I then was instructed on how to inject myself with Lovenox. Last night, Jennifer obtained instruction and successfully injected me. This morning I successfully showed that I would possibly shoot myself, so to communicate. I was told that I would be discharged later in up to date instances with 56 syringes, sufficient for 4 weeks of twice day-by-day injections. I'll be reassessed at that point to suppose of wither I can drop to a as soon as day-by-day injection. Perhaps finally I can be ready to switch to an oral blood thinner, such as rivaroxaban (Xarelto), despite the indeniable actuality that I was warned that Xarelto has solely been recently permitted for DVT and PE, and there's limited data on employing it with mets melanoma patients. In addition, Xarelto has not been as smartly-studied for drug interactions, so if I ever enter a medical trial and was on Xeralto, I'd probably ought to go again onto Lovenox. Plus, if ever I was badly bleeding and wanted to reverse the outcome of the blood thinner I was taking, Lovenox would possibly smartly be reversed, similtaneously Xeralto can not, and would ought to metabolize out. The question is, how plenty of a soreness it be to inject myself day-by-day or twice day-by-day, both in terms of the hindrance of doing it, and the continuing bruising and tenderness within the injection web sites, versus the feasible risks from Xeralto? Eh, I'll cross that bridge later.
I also had a seek advice from NIH's hematology department – the man showed up 90 minutes after the scheduled time, and the attending medical doctor wandered by a 1/2 hours thereafter. Oh that I would possibly bill doctors my regularly happening criminal trained billing rate for for all time that I've spent waiting for doctors. Anyway, I was questioned in depth by the man on feasible symptoms, causes, and domestic historical past of DVT and PE. Aside from my brother having had DVT and PE last year for unexplained reasons, there's not any prompt domestic historical past to my talents. Hematology will have my blood run via a couple of tests and possibly a broader genetic sequencing for further conception, having spoke of that the man guessed that my PE is a primary case of metastatic melanoma and chemo inflicting my blood to develop into sludge. Interestingly, the attending spoke of that there has been limited facts suggesting the Lovenox would possibly possibly inhibit the enlargement of express sorts of malignancies, so he mentioned that I remain on that as an alternative of shifting to Xeralto. Note to self: do a few take a look at-up research on that.
I also met as soon as again with Drs. Wood and Apolo. They are going to coordinate my take a look at-up care with Dr. Aragon-Ching, who will see me subsequent Monday. I gets back to visit with Dr. Apolo subsequent Tuesday, to further explore whether any medical trials are currently accessible to me, and in that case, whether now could be an perfect time to do one. Dr. Apolo spoke of that, despite the indeniable actuality that my supraclavicular nodes aren't expanding in size, Monday's CT scan was ready to detect that I have a cluster of supraclavicular nodes that are increased than formed: two are about 1 cm across on the transient axis, and others are smaller than 1 cm, having spoke of that still increased formed. Dr. Wood in contrast those nodes to a cluster of Hershey's kisses that have commenced to melt. They were still fantastic, having spoke of that the borders were starting to develop into less fantastic. While Dr. Wood's HER2 medical trial required a unmarried tumor in any case 2 cm in size, Dr. Apolo spoke of that, for the PD-L1 trials that she had in thoughts, it would possibly be feasible to think about the aggregate of those cluster of nodes to meet the minimum size. She spoke of that later in up to date instances she was going to sit down with the radiologist who at the beginning read Monday's CT scan, and do the following comparison of my CT scan. We'll communicate about subsequent week her suggestions on feasible medical trials.
I'm not of the thoughts that I deserve to jump into any medical trial that can be open to me. For example, Dr. Wood's Phase 1 HER2 study seems too unproven for me at this point. If I had optimum tumors in my liver or lungs, and there were no other therapies accessible to me, then I would possibly possibly think about it. But I currently have a comparatively dwindled metastatic melanoma burden, and know that, in all chance, my melanoma is possible to development in time. Each treatment is like a unmarried bullet: I'll possible be ready to use each treatment solely as soon as. There is no expectation that any treatment will cure me, since there's not any acknowledged cure for metastatic bladder melanoma, and none on the prompt horizon. Instead, each of these experimental therapies are meant to slow the enlargement of melanoma, and prolong my life. The question for any future is treatment will be a balance of my present condition against the wisdom of waiting; the likelihood that the treatment would work on my mets BC; and the possible aspect outcome. I'll be making that decision after in-depth consultations with my doctors.
I've principally abandoned the concept of getting my metastatic nodes eliminated. I questioned both Drs. Wood and Apolo about that concept, and they firmly rejected it, for three reasons: First, there's not any facts that a lymphanadectomy would support me. The reviews on lymphanadectomies on patients with metastatic melanoma differentiate amongst those nodes observed within the stomach (whereby there is a few facts that removal of additional nodes can support, which is why I had sixty one nodes eliminated on the time of my radical cystectomy), and nodes within the chest, whereby there's practically no facts of any a official suggestion . Second, a lymphanadectomy would not be curative, or probably therapeutic, because my bladder melanoma is systemic international my lymph node tools, and isn't always confined to my enlarged nodes. As Dr. Apolo spoke of, "you have a systemic disease. It calls for a systemic treatment." Third, the risks to having a lymphanadectomy of those supraclavicular nodes are significant, particularly nerve hurt to the shoulder, left arm, or probably the midsection, as smartly as potential hurt to the veins and arteries lacing that region. On balance, the risks of a lymphanadectomy outweigh the blessings.