Complete Treatment: a holistic strategy to integrate evidence based medicine and integrative health therapies to maximize Brad's health, survival and potential to achieve either chronic disease management or even possibly radical remission.
Brad's Case History & Timeline Summary: Stage IV Renal Cell Carcinoma (RCC) - Kidney Cancer August 20-November 27: Initial Symptoms, Diagnosis & Treatment Initial symptoms included lower left flank pain, night sweats, and general fatigue. Back pain was initially believed to be due to physical strain while working out or golfing. As the lower left flank pain increased, Brad had a bladder infection diagnosed and treated with antibiotics in early September. After 10 of the 14 days of treatment, he felt better.
The pain and other symptoms returned shortly thereafter. Brad saw a urologist in late September and scheduled an ultrasound. The ultrasound revealed Brad's left kidney to be dilated 2x its normal size. A CT scan was scheduled for Friday, October 14th. Brad's fevers, pulse rate and pain worsened and, on the advice of his doctors, he entered the St. Joes Mercy ER to accelerate the CT scan process on Tuesday, October 11.
Just after midnight, on Thursday, October 13th, one of Brad's best friends who works at St. Joes, entered the ER room to inform Brad and Dana of the initial CT results, baseline diagnosis and next steps. Brad's CT showed his entire left kidney was tumorous. His right kidney was healthy and normal. Brad had discernable metastatic tumor sites in his liver and lungs. An immediate stage IV diagnosis.
Brad was admitted to the hospital to conduct a full body bone scan, brain MRI and upper chest CT the next day. No additional tumor sites were found, but a biopsy of one of the lung nodules (7/20 tumor nodules were over 1cm in size) confirmed it was Kidney cancer. The immediate treatment recommendation of both St. Joe Mercy & the Cleveland Clinic was to conduct a Cytoreductive Nephrectomy of the left kidney, adrenal gland, and adjacent lymph nodes. Following the surgery, it was expected for Brad to recover for 6 weeks and commence initial front line immunotherapies.
The final pathology of Brad's tumors were not complete until November 17, 2016. The pathology report assigns the specific type of Kidney Cancer -- clear cell, transitional cell or translocational cell, and helps set in motion the available treatments. The hypothesis was Brad's tumor's resembled a translocational cell. However, the pathology came back as clear cell, which opened up additional front-line treatments, most notably Interleukin 2 (IL2), which is the only known treatment with a documented cure rate (3-6% of cases). Given this information, Brad and Dana began the process to explore this treatment option, which neither St. Joes or Cleveland Clinic would administer. Either way, with the 6 week surgery recovery timeline, it was expected Brad would start systemic treatments in late December or Early January.
Throughout this time period, Brad & Dana, along with his large network of family and friends, would conduct a thorough review of available clinical trials, current front-line therapies, and integration of nutrition and lifestyle therapies that support cancer treatments.
Integrative treatments: Immediate following surgery, Brad adopted a baseline supplement and general diet that aimed at being plant based and sugar free & gluten free. Brad also started a weekly acupuncture treatment. A lot of baseline research by Dana and her mother considered treatment centers in Mexico and Germany that provide a wide range of treatments in concentrated settings. Brad ultimately chose to work closely with a doctor based in Maryland to provide general counsel and strategic direction for the wide range of integrative therapies we would come to adopt and implement.
Brad's post-surgery recovery included the presentation of double vision (which led to an overnight ER and admit to secure an MRI from the Henry Ford Hospital on November 7, ongoing chronic back pain; weak general mobility and significant weight loss. That said, his post-surgery consults on November 15 found the weight loss to be in the 'normal' range, and his surgeons pointed out they no additional cancer had been discerned during the surgery.
November 2o - December 7: Progression & Accelerated Treatments Brad's back pain and general health took a dramatic turn for the worse over the course of Thanksgiving week.
Brad reported severe nerve pain across his lower back and "well of fire" in his right-upper quad anytime he tried to walk more than 10 steps. His fatigue worsened: he was in bed 16 hours a day over the Thanksgiving holiday. These symptoms resulted in another St. Joes ER & admit on the evening of Saturday, November 24.
Baseline CTs showed Brad's cancer had progressed dramatically: his liver had new tumor sites and the original tumor had grown 4x its original size; at least 5 new tumors were found on Brad's spine, including 1 deep in his L4 Vertebrae, that had been fractured as a result of the cancer. Additional cancerous abdomen lymph nodes and two brain hematomas (small pools of blood) raised serious and urgent questions about how to treat Brad over the short term to position him as quickly as possible to start systemic immunotherapies.
Unconfirmed, but the brain issues raised the possible risks of stroke and the open question of whether the cancer had spread to his meninges -- spinal fluid. The deep spinal cancer site required discerning if a surgery was avoidable, but if the cancer was too close to the spinal cord, how to try and remove it. The spinal surgeon quickly determined surgery wasn't needed.
Instead, Radiology would treat the spine in the short term. Although they preferred at least three weeks, they agreed to provide the equivalent of the 15 day regimen over 5 days from November 28-December 2.
On the front-line treatments, a October Journal of American Medicine study found that front-line therapy Cabozantinib (Cabometyx) was substantially better systemic front-line therapy for patients with advanced RCC. Treatments cost about $12,000 per month; we rushed an order for my case, which allowed me to start my systemic treatment on December 8, 2016.
Brad was discharged from St. Joes on December 2, briefly attended a holiday party and prepared to transition home again. Over the ensuring week, he would adopt a walker to help his basic mobility, start his systemic treatments, and commence a much more comprehensive approach to his integrative health support.
Brad wrote about the above experiences more extensively in his "Day Zero" blog post.
December 8 - Present: Systemic & Fully Integrative Treatments General Summary: Every morning at 7am, Brad takes a single dose of Cabometyx 60mg. In addition to pain management, Brad's St. Joes hospital team is closely monitoring the brain hematomas and his general health. Baseline scans are slated for the week of January 16, which will either support ongoing adoption of this complete treatment plan or potential second line therapies. Blood work reviews will also be used with Brad's functional medicine team to assess any adjustments to his diet or other integrative therapies.
Brad's daily work includes efforts on the podcast & memoir project. His daily integrative treatments now include an updated supplement strategy, juicing, a personalized version of the WAHLs protocol diet, basic mobility exercises, meditation and/or breathe exercises, and use of 'Simpson oil', a THC based pain management tool. Several additional therapies will be integrated, including IV Vitamin C infusions and GcMAF supplements. Many of these are costly, paid out of pocket with the support of hundreds of people who have donated to Brad's care.
Timeline: Treatments to date Treatment Goal: baseline pathology and complete diagnosis; tumor reduction surgery; pain management; decision on front-line systemic treatments, following 6 week surgery recovery process.
Baseline diagnosis: October 12, 2017
Cytoreductive Nephrectomy Surgery: October 27, 2017
Radiation Therapy: 15 dose administered over 5 days from November 28-December 2
Initial Integrative Therapies: baseline functional medicine consults, including blood panels to review cellular health; occasional acupuncture; supplements
December - Present Current Treatment Goals: “No worse” progression since November 25th scans; reverse weight loss trajectory; Have stable physical health with limited use of walker/mobility supports; weekly regimen of predictable treatments; manage daily contributions to support personal connection and memoir project. Continue with:
Front Line Immunotherapy: Cabometyx
Pain management and medical supports: Methadone for pain; bi-weekly consults, blood draws and scans as needed with St. Joes team
Integrative strategies: acupuncture; Vitamin C IV infusions; GcMAF; meditation/breathe exercise; basic mobility and strengthening -- daily walking, stretching, etc.; juicing; Simpson oil; dietary supplements
Diet: Version of the WAHLs Protocol diet (without fasting)