On 6/02/77 I had a near fatal heart attack. I was "coded" twice at the hospital.
In September of 1977 I had life threatening surgery -- a 20% chance of not making it.
I have had cancer three times.
My left kidney was removed in 1991 because it was cancerous. The tumor was the size of one-half of a tennis ball. A piece of one of my ribs had to be cut away to get to the kidney. Dr. Richard Frasure was my urologist and surgeon.
I have been found to be free of bladder cancer after having treatments for it on two separate occasions. I was treated for it by Dr. Richard Frasure.
My current concern started with a swelling in my right ankle about two months ago. I think it was in August. Dr. James Scarles had an ultrasound made and no cause was found.
Shortly thereafter I consulted Dr. Antonio Toledo because of family history of aorta problems. Dr. Toledo ordered a CT scan of my aorta because my father had an aorta problems which was treated surgically by Dr. Toledo.
The CT scan results (slightly enlarged aorta and small aneurysm) caused Dr. Toledo to have another CT scan made of abdomen. This scan showed two lesions on my left lung, one on my right lung, something on my pancreas and something on my back (between my shoulders).
On 10/4/2002 Dr. Toledo had the pathologists report after excising the growth on my back.
I met my oncologist Dr. Cynthia Sirard on 10/15/2002. After examining me at her office ($250) in the L&M Hospital she scheduled some "blood work".
She also scheduled me for a bone scan (10/22/02) at L&M Hospital, an echocardiogram (10/28/02) at L&M Hospital and a CT scan of my head (10/23/02) at Pequot Medical Center.
If all goes well Dr. Sirard will schedule me for 3 sessions a week, for 8 weeks, for Interleukin-2 treatments at the hospital.
On 10/18/2002 Dr.Sirard told me that my "blood work" was normal. She has been in contact with Beth Israel Deaconess Medical Center . I might be a candidate for a clinical trial. After I talked with Dr. Sirard I got a phone call from the office of Dr. Michael Atkins at Beth Israel. This is more about Dr. Atkins.
I will learn more on 10/21.
On 10/21/2002, after phoning BIDMC in Boston an appointment was set up for me on 10/30 at 1 PM to see Dr. James W. Mier, who specializes in Medical Oncology. I have to bring or have sent all my medical records since onset of kidney cancer. All pathology slides, x-ray film, CT scans, etc. will have to be on hand.
I went to Boston with Jean, Ann, Ellen and Patty.
I met with Dr. James Mier and associate-fellow Dr. Shandra on 10/30. After a minor exam Dr. Mier thought it likely that what cancer I had might be all that I would have. He pointed out that my condition was without symptoms, and was discovered by accident after a 12 year remission.
Needless to say my emotions were in turmoil from getting such bad news first and such positive news from Dr. Mier.
This is how Patty remembers the visit:
We had a nice ride to Boston today.� Dad's appointment was for 1:00 p.m.� We got in the exam room about 1:25.� Dad was first seen by a "fellow" (someone who isn't quite a doctor yet, I think).� She took Dad's medical history and read through most of his paperwork up to this point.� In the meantime, a group of doctors was meeting in a conference room across the hall discussing Dad's case.
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Dad was then seen by Dr. Mier who was very nice, articulate, and informative.� We all liked him from the beginning.� He recommended that Dad be put on a regimen of Interlukin 2 for a prescribed period of time.� He can get the treatment (by injection or I.V.) at L&M and doesn't have to go to Boston.� This drug has been FDA approved for 10 years and is like the penicillin of cancer meds.� At this time Dad isn't really a candidate for any other cancer treatment trials.� The Interlukin 2 is usually the first recommended treatment.� He recommended that Dad be scanned for any changes in the tumors or increase in number of tumors at three months and six months.� If the Interlukin 2 is keeping the illness under control (preventing the growth of more tumors) and even shrinking the tumors after 6 months, Dr. Mier recommended that the tumors be removed surgically.�
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The one spot on his right lung is easily accessible and removable through a fiber optic procedure called VATS that is a fairly easy procedure ("practically day surgery").� The two spots on the left lung would have to be analyzed more closely by a surgeon, but Dr. Mier feels these, too, could be surgically removed.
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Dr. Mier felt that it was a good sign that Dad had been cancer free for about 12 years and that time had been on his side.�
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We had a few questions about side effects of the treatment.� There would probably be flu-like symptoms like fever and chills, because the body naturally produces Interlukin to fight off viral infections and would behave as if Dad had the flu.� He won't have symptoms associated with chemotherapy like weight loss, hair loss, etc.�
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We left the hospital around 3:00 p.m. feeling very relieved and optimistic.
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The doctors in Boston will call the doctor in NL and concur with her initial recommendation for treatment (probably 3 doses a week for 8 weeks).� Dad sees his NL doctor on Monday and will hopefully begin treatment soon after that.
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I think this is a fair accounting of what happened today.� I will have Ann send you any additions and possibly her perceptions of the day.
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Love y'all.
-Patty-
I met with Dr. Sirard on 11/4/2002 and went over Dr Mier's findings. Dr. Sirard has ordered a MIBI stress test, without exercise, for 11/12/2002 or before that date.
I have an appointment on 11/5/2002 at the Cancer Center of L&M Hospital to learn about treatment with Interleukin-2.
I met nurse Kay Oddie at the L&M Cancer Center on 11/05 after a long wait. Kay said that the wait was because she had to review my case history.
Kay took a long time explaining the Interleukin-2 treatment. She explained all of the possible side effects (chills, flu-like symptoms, depression etc.) understanding that some, if not all, would not apply to me.
It appears that I am in for a three times a week six week cycle of treatment which may be repeated. The dosage to be used is based on a individual formula using 20gr. of Il-2 in weeks one and four and 10gr. for the other weeks. Midway in the treatment there will be a CT scan for evaluation.
I was given all kinds of information regarding diet, skin care and other things. I received a pocket folder with a lot of printed information. I told Kay that the folder looked like a cruise information package.
On 11/18/2002 I began Interleukin-2 treatment at the L&M Hospital Cancer Center in New London, Ct. The Cancer Center treatment area reminds me of a beauty parlor. Patients sit in reclining chairs while being treated. Patients can eat, read a book or watch television while being treated.
My first treatment was on Monday 11/18/2002. Before I went to the hospital I had to have a glass of milk, something to eat and take a 500mg Naproxen tablet. At the hospital I was weighed and had blood drawn. Next I was seated while a saline IV was started. Some Benadryl was added to the IV. I had to wait about one hour before I was given an Interleukin-2 shot, 5 million units times a number based on a body area formula, in the outside of my right thigh. I had no side effects then or later except drowzieness from the Benadryl. This initial treatment lasted about 4 1/2 hours, most of it under observation.
Nurses were Joanne Stevens,RN, OCN and Phyllis McCormack.
My 2nd treatment on 11/20 lasted about 2 1/2 hours and followed the same routine except that the Interleukin-2 shot was in the outside of my left thigh. I had no side effects at the hospital. While at home in the evening I had some chills followed by a hot flush. I took an extra-strength Tylenol for relief.
The 2nd shot was for 11 million units based upon a body area formula.
Nurses were Joanne Stevens and Phyllis.
3rd treatment on 11/22. I took meds at home at 9:30 am. 500mg Naproxen, 25mg Benadryl, 500mg Tylenol. At the hospital I was weighed (245 clothed) and got the same dosage of Il-2. Total treatment time from at home to end was 1:45mins. Side effects were the same as previous (chills and hot flush) did not require medication. Nurses were Kay and Phyllis.
11/25 routine was the same. I went with Patty.
11/27 A snowy day. I called the hospital at 8:30 AM. I took meds at 9:30 and arrived at the hospital at 9:45. I weighed 242.6 clothed. I got the same dosage at 10 AM from Desire� Sanchez. I left hospital at 10:05.
12/02 A chilly overcast day. I went with Jean. I weighed 243.4 clothed, blood pressure 131/76. I had blood drawn at 10 AM, took meds at 11:35. I got the same dosage at 12:30 from Phyllis.
12/04 I went with Jean for Shot #7. I weighed 245.5 clothed, blood pressure. I got the same dosage from Betty Garvie. I had chills about 4 hours later and went to bed.
12/06 clear and cold after 8 inches of snow. I went with Jean for shot #8.
I weighed 245.4 clothed, blood pressure. I got the same dosage from Kimberly. I met with Dr.Sirard and she thinks I am tolerating the treatment regime. I felt dozey when I got home and fell asleep sitting on the sofa. I woke up at 8 PM.
12/09 Took meds at home. I weighed 245.4 clothed. Other vitals BP 128/66. Swollen left ankle. Blood drawn by Joanne Stevens. Shot #9, usual dose, was given by Joanne.
12/11 Took meds at home. Shot #10, usual dose, was given by Sara Zebrowski assisted by Betty. I weighed 248.2 most ever, clothed, pulse 80, BP 122/80.
12/13 Took meds at home. Patty to me the Cancer Center. I weighed 247.9 clothed.Other vitals were pulse 76, BP 122/70. Shot #11, usual dose, was given by Desire� Sanchez.
12/16 Took meds at home. I weighed 244.9 clothed. Other vitals were pulse 72, BP 153/80. Shot #12, usual dose, was given by Phyllis. BP was high because of emotion.
12/18 Took meds at home at about 9:30am (all meds taken about this time). Ellen took me to L&M Hospital. I weighed 244.8 clothed. Other vitals were pulse 72, BP 138/84 (a bit high). Shot #13, usual dose, was given by Desire�. Received sputum cup for lab sample, if needed.
12/20 Took meds at home. Ralph Merrill took me to L&M Hospital. I weighed 244.8 clothed. Other vitals were pulse 81, BP 131/80. Shot #14, usual dose, was given by Phyllis.
12/23 Took meds at home. Ralph Merrill took me to L&M Hospital. I weighed 243.4 clothed. Other vitals were pulse 71, BP 149/90. Shot #15, usual dose was given by Kim Tassone. Kidney 1.9.
12/27 Took meds at home. Jean took me to L&M Hospital. I weighed 242.5 clothed. Other vitals were pulse 74 BP 149/89. Shot #16, usual dose was given by Joanne. Blood pressure was up because Kelsey and Josh were at the house for a few days. Kelsey, 6, wants what she wants when she wants it. Josh, 9, is laid back a great pal and listener.
Next appointment is on 1/10/03 at 1pm.
1/10/03 Met with Dr. Sirard. Starting regimen on 1/13 . Blood to be drawn every other week.Weight 241.5 clothed BP 148/76 (understandable given the circumstance).
1/13/03 Tooks meds at home. Jean took me to L&M Hospital. I weighed 240.8 clothed. Other vitals were pulse BP 134/72, creatine 1.9. Shot #17, usual dose was given by Phyliss. Side effects of chills for a few hours. Fell asleep for 5 or 6 hours while sitting on the sofa.
1/14/03 Had cystoscope exam by Dr. Frasure. Everything clear, re-exam in 6 months. If everything clear then exam on annual basis.
1/15/03 Took meds at home. Jean took me to L&M Hospital. I weighed 240.7 clothed. Other vitals were pulse 70 BP 160/92. Shot #18, usual dose was given by Joanne. Side effect of chills for only a couple of hours, much less then previous shot. Mouth wash of salty water and baking soda was effective on mouth sores.
1/17/03 Tooks meds at home. Jean took me to L&M Hospital. I weighed 239.9 clothed. Other vitals were pulse 83 BP 147/91. Shot #19, usual dose was given by Phyliss. Side effects of chills for a few hours.
1/20/03 Tooks meds at home. Jean took me to L&M Hospital. I weighed 241.1 clothed. Other vitals were pulse 78 BP 153/83. Shot #20, usual dose was given by Kay. Side effects of chills for a few hours. Fell asleep for 5 or 6 hours
1/22/03 Tooks meds at home. Jean took me to L&M Hospital. I weighed 243 clothed. Other vitals were pulse BP 168/82. Shot #21, usual dose was given by Joanne. Side effects of chills for a few hours. Zoloft suggested and ordered (I may not take it. I do not like the side effects.)Fell asleep for 5 or 6 hours
1/24/03 Tooks meds at home. Jean took me to L&M Hospital. I weighed 240.8 clothed. Other vitals were pulse BP 134/72. Shot #22, usual dose was given by Phyliss. Side effects of chills for a few hours. Fell asleep for 5 or 6 hours
1/27/03 Tooks meds at home. Jean took me to L&M Hospital. I weighed 243.9 clothed. Other vitals were pulse 68, BP 149/82. Shot #23, usual dose was given by Kay. Side effects of chills for a few hours. Fell asleep for 5 or 6 hours
1/29/03 Tooks meds at home. Jean took me to L&M Hospital. I weighed 243.8 clothed. Other vitals were pulse 78, BP 145/88. Shot #24, usual dose, was given by Desire�. Side effects of chills for a few hours. Fell asleep for 5 or 6 hours.
1/31/03 Took meds at home. Dr. Hellman allowed Benadryl med change to 12.5mg from 25 mg. Benadryl really wrecks my day by making me sleepy. Jean took me to L&M Hospital. I weighed 243.8 clothed. Other vitals were pulse 80, BP 153/77. Shot #25, usual dose, was given by Desire� Sanchez. I am halfway through the 2nd regimen. Only 9 shots to go.
2/03/03 Patty took me to L&M Hospital. We arrived at about 9:30. I had blood drawn. We waited quite a while for the results. I weighed 243.0 clothed.Other vitals were pulse 76, BP 128/70. Shot #26, usual dose was given by Desire�. Later I fell asleep in a chair for 5 hours.
2/05/03 I went to the hospital by myself. I weighed 243.0 clothed. Other vitals were pulse 72, BP 140/70. Shot #27, usual dose, was given by Joanne. Later, I fell asleep in a chair for 6 hours. Seven shots to go.
2/07/03 Cancer Center at L & M Hospital "closed". Took meds at home. Jean took me to Oncology & Hematology Assoc. in Bldg #3 at Shaw's Cove for Shot # 28, usual dose, given by Shawn Smith. Other vitals were pulse 79,BP 135/84. Oxygen level 93-94%, lungs "good, clear". Slept a long time, usual side effects. Six shots to go.
2/10/03 Took meds at home. Went by myself to Shaw's Cove for Shot # 29 , usual dose, was given by Shawn Smith. I weighed 241.0 clothed. Other vitals were pulse 70, BP 146/84. I slept for 6 or more hours. Usual side effects of hot and cold. Five shots to go.
2/12/03 Took meds at home. Jean took me to Shaw's Cove. I weighed 242.0 clothed. Other vitals were pulse 69, BP 143/82, lungs clear, 94% oxygen level. Stephanie Willert gave me Shot #30, usual dose. Four shots to go.
2/14/03 Dr. Sirard gave me a break. Only TWO shots to go ! No shot or bloodwork on 2/17/03.
2/19/03 Took meds at home. My daughter, Ann Miller, took me to L&M Hospital for my next to last Shot. I weighed 239.1 clothed. Other vital were pulse 87, BP 138/89, lungs clear. Desire� Sanchez gave me Shot #32 , usual dose. Side effects of hot/cold really flattened me out after some time off. Slept and dozed and felt dopey. Recovered as usual next day. One more shot to go.
2/21/03 Took meds at home. Jean took me to L&M Hospital for my last #33 Shot from Joanne. I weighed 239.1 clothed. Other vitals were BP 120/60. We gave the nurses a 2 lb. box of Russell Stover candy. The nurses gave me a small square four layer white cake with white frosting and sprinkles for my "graduation". I am glad this phase is over. Side effects were indigestion and hot/cold. I napped a lot and generally felt dopey. The next day I felt fine but tired. Next on the agenda is a "scan" on 3/04/03.
2/24/03 Dr. Sirard has taken a position out of state. I will need to find another doctor.
2/26/03 I got a phone call last evening from Sam Cohen's sister. She told me that Sam was killed last Saturday in an auto accident that happened in Las Vegas.
Sam was driving a pickup truck and had a young passenger with him. Sam's pickup truck was t-boned on the driver's side by a car driven at very high speed. The impact moved Sam's truck over eighty feet. Sam probably didn't know what hit him. Sam's passenger was in critical condition. I don't know the fate of anyone in the car that caused the crash.
Sam was a classmate and great friend of my son Paul. Sam and Paul went to Grasso Tech together.
Sam was tall, thin and had a gangly awkwardness. He had a shock of long light colored hair that fell in his face when he worked. He shook his head to keep it out of his eyes. Sam had a great sense of fun and was interested in what others do and say. I remember conversations with Sam. Sam would sometimes hold his head in his hands as he gave you his attention. Sam had a great loud laugh and was a pleasure to have around.
Sam wanted to build a car from the bottom up. His step-father would not let him build a car at home.
I let Sam build the car in my garage. It was something to see car parts arrive and the car slowly assembled. Sam was building a Camarro convertible to drive to California where he would establsh residency and go to college.
I will always remember when Sam fired up the engine. It had no exhaust pipes and could be heard for quite a distance. Another milestone was when Sam painted the car. There are still remnants of red spray paint in the garage.
As I write this it is as if Sam were still here.
Sometimes I get really self centered about my situation. The death of Sam Cohen makes me think again. Here I am, nearing a fullness of years, and Sam Cohen is not with us.
3/04/03 CAT scan at L&M Hospital. Drank 3 cups (900 ml) of READI-CAT barium sulphate suspension prior to scan. Stuff tastes yucky. Energy level way down. Feeling "bummed out". I wish I knew how this is all going to end.
From: [email protected] (S.L.�Holloway) Date: Wed, Mar 5, 2003, 12:04pm To: [email protected] (Dick Uguccioni) Subject: Re: Cancer
When will you get your results? I pray you are in remission for a good long time.
Sandra Holloway
Remission ? Remission ? No one has EVER mentioned remission. Sandra Holloway, my good friend, is the first to use the term. Small wonder that I have been distressed.
3/07/03 Jean took me to Oncology & Hematology Office in Shaw's Cove. I weighed 238 clothed according to Debbie. Other vitals were BP 138/84, pulse 78. We met with Dr. Jason Haldas. The scan results showed no shrinking of the cancers. I am in a "stable" condition. Renal cancer "is not responsive to treatment." I am to have 3 months off therapy then have new scans.
3/11/03 I talked with Dr. James Mier of Beth Israel Deaconess Medical Center in Boston, who returned my 3/10/03 phone call. I told Dr. Mier about current thinking of letting 3 months pass to see if I am still stable. If so then continue scans on 3 month interval. Dr. Mier suggested why not look into "microwaving" the tumors with a procedure known as Radiofrequency Thermal Ablation
The Medical Records Dept. at Lawrence & Memorial Hospital sent Dr. Mier my scan of 3/04/03 and the report for it as well as the report of the scan of 9/24/02.
I also visited Dr. Antonio Toledo to evaluate post-op condition of surgery he performed in removing a tumor on my back in 10/02. Dr Toledo said everything looked fine and suggested that a growth be removed from my back. That surgery is scheduled for 03/25/03.
3/31/03 The scan and medical records sent to Dr. Mier on 3/12 were "lost" and not found until 3/27. Meanwhile another set of the scan and reports were regenerated and sent to Dr. Mier. Dr. Mier told me on 3/27 that tumors had to be within a certain size range to be treated by RFA. Dr. Mier will call me after my scan and medical reports were reviewed.
On 3/25 Dr. Antonio Toledo removed an "adhering" deep cyst from my back. The cyst was about the size of a marble.
4/02/03 Dr. Antonio Toledo removed stitches from cyst incision on my back. Biopsy determined that the cyst was benign.
4/02/03 Received a phone call from Dr. Mier. Dr. Mier and radiologist Dr. Shraga Goldberg reviewed scan and reports sent in March. Dr. Mier said Goldberg prefers waiting to review another scan set to be made in about 3 months. It is Dr.Goldberg's view that he would prefer the tumors to be a bit larger and to be sure that there are no additional growth before RFA regimen. Dr. Mier said that the IL-2 treatments I have received have been beneficial because the treatments purge malignancies unseen on scans.
5/04/03 I believe that all of the shots have been assimulated. I can not feel any reaction lumps. The outside of my left thigh is still sore. The soreness could be from recent lawn cutting activity.
Every now and then I read an obituary about someone that died as a result of "a courageous battle against cancer." My cancer has always been on my mind. Thinking about cancer is insidious. There is no escaping it. Every ache and pain is thought about as a symptom. Though not every day, I have been thinking about my cancers since 1991. I do not feel courageous. I just am tired of it.
On 6/03/03, after three months, I will get new scans.
6/06/03 Radiologist Report of Scans made on 6/03/03 says: "IMPRESSION: No change from prior study."
6/09/03 This is extracted from an email I sent to Sandra Holloway today:
I have been thinking things over-- It is difficult to get around my luck to date-- It is as if someone standing right in front of me took a "can not miss" shot at me and missed --Since last October to date nothing has changed with my scans -- It is anyone's guess how long I was stable before the first scan--
I think of my brother Ray and what has happened to him since October and what he means to me and it overcomes me--
I told my sister-in-law Jean about my latest scan and results -- Jean, Tom's wife, has lost a mother, father and two sisters to cancer and has to deal with Tom's stroke-- Jean said, "Sometimes there is a God."
I have been "on hold" since last October and have provided for my family's future since the October report-- Once I got over the shock of it, and with your aid, I "got with the program"
I have resigned from the cable advisory council for a couple of good reasons-- I had enough of it and tired of one or two people.
I am looking forward to getting in the blazer sometime and going on a long postponed trip.
7/13/03 Dr. Richard Frasure gave me my six month check for bladder cancer. All is well. I have been bladder cancer free for five years. Dr. Frasure is now scheduling me for ANNUAL checkup.
7/19/03 My first, and I think best, oncologist Cynthia Sirard (who introduced me to Dr. Mier) left the group a while ago. I "googled" her and found out that "Parexel International appointed Cynthia Sirard, MD. to the position of Associate Medical Director, North American Medical Services, based at Parexel's Headquarters in Waltham, Mass."
7/24/03 A Budding Tumor Unmasked by the Vessels That Feed It (By ANNE EISENBERG NYTimes)
A Budding Tumor Unmasked by the Vessels That Feed It
By ANNE EISENBERG
For a tumor to grow, it needs a good supply of blood, which it gets by switching on the body's process of blood-vessel making, known as angiogenesis. Researchers are trying to develop drugs to inhibit angiogenesis as a way of fighting tumors, but they need ways to make sure the inhibitors, which have so far had mixed results, are effective early in therapy, long before the vessels affect the tumor itself.
One computer-based imaging technology may have the potential to detect changes in the blood vessels in and around tumors, signaling the power of a particular inhibitor.
The technique, an adaptation of conventional magnetic resonance imaging, or M.R.I., captures up to a thousand images taken serially of a tumor before, while and after dye is introduced. Software analyzes the images, characterizing what the dye (called a contrast agent) has revealed on its journey into and out of the tumor - leakiness, for example, a hallmark of vessels that are being formed.
The technology, called dynamic contrast-enhanced M.R.I., is largely confined to research institutions conducting clinical trials and should be considered experimental, said Dr. Peter L. Choyke, a radiologist and chief of M.R.I. at the National Institutes of Health in Bethesda, Md. For the past three years, Dr. Choyke has been working on refining the technique in collaboration with Dr. Michael Knopp, a radiologist at the Ohio State University Comprehensive Cancer Center, and other researchers.
Dynamic contrast-enhanced M.R.I. is one of several technologies that provide noninvasive images of the creation of new blood vessels in animals and humans. It has shown particular potential in analyzing extremely small blood vessels, Dr. Choyke said, and might therefore one day find wide use in identifying tumors and monitoring therapies that inhibit angiogenesis. The process yields a loop of images that can be viewed one after another.
"This process reveals a more complete map of regional vascular properties of a tumor than single snapshots taken with M.R.I. could," Dr. Choyke said.
Characterized by chaotic flow patterns and tortuous paths, blood vessels in tumors are markedly different from those in healthy tissue. Leaks are common. "Tumor vessels are full of holes, and that allows the contrast agent to leak out readily," Dr. Choyke said. "That's one of the things we measure."
A judgment on how aggressive a tumor is can be based in part on this permeability, he said. "You can characterize a tumor as highly vascular - that is, amenable to an angiogenic inhibitor," Dr. Choyke said, in contrast to a lesion that does not have many blood vessels.
The process might be helpful in determining whether a biopsy is necessary. Dr. Choyke cited a woman with a high risk for breast cancer whom he had examined recently. "We saw a little area in the breast, a nodule," he said. "But it didn't enhance with the contrast agent to suggest that it was a highly permeable vascular area, so it didn't have a pattern suggesting malignancy." In such a case, he said, it would be possible to postpone a biopsy.
Dr. Knopp said that dynamic contrast-enhanced M.R.I. might prove useful in preventing incorrect biopsy results. "We are recognizing that tumors are not a single entity, but a heterogeneous array of features," he said. Dynamic contrast-enhanced M.R.I. can help guide where the biopsy is performed. "If you have a bulky tumor, we can show where there is active tumor tissue and areas not as representative of the tumor."
In the experimental method described by Drs. Knopp and Choyke in recent papers, a dye is injected and scanning is repeated until about 10 minutes of data have accumulated. Algorithms analyze the images and map how permeable the blood vessels are, how much blood is flowing and the vessels' volume. Workstations with high-resolution displays can present colorized images of the data in views that create a composite of many scans.
The technology is not yet in wide use, partly, Dr. Choyke said, because different research groups use different software, setting different parameters, to analyze their data. He expects a consensus to emerge in the next few years as standard software becomes widely available and research groups move toward a universally accepted way of analyzing the data.
Dr. Michael S. O'Reilly, who did pioneering research with Dr. Judah Folkman at Children's Hospital in Boston on the angiogenesis-inhibitors angiostatin and endostatin, plans to use the process to study antiangiogenic agents in mice. Dr. O'Reilly is now an assistant professor of radiation oncology and cancer biology at the M. D. Anderson Cancer Center in Houston.
"Dynamic enhanced-contrast M.R.I. has the greatest potential - as yet unrealized - to monitor therapy early on," he said. He expects that when antiangiogenic agents are present, the M.R.I. will reveal changes in blood vessels that occur before the tumor responds to the changes by shrinking or stabilizing.
But Dr. O'Reilly said that even if that came to pass, considerable research would still be needed. "The expectation is that permeability will go down as angiogenesis is inhibited," he said. "But we may see the opposite." Even after studies with the mice are completed, he predicted, it will be difficult to apply the results to people.
"There is so much variability," he said. "Each mouse can have tumors of the same size and same type. But each patient is different."
Obituary
C. Francis Driscoll
Published on 8/10/2003
New London ? Charles Francis Driscoll, age 68, passed away Aug. 8, 2003, at Lawrence & Memorial Hospital.
He was born Sept. 12, 1934, in Utica, N.Y., to Margaret and Francis Timothy Driscoll.
Frank received his bachelor's degree from Le Moyne College and a masters degree from the Maxwell School of Public Administration at Syracuse University.
Frank served in the U.S. Army Reserve 1957-1963, was a field representative for the U.S. Housing & Home Finance Agency, New York City, 1959-1961; executive director, New London Redevelopment Agency, New London, 1961-1967; program manager of the U.S. Department of Housing & Urban Development, Renewal Assistance Administration, Washington, D.C., 1967-1969; city manager, New London, 1969 to 1992; receiver for Borough of Jewett City, Office of Policy & Management, 1993-1996; and arbitrator, alternate public member, State Board of Mediation and Arbitration, Connecticut Department of Labor, 1998-present, Hospice of Southeastern Connecticut, patient volunteer, 1998-present, New London Development Corp., board of directors and finance committee, 2001.
Frank will be remembered by the public for his faith and commitment to the church, his service and dedication to the City of New London, his compassion for the poor, his commitment to the employees of the city, and his fiscal frugality.
By his family he will be cherished always. They will remember his devotion to and adoration of his wife, Caroline. They will remember his soft-heartedness ? easily brought to tears over a touching story or simply the beauty of any one of his grandchildren; his affirmation of what was fondly referred to as the ?diversity? of his eight children; his dedication to maintaining family connections whether it was planning the next picnic on the porch or the recent family trip to Tuscany.
Frank was a devoted servant of mankind and a loving husband and father. Frank is survived by his loving wife, Caroline; his eight children, Kevin, Joseph, Marguerite, Jeremy, Christian, Justin, Kerry, and Katherine and their spouses; nine grandchildren; and many devoted friends.
A Mass of Christian Burial will be held at 11 a.m. on Wednesday at Saint Joseph's Church, 17 Squire St., New London. There will be no procession from the funeral home. Calling Hours are from 4-8 p.m. Tuesday, Aug. 12, 2003, at Thomas L. Neilan & Sons Funeral home, 12 Ocean Ave., New London.
In lieu of flowers, a donation may be made to The Community Foundation of Southeastern CT, 1 Union Plaza, P.O. Box 769, New London CT 06320, contact: Alice Fitzpatrick; or to Hospice of Southeastern CT, Inc., 179 Gallivan Lane, Uncasville CT 06382; or to the Visiting Nurses of Southeastern Connecticut, 403 N. Frontage Road, Waterford CT 06385.
I knew Frank for 30 years. He was City Manager when I was on the�City Council 1973-1977.
Frank was a smoker, almost one cigarette after another.
He was the best.
9/10/03 I saw Dr. Jason Haldas for a physical exam and about my 9/05 CAT scan results. He told me that there was a minor change since the last scan. He said that he had seen the report but did not have a copy because the computer link to the hospital was down.
After some discussion it was deceided to meet him in two months for a physical exam and bloodwork. If things look okay then see him two months later for exam, physical and CAT scan.
I did not like the idea of meeting Haldas and not have the scan report. It seems unprofessional and I am not dealing with something minor. After the exam I asked Jean to drive me to the hospital and I would get a copy of the 9/05 scan report. This we did.
At home I read the report, gave it some thought and waited until the next morning to take action.
I called the hospital and talked with radiologist Dr. Todd Blue who had writen the earlier (June) scan report. I told him that someone else, Dr. Brenda Koblick, wrote the report on the 9/05 scan and that I noticed a different style of writing.
Dr. Blue looked at both scans and both scan reports and said that small differences in small tumors were difficult to compare. He explained that the electron beam may go through at a very slightly different angle from scan to scan. He said that he believed that there was one place that seemed larger in the latest scan, the pancreas "soft tissue mass 29x23mm is slightly larger -- 9/05 report". It was "approximately 2.8cm. " in the 6/04 report.
It is disconcerting when dealing with "slightly larger" for measurements in millimeters.
The discussion with Dr. Blue was informative. I learned quite a bit about the of reading CAT scans.
I called Dr. Haldas and said that I wanted a CAT scan in two months after a physical and bloodwork. If things look okay then go to three months for the next scan. If things do NOT look okay take action.
1/05/04 I had the CAT scan. The scan showed that there was a very small measurable increase in tumor size for a couple of tumors.
Dr. Haldas spoke with Dr. Mier. Dr. Haldas recommended that I get a pancreas biopsy.
I had a copy of the recent scan report faxed by Haldas' office to Dr. James Mier at Beth Israel Deaconess Medical Center in Boston to keep Dr. Mier up to date.
I can not just sit on my hands and let time pass by.
There is so much going on in medical research that I fear helpful information will fall between the cracks.
I really don't know if this web page contains information on all clinical trials.
Also, if I had the choice I would not take a placebo.
If you could place me in the best hospital or research center where would they be ?
Included Page: Cancer.gov - Clinical Trials
1/15/04 I had a steroid shot for a herniated disc. For me there was no pain like a herniated disc. I suffered sciatic pain for about four months. On a ten scale the pain would be an eight when I was really hurting. The pain would extend to my right leg just below the knee.
1/20/04 I had the biopsy of my pancreas. There were four core samples taken. It was a little unpleasant to undergo, but bearable. A long thin needle was inserted just below and to the right of the sternum. I was awake and alert through the procedure. I remember two or three of the snips taken.The biopsy report showed that the results "were consistant with renal cell cancer".
When you (Dr. Haldas) told me to get the pancreas biopsy I hit the panic button. I googled "pancreatic cancer" and got some information. At about the same time (1/11/04) I read an article in the nytimes that contained a what seemed important phrase "comprehensive cancer centers". I googled "comprehensive cancer centers" and got Dana-Farber Cancer Institute in Boston.
I called Dana-Farber and made arrangements to consult with Dr. Leonard Appleman on 1/26/04. It is possible that Dr. James Mier at Beth Israel Deaconess and Dr. Appleman know one another. Appleman's residency was at Beth Israel.
I had not fully thought out the reason for the biopsy. The biopsy could give at least three results: renal cancer, another type of cancer or benign result. Also, the biopsy can help to determine my eligibiity for a clinical trial
1/27/04 On 1/26/04 Jean, Paul and I went to Dana-Farber in Boston to consult with Leonard Appleman, M.D., Ph.D.. (doctor, doctor) It was a pleasant trip. Paul drove. I really enjoyed Paul's driving and companionship.
My medical records, slides and films were available and on hand.
Dr. Appleman and Dr. Mier at Beth Israel Deaconess are friends and they talk pretty much on a daily basis.
Dr. Appleman suggests that I wait until the Spring for a suitable (phase II or III) clinical trial because I do not have any symptoms and the leisions are few, small and slow growing. I have time to be selective.
Because I talked with Dr. Mier first I will try to maintain that relationship and keep Dr. Appleman involved as needed.
Dana-Farber/Partners CancerCare is the cancer partnering group of hospitals in Boston. They are: Mass. General Hospital, Brigham and Women's Hospital, and Dana-Farber. Dr. Appleman said that Beth Israel Deaconess is also considered a partner. Beth Israel is across the street from Dana-Farber. All the hospitals are involved with the same trials except for special circumstances (staffing and equipment).
I am more at ease because of the consultation.
Dr. Haldas will have to help me choose the best of the possibilities for my future treatment.
There are over 1000 clinical trials going on concerning cancer. National Cancer Institute or Cancer.gov are the same web sites for that information. One small caution: there is so much going on that these sites may be slightly out of date.
3/04/04 The FDA approves first-of-its-kind cancer fighter Avastin.
3/04/04 Conversations with Dr. Mier and Dr. Haldas yesterday have given direction to my future treatment. After a scan in April I will explore radio frequency ablation (RFA) for my tumors. Other treatments will be decided upon at a later date.
5/25/04 Dr. Mier suggests that I leave well enough alone. He consulted with Radiology Dept. and there is a concern that RFA of the pancreas might lead to pancreatitis. Dr. Haldas' opinion is that there may be something going through the pipeline that may be f future benefit. Also, at present I am ineligible for clinical trials because I am too healthy.
In the News
Market Report -- Story Stocks (ONXX, AMGN, DNA, OSIP, BAY)
May 24, 2004 12:35:00 PM ET
Onyx Pharmaceuticals (ONXX) 44.49 +0.80: This niche biotech name is no Amgen (AMGN) or Genentech (DNA) - companies replete with a number of marketed drugs - but that's not to say it can't become the next OSI Pharmaceuticals (OSIP). The latter's EGFR-inhibitor drug (Tarceva) met the primary endpoint of improving survivability on April 26, which sent shares of this unprofitable biotech soaring as much as 160% that day. Onyx Pharmaceuticals fits a similar mold as it is (1) another small company (approximately 20 employees) focused on one disease state (cancer) and (2) possesses one of the most exciting compounds in all of industry.
BAY 43-9006 is a drug that has been in clinical development for 10 years. In 1994, Onyx entered into a collaboration agreement with Bayer (BAY) to jointly discover drugs that target molecular signaling pathways involving RAS, one of the most frequently mutated genes in cancer. Onyx was able to negotiate highly favorable terms with Bayer - equal share of the development costs on a worldwide basis (except Japan), and a roughly 50/50 split of profits in the US and the rest of the world (except Japan, where Onyx will receive a high single digit royalty on sales).
The compound recently (April 5) received Fast Track status from the FDA for treatment of metastatic renal cell carcinoma, or advanced kidney cancer. BAY 43-9006 is still in Phase III tests, but some industry observers believe the company could file the new drug application based on interim results so far, or even the strength of its Phase II findings. In that trial, the drug led to tumor shrinkage or disease stabilization in 68% of patients with progressive and refractory renal cell carcinoma. The below drug profile describes how BAY 43-9006 works, and its potential on the marketplace.
BAY 43-9006 Drug Profile
Compound targets multiple signal transduction pathways - specifically the RAS and VEGF pathways. First the drug knocks out an enzyme (RAF kinase) that's responsible for cells dividing - then it inhibits a protein on cell membranes that spurs blood vessels to grow and 'feed' the tumor (ala angiogenesis - like Genentech's Avastin).
'9006 is one of the most advanced agents that targets various aspects of the RAS signaling pathway. Why? Because it targets a protein (RAF) that is downstream from RAS and EGFR. This results in the ability to compensate for genetic mutations.
Drug is the only one that targets both the RAS and VEGF pathways in late-stage clinical development... and is the only one (other than Pfizer's C1-1040, currently in Phase I trials) that acts downstream of RAS.
'9006's first indication will likely be for advanced kidney cancer, with liver cancer and melanoma to possibly follow (both are currently Phase II trials)
Drug is still about 2-3 years out from a launch date, with sales estimates as high as $1 bln for its 3rd-4th year on the market (2010).
Onyx Pharmaceuticals will present new data points from BAY 43-9006's Phase II trials (in renal cell carcinoma) at the American Society of Clinical Oncology's meeting June 5-8. Investors should watch this event closely for more news flow on BAY 43-9006. The stock has already enjoyed a jaw-dropping 400% run over the past year, but that's not to say ONXX can trade even higher based on the strength of the novel drug's data. -- Heather Smith, Briefing.com
10/22/04 Visit to Dr. Haldas' office-- weight 245, temp 97, blood pressure 142/72 (slightly high).
Results of CAT scan 10/20/04 -- "completely stable". It has been 2 years since my condition was diagnosed.
On --/--/ visited Dr. Haldas who noted puffiness to the operation site on my back. He referred me to Dr. Antonio Toledo who I saw on --/--/-- . Dr. Toledo scheduled surgery for 3/03/05.
On 3/03/05 15 x 10 cm (= 6 x 4 inches = 24 sq inches) wide excision recurrent metastatic renal cell carcinoma
Dr. Antonio Toledo made as wide an incision as he could on my back, approximately twice the size previous, to excise cancerous tissue. The margins (edges) were clear upon completion. Nodules were in the old cavity. Nodules were not present in the second operation. Biopsy and medical reports are forthcoming. The stitches (20) are scheduled to be removed on 3/23/05.
"The patient had two other previous excisions in 2002 and 2004 with a recurrent metastatic renal cell carcinoma of the left back. Now it again is palpable and we felt that this should be excised. When this was noted, there was a hew (hue) that suggests that there may be some skin metastasis. We marked this with marking pen which we felt was the edge and giving it another 1 cm, and we excised this after he was prepped and draped inthe left lateral position under 0.25% Marcaine solution with intravenous sedation."
"We deepened it to the subcutaneous tissue and fascia. Any bleeders wre controlled with electrocoagulation or ties using 4-0 Polysorb with suture ligatures using 4-0 Polysorb. The incision was carried down to the deep tissue and muscle and there was an old cavity from the previous excision and there appears to be a metastatic nodule. This was excised completely and the only thing at the base of it is the chest wall."
"Any bleeders were controlled with electrocoagulation or suture ligatures of 3-0 Biosyn. The wound was then irrigated. It was then undermined. It was then repaired in two layers, 3-0 Polysorb for the subcutaneous tissue and fascia and 2-0 nylon and 3-0 nylon interrupted. The incision is almost around 20 cm. (a ROUND 20 cm. ? my comment) . A dressing was applied. Minimal blood loss. Sponge and needle counts were correct, and the patient was transferred back to the Ambulatory Surgery Unit in good condition."
Future procedures on my back will probably require radiological intervention (my comment).
On 3/29/05 I met with Dr. David Chang, Yale Resident Physician, and Dr. Richard Peschel, radiologist, at the Cancer Center of L&M Hospital in New London, Ct. The Cancer Center is operated by Yale-New Haven Medical Center.
Dr. Chang examined me, particularly the recent surgical scar on my back. The scar is the result of surgery performed by Dr. Antonio Toledo to excise a recurring carcinoma.
After examination and consultation it was agreed by all that I start a 12 session course of treatment by electron beam therapy at L&M Hospital beginning at 9:45 A.M. 3/30/05.
While at L&M Hospital I went to the Radiology Lab where the technician marked my back outlining the treatment area. A simulation took place to correctly position the equipment. In subsequent visits for treatment the equipment settings will be known requiring minor alignment of my body.
On 3/30/05 I went to the Radiation Lab at L&M Hospital for my first of twelve sessions of electron beam therapy.
I went directly to the Lab where the technicians, Kathy and Denise, aligned me in a face down prone position beneath a template attached to the beam casting apparatus.
The beam is focused by the template which covers the complete area to be treated, roughly 4" x 6".
Once correctly positioned the beam is turned on. The beam is turned off after about thirty seconds.
I have eleven more treatments to complete the regimen.
3/31/05 I had my 2nd treatment. Nurse Joanne Stevens, an old friend from my IL-2 days, told me about skin car and gave me a prescription for some ointment. Funny thing about that is the ointment is made by a French company and had prices ranging from $24 to $34 from five differnt places. Also, the costs through mail order were less than $9 but could not be delivered witin 48 hours. I settled for $20 each, $100 total for 5 3.3 oz.tubes. So, ointment applied 3 times a day times, say, 11 days equals 33 applications. I bought 5 tubes and probably will not need some of it.
One application will be done at the hospital following treatment and two applications will be done at home before the next treatment. The 2nd at home application has to be completed more than 4 hours before my next treatment. After each applcation is rubbed into my skin I will wear a cotton tee shirt.
I get 300 "Grys"(Grays) per treatment for a total accumulation of 3600 Grys for the regimen.
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