Tuesday, December 6, 2016

Hoping for monotony

Cancer treatment is sometimes monotonous, sometimes not. I suspect one would rather have it be monotonous. But here are my recent highlights:

First, and most important, when I had my latest scans – not the ones required when I recently had to go to Urgent Care, but the regularly-scheduled scans that are part of the clinical trial I’m in – they basically confirmed what the Urgent Care scans had shown. That is: my largest tumor is unmistakably smaller, while three other, much smaller ones seem larger. That might seem rather ambiguous news, but my oncologist and the clinical trial radiologist concur that the seeming growth of the smaller ones is actually the result of their liquefaction, in the course of which the inside material of the tumors dies. So it appears that, a year after my diagnosis, overall my tumors are less substantial than they were back then. And that’s very good news.

Second, I now have a new piece of hardware: a port. Many intravenous chemotherapy patients have ports; in fact, it may be very unusual to receive intravenous chemo for as long as I have (I started last December) without having a port installed. I was the reason for the delay, I’m afraid; I didn’t want anything else installed inside me if I could help it. But now I’m a convert to ports. My friend who's been around a similar block said I’d like it, and she was right. The port itself lies under my skin just south of my right shoulder; it can be felt but it can’t be seen under my shirt. What it does is to enable the hospital to take your blood, or inject chemotherapy (or other medicines) into your blood, without using your accessible veins, and that’s good, because over months of chemotherapy your veins get less and less accessible. With the port, a single needle-prick gives the medical people access, via a catheter that runs over to my circulatory system near my heart, to a vein that’s so big that chemotherapy doesn’t faze it. All this is good, and the process of installing the port – an outpatient “procedure” in which I was in some sense still conscious, but never felt any discomfort at all – not too burdensome.

Third, the least monotonous feature of the last couple of weeks: about a week after my last chemotherapy infusion, or in other words about a week ago, I began to have a lot of abdominal pain again. This was what had taken me to Urgent Care a few days after the previous round of chemotherapy, and it was what I thought I now knew how to control: for pain, take pain medication. I did, but not enough. We wound up back at Sloan Kettering on Friday of last week, to get IV fluids (because by then I was probably dehydrated), to receive a dose of IV pain medication (through my handy new port), and to consult with the pain management specialist. She was very helpful, but the help came at a certain price: to control the pain required a lot of medication, in fact about three times as much as I'd had before. I also switched medications, so the quantities before and after aren't precisely comparable, but my general sense is that now I’m taking, and authorized to take, more.

All of this worked; the pain receded, and that’s great. But the pain medication also seemed to make my thinking fuzzy. Perhaps that’s not so, but it is certainly worrying, and so now I’m trying to reduce what I take as rapidly as possible (but not faster than that!). The best way to do that is to avoid the incidents that required the medication. Doing that in turn involves an increased level of attention to my digestive process that I don’t entirely welcome either – but both these pain incidents seem to me to have been about digestive events (whose details I'll spare you), and as a result, my “bowel regimen” is now a matter of great interest and importance for me.

Tomorrow is my next chemotherapy day. I am hoping that by eating right and medicating right I can, this time, achieve monotony!


  1. Your students are still with you Prof. Ellman! And think of you often.