First Dose (again)

(5/13/09)

Well, it turns out that Dr. J and I were thinking along similar lines. The tradeoffs were these:

- Do chemo first and risk the tumors growing and becoming too unwieldy for radiation to handle

- Do radiation to the lungs first and risk having disease pop up somewhere else in the body

Solution: do both at the same time!

But of course, so simple! So that's the plan right now, to wipe out the disease in the lungs and clear it out everywhere else, too, at the same time. We'll probably switch up the chemo drugs after radiation is done, too, so we can keep the cancer from becoming resistant. 

It sucks of course, but so far this treatment is looking a lot easier to handle. I have daily cytoxan by mouth for 28 days, and on days 1, 8, and 15, I get a 10-minute push (injection) of navelbine (vinorelbine). Hopefully aside from losing my hair, I won't have too many side effects. Starting Friday I'll go in for radiation therapy every day for 15-20 minutes for 10 days. The radiation will target both of my whole lungs with a larger dose going to the two nodules. 

Getting on a path to solving the problem always makes one feel better, although at this point I'm starting to get good at dealing with uncertainty. . . 

As a parting note for this post, I have to give a shout out to one of my personal heroes, Steve, who is battling Ewing's Sarcoma and just came out of a really rough couple of weeks. He and his wife Ann are such a strong, upbeat couple, and their positive strength is incredibly infectious. Steve, you're a freakin' champion!! Ann, you're incredible, too! 

A photo post. . .

(02/19/09)

Step 1: Remove lung nodule. Check.

Three wounds, four days after surgery. Minimally invasive surgery is amazing.

Step 2: Defend Thesis. Check!!!!

Today I'll be talking about . . .

Immediately afterwards. . . Wait, I haven't had my closed session yet!

Me and my committee. Okay, now I can relax a little. . .

Dinner with some awesome peeps. . .

And of course, cake!!!

Step 3: Go to Mexico!!!!

Out!

(2/3/09)

Step 1 - Remove nasty lung nodule. Check.
Now on to Step 2 - Defend Thesis. (Feb. 13th, 9am, Packard 202 at Stanford)

I'm out of the hospital, minus a chunk of my lung that I left there for the pathologists to poke and prod. We showed up yesterday at 8am for a 10am surgery that started around 11 and finished before noon. Strangely, the waiting and anticipation beforehand was more annoying than anything else. This time I wasn't really nervous, since I knew exactly what they were going to do and it was supposed to be pretty straightforward (luckily, it was). I was one of just a few patients in the pre-op area at first; then more and more were brought in while I answered the usual random questions ("Do you have allergies to medications? Does anyone at home hurt or harm you? Have you fallen down in the last six months?"). My mom and sister came in after the question/answer session with the nurse, and we basically waited around for half an hour or so. The attending anesthesiologist had a laughably gruff bedside manner - he basically rattled off a bunch of words in sequence in a total monotone - but I guess I didn't mind since I'd been through surgery before. The resident was perfectly friendly and intelligible, and luckily he didn't have the med student practice putting an IV into me. That honor was left to the next lucky patient. My surgeon said a quick hello and then scurried off to prepare things. Finally it was time to go in. I remember the anesthesiology resident giving me an injection and putting the oxygen mask over my nose and mouth, then voila, I woke up in the recovery room with a sore throat (from the breathing tube) and some pain in my left side (from the, um, holes they poked there).

They moved me to my room in one of the post-surgery wards, and the next few hours were interesting. At first I was pretty awake, and the pain wasn't terrible, until I tried to move around. I got up from my bed to sit in the chair for a bit, and then the pain shot up on my left side, so the nurse gave me some IV pain killers, which made me instantly drowsy, woozy, and a bit dizzy, such that I had to get back in bed again. Then I felt nauseated, so she gave me some anti-nausea meds, and I basically spent the next 4-5 hours drifting in and out of sleep, as my various visitors will attest to (thanks for coming, guys!). Then, since I couldn't really get up to walk around, they kept these leg pump cuffs wrapped around my legs to prevent deep vein thrombosis. Basically, they're like blood pressure cuffs that keep inflating and deflating to keep blood flowing in your legs and prevent clots. If you just imagine an octopus or something alternately squeezing each of your legs while making a loud, low-pitched buzzing noise every couple of seconds, you'll get the idea. This, plus the gurgling water pump they had hooked up to a chest tube to drain the blood out of my chest and my neighbor's snoring made for a tough sleeping situation. Also there was the pain, dry mouth, and general discomfort from just having had surgery. Oh yeah, and of course don't forget the nurses and technicians coming into the room every couple of hours to draw blood, check temperature and blood pressure, etc. I'm sure I've said it before, but a note to anyone who has to spend a night in the hospital: be sure to ask for ear plugs!

Anyhow, this morning was much better, although the pain was still pretty bad when I got up to sit in the chair and nibble at my breakfast. It turned out, though, that the bulk of the pain was due to that stupid drainage tube stuck in my back. I spent most of the morning waiting for the resident to come by and take the thing out, and meanwhile I kept getting conflicting reports of when I was going home - my doctor (the surgeon) said they would discharge me later in the afternoon, then his nurse practitioner came by and said it might still be one or two days after the tube came out. All in all, though, the morning after was much more pleasant than the night before. Finally, the resident came in to pull the tube out, but she wanted to give me some pain medication first - having learned from the previous day's response, I negotiated a reduced dose of Dilaudid (Strong stuff! Either that, or as my sister said, I'm a drug lightweight). While she pulled the tube out I had to puff up my lungs by blowing against my wrist so that no air got in the space between my lungs and chest cavity. It definitely stung a bit, but I'd have to say insertion and removal of urethral catheters take the cake for pain and discomfort. Once the tube was out, the pain was immediately 10x better, and my range of motion increased dramatically. I haven't even needed any pain medication since then, though I'll probably take some tonight before I go to bed.

Now I just have to wait for the pathology to come back. While I continue to prepare for my defense, of course. One step at a time. . .

Freakin' frik frik

Happy Chinese New Year's Eve!
(01/25/09)

Yes, I realize the subtitle here is a little incongruous with the main title of this post. Today is a day for celebration (or at least the start of celebration, as Chinese New Year usually lasts for weeks, for some reason), but I have some unfortunate news to share as well.

Remember those pesky lung nodules I had throughout the past year? They're the reason I was denied from the medium risk clinical trial and put into the high risk category. They were on my initial scans but then didn't change too much, and so we thought that perhaps they weren't anything to worry about in the first place (since they weren't responding to the chemo). Well, one of them is misbehaving and has grown since my last scan in October. It was about 4mm and is now up to 9mm. That's still pretty small, but my doctor and the tumor board (that's the collection of doctors, surgeons, and radiologists who meet every week to discuss cases) agree that it needs to come out. Luckily, the nodule is pretty close to the surface in my upper left lung, so it should be pretty easy to get to in a minimally invasive way. They'll poke three holes in my left side and go in with laparoscopic tools to cut out the offending bit of tissue. I should only be in the hospital for a couple days (surgery will be on Feb. 2).

Of course I found all this out after scheduling the date for my defense on (of all days) Friday, the 13th of Feb. I guess we'll just have to see how things go, but if I can stay on track and defend, then I'll at least get that hurdle out of the way. Writing and turning in the dissertation shouldn't be too bad after that. I have a lot written and have just a couple more experiments to re-do so we can publish our data.

How do I feel? Honestly, kind of crappy. I'm trying to stay optimistic, I really am. It's just tough. Uncertainty is such a bear. Not a teddy bear, either. Anyhow, I've been reading different books about good nutrition and am slowly working on changing my eating habits, but honestly who really knows what will work in the end? I guess you just try and do everything you can and hope for the best. On the plus side, my strength is definitely coming back, and I've been able to climb more and more, which is great.

If I can get through this month I think I'll be golden. . . have surgery, defend, and then spend a few days in sunny Mexico. . . should be good. . .

Well well well. . .

(3/25/08)

Well, folks, I finally got out of the hospital two Saturdays ago, and I basically laid around the house for a couple days while my leg got slowly less painful. By Wednesday I could walk pretty well again, so since then I've been trying to do as much as fun stuff possible. A couple high school friends are in town, and we've been traipsing around the area. A little rock climbing, a little karaoke, a little bit of running around on the rocky beaches in SF and almost getting poison oak (cross yer fingers for us), some ice cream crepes in Japan town, bocce ball in Campbell . . . All in all it's been a good few days.

I was supposed to go in for treatment yesterday (Monday), but my total neutrophils were a little low (1200 - they can treat me at 1500). I'm going to try again tomorrow to get in, but I guess I'm not holding my breath. It's again the mixed blessing of well, I get to spend a couple more days feeling good, but I don't get the treatment in. . .

Update on my lung nodules

I did finally get a chest CT last week, and fortunately or unfortunately, the lung nodules are still there. They've supposedly gotten smaller (the largest is 3mm, used to be 4mm I think), but they're still there, which could mean a couple things. It seems to me like the resolution of the CT probably isn't good enough to distinguish 1mm. My doctor thinks they're probably just random specks of something, possibly just some inflammation, but the fact is we don't really know. If they are malignant, the chemo should have wiped them out by now. We can't biopsy them, since they're so small, and so there's no real way to know what they are. I guess we can hope for the best, which is that they're not malignant, and the disease has not metastasized beyond the pesky butt bump. More uncertainty, but I guess that's par for the course in this situation . . .