Back at MDAnderson yesterday and today for our three week routine visit.  On the prior protocol our visits were every two weeks and on this new protocol, visits are every three weeks for four times, then they will re-evaluate.  The new protocol, a chemotherapeutic agent "Abraxane" and an immunotherapeutic agent, "Ipilimumab", have, within two weeks of the first dose, caused Rusty's hair and beard to fall out...he is now a doppelgänger for his late father, John, and his son, John!

In scrubs (his "doctor suit") waiting for imaging.

CT scan yesterday revealed a cluster of melanoma tumors in the left thigh which, according to lab results and decreased pain levels, are responding well to the chemo.  He was assessed for possible radiation to the thigh, but the consensus is that since the chemo appears to be effective, and since radiation is palliative only, they will not do radiation at this point.

Rusty also had a brain MRI yesterday in preparation for a follow up visit with the neuro-oncology radiologist who performed the Gamma Knife surgery for two brain tumors in August.  One tumor is gone and the other has slight inflammation..."treatment related".  They will continue to follow and will repeat MRI in six weeks.

It is so reassuring to know that all these treatment teams communicate with one another during the days that we are here.  Each one confers with all the others prior to determining a course of treatment.

Generally, Rusty feels pretty good.  No more seizures since seizure meds were adjusted.   He has some intermittent short term memory loss and he is frustrated that he is not allowed to drive because of the seizures.  Fatigue limits his activities and is caused, in part, by the effects of bone marrow depression from the chemo.  He was reassured today that, once the chemo is finished, some of these issues should return to normal or almost normal.  The staff continually reminds him that he is 77 years old and should adjust his expectations accordingly.

When we leave Houston tomorrow we are heading east to Sabine Pass to spend a few days camping at Sea Rim State Park...exploring, walking, watching sea birds and taking long naps.  We'll be back at MDA in three weeks.  

As always, your interest, prayers, love and support sustain and comfort us.  Thank you.

Back up to MDAnderson yesterday afternoon to prepare for visits today (January 9). We had some anxiety because, since the encephalitis episode, Rusty had been withdrawn from the Clinical Study protocol, and we were sure about what the new recommendations for treatment might entail.  Since we had been told three weeks ago that there were new tumors, we were afraid that we might have to make some difficult choices...i.e. Quality vs quantity of life.

Happily, that was not the case.  The Melanoma team recommended a new, different combination of IV chemotherapy and immunotherapy.  Pending Rusty's consent it was scheduled to start today.  The chemo is intended to shrink or obliterate existing tumors, including the one in his leg which has limited his mobility.  The immunotherapy is intended to boost the immune system so that it recognizes and attacks tumors.   Immunotherapy takes some time (weeks or months) to be effective, but the chemo is expected to work immediately. Discussion of possible side effects was a little scary, but Rusty is very ready to begin the new regimen, and side effects do not happen in all cases.  There will be four cycles of the drugs, three weeks apart, then a series of scans to determine status.

 Jeff was with us again for this visit and the three of us were very relieved and grateful.  Rusty had the first of the chemo and immunotherapy infusions today, and we'll come back in three weeks for the next round.

Rusty and Jeff back at the travel trailer with take out ribs from Pappa's Barbecue.

Thank you for your prayers, messages and support.  I'll post again when there are changes or when we come back in three weeks.