Don M

Linzy, please don't let this doctor dictate to you what the outcome of your cancer will be. You should see another doctor. It sounds like you may have stage IIIa cancer which often has a good outcome when treated with chemoradiation. there should be a number of options available to you. Don M

Good job with the notes. So they know for sure you have a well-defined 1.4 cm adenocarcinoma lesion in your left lung and they have identified the abnormality in your right lung as possibly bronchioloalveolar carcinoma (BAC). They want to wait and see about the BAC I think. One thing I have read about BAC is that it can be slow growing. I guess I would not mind waiting to see about the BAC, but I would want to get something going on the l.4 cm mass if it is not BAC. If they are 2 different primaries, why not start treating the left one right away? If it is a primary, and there are no mets or lymph node involvement, I would seek getting it killed with some form of targeted focused radiation while I wait to see what is up with the BAC features in the right lung. Apparently IGRT, a good form of targeted radiation is available in Canada. Here is a page from one of the IGRT manufacturers addressing Canadian customers. http://www.elekta.com/healthcare_intern ... 069886.php Here is some more on Princess Margaret Hospital. It looks like they have a large radiation therapy program and staff. If your next step is to see an oncologist, I would go to Princess Margaret and ask about IGRT to treat the left lung. http://72.14.253.104/search?q=cache:FWg ... cd=3&gl=us Here is a page at the Electa site that talks about IGRT. http://www.elekta.com/healthcare_intern ... herapy.php “You have a few of these fluffys on both sides”… I guess “both sides” means both lungs, but I am not sure. If the BAC features were in both lungs, maybe a systemic treatment would be best and you should wait and see before doing chemo as they say. Maybe they think the 1.4 cm lesion might be a resolved form of BAC and that is why they want to wait and see what it does. If you are already going to Princess Margaret, it looks like you are in good hands. I wonder what Dr. West would say about this. Don M

There were 47 million uninsured Americans according to a census bureau report in 2006. These people don't go to see a GP. They wait until a problem gets serious and then go to the ER thus driving up medical costs for everyone else. A National Health Care Plan that works as it apparently works in Australia can't be a bad thing. However, if we in the US had a situation such as exists in Canada or the UK, from what I have read, I would not have been able to get my ck treatment, and that may be the only treatment that will work for me. My current tumor has ignored 2 sets of chemo and 33 sessions of radiation. I would like to see the 47 million Americans get good medical care, but I also want to be able to have access to the latest advances in cancer treatment, not just average good care. Don m

Robin you have my prayers. don M

Deanne: I hope you get some resolution with this soon. It is hard to believe that one could be denied medical care because of a doctor having a hissy fit when you talk to another doc. Don m

Hi Ernie, I am sorry to read about your new nodules. I don't know anything about the 21st Century group Ernie, but I see that they have IGRT at some locations. Not many hospitals have that capability. I had it at Swedish Medical Center in Seattle just over a year ago. Unfortunately for me, it did not kill my tumor, but I think my situation would be unusual. I think treating your nodules with a targeted radiation would be reasonable. They are small and there are only 2. IGRT will conserve your lung function and get rid of the nodules. You could also use cyberknife, but it is much more expensive, there may be insurance hassles and IGRT would be effective. It has less accuracy than ck, but a few millimeters less accuracy does not make that much difference in the lung. Still, one thing to consider is that with ck, you would likely have just 3 treatments for each nodule and for the IGRT, there would probably be 33 treatments for each nodule. I suppose they would deliver a dose to each nodule on the same day for the IGRT, but I don’t know for sure. I think that even though you have a history of stage 4 disease, that a ck center would treat your nodules because there are only 2 and they are local. They may tell you that it is not a cure and that they could pop up again in a year or so. But, who knows for sure? It has been over a year and maybe you have a new primary. I have not had new disease in 2 years since my 3rd cancer popped up. Now if I could just kill the stupid thing… I see from the map that the 21st Century outfit has many locations in Florida. I don't know if the Naples facility has IGRT or not. Naples also had a ck center: http://cancer.nchmd.org/index.aspx?sect ... y&id=30343 I hope you quickly get rid of the nodules Ernie. You could follow up with chemo after the radiation. Don M

At one point I was having an xray every 6 months and at the 3 month interval between xrays, I had a ct scan. My third cancer was picked up by my radiologist on an xray when it was only 1 cm. It just looked like a subtle white blob to me. Perhaps a good radiologist could keep an extra sharp eye out if he knew the purpose of the xray was to look for nodules. Don M

I would kill it off with cyberknife. Most cyberknife centers will treat the primary tumor after conventional treatment. It would conserve your lung capacity and get rid of the primary. There would be no risk from surgery. If you have a recurrence in your lung, you would still have lots of lung power left to deal with another cancer. You could just zap it again with ck. http://www.cyberknifesupport.org/forum/ Don m

Cindy, I am sorry the first hospice did such a dismal job for you and your husband. Please accept my condolences for your loss. Don M

Cindy, you and your husband have my prayers. don M

congratulations. i hope you have a good trip. Don M

Hi Sue. welcome. You have gotten some good advice on organization. Maybe you are headed for an operation with intent to cure since they gave you the pulmonary tests. Take good notes and good luck. You know, I always had a second person with me at consultations. I researched everything I could find about my cancer and I had a list of questions. I kind of put myself in the space of an observer talking to the doctor about my cancer as if we were both being objective. For me, learning all I could about my cancer and its treatment was a way for me to stay focused. Others may not want to deal with it that way. If you do go to web sites to rad about it, ignore the statistics. Don M

Hi and welcome. I have read of others who have sclc go on to cyberknife treatment to kill residual disease. I think the tumor surrounding the heart may not be a problem for cyberknife. They would probably tell you it would not be a cure, but your wife could be less symptomatic after treatment and possibly be cancer free for a while. You can talk to radiation oncologists about it at: http://www.cyberknifesupport.org/forum/

Hi Heidi: I hope that whatever it is does not grow. Don M

Well, I think if she can walk up 40 steps, even with sob afterwards, she is probably ok as far as pneumonitis goes. I had some sob with my alimta too. Don M

Bam: if by extreme shortness of breath, you mean your mother has trouble just walking across the room, she should see a doctor right away. It is good that she is having a ct scan today. Maybe she should ask her doctor about the possibility of chemo induced inflammation (alergic reaction) in her lungs. I think it should show on the ct scan if there is inflammation. Don M

Hey Robin, you have my prayers. I ascribe to the scar tissue theory. Don M

Hi Mike and welcome. Don M

http://www.washingtonpost.com/wp-dyn/co ... rrer=email

Those are good links from Randy. I think Stanford pioeneered ck. Basically, it is very intense and very acccurate radiation. It is so accurate, that they can claim surgical precision using computerized robotics hence the name cyberknife. I have read of otheres doing ck for sclc. I think it is done just to control mets. I think they don't treat sclc very often though because it is usually very responsive to chemo. Probabaly they would use ck aftr a chemo regime has been completed and there is still residual disease. The radiation oncologists at the ck support message board are very responsive and very helpful and can asswer questions aabout ck for sclc. Don M

Welcome Valadi: I hope your surgery goes well. I think you should be able to have Video Assisted Thorascopic Surgery (VATS). There is no rib breaking in that kind of surgery and the incision is smaller and the recovery time is weeks instead of months. If you are having a full, open thoracotomy which often results in a broken rib, there is one advantage to that in that the surgeon can feel around your lung with his fingers to find any hard densities that a scan would miss and that could not be be discerned with VATS equipment. Don M

It is good to hear from you Rich and I hope your ailments go away. don M

I took lexapro for depression for the first couple of years. I think it helped. I don't take it now. So, your dad did not recover from the infusion by the 3rd week? When I did chemo I was wiped out for the first week or 2 and was nearly back to feeling good by the time of the second infusion. My first chemo was 4 rounds of carboplatin/gemzar. One thing to consider is to go for 4 rounds instead of 6. My oncologist told me that the benefits from the 5th and 6th rounds are marginal. I did only 4 rounds because my treatment was for adjuvant purposes following surgery. Don M

Hi sue: I hope your mom recovers quickly. I think they will probably just reduce the dose after she gets stable. don M

Hi Barb: I just want to welcome you. Don M