Today I saw my oncologist to find out about my next round of cancer treatment, but even before that, the chemo ward called me yesterday and said they'd had a wait-list cancellation. My first appointment tomorrow is, Friday, at 2 p.m.
So by tomorrow at this time, I may feel like throwing up for two or three days (or not—some new anti-nausea drugs are now available). On the other hand, I'm ready to get the hell started. This regimen is similar to some of the chemotherapy I've had before, so I have a decent idea what to expect. Unfortunately, it's not much fun.
I'll post more information as soon as I feel like it.
I found out yesterday that there are new cancer tumours in the centre of my chest—several of them, each 2 to 3 cm in size, near where my lungs meet. They showed up on the CT scan I had Monday, and they were not there on the scan in September. That means they've grown quickly, which is fucking bad news.
After meeting with my doctors at the B.C. Cancer Agency yesterday, I've stopped using cediranib, the drug that had kept my existing lung tumours growing only very slowly over the past year. I'll likely return to more conventional and aggressive chemotherapy again sometime in the next couple of weeks.
Since I found out about my cancer almost three years ago, it has never been in remission. Some people who read this blog or know me in person have, mistakenly, thought otherwise, because I've often appeared in good health.
But my cancer has never shrunk, only slowed down. It started in my large intestine, then spread to my lungs from there. The bowel tumours came out with surgery in 2007—otherwise I would probably have died later that year. But the lung metastases can't really be tackled with surgery or radiation, because there are too many, too widely spread, and too deep in my body. Chemo is the best option.
This is serious. Faster-growing metastatic tumours near my lungs, my heart, my trachea, and my esophagus are dangerous and potentially lethal. In addition to attacking them with chemo, in a few months there may be some clinical trials of MEK inhibitor drugs available to me, but that's not certain. Those experimental medications operate on the kinase cascade metabolic pathway that helps cancer cells grow. So we'll see about those too.
New, fast-growing cancer is not what anyone wants in my body, but I can't say it's unexpected, or a genuine surprise. This is how cancer often goes. Treatments work, sometimes better, sometimes worse—and then sometimes they stop working. It's always a fight, and one I might lose.
I've been a little sick this week. Not with an infection, but with what I think are side effects both from my cancer medication and from the H1N1 and seasonal flu shots I had last week. My right arm, where the H1N1 vaccine went in, is still sore like I've been punched. I've had periodic mild fevers all week, I've slept a lot, and the intestinal symptoms I usually have are more pronounced than usual.
I assume it's the combination of side effects that have made me a bit more ill, but it's hard to know. My cancer is growing very slowly in my lungs, but it's not shrinking. So I can expect that eventually it, or the effects of long-term therapies, or both together, will make me weaker and give me more pain. I don't think that's happening now. I expect and hope that as my immune system builds antibodies to the two flu strains (something that takes a week or two), I'll perk up a little.
I can't be certain. I always have some fear that a new weakness or pain I develop won't get better. The fear itself can be tiring, either at its usual low level or when it flares up. But that too is something I've become used to. Fear, like pain, like fatigue, comes and goes.
Some other things, I have discovered, do not. They stay. Love is one.
I studied classical guitar as a kid, between 1978 and 1982, but I was never especially good at it. I quit when I changed schools and forgot pretty much everything about it, including my rudimentary ability to read music.
A few years later I discovered a talent for the drums, and with my then-roommate Sebastien learned to play classic sixties garage rock. By the end of the 1980s we'd formed a band and played our first gig. Twenty years later, he and I are still in The Neurotics together, playing many of those same songs.
I don't play as often as I used to, because my cancer and the associated medication side effects make me weak and unreliable, but the group is kind enough to let me sit in when I can, alternating with Christian on drums and percussion on nights I can make it out. This upcoming weekend, I plan to play yet another show, but in addition to drums, percussion, and vocals, I'll be trying my hand at electric guitar for a good chunk of the set—the first time I've done that live onstage in any serious way for many years.
Of course I resumed playing guitar a long time ago, not long after we started that first garage band in 1989, and I've even recorded a whole album of guitar-based instrumentals, derived from my irregular podcast. But that was by myself, in the basement, where I could fix my mistakes. Live, in front of an audience, I don't get that chance.
So I'm spending some time re-learning all those songs I've known for decades, but this time I have to know what key they're in and what the chords are. My fingers are a little sore from the practice, but one other advantage is that I'll know a bunch of tunes I can teach my youngest daughter, who says she's ready to start playing the guitar I bought her a few years ago. She's nine, the same age I was in 1978.
I don't write as much about my cancer here as I did a couple of years ago. That doesn't mean it's gone, or going away—I still have nine malignant metastatic tumours in my lungs, but my treatment has turned into a routine, something of a drudgery. I take a small but nasty pill every day, and have side effects that keep in me in the bathroom for an hour or more every night or two. Every two months I go to the B.C. Cancer Agency and lie down in a big doughnut-shaped machine for a CT scan, and then a few days later I meet an oncologist to get the results.
And today, for maybe the first time ever, the news is relatively positive. I usually walk into the clinic expecting bad news, such as that the tumours would have grown substantially. If that had been the case, I planned to stop the current drug and take a break, then try something else in a couple of months. Yet there aren't a lot of something elses anymore, so that would have been a bummer. Still, it's what I expected, since it has been the pattern. I had asked my wife to come with me, expecting I'd need her support.
But instead, today the doctor told us that there has been no measurable change in my lung tumours. No, they haven't shrunk, but they are no bigger either.
Apparently there is one lymph node they had noticed before (though I hadn't heard about it) which has grown a bit, but overall he called it called it "no change," i.e. the cancer has been stable over the past two months. That means the cediranib pills are probably doing something, at least keeping the tumours at bay, and while the side effects aren't fun, they're manageable. Otherwise, I feel pretty good.
So, more of the same treatment for now. Pills, and side effects, but a livable life. And we'll see how things are in two months. I'm encouraged: this is the first time that the lung metastases haven't grown significantly between scans. I can plan for the summer and maybe ride my bike some, and we can do our thing here at home. That's good enough for me today, and I have some spring in my step this afternoon.
Plus, it looks like I may see the Olympics come to town after all.
Buzz Bishop has a good point: if you measure the effectiveness of terrorism by the fear it generates and the behaviours it changes—the goals of terrorist organizations, after all—then the biggest terrorists are the news media. We humans, as usual, suck at evaluating risks, so TV, paper, and radio news often take advantage of us because of that.
I inherited my Oma's strong teeth: when she died at age 91, she still had most of her natural teeth, despite having lived through two world wars, the Berlin Blockade, and a career as a restauranteur. While I had lots of orthodontics when I was a kid, and had to have all four widsom teeth removed in 1990, I have never had even a single cavity.
Until now. When I went to see my dentist this afternoon for a routine cleaning, a bit of sensitivity and an X-ray showed a tiny amount of decay on the front surface of the last molar on the top left side of my mouth. I'll set up an appointment to have a filling next week.
Since my teeth have put up with almost 40 years of abuse so far, I can't really complain. Especially considering how minor a cavity is compared to the other shit I'm dealing with these days. A few years ago I would have been pretty disappointed by tooth decay; now it's almost laughable.
In fact, there's a good chance the only reason I have this cavity is because the chemotherapy and other cancer treatments I've had over the past couple of years are pretty hard on my immune system and the rest of my body, teeth included. My dentist said my gums are actually in surprisingly good shape, considering. My Oma-teeth are still holding in pretty strong.
Not only that, but after all the surgery and stuff I've experienced recently, and all the heavy-duty painkillers and other drugs I've had to take, a bit of dental work is about as threatening as a mosquito bite. I'll drop in for 45 minutes, have my jaw frozen, listen to my iPod, and head home. From my current perspective, it's a piece of cake.
Frightening if you were the doughnut, anyway:
I was 11 years old when Raiders of the Lost Ark premiered in 1981. Loved it, including the famous melting face scene near the end. I don't think I had seen Alien yet, but I had a photo book of the movie and knew it nearly by heart, including the infamous chest-burster. In short, to me the gross stuff in those movies, and others, was cool, and didn't freak me out too much.
I also liked watching those '70s-era boogie-man shows like In Search Of, and I still recall waking up late at night during a sleepover in the basement at my friend Sean's house to watch a Ray Harryhausen stop-motion monster wreak havoc on TV. It scared me, and I liked it.
That doesn't seem to be the case for my daughters, aged 8 and 10. They asked me to tell them when to hide their eyes during scary parts of Raiders on DVD the other day, so neither of them actually saw the melting face, or a few other things. Based on that, we skipped Temple of Doom entirely. Tonight we watched Indiana Jones and the Last Crusade, which has even fewer freaky bits than Raiders, but the rapid aging and decomposition of the Donovan character when he drinks from the wrong Holy Grail was also more than they wanted to see. Our youngest hid her eyes, while our oldest didn't, but had trouble getting to sleep.
On the other hand, two and a half years ago our oldest was okay with King Kong, especially after a day or two to process it. But I still don't know whether we should take them to see the new Indiana Jones movie. I'm sure their friend Clive will love it as I did (he's 9, and watches action movies all the time), while after two Indy movies at home our daughters might not even want to go.
Fiction has always been a way for children to face scary things, and learn to live with them. That's what most fairy tales are about. So I don't want to shelter our girls too much. We're not going to force them to see Indiana Jones and the Kingdom of the Crystal Skull, but if after a bit of time they want to go, I'm not sure—should we take them or not?