers, or is really there no cancer in the pancreas? And if there is lung cancer (not just pancreatic cancer in the lungs), is its driving mutation a useful one like EGFR?

Another thing that is odd is the use of x-ray to try to diagnose lung cancer instead of using a CT scan of the chest. My m-BAC lung cancer didn't even show up on an x-ray. I know that sometimes x-ray is sufficient for a solid tumor or if they know what they are looking for, but I think CT is the best diagnostic tool, esp. when dealing with mucinous BAC.

Given the x-ray seemed to see something like infection or thin cancer in both lungs, and given that a biopsy found cancer is present (which makes it more likely that it wasn't infection in the other lung but cancer), it wouldn't surprise me if her doctors suspected stage IV cancer, but you really need to rely on her doctors' knowledge of her case and their experienced judgement about that. A CT might make it more obvious one way or the other, though.

If doctors believe cancer has spread far in the body (either from one lung to a distant part of another lung, or from lung to pancreas or pancreas to lung), it indicates cancer cells are migrating through the bloodstream. In the case of lung cancer where cancer has spread far (stage IV), surgery is more likely to reduce the odds of surviving 5 years (which is already very small unless there's a driving mutation that can be inhibited and stays effective for a long time). (Reasons: I've heard the thought that surgery would reduce precious spare lung capacity without stopping the cancer, and the thought that surgery might disrupt blood supply making it harder for drugs to reach all the cancer cells. I don't know the real reason, but a surgeon told me that even in stage III the odds of surviving 5 years are cut in half if surgery is tried before chemo, so he recommended I not consider surgery and he reconfirmed that when an oncologist was able to say I was already stage IV. (When a surgeon tells me to not get surgery, I pay attention.)

Why doesn't surgery stop the cancer? Because the cancer cells are already wandering around and may already have set up undetectable spots of cancer that would be missed. Two months after surgery to remove visible cancer those spots could become visible. So instead, when they have a reason to think cancer cells are wandering around, they prefer a systemic treatment like chemo that has a chance of affecting cancer cells wherever they are.

FYI - I don't know anything about oxygen concentrator devices.

Although there is probably little harm (except to your money and time) in trying non-medical things prior to strarting any medical treatment, it probably wouldn't be wise to rely on anecdotes or promotional sources instead of pursuing medical treatments with proven odds of effectiveness. For example, I don't know of any credible studies indicating effectiveness of the "cancer bush" idea. E.g., see:

http://en.wikipedia.org/wiki/Sutherlandia_frutescens

(BTW, treatments that "seem" to help might not be, and treatments for one kind of cancer usually won't help another kind.)

There is no such thing as lung cancer that is "90% cured." What I think you mean is that a drug made the cancer shrink by 90%. Yes, that sometimes happens with drugs that are targeted to a specific driving mutation, like Tarceva for EGFR-driven cancer I described to you before. (Sometimes chemo can do that too, though the odds aren't as good as knowning you have the right driving mutation and a drug for it.) A treatment like this doesn't apply to every patient, but only patients who have the right driving mutation. (Driving mutation = the gene mutation that is driving the cancer to act like cancer, and if that were inhibited the cancer would behave like a normal cell or even shrink.)

Tarceva (for EGFR) and Xalkori (for ALK or ROS1) are not "chemo" and are not "radiation." They have their own side effects, but usually easier to tolerate.

Does that help? The new data you shared seems to make the picture more confusing, so I hope that can be sorted out.

Best hopes,

Craig

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Craig I am increasingly grateful for your insight. Thank you!

Yes I too feel the same confusion and hence I have asked for a CT of her brain as well.

It may be wise to do a biopsy of the pancreas too while she's at it so they can correctly determine what the source / origin is.

I will be going home tomorrow and see her on Saturday. She spoke to me today via phone and she sounds so much better than when I last talked to her on Sunday. But I guess it's her diabetes coming down to manageable levels. She said it came down to 4 yesterday and thereby much BELOW the required level of 8.

Once her diabetes is stable and under control it will be easier for her to explore other options on treatment. For now we are seriously considering non-medical options as they will not damage her system or make it unresponsive to medical treatment In future.

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By the way, they did do a CT scan of her abdomen etc. sorry I forgot to mention. We even got a whole cd full of photos and data which we have sent to doctors for review. Expecting a reply by tomorrow morning. Will keep you updated.

In the meanwhile, I need to try get my hands on the cancer bush for now...:)

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FYI, where I am brain scans are usually MRI, not CT, but it depends on what they are looking for. MRI's are slower, but don't have the radiation that CT's have. (Radiation has a very small chance of causing cancer, so the more exposures you get the greater the chance of causing a 2nd problem. The risks from CT radiation probably don't matter if a patient isn't expected to live long anyway, but I hope to live more than another year or two so I prefer to avoid unnecessary radiation to my brain. For my chest scans, there's no good alternative to a CT here, although after a year of checking me my doctors changed my scans to a low-dose CT with fuzzier images, but the images are adequate for a radiology expert to see any significant changes.)

Best hopes,

Craig

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Ah! I'll keep that in mind. Thank you.

The specialist doctor that reviewed her reports yesterday has said that since the problem is in it's advanced stages we should make plans to bring her to India so she can begin treatment immediately.

Gonna take a bit of convincing her because of her intention to rather do it here (in SA) so she can be closer to us too.

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Yes, she'll decide based on her values and preferences, regardless what other people might want.

I would guess that there probably isn't much difference between treatments available in India vs. South Africa which are effective (as proven by credible published research), but that probably depends on what kind of cancer, type of cancer, & gene mutation driver of cancer she's got vs. what Rx drugs are available or in trials in each location. I would imagine, though, that Rx's that are available in India might be cheaper there.

Best hopes,

Craig

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I can't speak to whether or not your Mom would get better or more up-to-date treatment in SA or India - but I know from my own experience that your general outlook and optimism is important. Treatment can be touch, and I think it is perhaps also important to factor in where she feels most "at home" and surrounded by family who are able to support her emotionally and physically. Just a thought.

Diane

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Thank you Craig and Diane. We have provisionally booked her tickets and awaiting confirmation of oxygen availability onboard. Planning to fly her to our home tomorrow and then to India on Wednesday.

Her diabetes has stabilized significantly and she is now sitting walking and sleeping without oxygen. She also goes for walks around the hospital block twice a day. She also doesn't feel any pain but does cough every now and then, bringing up clear phlegm.

Her only complaint is she is constantly tired and her appetite is very low. The "weekend" doc prescribed multivitamins for that. But he says there Is not more he can do as it's her lungs that is keeping her tired.

I've got her to do the deep breathing exercise whenever she can. I guess it's the lungs that cause her to become short of breath often.

And she also says her eyesight has become poor. Isn't this due to her being tired rather than a symptom of her sickness?

We get a real lot of visitors here during the day and that also drains her. So today I've decided to tell them to keep conversations to a minimum as soon as they come in.

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I have been reading and following along as you all have been posting.. Lots of great advice and info coming to you.. The Multivitamins are good but can not fix the weight problem. What you need to find out is if you can get meals or snacks for whenever she is hungry.. weight loss suddenly and rapidly is not good for anyone and can cause what is known as Cachexia in patients.. this is also known as muscle loss.. Not a good thing.. Fi you can not have food or snacks for her due to hospital rules is there a possibility of having something like what we have in the US also know as Ensure on hand? these are basically protein shakes designed to help hunger issues and add vitamins and minerals to a diet or also as a meal substitute. another option is to get a shake of some sort from Hospital commissary if you can not get food and add a couple of spoonfuls of Protein powder similar to what body builders use from a Drug store pharmacy or possibly a grocery store. you could also get folks if hospital allows it to bring soft fruits or yogurt of some sort when they come to visit for her... Just some ideas on dealing with the weigh issues....

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