Need a New Path

I had a scan last week to check on the progress of treatment and a meeting with Dr. S at which, I had hoped, to talk about how much longer I might be on Vectibix before getting a break.  But my scan was quite poor and the situation now is entirely different.  Evidently, my Chinese hamster had short legs and he ran out of gas.  My tumors are again growing and, even worse, in the week or so before the meeting, I starting seeing signs of a return of jaundice.  The jaundice was confirmed at our meeting, with a reading of 6 mg/dl.  The acceptable maximum for normal is 1.  I am now in a position very similar to the one I survived last fall.

Unfortunately, Dr. S had an emergency last Thursday so I got the news from a fill-in who was, frankly, pretty pessimistic about my future.  He effectively told us that there isn’t much MSK will be able to do for me.  But we scheduled a meeting with Dr. S on Tuesday and insisted that my scan be sent to the surgical areas for evaluation.  So, after a nervous weekend, Robbie and I met with one of the surgeons on Monday and Dr.S on Tuesday and have put a plan in place.

Since Vectibix has now failed, I have only one drug in the cabinet – irinotecan (pronounced like “I’m in a tea can” if you replace the ‘m’ with an ‘r’.)  However, irinotecan cannot be given to a person with jaundice.  This is the exact issue I had in the fall.  The difference this time is that the major liver blockage I have on the current scan is in a place the surgeons can reach.  So, if they can insert a stent, it is possible that my billirubin level might fall below 2.0 and Dr. S might be able to use some irinotecan.  He is not sure that we can get below 2.0 since the major blockage may not be the only one, but it’s worth a try.  Alternatively, if the stent does not get my billies low enough, Dr. S said that he will search the available experimental drugs or try to “finesse” some small amount of irinotecan, although it would be very harmful to me to take very much.  Overall, it’s a long shot, as this paragraph is full of “Ifs” but at least it is a plan.

The technique they will use for the stent is an endoscopy which is pretty non-invasive.  It involves snaking a tube down your throat, taking a left at the stomach and a right at the duodenum.  Then, staying right at the turnoff for the gall bladder, you arrive at the base of the liver’s main billiary duct.  You can mapquest it, if you like.  The important point is that they won’t need to cut anything and I’ll be home in a day – probably with a sore throat! And a side benefit of the stent, even if it doesn’t extend my life, is the clearing of jaundice symptoms – the worst of which are exhaustion and intense skin itchiness.

My endoscopy will be tomorrow and it will take a week or two to see how low my billies will go. Then we’ll figure out what paths may be available for a return to chemotherapy.

And so, much like last fall, I have come face-to-face with the “no more treatment options” scenario but do have a possible path out of it.  I’m hoping for another miracle and a little hope is better than none, I always say. 

May Day Sit-In

I see it’s been a few weeks since my last entry. I’ve had a couple of rounds of treatment since then which went just fine. In the interim, I went to Florida briefly to get my Dad’s car and drive it back. Since I don’t generally have a lot of energy, I split the trip into segments of no more than 4 hours of driving and so, it took about 5 days total to get back to NJ. Along the way, I stumbled across a truckstop with the best fried chicken I’ve ever had – just north of St. George, SC. It called itself a café but, in my book, when you’re attached to a gas station/convenience store, you’re a truck stop. Nonetheless, the fried chicken, mac and cheese and collard green lunch was superb! Good thing the hotel was right next door so I could sleep it off! I also stopped in Richmond for a terrific dinner with my old friends from Genworth - and that was a treat to get caught up with everyone. And, one final stop off in DC for lunch with another former colleague made for an enjoyable trip.

This week’s treatment coincided with the Occupy Wall Street May Day protests in the city. I met Vicki for some lunch before my appointment and decided to walk to treatment which took me, as usual, through Bryant Park, one of OWS’ rally points. They had a pretty good drum circle going, surrounded by protesters who, I suppose, played in their high school marching bands, so it almost had the atmosphere of a college football game tailgate party. Except that the big dancing mascot was the Statue of Liberty. There was also a group dressed in uniforms designed to look like the old Brooklyn Dodgers except the team name was the “Tax Dodgers” and every player wore the same number – “1%”! I thought that was pretty creative. One curiosity, though, was that a large group of protesters apparently had come down Fifth Avenue and turned onto 42nd Street across from the NYC Public Library where it appeared they were being held up by the police – there were a LOT of police, at least 20 or 30 of which were on motorcycles to form a wall keeping the protestors on the sidewalk. In any event, they were sort of corralled right at a Qdoba, which made it appear that they were protesting the fast food chain! I was expecting some pithy chant – maybe “Hey Hey Ho Ho, we don’t need your Burritos!” But I think they were really just being held until the cops could stop traffic enough for the group to cross into the park.

So, that was all the excitement before I held my personal sit-in in the Big Chemo Chair on 53rd Street! Hope you are all well, BB