The Middlegame - Strategy & Tactics

Three years ago this week Kevin’s regular check-up scans revealed his latest reoccurrence. There were no outward signs - he didn’t feel sick, but then he never did. This reoccurrence was however very different from the others. This was not just one or two isolated tumors that could be easily watched and when became “undesirable” could be surgically removed. This time the cancer had spread far and wide. His oncologist explained that the Beast had made a very aggressive move that should be countered with an equally aggressive treatment plan. The good news was that the brain MRIs were clean.

We had known about the traditional and only “approved” chemo treatment for melanoma since the original diagnosis, but because of its very poor response rate and very bad side effects it was never recommended, but now since surgery was no longer a viable treatment plan we were left with few options. Still, his oncologist had reservations about the bio-chemo treatment (for the same reasons as earlier) and suggested we try an alternate first. So in early June, Kevin started high-dose Interlukin-2 treatments. Because of the potentially lethal side effects, the entire treatment was in-patient in the ICU. After a few rounds, his body couldn’t tolerate any more and there was no improvement in the scans so it was decided to switch to the traditional bio-chemo treatment. This too had to be administered in-patient due to the dangerous side effects. He spent one week in the hospital, two weeks at home to recover and then back again to repeat. Out of the three week cycle, only during the last 3-4 days did he feel well enough to venture out of the house. These treatments made him so sick, that he remembers very little from this entire time period - June through Sep 2005.

There was a positive response – many of the tumors shrank, but his quality of life had gone from 100% to about 20% because of the treatments and in Aug we were informed that now the MRIs showed the cancer had spread to the brain. But, it was explained, we should not despair. The met was in an isolated single location near the outer surface of the brain that could be radiated or if unsuccessful, could be surgically removed. They ordered a spinal tap and confirmed that there were no cancer cells in the spinal fluid. The Stereotactic Radiosurgery occurred later that month and subsequent MRIs indicated it was successful. Kev had some residual side-effects but was recovering nicely from the chemo treatments when a few months later, Feb 2006, he began experiencing seizures. The MRIs were inconclusive and the neurosurgeon was reluctant to open up his skull so we followed a medication route to treat the seizures and a “wait-and-see” approach. It took a while to work out the necessary doses, but this worked fairly well with him experiences only a few seizures through the spring. However in early July, the seizures came back strong and were uncontrollable – we were back in the ER and the MRI showed massive bleeding, swelling and tumor growth so it was decided to surgically remove the brain tumor. But not so quick...they needed to reduce the swelling before opening up the skull. So while keeping him in the hospital he received high doses of steroids for a couple weeks. The surgery was very successful and we also discussed a couple new experimental chemo treatments that would be available after healing from the surgery. This is where the blog picks up in late Aug 2006...