It seems the insurance company has a “3 strikes and you’re out” policy with regard to PET scans. After you’ve had three in a year, they say NO MORE. That is unfortunate if you are trying to evaluate chemo treatment, as the PET scan shows not only the size of the tumor, but also its metabolic activity. In other words, is the tumor dormant or active? Is it a dead volcano or a volcano about to explode? Dr. P initially wanted me to take a two to three week chemo pause and do the SIRT Y-90 “nuke my liver tumor” treatment. However due to some really stupid and needless insurance delays with my SIRT treatment authorization, I have now been off chemo for a month and the nuke procedure is not for another three weeks. Dr. P felt the PET scan was necessary to evaluate me for the next step.
The insurance company said NO several times to Dr. P’s request for a PET scan, then changed it to maybe, then finally yes thanks to Dr. P’s perseverance. The CT scan I had in August showed the size of my tumors were stable about the same size they were from my July PET scan. The PET scan I just had showed some tumor growth with significant metabolic activity. Dr. P feels the Lonsurf chemo treatment was effective in slowing down the disease progression, so he wants me to resume my oral chemo. Now we have to figure the timing and how to manage the side effects of the chemo and the SIRT procedure so they don’t happen at the same time. Ya Hoo…we’re having fun now!
The PET scan shows three tumors that are most problematic, one in each lung and one in the liver. So as we are nearing the end of chemo effectivess, we are turning from a systemic approach to treatment to a “whack a mole” approach. Assuming the dry run mapping on October 21st is successful, they will nuke the liver tumor on November first. Dr. P is now referring me to another radiologist to see if I’m a good candidate for Stereotactic Body Radiation Therapy (SBRT) to take out the lung tumors. In this procedure they use very high does of radiation, using several beams of different intensities at different angles to precisely target a tumor. This targeting approach prevents damage to healthy tissue while destroying the nasty stuff. Of course we no doubt will have to do more battles with the insurance company, so who knows when or if I’ll get to enjoy the thrills of SBRT.
In the meantime, I have some celebrating to attend to! It seems my birthday is rapidly approaching. Joining us in the festivities are eight friends flying down from Oregon, four Ducks and four Beavers. I know, it’s astounding that I have Beaver buddies. Although I tried to wait for them to celebrate, I just couldn’t hold off. The celebrations began last night with a fabulous Wala Walla cuvée, grilled lamb chops and a surprise gift from our friends John and Sandee.