About her

Regular (annual) doctor and dermatologist visits. Lump on upper left back visible as early as 2007 was viewed as a lypoma and nothing to worry about. No external pigmentation or skin anomolies.

May.            At regular annual exam, decided to have an ultrasound of a developing mass discovered on upper right breast.
May.            Results of ultrasound indicated that a biopsy would be in order.
June 29.       Ultrasound guided biopsy of upper right breast mass.
July 2.          Pathology report indicated malignant breast cancer, triple negative variety, no indication of melanoma.
July 8.          Met with surgeon (Dr. Hanson). 
July 12.        Underwent BRCA testing. Results on July 21st indicated no mutation of BRCA1 or BRCA2 genes.
July 13.        Ultrasound of mass on upper left back - undetermined as to what it was.
July 20.        Initial meeting with oncologist (Dr. Hank Kaplan) - assumed breast cancer - discussed treatment protocol.
August 10.    Breast lump removed in surgery (right breast partial mastectomy) by Dr. Hanson.
August 13.    Pathology indicated removed tumor is triple negative breast cancer, no indication of melanoma
August 26.    Back lump removed in clinic procedure - pretty clearly a tumor at time of extraction
August 31.    Dr. Kaplan results visit, but pathology still unclear as to status of back tumor and connection to earlier diagnosed breast tumor.
September 1.   Pathology finding that the back tumor matched the breast tumor, and we were informed it was originally misdiagnosed as breast cancer but was in fact Stage 4 metastatic malignant melanoma.
September 2.   Port o Cath installed.
September.       Course of Leukine started - self injection. Side effects emerged - rash on day ten - discontinued use for three days, restarted, rash returned, Kaplan decided to halt and call it a failure (tolerance for treatment) and move to Ipilimumab under compassionate use status.
October.          Tumor on back of neck removed.
October 26.      Baseline scans for Ipilimumab
November.        First Ipi infusion (2nd) , second Ipi infusion (23rd).
December 14.   Third Ipi Infusion

January 4.     Fourth and Final Ipi Infusion 
January 25.   PET/CT scan. Continued growth of tumors and new ones. Dr. Kaplan agrees with trying anti-hormone therapy and prescribes Tamoxifen and Lupron (injection) based on emergence of tumors at time of monthly cycle.
February 22.  CT scan
February 23.  Results indicated continued growth of tumors and new ones. Switched to Fereston and continued Lupron (injection)              
March 30.      PET/CT scan
March 31.      Scan results indicate no further internal lung or any other organ spread. Existing lung tumors - two are stable, one grew slightly from prior scan. Subcutaneous tumors continue to grow, and one additional tumor identified through PET scan on inner thigh. Status as of this day - 3 lung tumors, 5 subcutaneous tumors One on stomach, two on back, one on inner thigh, one on upper left arm. Discontinued use of Fereston.
April 8.          Brain MRI
April 10.        Discuss results with oncologist, Dr. Kaplan
April 10.   Brain tumor bursts. Twelve days in the hospital recovering from brain surgery and surgery complications (cranial sodium wastage). Suffered many insults to the brain, including cognitive, mobility, visual and physical weakness. However, gained a new perspective and is remarkably upbeat and positive.
April 23.   Discharged from hospital and returned home
April 25th.    Met with oncologist, Dr. Kaplan. Will monitor over next four weeks before determining further course of treatment (her brain inflammation and swelling needs to come down). Probable treatments are brain radiation on tumor site and one other potential identified in earlier brain MRI. Then after allowing time for the brain to calm down from radiation treatment, a two week course of Interleukin-2, a two week hospital stay.
May 16.   Radiation scans scheduled for May 19th in preparation for the Cyberknife brain radiation treatment. Both tumors were removed in brain surgery so the radiation as far as we know is the mop up only. Treatments should start by May 26th. Expect 5-7 treatments although final plan is being developed.
June 5.   Brain radiation (Cyberknife) treatments completed (5 total). A little fuzziness. But otherwise came through in fine shape. on June 7 is scheduled to have two skin tumors removed in an in office procedure with local anesthetic. They are on her back and stomach and have grown large enough to be uncomfortable.
June 7.  Local excision of tumors on back and stomach.
June 8. Meagan has 4 seizures, ending up in emergency room and then ICU of Swedish Hospital. First seizure was evidenced by inability to speak. Kids were around her for this. Called me into room, after making several calls to brain radiation people, put her in car and drove, quickly, to ER at Swedish. Within two blocks of Swedish she went into a grand mal seizure. Controlled her and got to ER. She had two more grand mal seizures in ER. Transferred to ICU where she spent next five days. MRIs determined there was no further brain damage, just irritation of brain caused by radiation treatment. Underwent continuous EEG monitoring. Put on heavy doses of steroids and anti-seizure medications. Back incision having difficulty healing due to being on back in hospital. Discharged June 14.
June 21.  Visit with Dr. Kaplan.  Under watch and wait protocol. Anticipate undergoing Interleukin 2 treatment around first week in August, assuming no new issues and brain scans show no irritation or new tumors.
June 28. Met with Dr. Coury (neurologist). Decided to slowly ramp down the Dilantin (one of the three anti-seizure meds).
June 29-July 6. Emailed or called the other three major centers for melanoma research after being told the National Cancer Institute would not consider her for clinical trials due to brain bleeding and seizure history. Turned down by Moffit, essentially turned down by MD Anderson, UW non-responsive after long conversation ("don't think so but let me get back to you").
July 6. Visit with Dr. Kaplan. Started her on course of Temodar (chemotherapy). Scheduled brain MRI for August 1 and followup visit with him for Aug. 3.


August 3. MRI discovered three brain tumors, small. Gamma knife radiation surgery scheduled for August 12. No impact on brain function expected. Continues on Temodar. Presence of brain tumors rules out any pursuit of clinical trials, even on compassionate use argument. Will mean continued use of steroids and anti-seizure medications indefinitely. Therefore no possible use of Interleuken 2 and melanoma continues unchecked and only option at this stage is to cut or zap a tumor as it becomes symptomatic or known through a scan.

On August 11 she will have a chest, pelvis abdomen CT scan and on August 15 she will have a bone scan. All to determine source of new pain in her tailbone and it has been six months since her torso has gotten the once over. 

August 12. Gamma knife radiation treatment of brain tumors.

August 15. Results from CT scan show new tumor near tailbone area causing pain. Treatable with radiation. Also identified was cancer infiltration of the spine - not treatable according to Dr. Kaplan. Meeting with Dr. Kaplan on Tuesday the 16th to discuss specifics and full extent.

After further MRIs and analysis, she was referred to Dr. Landis at Swedish's Cancer Institute where she will undergo radiation treatment of the spine using Tomo Therapy. She will have 3-4 weeks of radiation, 5 days a week, for about 12 minutes each time. They have identified twelve tumors, plus expect there is cancer in the spaces in between. The Tomo Therapy radiation treatment can bathe the entire spinal column epidural space with radiation without hitting the actual spinal cord or other internal organs. This is not a cure but does buy time, at presumably a high quality of life. 

August 22. Met with Dr. Landis. Had initial CT planning session. Radiation started August 25 at 11:30am.

Sept. 16th. 15 radiation treatments completed. Will have follow-up scans in 45 days or so. On the 16th had a brain MRI as follow-up to the gamma knife treatment of the previously discovered and treated tumors and to see if there are any new brain tumors. Results meeting with Dr. Vermeulen on Monday the 19th. She is still on Temodar (chemotherapy) and all the other medications (steroids, anti-seizure).

Sept. 19th. Two brain tumors detected. Gammaknife radiation treatment scheduled.

Sept. 29.  Pre-treatment scan revealed three more brain tumors. All five were addressed by Gammaknife treatment. Post treatment sude effects included more memory and cognition issues.

Oct. 12. Severe pain in right arm, shoulder and neck. Three MRIs did not reveal cause. Referred to neurologist. Nerve conduction study scheduled for Oct. 24. Brain MRI scheduled for Oct. 28.

Oct 20. Started chemotherapy treatment (Abraxane).