Update: a quiet end of the year

Last Wednesday, December 21, was my regularly scheduled chemotherapy day. It went pretty well – well enough that afterwards Teresa and I had the energy to walk a little ways downtown to Bryant Park, near the New York Public Library, to do some holiday shopping in the open-air market there.

The previous two weeks had been pretty uneventful – which was actually quite a big event, since what it meant was that I hadn’t had another round of the painful digestive issues that had made things difficult in previous chemo rounds. To our surprise, however, on Wednesday morning a few hours before the treatment – we got up about 5 AM to drive to New York before rush hour -- my stomach or abdomen began to hurt in roughly the same way as in those previous episodes. That was disappointing, but fortunately there was one important difference between last Wednesday and the two previous rounds: it wasn’t as bad, and the pain pills I took brought it mostly under control. That’s been the case since then as well; with enough attention from me to the details of my digestion, it stays pretty much okay.

In one sense, it was good that this incident took place on Wednesday morning, because it meant that my oncologist got to see me as it was taking place. She pushed and prodded my stomach, examined my morning’s lab data, and concluded that we should wait and see. She raised the possibility of moving up the date for my next scans, currently scheduled for early January, but felt we didn’t need to do that if matters remained under control – as they did.

So off we went for treatment. (Actually, off we went back to the waiting room, where we read for quite a while; then we went for treatment – but we’ve gotten used to this pace.) I was having both the systemic chemotherapy, gemcitabine (which used to be intravenous but now goes in through my wonderfully efficient new port), and the pump chemotherapy, FUDR. There were only two surprises along the way. One was that we gradually realized that the nurse who was responsible for most of our treatment, a young man who looked familiar but whose name we didn’t seem to know, was actually the identical twin of another nurse on the ward. I think the second twin may have been a holiday temp; at least I don’t recall seeing these two guys walking up and down the treatment suite hallway ever before!

The other was that when it came time to administer the pump chemotherapy, the nurse who handled that (not the newly revealed identical twin – if he wasn’t a regular member of the staff then he wouldn’t have been likely to know how to use this particular technology) said to us “For your information, the dose has been reduced.” It turned out that the dose had been reduced by 50 percent. The reason was that one of my liver function numbers, as measured in that morning’s blood work, was off – not wildly off, but far enough to trigger a mandatory dosage reduction. The rationale is that probably what’s causing the liver issue is that the pump chemotherapy is a burden not only on the cancer cells of the liver but on the healthy cells as well. Actually, this was the second time the liver numbers had been off, but the first time they didn’t reduce the dose because they thought the problem might be dehydration caused by my digestive problems; this time, I think, my digestive system was functioning well enough that that explanation couldn’t account for the liver number. It was disappointing not to get a full dose, but Teresa tells me that many pump patients have to have their dosage adjusted, and often more quickly than I’ve had to. Now, in any case, I’m hoping that a half-dose holiday will let my liver get back to normal, so that the chemo can be ramped back up too.

So that was that. I’ve now been in chemotherapy – with a pause for surgery along the way – for a bit more than a year. I don’t love it, but I can live with it, and I’m very grateful that so far it has helped me fight this disease with some success. I’m ready for more in the New Year. And Happy New Year to all of you!