Despite the Doctor's Disappointing Diagnosis

   A couple of weeks ago, we started to notice some changes in Yvonne's condition. She was sleeping more, up to 90% of the time. She would trace patterns on tablecloths, repeatedly. She wasn't even finishing her morning coffee! Several times I would wake up close to morning and find her having slipped out of bed onto the bedroom floor. Her lower lip protruded and words were fewer.
   At our family doctor's office's suggestion, I took her to emergency at Wingham Hospital, where the doctor on call arranged a CT scan that evening at Listowel. The CT scan did not show signs of a stroke or anything definitely out of order, but our neuroncologist at London Regional Cancer Program moved ahead a routine 6-month periodic MRI from May to March 14. Today we found out the results.

   The photo on the left is from her previous MRI Nov. 20 2017; the one on the right is the most recent one (Mar.14/18). The view is as if looking up from the base of her skull, with face side shown on top. You can see in both photos the large empty area filled with liquid from where the surgeon removed her right frontal lobe back in the initial surgery in 2003.
   What's new is the largish tumour at the right (actually the left side of her brain). As the radiologist report notes, "Postcontrast, there is new irregular enhancement in the left frontal lobe measuring 22 mm."
   Here is another view before the dye contrast was applied:

   The 'whitening' in the more recent image on the right is not a good sign. As the radiologist put it, 'There has been signficant worsening in the left frontal lobe. Parenchymal T2 signal is more extensive with greater fullness. It is more heterogeneous."
   Yvonne's neuroncologist Dr. David Macdonald estimates the 'new' tumour is likely to be a more aggressive Grade 4 than the original Grade 2 astrocytoma back in 2003.
   What are the treatment options? To begin, a steroid (dexamethasone) to hopefully immediately decrease some swelling and improve function in the short term (you can see how the tumour growth is causing brain matter to bulge into the normally-empty ventricle mid-brain).
   The tumour is deep enough that surgery could do more damage than help because of cutting through healthy tissue.
   As for radiation -- perhaps a few treatments could help (e.g. 10 instead of the 30 Yvonne received back in 2006), although that side of the brain was already radiated back in the previous treatment. And there could be collateral damage due to additional diffuse 'radiation burn'.
   Chemotherapy could be attempted again; the 15 month treatment with Temozolamide ('Temodal') in 2014-15 proved effective. However the cells in this tumour presumably escaped that drug and may have developed resistance. Other chemo drugs (e.g. Bevacizumab - 'Avastin') could be an option but come with their own risks (blood clots).
   In short, Dr. Macdonald estimates Yvonne's situation "could be" / "is probably" palliative. It's doubtful that treatment would knock back the new aggressive tumour. Focus would be more on alleviating symptoms and enhancing Yvonne's quality of life for the time she has left, rather than attempting heroic efforts at giving her extra months but at the cost of making her miserable through potential chemo side effects.
   I will be contacting Yvonne's case manager at the local LHIN (formerly CCAC) to see if Yvonne's new status would qualify her for more home / respite care. Dr. Macdonald noted a local hospital may also have palliative care beds available when needed.

It was a sobering drive home from London, although some of Robin Mark's music helped. His song "There's a Cry" has a chorus repetition:

Your Kingdom, Your Name and, Your Throne will last forever (8X)

Some things last forever -- in God's realm. Not us mortals. Yet the wonder is that, when we are "in Christ", we understand we can look forward to a resurrected, glorified body like Jesus'.

~Chorus~
Those who weep
Return with songs of joy
You have turned, their mourning into dancing
Those who seek
Shall find the Lord of lords
Jesus Christ, desire of all the nations

Days like this, one can be forgiven for feeling like weeping and mourning; yet this whets our desire even more for eternal things, and the eternal life Jesus promises.

One other song of Robin Mark's was playing; a very simple melody, upbeat -- yet the childlike faith of "We're Believing" (on Spotify) also points to some massive eternal realities that outlast us and the Bible invites us to bank on...

The Lamb of God once slain before the world was made 

Has turned our mourning into dancing once again 

Knowing that the promise is true 

Knowing that our hope is in You 

We're believing, we're believing 

Telling of the love we have found 

Living lives that You turned around 

Still believing in You 

The Alpha and Omega, God's anointed Son 

This world will praise You for the works that You have done! 

There's a song of praise on our lips 

There's a song of joy in our hearts 

And we're believing, we're believing 

Believing that the promise is true 

Living out a life that is new 

We're believing in You