CT scan

Joseph's CT scan today did not show any increased pressure which is good. They did not have his most recent MRI to compare the images, but there did seem to be a larger area of abnormality. Like I said in the last post we knew we weren't going to learn anything today about the nature of this spot, and true enough they weren't able to tell us anything new. This increase could be swelling from an area of necrosis or true progression. We have to wait until next week when we go to St. Judes. So the plan is for Joseph to keep taking his steroids to help with his symptoms while we wait for next week.

Joseph did great and was able to have the scan without any sedation. It only took about a minute and Mom and Dad were both in the room with him holding his hands and telling stories. He completely understood that if he was really still then we wouldn't have to access his port, and he was still as a statue.

Thank you all for your messages, emails, phone calls, and prayers. We continue to need them through next week.

MRI Tomorrow

Over the past two weeks and since the whole pseudoprogression thing, we have noticed that Joseph has started his head tilt again. It was gradual and we denied it as long as we could, but it is definitely back. This was the first sign that something was wrong way back in November. Over the past few days his walking has become increasingly unsteady. This is obviously very concerning for us.

They told us that even if this truly is psuedoprogression we may see some symptoms, but they appear to be increasing daily. After talking with his doctors at St. Jude, we are hopefully going to have an MRI tomorrow (Wednesday) here at Vanderbilt. The images will be sent to Memphis and they will compare it with the previous ones. Hopefully this will help us find out what's going on. Best case senario is that the spot is still the same size and shape and that his symptoms are due to whatever necrosis and stuff makes up the spot. Worst case is that the spot really is a progression and that it is growing bigger. If that is the case, then we will stop the Tarceva and start on a new chemo regimen. We think he'll start CPT-11 and Avastin, but we're not totally sure yet. He will also probably restart steroids regardless. We have no idea if another surgery would even be an option.

This is a very difficult time for us. Seeing him like this reminds us of the terrible days back in November. Please be praying for him and for us. We really appreciate it.



UPDATE:
Okay, now the plan is to get a CT scan here to see if there is any increased intracranial pressure. They will not be able to tell whether this is progression or not. We will be going to St. Judes on Sunday for an MRI and PET scan Monday and Tuesday which will be able to tell what's going on. So we won't find anything out until next week.
Please pray that Joe will take his medicine easily without much fight and that he will have great patience and endurance for the battery of tests that await. Thanks.

A few beach pics

We had a really fun and relaxing trip to the beach. Oddly enough, it was not nearly as crowded as normal which was fabulous. We had great weather and Joseph and Holly became even more comfortable in the water and on the beach. Thanks to Nana and Grandad for allowing us to use their beautiful beach house and to Mimi and Big Daddy and Uncle David for spending time with us down there.

At the beach again

We're back at the beach and the kids are loving it. Uncle David is here with us helping take care of the kids, and Mimi and Big Daddy also happened to schedule a vacation this week too. We have had a great time so far and will be coming back later this week.

Joseph and Holly are now experts in their floaty rings at the pool and are starting to warm up to the ocean. Joe gets a little scared of the waves, but Holly charges right in. Joseph is doing great and has been in the best mood since coming home from Memphis. We head back in early July for the next scan to make sure that he has pseudoprogression.

We don't have any video of the beach, but below are some videos that we were going to post before the last scans but never got around to it.

God is good all the time--A tribute to Peggy Southard

Today is the anniversary of the passing of a dear woman and friend of our family's, Peggy Southard. She died of cancer one year ago today, and her life and love influenced many people, me included. I always marveled at how she made everyone feel like he/she was the most special person in the universe. After talking with her you felt like a million bucks. Even through every stage of her illness, she would say "God is good all the time." Amazing! In her honor, I wanted to share a neat story of one (of the many) way God has shown his love and goodness and mercy to us amidst some heartbreaking times.
I believe I shared a couple of months ago that Joseph lost his corneal reflex in his left eye through the 2nd surgery. It was a major concern b/c he wouldn't feel if anything got into his eye and it could potentially scratch his cornea and cause damage. So, I asked for prayer that God would protect that eye or eventually heal it right up. Well, since then he hasn't gotten anything in that eye. And, many people have commented on his long beautiful lashes and how many women would pay big money for them. Well, at the doctor's visit last week, Dr. Nick was trying to get his cotton swab to touch they eye to see if he had a reflex. He ended up giving up (not b/c Joe was moving, which used to be the case) because the eye lashes were too thick and he couldn't get the cotton swab through! He commented that it was a side effect of the drug he was taking, Tarceva. So, God provided protection of his eye by allowing one of the side effects of the drug to be growing extra long lashes. Have you ever heard of a drug causing eye lashes to grow longer (now, women, don't go looking for this drug---pretty sure taking it for the side effect would be a very bad idea)? I just thought that was so cool and had to share.
We miss you Peggy and love you, Southard family.

Pseudoprogression

We are relieved to say that the tumor board was unanimous in that it looks like pseudoprogression. So, the plan is to stay on Tarceva and we will come back in one month for an MRI. Thank you all so much for praying for us. Joseph has been really happy and upbeat---definitely our most low-stress trip to St. Jude's so far, mainly because of Joe's mood. We are praising God for a good report (a rarity in our journey so far) and hope that Joe will continue to soak up and enjoy life as much as he is right now. Thanks to the Barrs for feeding us and entertaining us while we were here in Memphis, and thanks to Nana and Grandad and Davey for taking such good care of Holly while we had to be gone.

Tumor Board Meeting Today

Hi friends,
Joseph has done really well so far. We did the "magic cream" before they accessed his port and I think that really helped with the pain. He just sat in my lap and we had a nurse at the ready to hold his legs, but I don't think she really had to hold him much. He had his PET scan then MRI and was finally able to eat at 3:30 in the afternoon. He had woken up at 4:30 that morning ready to start the day, so it was a long day to not eat or drink. What a trooper!
Today is the tumor board meeting, where they will discuss Joe's scans and all the different doctors (radiologists, surgeons, oncologists) will give their opinion on what this new mass looks like. Unfortunately, since they discuss many different cases, we won't be able to meet with our doctors until tomorrow morning at 9:30. Please continue to pray for clarity and wisdom for the doctors and that we would have peace no matter what the final consensus is.
We are off today so plan to go to Target (the big excitement for Joe P.) and swimming with Winnie Kate and Aunt Jennifer. Thank you all for holding us up in prayer. Joseph is really so happy and actually likes going in to St. Judes now, which I never would have believed possible. He is excited to see the doctors and play with the toys in the waiting room. We will keep you updated as we find out the results.

Heading back

After another impromptu meeting with the oncologist on Friday, they told us that they want Joe to come back for a few more tests on Tuesday. These tests in a best-case senario would show that it is pseudoprogression, but they are just as likely to come back inconclusive. Hopefully this will give them enough information to make a better diagnosis. We will meet with our doctors again sometime after the tumor board meeting on Wednesday.

So we'll be going back to Memphis on Monday but we don't know how long they want us to stay. Thanks for all your prayers and messages.

Progression vs. Pseudoprogression

Well, today's MRI showed that something was there. The MRI from March showed a shocking lack of tumor, but this one showed something in the tumor bed that was not there before. It is about 1cm x1cm and the radiologist called it a progression of his original tumor (meaning that she thinks it's growing again). Our oncologists, however, were not so sure that this was true progression but rather it could be something they call pseudoprogression. Pseudoprogression looks and acts like a progressing tumor, but it is actually due to necrosis (death of cells) and other inflammation that is attributed to radiation and chemo. Pseudoprogression would remain stable in size and could eventually go away. It is often seen around this time after radiation, and the fact that the last MRI was so clean makes them suspect that this is pseudo even more. Joseph does not have any signs or symptoms due to the mass that is there, but this does not help in the diagnosis either way because pseudoprogressions can also cause symptoms.

So, our team is going to the tumor board next Wednesday (the group of radiologists, neurosurgeons, and oncologists) to discuss his case. It sounds weird and non-scientific, but they are going to come up with a consensus on whether to call this true progression or not. So we have to wait until next week to see what the other opinions are. Joe will continue to take his current meds until it is officially a true progression.

Obviously, we are rooting hard for a pseudoprogression diagnosis. Unfortunately the only way to know for sure is another biopsy, but that has not been discussed yet and I doubt they would recommend it. My best guess as to what the course of action will be is that they will have him continue Tarceva and then come back in 4 weeks for another MRI, but I'm guessing.

What does this mean for Joe? If it is pseudo, then he will continue Tarceva and we'll go on like we didn't go through this horrible day. If it is true progression then he will stop this trial and we will move on to a new one. We have some other trials already in mind if this should come up.

So we're in limbo for the next week and probably for the next month. Please pray for the meeting next week, that the diagnosis would be obvious to everyone. Please pray for strength and peace for us as we are feeling frustrated, angry, and helpless. And continue to pray for healing for Joseph.

After Joe had his port accessed (it took five people to hold him down) he was great and did not complain or cry too much. He actually hugged all his doctors and played a lot with Aunt Jennifer today while we were talking to the doctors. We even had time in today's schedule for a visit to the Children's Museum with Jen, WK, and her Nana. We will be coming home tomorrow after PT/OT appointments. Thanks for all your prayers.

MRI this Thursday

We had a great Memorial Day weekend. Joseph's friend, we'll call him Yogi, and our friends from Atlanta came up and we had lots of playing and fun. Joseph was so sad they had to go back.

We leave tomorrow for Memphis for the three month MRI. We have three days of scheduled tests and meetings, and Joe will have his port accessed tomorrow night. This will be the first time they've left the needle in overnight since radiation, so we are not anticipating a good night's sleep. He always freaks out with any blood draw or IV, so please pray for him to be strong and calm. The MRI will be first thing Thursday so we'll know the official results by the end of the day.

We are emotional and apprehensive about this MRI. He isn't showing any signs or symptoms of regrowth, but there could still be some growth. I guess this is how every MRI is going to be for a while. Please continue to pray for him and for us.

Also, if you've been following the other three year old boy with GBM in the links section, he is not doing well and is not expected to live much longer. Please pray for him and for the family.