Thursday, September 24, 2009

Nine down, one more to go


What a way to spend a summer. Well, not the whole summer. I guess things were okay up until the beginning of August. The Navelbine/Cytoxan treatment regimen I was on wasn't too bad to handle. I was still able to get out and climb a bit, go to school, do some normal stuff. Then August hit with its lung issues, surgery plus complications, then the completely unexpected liver issue. Now it's almost the end of September and I can barely walk around the block without getting winded.

Emotionally I think this has been the hardest part of this whole ordeal. Somehow, in the beginning, partial denial plus hopefulness buoyed my spirits. I really thought that year or so of chemo was going to be the trick. Even with the lung recurrences, it looked like the radiation therapy was doing its job. Now, trying to recover from lung inflammation and facing the possibility of metastasis in yet another organ. . .

I think what helped before was that despite what was coming at me, I could still occasionally pull of a semblance of a life. I could get myself up a couple of climbs at the wall, I could get into school and make a little progress on my thesis. Heck, I defended my thesis a week after my first VATS (lung surgery)! I even took a few trips with friends and got to go to India for the first time.

Right now, though, it's all I can do to haul myself out of bed in the morning. Sitting on the couch is of course super boring, but it's about all I can handle. Even conversations get me a little winded. I know it will get better. Day by day my appetite gets better. Hopefully I"ll start to gain back those ten pounds I lost in the past month or two. My mom's been feeding me quite well, and I've got good friends coming by to visit (though there could always be more - hint, hint).

Anyhow, for now, I'm looking forward to getting tomorrow over with, and getting a week's break. I've lucked out in some sense, in that the worst side effect of this Irinotecan drug - diarrhea - hasn't really affected me at all. It's just left me incredibly tired. Whew.

Thursday, September 17, 2009

Day 4 of Chemo Goodness


Well, all the little fresh kiddies are running around campus now, with their laminated name tags hanging from red lanyards. Class of 2013 has arrived at Stanford. Oh man.

Meanwhile, back in my fun world, I pushed through Day 4 of the Irinotecan Temodar regimen that we've been meaning to start for, oh about a month and a half now. Aside from feeling crappy, nauseated, and generally tired, it's not been any worse than any of the previous regimens so far, so I guess that's a good thing. The difference is that I'm coming into it while still recovering from two semi-invasive procedures that have been, well, quite traumatizing.

Strangely enough, the most recent liver embolization, which really only left a small incision in my groin (ah the wonders of minimally invasive therapy), has been the hardest to get over in terms of pain and other side effects like fevers and night sweats. I've just been exhausted and needing to sleep for hours and hours a day. The VATS procedure on my left lung has healed up quite well, and aside from a slightly misshapen left pectoral muscle, it hasn't been too painful at all. The main trick is to keep from sneezing (ouch).

Zap it?

So here's the state of things. As far as we know, the biopsies from my lungs came back negative for malignancy. In fact, all they could see was "inflammation", caused by what, we don't know, but it should go away over time. The real question now, is the pesky liver. The embolization stopped the extraneous bleeding, but scans can't distinguish between blood and tumor or whatever else might be there. So, it's a bit tough to tell how big the tumor is or if there is one at all (could have been some spontaneous bleed). Right now we're going to hit it and all of extra little baddie cells that might be floating around with some chemo for a while. We'll scan again in a couple months and see how things look.

For now

I pretty much feel like crap. I've spent two to three weeks being in pain, exhausted, and having fevers and night sweats. Most of the pain has died down, I"m still exhausted, now nauseated, and generally trying to stave off the diarrhea that's supposed to be the main side effect of irinotecan. In a word, it sucks.

I've been mostly recovering at my sister's new place, which is pretty close to campus, so I guess that's a bit of a convenience. It's hard to focus on doing much else than just sitting around and vegetating though. Not exactly what I thought the end of the PhD was going to be. Anyhow, if anyone is up for visits or hug deliveries, I'm all up for it, if you can put up with my incessant hiccuping. . .

Wednesday, September 02, 2009

Can't fight the fever


Home at last!!

Well, only about two weeks later than I was expecting, I'm finally back home. I'm still having some low-grade fevers, most likely due to the post-embolization syndrome (that's a great catch-all, isn't it? "Oh doctor I'm having major headaches and bloody noses after my ankle sprain." "Oh that? That's just post-ankle-sprain syndrome. It's very common, nothing to worry about."). It turned out that I was having some slightly worrisome symptoms, as my fevers were mostly low grade until two nights ago, when I had one that spiked past 102F. Given everything that was happening, the doctors wanted to be conservative, so they kept me on antibiotics and watched me for another day. I had another CT scan yesterday to see if there were any other possible reasons for the fevers. The scan showed a couple things: my gall bladder is inflamed, and there were a couple of little bubbles inside of the liver mass. The theory is that the gel foam got into the arteries supplying the gall bladder, so it's not able to compress as much as it normally does. The liver bubbles are probably also from cells dying and releasing gas or from the gel foam itself, which has gas inside it. There's a minor possibility of infection, but it's not likely since my white counts weren't elevated.

Oh, the gall

Yesterday the docs laid out the options for dealing with the gall bladder issue:
  1. Watch and wait - it's very likely the inflammation will go away on its own; apparently it's very rare for people to get CT scans this soon after an embolization, so it's entirely possible that this happens in most people and they just don't detect it;
  2. Insert a catheter into the gall bladder to drain the fluid and allow it to be less "stressed" for a while (this would require carrying around a little pouch that I would occasionally drain for 4-6 weeks); and
  3. Have surgery to remove the gall bladder.
Luckily, we've decided to go with number one, given my good response the past couple of days. On Friday I'll talk to the oncology surgeons about possible options for the liver mass (I will eventually talk to the radiation therapy team as well), and next Wednesday if all goes well I'll start that new chemo regimen we've been waiting for. . .

Until then, I'm trying to heal and enjoy being at home. It's hard not to feel freaked out about this liver thing, but as usual, speculation only seems to lead to unanswerable and worrisome questions. Right now there's really no new information beyond what the scans showed: there was a mass that was bleeding near the edge of the liver capsule. The mass is pretty large, 4-6 cm, but it's unclear how much of that is blood and how much is something else. It seems unlikely that something that large would have grown in the span of a month and a half, but I suppose it's possible (or it's possible that it was much smaller but located precisely to cause a bleed). There's an outside chance this was all caused by a random blood clot, but the radiologists seem to think the mass doesn't look like it has a homogeneous make-up.