Update on me (Lemongrove)

I have spoken to Chris this evening, as soon as I saw your post, Lemongrove and she will be in touch with Father John.
I will PM you also.
Re our local A&E, I have had good experiences there for myself and others, but the team that would be involved thereafter does not inspire me either. Wishing heartily that neither of us have to be there.

Lavender
xx

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Lemongrove, You don’t know me, I’m a ‘newbie’ but I have been reading some of your posts and I can honestly say, I have nothing but admiration for you. After reading about what you have gone through, it has quite frankly left me in total amazement. How you have to sometimes fight to get the best treatment and still come back on here to stand up for our rights and tell people how it is in the real world. I wish you well with your continued recovery.

Lucky Gal, what a lovely thing to say. Best wishes for your treatment.

Just thought I would post another update. It’s not that I think I’m important, I just hope my struggles might help others who find themselves in a similar sitution.

I’m basically OK and the Lap/Cap combo seems to be holding the brain mets at bay. The Prof who manages my treatment referred me to the Marsden for Cyberknife, but the Marsden declined to see me because they were under the impression that I have five brain mets (and they only treat a maximum of three with CK). This turned out to be very annoying because a new Neuro-Oncologist at Charing Cross has since reviewed my scans and decided in fact I do only have three. Had they decided this before, the Marsden might have seen me.
Anyway when the Marsden declined to see me, I asked to be referred to the Cromwell for Gamma-knife, which is also a form of stereotactic RT, but can treat more metastases (the main difference between Gamma-knife and Cyberknife is that Gamma-knife is only used to treat head and neck cancers whereas CK can treat cancers virtually anywhere in the body). Afer finding out I only have three brain mets, I did think of asking to go back to the Marsden but decided to stick with pushing for a referral to the Cromwell - for two reasons (1) The MRI at the Cromwell is much more sensitive than either Charing Cross or the Marsden, so if they discovered more mets, they could treat them. (2) It’s easier to get funding for stereotactic RT for brain mets, than mets elsewhere in the body, and as CK tend to be described as a Whole Body treatment I know that the funders are more approving of Gamma-knife (in fact since NHS England took over specialist funding since 1st April, they only fund stereotatic RT for brain mets and inoperable lung lesions).
Needless to say there has been a lot of dithering over whether I should be referred. Trouble is, while most of the medical team caring for me feel stereotactic is the way to go, there is one ultra-conservative doctor who remains adamant that I should have Whole Brain RT. This is currently a major problem, because the first requirement for specialist funding is that there is consensus amongst the medical team that this is the best treatment. Again this is very annoying, because I actually meet all the other requirements and am confident I would get funding.
Anyway I’m equally adamant that I’m having Gamma-knife, because WBRT offers no survival advantage, and is merely palliative. Sterotactic on the other hand does potentially offer a survival advantage, and if I’m very lucky and there are no other unseen brain mets, it could knock out the existing ones, and solve the problem.
Charing Cross must hate me because I’m so pushy (both the Prof and secondary BC Nurse say they have never received letters from patients before). But what is the alternative? Should I just lay down and die?

Lemongrove you are an inspiration. I have just had to fight to get my treatment changed when Letrozole had clearly stopped working. Breast turned from having a lump to being just one huge Solid lump. Shows up on scan as 26mm in real life 5 to 6cm. Tumour markers also went from 70 to 280 and they made me wait around for another four weeks effectively having no useful treatment. Firmly believe they only eventually listened to me when I asked for a second opinion. I do think they were partially reluctant to change from Letrozole to Capcitebine as I believe Invasive Lobular cancer does not always respond well to chemo. I also think because I have secondaries they have given up on me.

I am sure you will be able to get the Gamma-knife just such a shame we have to fight for treatments.

June

Lemongrove, I hope you soon have access to the treatment you need and that it does a wonderful job for you. It is amazing that you can find time with all that you are going through to share your knowledge and experience with others and inspire us all to fight for the treatments we need. I know you have encouraged me to be a more informed and proactive patient. My very best wishes to you x

Lemongrove. I quite often read your posts and I have to say the knowledge you give to others is amazing. I am relitively new to breast cancer ( dx double whammey this year) so the information you give and the convidence you inspire people to have is great. I hope you have your treatment, which I am sure you will. Please keep us updated.
Best wishes x

“But what is the alternative-do I just lay down and die?”
Get that printed out on to a badge or a mini banner and wave it at them when they filibuster.
I feel the fact that they have never had letters from a patient before suggests that they have been good at their job thus far, but also that they and their patients have been lucky. You may have been the first but you will not bethe last in today’s world that questions their treatment.
Keep On Keeping On, Lemongrove, we need you! Very glad to hear that you are stable.
(BTW the room air was blue as I read abut the CK referral fiasco continuing)

So sorry to hear your latest news Lemongrove. I thought you had probably had your treatment by now. As if any of us have the luxury of waiting the whole of summer for doctors to come to a consensus! I hope you can now have this treatment asap.

Well I’m in utter despair today, and don’t have a clue how to proceed now.

As peeps will know from this thread, over the past few weeks Charing Cross Hospital have been saying they have concerns about referring me for more Cyberknife or Gamma-knife because my brain metastses are located close to where I had Cyberknife for skull metastases in 2010 (and treating the same are might cause over-exposure). Because of this I contacted the doctor who treated my skull mets with Cyberknife in 2010), and asked if he felt the treatment I had in 2010 would preclude treating brain metastases in that area. He said he couldn’t see any clinical reason because they had minimized radiation to the brain, and that if the NHS wouldn’t do it, he would sort it out.

I was naturally very pleased about that, because it supported my view and gave me the option of private treatment as a fall back position. However, I then made the fatal mistake of telling Charing Cross what the doctor had said. As a result they have completely changed the goal posts too justify their position. They are now saying that I don’t have five brain metastases at all - what I have are three skull metastases growing into the brain. Consequently, treating the the area growing into the brain would mean treating the skull - and as the skull has already been treated they feel it would be too risky to do it again.

So I’m completely stumped now and don’t yet have a clue what to do. I know full well the problem is not skull mets growing into the brain, because I have had numerous scans and none have mentioned skull mets getting bigger. Therefore how can they say I have skull mets growing into the brain without any sign or them actually growing or changing?

I’m now worried that if I go to a private hospital they will contact Charing Cross, and refuse treatment simply on the grounds of what Charing Cross have said. In fact, that seems to be happening already, because I immediately Emailed the doctor who treated me with CK before to take him up on his offer, but when his Secretary rang this morning she said he had said to tell me that he was in contact with the Prof, and was fully aware of the situation. In other words, it sounds like the Prof has already told him that he doesn’t agree with treatment and doesn’t want to be undermined.

I have also written to my GP to say that in view of the misdiagnosis, sloppy management of my case, delay and muddle, I no longer wish to be treated at Charing Cross and have asked to be referred to the Royal Marsden intead. I have said that I want a second opinion and want the Marsden to look at my case completely afresh. My only hope is that the Marsden agree to take me on, re-evaluate my scans and disagree with the Prof.

I cannot begin to explain how upset and let down I feel about this. They have not carried out any dosimetry and therefore have no evidence to support the view that more treatment would cause over-exposure. What’s more, It has taken them almost eight months to reach this unfounded decision - and during that time, I have had to endure months of misdiagnosis, sloppy management, disagreements about approach, terrible advice and dithering -when what was required was prompt action.

I now feel like my life-line has been cut, and my only hope has been taken away. What’s worse is that the Prof doesn’t seem to understand how resentful I would feel if I had to accept the treatment he is now proposing (i.e, stay on Lapatanib Capecitabine until it fails and then have WBRT). The fact is, if I had to have WBRT, knowing that when my mets were small and potentially controllable, I could have had stereotactic RT and posibly avoided WBRT together, I would be in total despair.

While writing I must apologise to Ponsmuir because I met up with her at Charing X Hospital yesterday, but rushed out without a goodbye. I wasn’t being rude, I was just on the verge of tears and didn’t want to make a spectacle of myself.

Hi LG
No wonder you are so in such despair. I do think a lot of oncologist really do not understand what we have to deal with on an emotional level as well as the physical side of things. This seems such a waste of time going backwards and forwards between medical professionals. who kow the facts about your case, when all you need is a treatment plan to be already in place. All I can offer is support but, from someone that has also had major problems with conflicting decisions, I do understand just how frustrating this must be for you - let alone downright worrying. Just hoping a suitable solution is decided on very soon to get you out of this limbo and also that the Cape/Lapatinib combo is still working well for you.
Nicky x

Hi Lemongrove,
This is just awful,no wonder you are upset. It seems that oncologists do not like it when we do our homework. They can’t stand being challenged. You made the right decision to ask to go to the Marsden instead and I am sure they will take you on and take a fresh look.
I feel a letter of complaint is in order once you have managed to calm down.
You take care.xx

I can only echo what Nicky has said. Totally know where you are coming from as I also feel badly let down by oncologist and I am awaiting a second opinion. What makes your situation worse is that you are so knowlegable and have helped so many of us both with inspiring us and giving us confidence to question treatments. Thoughts are with you.

June

No need to apologise, dear Lesley (Lemongrove). It was an unexpected pleasure meeting you at the hospital and chatting while we waited together. You told me that Lap/Cap is keeping you stable which was great news. I was so sorry to see you so upset after your consultation and understood you were rushing off anyway to have your Zometa.
I don’t see why you shouldn’t ask for a second opinion at the Marsden. But I would advise you to sleep on it a bit before you commit to paper such negative feedback. I understand how angry and upset you feel - but we were both in a very bad way over Christmas/New Year and the hospital pulled out all the stops to sort your serenoma problem at an ‘anti social time’ and do the surgery. And then it had to heal. So it wasn’t all sloppy or mismanaged, they would say.
I am sure you will take this set back in your stride and find a new way forward when you have rested up. And don’t forget - you’re stable.
I look forward to you giving me the benefit of your wisdom for years to come, as we discussed.
susan x

It’s at times like this we all wish we had that magic wand, not just to get rid of the bloody cancer, but also to take away the frustration, worry and downright despair… I really hope you can get a speedy resolution to this and the treatment that’s right for you. But in the meantime, hold on to stable and keep on fighting for what you want and need like only you know how.

Can’t believe this! Am so angry and upset on your behalf. Will be in touch and hope to see you next week xx

My goodness I can only imagine how worrying this must be for you Lemongrove.
Like everyone else I’m hoping this is all resolved soon. My very best wishes.

I can only echo what has already been said. Heres to getting your second opinion and next treatment plan. I was getting cross as I was reading your post. xxx

Well after the recent fiasco over whether I have brain mets or ingrowing skull mets, I have made an appointment with the Dr who did my Cyberknife for skull mets in 2010. I will be seeing him on the 8th August at Harley Street. I managed to get a copy of all the MRI’s I’ve had since Christmas and will be asking if I have skull mets or brain mets. If it’s the latter I will be asking if the treatment I had in 2010, would preclude further treatment for brain mets. In actual fac he has already said it wouldn’t as they minimised radiation to the brain, so we will just see.
I also asked my GP to refer me to the Royal Marsden in Chelsea, and have an appointment on the 12th August (I have a great GP and they have been very prompt in getting things organised). Hopefully I will now get some answers and some action.
Ponsmuir (Susan), I titlly agree that it’s worth calming down before making decisions, and committing to paper. I think Charing X is on the whole a good hospital, but the Prof has become a bit obstructive. He actually refused to let me have the operation on my ruptured seroma at Christmas, and it was only the Plastics Consultant and Prof persuading him that made him relent. Had it been left up to him, I would have spent the last seven months waiting in everyday for the district nurse to dress the open chest wound or would possibly have died from a massive infection by now. I just think the Prof is concocting ridiculous excuses to avoid offering more expensive treatment. But us secondary peeps have paid out taxes, and deserve to be treated with the same vigour as those with primary BC

I hope further treatments other than WBRT will be available to you lemongrove. Good luck for August meetings.