I'm still in the NIH hospital. They'll keep me here until tomorrow, since they want to confirm that I am getting the right dosage of Lovenox to break up my pulmonary embolism (PE). I've been getting 120 mg of Lovenox twice a day. Tonight the nurse will teach Jennifer and I how to do self-injections. Tomorrow morning I'll prove that I can do it, and then I'll be discharged after another set of labs confirm that everything is ok.
I'll have to keep up with the Lovenox injections twice daily for at least 4 weeks. The doctors want to be sure that all of my clots and deep vein thrombosis (DVT) has been addressed. After 4 weeks, I might shift to once daily shots, which could go for 6 months, or it could last as long as I have bladder cancer. We'll see. Since mets cancer is a known risk factor for DVT and PE, her thinking is that I should probably stay on the Lovenox for the rest of my life. Neither Dr. Apolo nor Dr. Wood recommended that I go on coumadin, because it is so hard to regulate and can be rather unpredictable. I'm not excited about daily shots into perpetuity, but it's better than dying from a stroke. (A few minutes ago, I spoke with Dr. Aragon-Ching, who said that it may be possible after 30 days or so to transition me from Lovenox to oral Xarelto. I will meet with her on Monday to get her views on my follow-up care.)
Dr. Wood gave me a copy of my CT scan. It showed "redemonstrated right lower lobe calcified granuloma", as well as "new, well-defined, linear low-density filling defect within the central aspect of the main portal vein, extending from the portohepatis to the confluence of the SMV" and "an additional filling defect is noted in the central left portal vein." In other words, I've got a bunch of blood clots in my lung and portal veins in my liver. The results of this scan were what caused Dr. Wood to order me back to the hospital last night. Reading it, I can understand why. Compared to my scans of 9/2/14, 7/15/14, and 3/25/14, these clots are new and dramatic. All of the medical professionals that have attended me - the doctors, PA's, nurses - have repeatedly told me how lucky I am that I just happened to have a scan that detected the PE before I had any symptoms.
The CT scan also reported on the size of my enlarged lymph nodes under my left clavicle. The radiologist reports "mild interval decrease in the size of the superior left supraclavicular lymph node, measuring approximately 1.0 cm in the short axis dimension, previously measuring 1.3 cm." My other nodes in the area are stable in size, the largest about 1.0 cm across. This finding that my largest lymph node as decreased in size is somewhat surprising, since I have not had any therapy since my last scan. It could be due to how the CT scan sliced the node, although the radiologist was definitive in his conclusion of "stable and interval decrease in size, respectively, of the two prominent supraclavicular lymph nodes."
Aside from the PE, there are two other immediate takeaways from this CT scan:
1) My cancer seems to have stopped growing for now, and is in fact receding. This is a surprise, and so far, no one has been able to explain it. I'm grateful that it has, and give thanks to God for this news.
2) The smaller size of my nodes mean that I do not qualify for the HER2/neu trial that triggered this latest round of fun and games. The minimum tumor size has to be 2 cm. I also likely will not qualify for any of the PD-L1 trials at this time either. Dr. Apolo told me this morning that she was going to personally measure the node size when she reviewed my CT scan images, but I have not heard back from her. This means that I'm back to watchful waiting - the same place I was prior to about 11 am yesterday morning. Ooch, whiplash.
Smaller nodes! YAY!!!
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