Wednesday, August 27, 2008

What's Up With the Doc 23? - Moving Right Along


This is convoluted, so I apologize in advance. First, yesterday's scan shows stable disease to mild improvement. My oncologist is taking all the scans to his favorite radiologist to review. If they decide that there is continued decrease in tumor size the choices would be:

1) Continue the current therapy
2) Stop the Carbo/Taxol and continue with Avastin alone
3) Stop the current therapy and switch to Tarceva

I think he is leaning toward #3. Tarceva is a pill with much fewer side effects than the intravenous chemotherapy and it's what they would have done first for me if my liver hadn't had a heart attack. They would obviously watch very closely and frequently to make sure that the tumor is not progressing on the Tarceva. Because I have not developed resistance to the Carbo/Taxol/Avastin they could always go back to that if the Tarceva doesn't work. Tarceva offers me the chance to grow my hair back and feel stronger without all the bone and joint pain and, because I'm a never-smoker, is actually more likely out of the box to produce a response than the Carbo/Taxol/Avastin was. I actually think this is what he's going to recommend. Which makes me really, really happy.

Probably he will want a PET scan soon after I get back from the cruise to determine how much active tumor is really left. We could be looking at scar tissue everywhere. That wouldn't change anything except that he's still thinking it might make sense to go after the largest liver lesion with cyberknife while it's small enough for the cyberknife guys to be willing to do it.

My shoulder went crazy again over the weekend to the point of ice, oxycodone, PT for phonophoresis/electrical stim, and tears on my part. It is much better than it was Monday, but I will probably see if the orthopod will inject it tomorrow to give me the best chance of not being miserable on the cruise.

I had a little fever yesterday so they drew blood cultures and labs today just to make sure I don't need antibiotics. I have to doctor myself while on the cruise if I get a fever, since no culture facilities will be available.

So I'm making reservations for NM in Christmas because all indications are that I will be around and feisty.

Thursday, August 21, 2008

What's Up With the Doc 22? - How Crappy is Crappy?


OK, so it's been a little over two weeks since last I wrote. I had chemo cycle #8 on August 12th. I almost didn't because my white count and absolute neutrophil count were borderline, but my oncologist knew he was in for a BIG fight if he tried to put it off so he just gave up and hung the bags. Hannah spent lunch with me because we thought volleyball was going to be televised on the Olympics, but no such luck. As always, no trouble on infusion day or the next day. I started with my achiness Thursday evening and felt just generally crappy Friday and especially Saturday, but by Sunday was feeling better. Hannah and Philip and I headed over to Long Island to see my aunt and uncle. They waited on me hand and foot and let me just cocoon with a blanket in a recliner - just what I needed.

The thing that's starting to get to me is the constant respiratory tract inflammation that the chemo causes. My nose runs like a faucet, I'm sneezy, I have a sore throat and very unsexy raspy voice and a mild cough that doesn't bring anything up. I just always feel like I have a bad cold. This, combined with the numbness in my feet (now probably >50% of the soles of my feet are numb), is just making me tired of the side effects of the chemo. I'm OK with almost no hair (although the loss of eyelashes means I'm always getting stuff in my eyes) and the fatigue is not too bad, but the everyday overall feeling moderately crappy thing is getting old. Better than dead, mind you, but old nonetheless.

Back to school is swinging into motion here. The parent/player volleyball meeting was Tuesday evening. I am so thankful that Hannah is now driving - all I have to worry about is getting to games! Freshman orientation for Philip is next Tuesday and Thursday is the first day of school. Emma goes back to class on Monday. Her vet school applications are almost done! Ian had his first med school interview on Monday and has another one tomorrow. Classes start after Labor Day for him.

It's absolutely shocking to me that we leave for our Alaska cruise a week from Sunday. One of the nurses I work with confided that she really didn't think I was going to make it until the cruise. That sort of took me back a bit, but then I remembered that that's how it goes for the majority of people with advanced lung cancer and reminded me to be thankful for this chemo regimen and what it's doing for me, crapness aside.

Next scan is scheduled for Tuesday and I meet with my oncologist on Wednesday to discuss next steps. If we are going to continue on these drugs I at least get a week's break since the cruise is scheduled for my usual chemo week. All the more reason to savor that vacation. By the time we get back I will be six months from my diagnosis. I am much more optimistic than I was three months ago and cautiously thinking about scheduling things like Christmas and my mom's birthday in New Mexico and graduations for Emma and Ian. Rather than thinking I won't be around to hear about their professional school acceptances (keep fingers crossed for both of them) I'm already getting impatient to know what they're going to be doing next fall!

So life keeps rolling right along, thank you very much. It's been busy at work, which is good for me even though I grumble. Start of school is always a crazy happy time while the kids settle into a new routine with new classes and teachers. Life is good, crapness aside, and I'm thrilled to be here typing away to all of you.

Next update after I see the oncologist next week.


Tuesday, August 5, 2008

What's Up With the Doc 21? - Living Life


Since my last update the deaths of two cancer victims have touched me. First, on July 25th, Randy Pausch died of pancreatic cancer just under two years from his diagnosis. I had actually viewed his Last Lecture before I was diagnosed and, while it didn't cause any major change in my already sunny and positive disposition, it certainly helped me turn to that as my most powerful weapon in this little war I'm waging. Last Saturday a colleague of mine, also a never-smoking woman physician just a year older than I, died of stage IV non-small cell lung cancer that was diagnosed in April. She had daughters who are 12 and 18.

I certainly don't know why my tumor is responding to chemotherapy when hers didn't. I believe that it's all pretty much luck and biology and I am exceedingly grateful that I wound up on the good side of that coin flip. The upshot of these two sad deaths is that I feel more compelled than ever to live every moment of every day to the fullest and to appreciate every bit of joy and beauty resident in each of those days.

So it's a week until chemo cycle #8. I took Hannah to Washington, DC on Friday. We had dinner with my stepsister Tanis and her children and then crashed on her couch. Saturday we did Hannah's first college visit at George Washington University. Then we checked her in for volleyball camp at GWU. I met some invisible friends for Indian food and then stayed up way too late making up for all the years it's been since Tanis and I got to just chew the fat together. My drive home Sunday was fairly uneventful, although I do so hate the George Washington Bridge. I knew I'd pay some price for all the walking and talking on Saturday and so I'm dealing with a sore throat, stuffy head, runny nose and headache that I always have to greater or lesser degree after each cycle - just a little worse this time than the last couple of cycles because I diverted some of my energy away from fighting that to my DC activities. Totally worth it on all fronts.

My energy level is good, my toes are just the tiniest bit tingly, and I am alive and able to enjoy it. There are lots of fun things coming up in the next few weeks and months. Next up Robert is going to Texas to meet Ian and Isaac and their families. Ian has medical school interviews (I keep telling him he's going to get into medical school but I don't think he really thought it was a possibility until those first interview invitations came in) and Robert is looking forward to showing him as much of Texas as they can squeeze in in a week. Philip and I will be spending a weekend on Long Island with my aunt and uncle. I plan to be waited on hand and foot and Philip is looking forward to learning to play pool from the old shark. Hannah and Philip start school on August 28th. The Alaska cruise is August 31 - September 7. Anyone with recommendations about shore excursions PLEASE email me with them.

My crazy employer gave me a new contract and a raise and they are still being wonderful about flexible scheduling. The patients are still crazy but that comes with the territory. We have a new occ doc and so I am not having to do all of the drug screen medical reviews any more. Incrementally less entertainment (Cocaine?!? Shit! Someone must have laced my joint.) but infinitely less hassle, especially on my days off.

I am starting a secret project very near and dear to my heart, enjoying Robert's wonderful cooking, nearing the end of Henry James' Portrait of a Lady on my commute and raising money for the National Lung Cancer Partnership by walking in their Free to Breathe Walk in Glastonbury on September 21st. The hospital I work for is doing a story on me for the employee paper and hopefully for the newsletter that goes out to the community. The Rachael Ray piece airs on September 5th, the same day that the three major networks launch their Stand Up To Cancer program with a one hour on air fundraising special at 8 pm EDT. Life is good.