Loose Strife

Laura has been in the hospital now for over three days and is bored, so call her at 617-732-4366. She’ll still be there for at least another two days.
The cause of her troubles is still uncertain, a treatment plan hasn’t been settled, and her symptoms aren’t adequately controlled. Not for lack of trying.
Laura has had a head and spine MRI, CT scan, a shunt series, a shunt tap, a spinal tap, and an analysis of her spinal fluid. The results are a little contradictory and not very encouraging. Surprisingly, as I previously mentioned, the visual evidence in her brain MRI of cancer in her spinal fluid has decreased, but her ventricles, which hold much of the fluid are slightly bigger. Her spine MRI looks better according to one doctor and the same according to another. Regardless, comparing the head and spine scans to those taken in May suggest that there’s some evidence of increased pressure, but no visual indication that the cancer cells are worsening or affecting specific parts of the nervous system. The apparent increased pressure suggests that her shunt is not working perfectly, but the pressure measured from both her head and spine are normal and all the indication are that the shunt is functioning properly.
The hospital neurology team, her neuro-oncologist, and her neurosurgeon all agreed this afternoon to “dial down” her shunt to reduce the pressure and see if that helps. But nobody is optimistic because Laura didn’t experience any relief when she had fluid removed during the taps, which should have the same effect in the short term.
So, there’s some evidence for and against inter-cranial pressure. I’m hoping that she’ll respond well to the shunt adjustment over the next day or so, since it’s the only specific single point of failure and it can easily be fixed.
The pathology report on her spinal fluid unfortunately found very high levels of breast cancer cells. It seems to imply that her current chemo is probably not improving her CSF mets. (It might be keeping cancer stable in the rest of her body.) Her neuro-oncologist said that sometimes patients have symptoms like Laura’s with no specific tumor sites or visual evidence of disease.
In the mean time, Laura hasn’t been able to keep very much down, so she continues to take in only a few calories. Unfortunately, there doesn’t seem to be much that can be done to treat that specific problem. All the standard medicines treat nausea, but Laura doesn’t really get nauseated, she just throws up. (This turns out to be a classic indication that the problem is neurological. Furthermore, the fact that she has no abdominal pain or other related symptoms and that nothing is found on her PET/CT scan pretty much rules out a gastrointestinal problem.) Also, we learned that her neck and back pain are consistent with complications of CSF mets and can be unrelated to Laura’s mets to her spine and other bones. This is consistent with her PET/CT scan that showed that the bone tumors were quiescent — a finding that I previously found baffling.
So, it seems that the most likely explanation is that the CSF mets are causing her troubles through non-specific infection of the nervous system. However, her neuro-oncologist could not offer a good physiological explanation for what might be going on and instead suggested that Laura may be declining due to “cancer load” — which is just general oncology talk for feeling like crap due to all the cancer cells in your body.
Tomorrow I’ll write about what Laura might do about all this. I’m too tired to write much more right now. But I will quickly say that I drove the girls and my parents to Boston on Monday, we spent the night at an incredibly generous and hospitable friend’s house, and we took in the New England Aquarium today. Of course we visited Laura several times. We had a pretty good time, all things considered.
All for now. Good night.