~In-Patient Hospice For Mighty Oak~Letting Go....
 

The brain mets and the Decadron has left me no choice but to put him in Hospice. He has tried to flee and escaped the house. This is a man that cannot feel his feet and has trouble getting out of chair, bed, couch. I promised him to die at home with dignity and grace, I can only provide him the dignity and grace. He is paranoid from the drugs and mets and no longer trusts me. He refused pain meds, refused to change for me....etc.

My heart is heavy as I sit here in complete silence. My oak is away and will not be returning. I find myself walking light and being quiet and there is no one here I need to do that for.

I will start with work soon and shall continue to fight this beast in the honor of our lost Warriors, for the Warriors I love and for all those to come. Make room for me cancer, I am here and ready to continue to kick your ass over and over again!!

I have not yet begun to fight!!>>Love Marie

PS: My job description will include all PUBLIC SPEAKING AND PLEADING for the foundation and I am just the tiger to do it..........This is for you Mighty Oak and for all of us that live this horror!!

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

May Mighty Oak's spirit be a shining light in your brave new road. And may God give you strength in this difficult time.

My extra prayers go out to Mighty Oak, you, and your family and friends. We are all here for you.

With much love,

Marcia (bejuce)

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

Dear ferocious Marie -
What an emotion-packed message! Your tiger claws are out at the same time you are padding around softly in respect to a dying man. YOUR dying man.

Decadron does do weird things to us and I remember well. Sometimes I wondered if I was going a little mad, and I had a light dose.

Your darling does not mean it and is beside himself. He is also fighting like a tiger with little ones.

Many, many prayers for the warm light of peace and love to bathe you and Mighty Oak.

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

now that he is in hospital, could either of the following be considered palliative care--trying to relieve the pressure on his brain to alleve his pain and paranoia and help him say what he wants to to you and others? Palliative care does not mean doing nothing...it just means concentrating on being comfortable rather than trying to cure

(1)fulvestrant (an injection)


case report
A 64-year-old man was diagnosed with breast cancer and underwent surgery in October 2000, when a radical mastectomy and axillary node dissection were carried out. Pathological examination revealed a 3 x 2 cm2 well-differentiated, invasive, ductal breast carcinoma (stage IIb), involving 1 of the 12 nodes that were tested. The tumour was found to be positive for both estrogen receptor (ER present in 40% of the tumoral cells) and progesterone receptor (in the 90% of the cells) and was HER-2/neu negative. The patientreceived six cycles of adjuvant chemotherapy (FEC75 regimen) followed by chest wall irradiation and tamoxifen 20 mg/day p.o. for 5 years.

In June 2005, the patient presented moderate/mild dyspnoea on exertion. Chest X-ray and thoracic computed tomography (CT) scan revealed pleuropulmonary metastatic disease. Four courses of 4-epirubicin chemotherapy (75 mg/m2 i.v., every 3 weeks) were administered, followed by four courses of docetaxel (75 mg/m2 i.v., every 3 weeks). In the evaluation after the fourth cycle, we found a pulmonary progression. Then, he received four cycles of capecitabine treatment (1250 mg/m2 b.i.d. p.o. on days 1–14, every 3 weeks). At the next evaluation, there was an increase in the number and size of lung lesions (Figure 1). As he did not respond to chemotherapy, it was decided to initiatetreatment with fulvestrant (loading-dose regimen: 500 mg i.m. on day 1, 250 mg i.m. on days 14 and 28, and followed by 250 mg i.m. monthly thereafter).




After 4 months of fulvestrant treatment, the patient reported an improvement in his dyspnoea and a new chest CT scan showed a partial response (partial reduction of the pulmonary lesions and pleural effusion), with a decrease in the size and number of the pulmonary nodules and pleural effusion (Figure 2).



discussion
Male breast cancer is rare in comparison to female breast cancer and represents 1% of all diagnosed breast cancers [1]. The low incidence of male breast cancer precludes the development and completion of large clinical trials to assess the efficacy of breast cancer treatments in this population and, therefore, it is recommended that its management follows the same general principles as for female breast cancer [2]. Although male breast cancer shares many similarities with breast cancer in women, there are also important differences, mainly in relation to its hormone dependency and responsiveness to endocrine therapy [3]. In females, 60%–70% of breast cancers are ER positiveand/or PgR positive. In contrast, 90% of male breast tumours express ER and >80% express PgR, showing a greater expression of ER-beta [4] and being probably produced by low estrogen levels in growing tumour microenvironment. The lower rate of HER-2/neu and p53 expression and a higher rate of Bcl-2 overexpressionhave been reported in male breast cancer [5]. Physiological mechanisms of hormonal production and conversion together with metabolic aberrations may also play an important role in the development of resistance to the hormonal manipulation. This should be considered during the design of a male breast cancer treatment plan. Consequently, it may be inappropriate to extrapolate the treatment principles established for female breast cancer to the management of male breast cancer.

In male breast cancer treatment, best responses have been observed with hormonal therapy. Among the different endocrine options available, tamoxifen is the best established [6]. However, additional hormonal treatment options are required. The use of aromatase inhibitors can be ineffective due to the high proportion of circulating estrogens in men that are independent of aromatase activity [6, 7]. Taking into account the experiences showed in the hormonal treatment of prostate cancer [8], different activity between steroid and nonsteroid aromatase inhibitors in male breast cancer should be considered.

Fulvestrant is an additional therapeutic option that has confirmed efficacy in women previously treated with tamoxifen. To date, there have only been limited data on the use of fulvestrant in male breast cancer. Its novel mechanism of action, along with the available in vitro data [9], indicates that fulvestrant may be a useful treatment option for these patients. The activity in this case report supports further evaluation of fulvestrant in the male breast cancer setting.



J. R. de la Haba RodrÃ*guez*, I. Porras Quintela, G. Pulido Cortijo, M. Berciano Guerrero and E. Aranda

Department of Medical Oncology, Hospital Universitario Reina Sofia, Cordoba, Spain

* (E-mail: juandelahaba@hotmail.com)


Endocrinology. 2008 Oct;149(10):5219-26. Epub 2008 Jul 3.

ICI 182,780 penetrates brain and hypothalamic tissue and has functional effects in the brain after systemic dosing.

Alfinito PD, Chen X, Atherton J, Cosmi S, Deecher DC.
Women's Health and Musculoskeletal Biology, Wyeth Research, RN 3164, 500 Arcola Road, Collegeville, Pennsylvania 19426, USA.
Previous reports suggest the antiestrogen ICI 182,780 (ICI) does not cross the blood-brain barrier (BBB). However, this hypothesis has never been directly tested. In the present study, we tested whether ICI crosses the BBB, penetrates into brain and hypothalamic tissues, and affects known neuroendocrine functions in ovariectomized rats. Using HPLC with mass spectrometry, ICI (1.0 mg/kg.d, 3 d) was detected in plasma and brain and hypothalamic tissues for up to 24 h with maximum concentrations of 43.1 ng/ml, and 31.6 and 38.8 ng/g, respectively. To evaluate antiestrogenic effects of ICI in the brain after systemic dosing, we tested its ability to block the effect of 17 alpha-ethinyl estradiol (EE) (0.3 mg/kg, 8 d) on tail-skin temperature abatement in the morphine-dependent model of hot flush and on body weight change. In the morphine-dependent model, EE abated 64% of the naloxone-induced tail-skin temperature increase. ICI pretreatment (1.0, 3.0 mg/kg.d) dose dependently inhibited this effect. ICI (3.0 mg/kg.d) alone showed estrogenic-like actions, abating 30% the naloxone-induced flush. In body weight studies, EE-treated rats weighed 58.5 g less than vehicle-treated rats after 8 d dosing. This effect was partially blocked by ICI (3.0 mg/kg.d) pretreatment. Similar to EE treatment, rats receiving 1.0 or 3.0 mg/kg.d ICI alone showed little weight gain compared with vehicle-treated controls. Thus, ICI crosses the BBB, penetrates into brain and hypothalamic tissues, and has both antiestrogenic and estrogenic-like actions on neuroendocrine-related functions.
PMID: 18599545





(2)a tiny study but shows response, duration

Clin Breast Cancer. 2009 May;9(2):118-21. Links
Bevacizumab and paclitaxel for breast cancer patients with central nervous system metastases: a case series.

Labidi SI, Bachelot T, Ray-Coquard I, Mosbah K, Treilleux I, Fayette J, Favier B, Galy G, Blay JY, Guastalla JP.
Department of Medical Oncology, Centre Leon Berard, Laennec, France. labidi@lyon.fnclcc.fr
Central nervous system (CNS) metastases are a major concern in patients with stage IV breast cancer. Recent studies have shown the efficacy of anti-vascular endothelial growth factor drugs on brain tumors, in particular glioblastoma, but none has explored their efficacy and tolerance in breast cancer patients with CNS metastases. We report 4 cases of patients with CNS metastases treated with bevacizumab and paclitaxel. All but 1 had previous whole-brain radiation therapy, performance status 0-2, and radiographic evidence of progressive CNS metastases. Patients received paclitaxel 80 mg/m2 on days 1, 8, and 15, and bevacizumab 10 mg/kg on days 1 and 15. Response was evaluated according to the World Health Organization criteria. Three patients had brain metastases, and 1 had meningeal lesions. Only 1 patient was chemotherapy-naive. Significant antitumor activity was observed, with 1 complete response and 3 partial responses in the CNS metastases. With a mean follow-up of 9 months, duration of response was 11, 10, 8, and 6 months. No patient had extra-CNS progression. This observed antitumor activity suggests efficiency of the combination of bevacizumab and paclitaxel and warrants further evaluation of this combination as an alternative option for the treatment of multiple CNS metastases in breast cancer.

PMID: 19433393

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

added to previous post

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

Dearest Marie, You did everything you could for the Mighty Oak and so much more. He was so blessed to have you fight this beast with him. Your love for him shines brightly. I know it can get tough towards the end with the pain medications. Hospice really have some of the most wonderful caring people. But my heart really goes out to you right now because I know it's not easy. Sending you much love at such a difficult time. Know that we care about you. I'll be keeping you and the big guy in my thoughts & prayers. I sure wish there were something I could do for you. Please take care of yourself and give yourself time to deal with all this.

(Big hug coming your way!)

Chelee

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

The hardest journey any of us makes in life is this one. My heart breaks for your special guy and for you, Marie. New twists and turns change us, but make us strong. I'm praying for you both daily, but most of all believing with you for a rich tomorrow.
Luv ya girl, ma

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

You have the empathy and sympathy of all of us here. We understand! Stand strong! My husband wears a t-shirt that says Cuck Fancer. I am praying for you and your inner peace.
Brenda

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

This was sent to me this morning and the first person I though of was Marie. I hope this is not a bad time to post this, but it is a reminder that God is always with us, even in our darkest hour. Marie and Ed, my prayers and thoughts are with you.

THE BIRTH OF THE SONG 'PRECIOUS LORD'

Back in 1932, I was a fairly new husband. My wife, Nettie and I were living in a little apartment on

Chicago's south side. One hot August afternoon I
had to go to St.Louis where I was to be
the featured soloist at a large revival meeting. I didn't want to go.
Nettie was in the last month of pregnancy with our first child.
But a lot of people were expecting me in St. Louis. I kissed Nettie good-bye, clattered downstairs to our Model A and, in a fresh Lake Michigan breeze,chugged out of Chicago on Route 66.
< strong>However, outside the city, I discovered that in my anxiety at leaving, I had forgotten my music case. I wheeled around and headed back.

I found Nettie sleeping peacefully. I20hesitated by her bed; something was strongly telling me to stay. But eager to get on my way, and not wanting to
disturb Nettie, I shrugged off the feeling and quietly slipped out of the room with my music.
The next night,in the steamingSt.Louis heat, the crowd called on me to sing again and again. When I finally sat down, a messenger boy ran up with a Western Union telegram. I ripped open the envelope. Pasted on the yellow sheet were the words: YOUR WIFE JUST DIED. People were
happily singing and clapping around me, but I could hardly keep from crying out. I rushed to a phone and called home. All I could hear on the
other end was 'Nettie is dead. Nettie is dead.'
When I got back, I learned that Nettie had given birth to a boy. I swung betwe en grief and joy. Yet that same night, the baby died. I buried Nettie
and our little boy together, in the same casket. Then I fell apart.
For days I closeted myself. I felt that God had done me an injustice. I didn't want to serve Him anymore or write gospel songs. I just wanted to
go back to that jazz world I once knew so well. But then, as I hunched alone in that dark apartment those first sad days, I thought back to the afternoon I went toSt.Louis.
Something kept telling me to stay with Nettie. Was that something God? Oh, if I had paid more attention to Him that day, I would have stayed and been with Nettie when she died.
From that moment on I vowed to listen more closely to Him. But still I was lost in grief. Everyone was kind to me, especially one friend. The following Saturday evening he took me up to Maloney'sPoro College, a neighborhood music school. It was quiet; the late evening sun crept through the curtained windows.

I sat down at the piano, and my hands began to browse over the keys Something happened to me
then. I felt at peace. I felt as though I could reach out and touch God. I found myself playing a melody, once into my head they just seemed to fall into place: 'Precious Lord, take my hand, lead me on, let me stand, I am tired, I am weak, I am worn, through the storm, through the night, lead me on to the light, take my hand, precious Lord, lead me home.'

The Lord gave me these words and melody, He also healed my spirit. I learned that when we
are in our deepest grief, when we feel farthest from God, this is when He is closest, and when we are most open to His restoring power.

And so I go on living for God willingly and joyfully, until that day comes when He will take me and gently lead me home.

-Tommy

Dorsey-




For those too young to know who he is, Tommy Dorsey was a band leader in the Thirties and Forties.

Did you know that Tommy Dorsey wrote this song?

I surely didn't. What a wonderful story of how God CAN heal the brokenhearted! Beautiful, isn't it?

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

Dear Sweet Marie,

My deepest sympathies to you and the Mighty Oak. You have been a faithful, loving, determined warrior yourself, as Ed's constant champion and caregiver.

May you find comfort and peace in the days ahead.

all the best
caya

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

Oh Marie...Words fail. I pray that the Lord will take him gently home soon for yours and his sake. You've been so strong thru all of this. I pray for the strength needed for the last bit of the way. Ed is so lucky to have you, even if in a medical fog right now he doesn't seem to be able to see it.

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

Marie, words seem to have escaped me, but I couldn't have said anything more gracious or eloquent than the other wonderful people on this site. You and Ed are in our thoughts and prayers.

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

Marie, this is the only thing I can come up with:

Sing with me,

"Lean on me. When you're not strong, and I'll be your friend, I'll help you carry on. For it won't be long til I'm gonna need somebody to lean on."

Love yah,

T

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

God bless. Please take care of yourself. I honor you for gearing up to fight cancer. You can make a difference.
As for Mighty Oak -- it ain't over til it's over. The main thing is that he is made as comfortable as possible, mentally and physically. Thinking of you

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

Dear Marie....You know my heart and know my prayers are with you. God is with you and Ed also.........He may feel far away from you but you trust me on this.....HE IS ABSOLUTELY RIGHT THEIR. Hear His voice say to you....I love you Marie and Ed. Praying Peace at this time........praying for a quick passing for Ed.

Love you Marie and I'm always hear for you...

Mary Jo

P.S. "naturaleigh" Thanks for sharing that story. It was very moving and an inspiration to me. God Bless you.

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

Terri B, that was the best thing you could have said.

Marie my dear sweet sister I have no words other than I love you and Ed and I hope God takes your dear Ed soon, so that both of your struggles end.

Your in my prays.

Love
Randi

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

Marie, May God keep you close and I hope that peace will come to you and our dear Mighty Oak. You will make a wonderful advocate when you are ready. I know you are a blessing to Ed. xo Ceesun

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

Bless you, Marie and blessed be the love you and he share. I'm with you as I dance today, dancing with his spirit, and honoring him with my art.
I love your brilliant bright light. Let it shine.

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

Marie,
You know I am holding you both in prayers. May you both be held in God's loving arms forever.

You haven't fallen short on your promise to Mighty Oak, that he be able to die with dignity and grace, and at home. Home is not your house, rather it is where your heart resides. You are Ed's home.

Much much love,
chris

Re: ~In-Patient Hospice For Mighty Oak~Letting Go....
 

Marie,

You've always done your best for Ed and are still doing that and but for the Decadron Ed would fully see that too.
Even now, when most people would sit and rest a while you plan yet another attack on this disease showing what a dignified warrior you are to not alllow anything to steer you from the course you are set on:)
You will be wonderful in this new position, and in the meanwhile we'll all sit quietly with you and hold you close. ((((hugs))))