Time Line

All Pat's info:

Doctors:
1. Primary: Dr. Wong
2. Internal Med.: Dr. Tran (his doctor in the hospital, and one who read the x-ray and CT scan)
3. Oncologist: Dr. Chaisanguanthum (Dr. Chaise)

Timeline for Dad

Aug 18, 2009: Pulsation feeling in left arm for approx. 10 seconds. Then experienced lingering numbness/weakness in arm and hand/fingers all complicated/confused by his Charcot Marie Tooth disease. As feeling and strength returned in arm, numbness in fingers remained
Aug 24, 2009: Pulsation feeling in left arm for approx. 15 seconds followed by same symptoms listed above.
Obtained Doctor’s appointment with Dr. Wong for Aug _____ , 2009 and some tests were ordered: – MRI scheduled for Sept 1, 2009 at 5:30PM. Blood drawn for testing. (Mom and Dad were at this appt.)
Sept 1, 2009: In am, while still in bed, pulsation feeling in left arm for approx 5 minutes, followed by same symptoms listed above. Called Dr. Wong’s office and left message.
Went to MRI appt at 5:30. (Pat with Mom and Dad) After MRI, spoke to Dr. Wong or his office, and was told he was going on vacation soon and an appt. was scheduled for Sept 3, 2009 at around 11:00am, prior to his vacation departure.
Sept 3, 2009: Dr. Wong explained that although the radiologist had not reviews the MRI, they could see 2 “shadows” in the brain area. When pressed on what this could be, cancer was mentioned, but advised to take it slow, and that a lot of test would be ordered. (Mom and Dad at this appt) Upon returning home, they received a call to schedule a “contrast” MRI at 5:00 the same day. A neurology appt was set up for Sept 4, 2009 with Dr. Shaw.
Sept 3, 2009: At 5:00, went to Contrast MRI appt. (Pat with Mom and Dad)
Sept 4, 2009: At 9:45, went to neurology appt – Dr. Shaw (Pat with Dad) Dr Shaw ran Dad through some strength tests and reflex tests. No discernable difference was found between his left and right side. He then disclosed that there were 3 tumors in Dad’s brain – 2 on his left and 1 on his right. Being that there was more than 1, they believed that there was another tumor somewhere in his body that had metastasized, or traveled to his brain. We were told that since it had metastasized, they would most likely find that the tumors would be malignant/cancerous. They would need to run tests and they felt the most time efficient way to do that was to admit him to the hospital. We were advised to go directly to emergency to be admitted. I asked about the blood tests that had been done with Dr. Wong’s office on Sept 3rd, and was told that everything in those tests looked ok, and that Dad’s prostrate was ok. Dr. Shaw also stated that they would be putting Dad on anti-seizure medicine (because the tumors can cause seizures), and steroids (to control swelling). Dr. Shaw also stated that the pulsation in the left arm was not a seizure.
Arrived at emergency at 10:50am, and was seen to an emergency bed/bay at approximately 12:45. At approx 1:00pm, Dr. Blair spoke a few words to Dad, said they would take some blood for testing and do an x-ray, and internal medicine doctor would come to admit him. Over time, blood was drawn, and a chest x-ray was done, and an iv was installed with anti-seizure and steroid medicine. The internal medicine doctor – Dr. Tran – came by and spoke to us briefly. She again explained why they thought there was another tumor somewhere else – because there were 3 in his brain, rather than 1. She could not say how long Dad would remain in the hospital, since they didn’t know how quickly they would find the main source. She also did a private examination on Dad. She said they would be admitting him, and were trying to get a bed ready. She later returned to say that they had found a mass/tumor on his left lung from the x-ray. We were told that it was typical of Lung Cancer to travel to the brain, so this probably was the primary source. The brain tumors are considered a “secondary” cancer, and although in the brain, would be considered lung cancer. They would continue with a CT scan (to see the lung tumor more clearly and to see if there were any other tumors) and schedule a biopsy, which looked like it would be Tuesday. They would continue to admit him to the hospital to get the CT scan done the next morning, and to monitor him on the new medication to make sure Dad tolerated them ok. Later, Dr. Chaisanguanthum, -goes by Dr. Chaise) Oncologist, came in and spoke to Dad, Mom, Anne & John. (Theresa and I were in the waiting room) She spoke to them about the tumor on the lung, and that it would be inoperable, since it has metastasized. Dad asked about removal of the lung, and she said there would be no sense putting him through that major surgery, because even if they removed it, he still would have cancer. (This is again under the assumption that it is cancer.) She said that her primary concern is to treat the brain tumors ASAP. They then spent some time trying to move up the biopsy appt., while finally moving him to the hospital. When John & Joe left the hospital that night, they thought that the biopsy would be done the next morning, along with the CT scan.
Sept. 5, 2009: Pat arrived at the hospital at approx 9:00am. Dad was awake and stated that he they would not serve him breakfast due to the CT scan. He was on an iv for fluids. They did not have a time on that yet, and the biopsy was moved back to Tuesday. Around 10:30 am, Dr. Chaise arrived, and during our conversation with her, Mom and Anne arrive to hear most of what she had to say. We were told that for the CT scan, they would normally give a contrast solution in Dad’s vein, but that this was hard the kidney’s and his were not in good shape. I asked about that because in viewing Dad’s med. records it shows he has chronic kidney failure, and Mom and Dad have never been told that. She said that at Dad’s age, basically everyone has this. Anyway, she said that they could also give him a contrast solution orally, but this made the scan less effective. (I believe that this was less harsh on the kidney’s, but still harsh, so there was talk that perhaps they wouldn’t do the CT Scan, although they wanted the info it would provide) She left the room to contact Dr. Tran. Dad’s nurse came into the room with 2 bottles of a white solution – looked like milk – and poured one in a cup for Dad to drink. Dr. Chaise returned as Dad was starting to drink, and confirmed that this was what they would do. As Dad drank, Dr. Chaise discussed her primary concern was the brain tumors since they will cause a lot of problems if they continue to grow. She confirmed that the br. tumor on the left is the largest, and that there are 2 on the right. She also confirmed that the pulsation in Dad’s arm was not a seizure, but probably one of the tumors pressing on a nerve. Dr. Chaise stated that she wants preliminary info from the biopsy confirming cancer asap, so she could then set up radiation treatments to attempt to shrink the brain tumors. Even though she would have liked the biopsy to happen sooner, she said that the reality was that they still probably wouldn’t get any results until Tues or Wed., so, not getting the biopsy done on Saturday morning was not causing much of a delay. She said that she hopes to have a preliminary result of the biopsy by Wed. or Thurs at the latest, so she can set up the radiation treatments, which could then happen as soon as Thursday or Friday. The radiation plan will be for a week or two – done M – F, and the appointments will be at a Kaiser location on Sunset Blvd., & Vermont. The actual radiation lasts for a few minutes, and will be done daily. There will also be a consultation appt. that could happen locally, but will probably be at the Sunset location for time efficiency. Side effects of the treatment are: sunburn to area treated, hair loss to area treated, and there can be cognitive function loss. This risk is FAR less than the risk of not doing the radiation treatment. She stated that they have good results with the radiation treatment, and that their expectation would be for the tumors to shrink, or for the treatment to at least slow the growth of the tumors. Towards the end of the radiation treatment, or once completed, Dad will have an appt with Dr. Chaise to go over his prognosis, any further treatments that might be available and that they might suggest. She said that due to the side effects of steroids, she will be trying to wean him off of steroids after the completion of the radiation treatment.
Dad was taken at approx 12:00 noon, and Anne, Mom and I left to get some lunch. We returned about 1:20 or so, and Dad was just finishing his lunch, stating the scan had only taken about 5 minutes.
Dr. Tran arrived around 2:30 or 3:00pm and discussed the preliminary results of the CT scan. It has not been read by the radiologist yet, but did confirm a large tumor on his left lung. She did not see any other tumor, but said the radiologist will get a better reading on this. She was able to pull up the scan on the computer in Dad’s room for us to see it. At this time we were informed that the steroids can cause hypertension, or high blood sugar levels, and this was the case with Dad. To manage this, they would have to prescribe insulin shots, or a diabetes pill, and a machine to measure his blood sugar levels. She said the pill would be easier, so that was prescribed. These pills should drop his blood sugar level, and he is to take ½ of a pill each morning with breakfast. He is not to take this pill if he is not eating breakfast, like prior to a test that requires an empty stomach. Dad is to measure his blood sugar 4 times per day – before breakfast, lunch and dinner, and prior to going to bed. A good blood sugar level is between 70 and 110. In the event that it reads as high as 300, we are to call Kaiser. In the event is drops below 70, he is to drink a glass of juice and some milk, or eat a piece of sweet candy – like chocolate- that melts quickly, and call Kaiser with his blood sugar reading. Signs of low blood sugar are confusion, being shaky, and/or sweaty. Low blood sugar is more dangerous. No real signs of too high a level, but he might just not feel right. He was also sent home with the steroid medicine – taken 4 times per day – like 9am, 1, 5, & 9pm, and the anti-seizure medicine. He is not to take aspirin or ibuprofen, but to continue with his other meds for high blood pressure, etc.
Dad was release and home by approx. 6:30pm, while Anne and Mom picked up his meds.
Dad is to set up an appt with his primary doctor – Dr Wong in 2 wks – and at this time will get more information on what the radiologist found on the CT scan. His biopsy appt is on Tues, 9/8 at 8:00am and John will take him. He is not to eat or drink anything after midnight Monday night.

And, by the way, his nurse made his day when she said he sounded just like Sean Connery. And... Anne and I did eat some of his chocolate. It was Cadbury - can you blaim us! He will have to make do with the apple juice. That is safe, at least til the grandkids come over!

Pat