Saturday, July 22, 2017

My new treatment

One purpose of this blog is just to describe how cancer treatment is done – at least how it’s done in my case – and since there’ve been new developments in my treatment it’s time for a new description.

I’m no longer receiving my chemotherapy through my port – the ingenious entry-way implanted just below my right collarbone that enabled me to stop having chemo through my increasingly stressed veins. Now I’m back receiving the chemotherapy through my intra-hepatic pump – the other ingenious device that’s been implanted in me. This one is a good deal larger, and required abdominal surgery last August to install; its function is to send chemo directly to the liver.

The pump was installed, almost a year ago, with the immediate goal of putting me in a clinical trial using one drug, FUDR, via the pump and another, gemcitabine, intravenously. Unfortunately I failed out of that trial when a new tumor appeared in January, and then I went onto intravenous treatment, or rather treatment via the port, with a different set of medications, called 5FU and irinotecan. The intravenous treatment has now failed too, or at least not succeeded; that’s the import of the presence of the two or three small, new, “atypical” tumors I wrote about last week. And now, as I said already, we’re back to the pump, but not quite the same way as last time.

The process started last Tuesday (July 11) with a steroid, meant to combat side effects; that did go in through the port, but that was the only use made of the port. Then I got two chemotherapy drugs. One was FUDR, which was part of the clinical trial combination too. I’m not quite sure why we’ve returned to this drug, but I take it that the doctors think that, at least in combination with the other one I’m now getting, it can still be effective even though it didn’t succeed back in January. Anyway, FUDR went into the pump first, into a compartment of the pump from which it infuses into my liver over a two-week period, which is still ongoing. Then the nurse took the needle out – the rather big needle that penetrates the skin of my abdomen and then goes into the pump. But that wasn't the end.

Next the nurse connected up a container of a second drug, called mitomycin; this is the new drug (new for me, that is) that’s been added to the mix.  Then she – my nurse was a woman – put the needle back into my abdomen, in what seemed to me to be the exact same spot she’d used the first time! I think it was the same needle, but I admit I might be wrong about that; maybe it was another needle, equally large. It looked to me as if the needle had wound up going in in the very spot where a drop of blood had emerged from the first injection; but, again, I might be wrong, and maybe that drop of blood (only one) was new. I was a bit rattled! Anyway, even though the needle had gone in in essentially the same spot both times, the second time the nurse, in some way that I didn’t quite follow, used the needle to access a different compartment of the pump, one that doesn’t store the drug but sends it immediately to the liver. And then this drug was administered via this hook-up over a 45-minute period, during which I was told I needed to stay very still, which I did my best to do.

The alarmingly large needle hurt for a moment as it was inserted each time, but only for a moment. So the experience of having two injections into the pump during the same few minutes was actually only strange, not really painful. The whole process did require me to take a long look at my tummy, though, and since I’ve gained weight while being treated for cancer – a good thing – the esthetics to my mind left a good deal to be desired.

Friday, July 14, 2017

The latest news

It’s not the best news, but not terrible either.

In June Teresa and I spent two busy and enjoyable weeks in England and South Africa, mostly doing research for my biography of the South African lawyer and judge Arthur Chaskalson. We got back from South Africa and the next day, June 23, I had a CT scan. It showed that there had been no spread outside my liver (which is very good), but it also showed two or three new, small growths in my liver. The problem was that the appearance of these growths was “atypical” for tumors, so it wasn’t clear what they were. As a result, Sloan Kettering ordered an MRI to get another view.

This was a total ordeal, because the place it was done, East River Medical Imaging, wasted vast amounts of our time and didn’t produce prompt results. So although the MRI was originally supposed to get done on June 28, it was only done on June 30, and we were told not to expect results before Monday, July 3.

But we didn’t get results that day either, because our oncologist decided that the scans should be presented to the MSK doctors’ regular conference for their assessment. That took place on Thursday, July 6. Even after that we didn’t get the results until after the oncologist had consulted with another doctor -- the reason for this being that our oncologist is leaving Sloan Kettering (for what sounded like an irresistible opportunity elsewhere) and this other doctor is the person our oncologist chose to take over my case. Anyway, the two doctors spoke on Friday, July 7, and were in complete agreement, and here are the conclusions:

First, even though the MRI found the same thing as the CT – new growths of atypical appearance – they’ve concluded that these are new tumors. That means that the chemotherapy I’ve been on since February or so has stopped working, so it’s time to change gears.

So, second, the new plan is to return me to chemotherapy via the pump that’s been sitting in my abdomen all year not really doing anything. I’ll be getting a combination of a drug I had previously, called FUDR, and one I haven’t had yet, called mitomycin. This has in fact already begun, three days ago (July 11). Hopefully it will stop these new tumors.

Meanwhile, I feel fine – except that I’m still getting over my second round of bad cold/bronchitis in a month. Teresa and I had both been completely healthy since I was diagnosed with cancer (that is, aside from the cancer), and now we’ve both had these two bad colds. Boo.