Sunday, July 17, 2016

Two reminders that chemotherapy is no joke

Here’s one: This past Wednesday, July 13, was my latest chemotherapy day. As the Sloan Kettering nurse was assembling the apparatus – the fluids being injected are mostly hung in plastic bags from a frame, and connected by one or more tubes to the final tube that ends in the injection needle – she installed an item in the line that we hadn’t seen before. It was, as far as I could see, a plastic coil, just a couple of inches long. Its purpose, the nurse explained, was to protect the nurses from any “aerosol” emerging from the chemotherapy fluid – I think by providing a contact surface, the coil, on which the aerosol could congeal so that it wouldn’t escape into the air. And the reason? Evidently even the aerosol version of some chemotherapeutic drugs can cause harm to people exposed to it. Our nurse said that there’s one drug she can’t administer to patients at all, because of the headaches that she gets when she tries.

And here’s another: At my chemotherapy session just before we went abroad, back on June 22, I felt more aching in my arm than I usually do. Some aching is normal, because at least one of the chemotherapy drugs I’m receiving is an irritant for the blood vessels through which it passes, but this was, perhaps, more. I didn’t raise this with the nurse till near the end of the process, and that was probably a mistake: the patient must speak up. But anyway, when I did mention it, the nurses took it very seriously. They concluded then that what I’d experienced was an “extravasation,” or in other words a leak in which some of the fluid being injected had escaped my vein and got into my arm; fortunately, they thought what had leaked was not the chemotherapy agents themselves, but just the hydration – i.e., the saline solution -- that concludes the process.

That may have happened, but I’m still not sure because of what followed over the next couple of weeks. What followed was some bruising, but also the gradual emergence to view of a vein that probably had always been visible in the crook of my left arm (where the chemotherapy injection went in) but now became evident, and a bit painful, up and down the arm for several inches. My oncologist looked at it and called it an inflammation. It’s still there as I write this now; it’s not a big deal in and of itself and I expect it will go away in the coming weeks.

But the fact that the inflammation seems to follow the course of the vein makes me wonder whether there actually was any significant “extravasation,” or whether – since the aftereffects seem to be concentrated in or near the vein – this is simply the irritation of the blood vessel by the chemotherapy that is, by design, flowing through it. Chemotherapy takes its toll, and evidently the irritation my chemotherapy causes can be cumulative. (Fortunately I don’t have the kind of chemotherapy that is tissue-destroying, rather than merely tissue-irritating!) So what would that mean? Nothing terrible, but I might need a “port,” a delivery point for the chemotherapy that’s installed for a prolonged period and takes the burden off the veins in the arm. Not yet, though: my right arm is fine and the most recent chemotherapy, injected there on July 13, went in without a fuss.

So in case anyone had any doubt: chemotherapy isn’t good for you, unless you need it to fight cancer. Then you want as much of it as you can possibly get!

One more example of cancer hospital advertising

This one, I’m glad to say, is from Memorial Sloan Kettering (MSK), where I’m being treated. In the New York Times Magazine’s May 15, 2016 issue on “The New Anatomy of Cancer,” MSK bought a full-page ad. That of course wouldn’t have been an accident; I assume that the Times advertising staff put lots of effort into generating institutional advertising for this issue, which also includes cancer-focused ads from City of Hope (in Los Angeles), Dana-Farber Cancer Institute at Harvard, IBM, Oregon Health & Science University’s Knight Cancer Institute, the Cancer Treatment Centers of America (a 2-page insert), and Mount Sinai (the back cover). A lot of money was spent to put these institutions’ ads in front of the readers of this particular issue of the Magazine.

MSK’s ad told the story of a firefighter named Danny Soto, who, as the ad said in large capital letters, “had a family history of cancer. We didn’t let it define his future.” It described MSK’s approach to his case, which “helped Danny gain more control over his treatment with a precise surgery and intraoperative radiation,” and offered more information at a webpage called “”

All of this seemed factual; of course no cancer institution’s stories are all happy ones, but I think it’s fair to tell a happy and truthful story. What I particularly liked, however, was MSK’s slogan, to which that web address alluded and which the Magazine ad highlighted: “More Science. Less Fear.” That’s simply correct; they are developing the science of cancer treatment and those advances do lead to less fear. All this an institution can rightly say, without claiming, or seeming to claim, that they’ve already found the key to fighting cancer. When someone finds that key, I hope they’ll advertise it, but right now, what it makes sense to claim, as MSK does, is focused effort and progress. More power to them.

Travel and treatment

Just back from England and South Africa – a two-week trip, in between chemotherapy appointments. The trip was fascinating, filled with interviews of family and friends of Arthur Chaskalson, the South African judge and anti-apartheid lawyer, and my longtime friend, whose biography I’m writing. It was also a lot of fun; many of the people Teresa and I were talking with were old friends, and along the way we got to spend time with my sister Lucy and her husband Todd in London, just after the appalling Brexit vote.

As Teresa wrote on Facebook, we’re very grateful to Sloan Kettering for the care they’ve given me, which has done so much to make a trip like this possible. We also learned that air travel is a lot easier in economy-plus seats! With all that, plus the energy shakes that Teresa made every day, I actually felt the jet lag was easier to handle than it sometimes has been for me – and aside from one evening when I got overtired and reached 99 degrees on our thermometer (warm for me), I felt pretty good even though we were really working quite hard.

The big medical news now that we’re back is that my next CT scan has been scheduled, for Monday, July 25. We’ll learn a few days later what it shows. The main question is whether this is the moment for me to enter Sloan Kettering’s clinical trial. As readers of this blog know, this clinical trial has been a possibility for some time. It involves abdominal surgery, to implant a pump which in turn would transmit chemotherapy directly to the liver; this would complement the kind of “systemic” chemotherapy I’ve been receiving so far, which is injected intravenously and aims at my entire body. We’ve hesitated to depart from the current, systemic chemotherapy, since it has been working so well. But at the same time we don’t want to lose the moment for adding this clinical trial approach – and it may be that the coming CT scan will show that we’re at a tipping point where the clinical trial will make sense. In any case, we’ll know a lot more soon. More to come on that!