We Add a Therapy (#21)

Another day of chemo and this one much longer than normal.  We have added yet another chemo drug:  Avastin.  Unlike Alimta and Carboplatin, Avastin is considered, for some reason I do not pretend to understand a “targeted anticancer drug.”  Here’s what the manufacturer says about targeted therapies:  Targeted Biologic Therapies are drugs that can be added to chemotherapy, to target specific cancer cells.

That sounds promising and I suspect most of you have heard of the company that developed Avastin:  Genentech.  Genentech also reports that “Avastin® (bevacizumab) is the first U.S. Food and Drug Administration (FDA) approved therapy designed to inhibit angiogenesis, the process by which new blood vessels develop and carry vital nutrients to a tumor.”  It is, by the way, approved by the FDA for treatment, in combination with Alimta and Carboplatin of “non-small-cell cancers of the lung.  That’s what I have.

It is counter-indicated for certain people:  pregnant women, children under the age of 18, people about to have surgery, and people who bleed very easily.  The only one that vaguely bothered me was the fourth.  I am most certainly NOT pregnant and have not been under 18 since I was at French High School on the orth side of Beaumont, Texas.  Nor am I scheduled for surgery.  Since being placed on an aspirin and Plavix® regimen ten years ago, though, I do bleed fairly easily.  Brush against a door:  I bleed.  Humidity really, really low: I bleed when I blow my nose.  We solved that by taking me off aspirin and Plavix® two weeks ago.

Okay, no more scientific stuff.  Ask my old teachers at French High School:  I was simply NOT one of the best science students around.   In fact, Bob Meinig, one of my favorite teachers, a superior math teacher from whom I had algebra and solid geometry, was stunned that I scored highest in my class on a standardized national math test.  I explained to him that I merely tested well on standardized tests.  That’s true.  I always have!  As we used to say in Vietnam (at least I think we did):  “Don’t mean nothin’!

The addition of Avastin to my chemotherapy cocktails stuck about 110 more minutes to my now every-four-week chemotherapy treatments—90 minutes for the Avastin, 20 minutes for the chemical flush.  I have no idea what a “chemical flush” does and I really don’t care to know.  I do know that I got to Doc Onc1’s office at 9:30 and did not finish treatment until 2:30!!!!  I really shouldn’t bitch about this:  there were a few patients there when I got there and still hooked up to IVs when I left.

When I got back to the parking lot, I pushed the top back on my Mazda MX-5 and drove quickly back home.  Temperature in the low 90s, a clear sky, wind in what remains of your hair.  Hey!  Nothing makes you feel better than speeding down a highway with the top down!!  Yeh, something does:  listening to John Fogerty, car amplifier cranked up high, Bose speakers shaking the little car, while you do it.

Tomorrow, I will go back to the office for my follow-up shot.  For some reason, I need shots to counteract the IV drips the day after receiving treatments.  I think those control nausea.

In a couple of weeks, I will have another CTscan to see the state of the cancer in my lung and brain and then, in four weeks, yet another chemofest!  I can hardly wait. Believe me, it is good that the folks working at the START Center are good people.  That cuts back on my sometimes ill temper.  Between the next scan and the chemo I will be in New York for a short period of days to see a few plays and musicals.  Life continues between post-Chemo exhaustion for a few days and the next chemo treatment.

I am, I think, pretty much on what Doc Onc1 calls maintenance now:  treatments every four weeks that will become quarterly treatments.  Quarterly treatments should equal 8 days each year of feeling fairly exhausted. I can live with that, but not without it.  The prognosis remains positive.

I do wish this were somehow more amusing.  Perhaps it would have been had I let it sit a couple of days prior to writing it.

I've been thinking about the pond again and about a poem I wrote not too long ago and seems relevant now for some reason, I hope others can see the reason. It was one of those times when the cam showing the pond got stuck in one place and we all wondered what was happening just out of sight, over there where it was light but where the camera could not show us what was happening, but the mic indicated something was happening.  One of those times when you kept movin your mouse as if that wold make the cam move:

Against the Dark

Sometimes bugs, lit by floodlights, glow and appear
to be something they have never been, especially when
they fly low along dusky ground and bright white sears
an image of some swift, small animal into our eyes:
perhaps a cat, a dog, some scurrying fox…we look and then
try once more, knowing that what we see is not exactly lies

but some arching apparition, some glowing ribbon flaring
into life because our sight is not quite fast enough
and light streaks leave us, mouths agape and staring
open-mouthed as if the thing we saw could never be
what it so clearly seemed to be.  So we shrug, slough
it off and gaze once more upon the scene, hoping to see

what we have and have not seen before and know is there:
a cheetah, a pride of lions, a herd of wandering wildebeests,
a hundred elephants, elegant giraffes, ostriches, a pair
of often too loud Egyptian geese, a sacred ibis, a knob-billed,
awkward-looking, lazy duck—all too much, a daily feast
for eyes burning with smog and dust in dark cities filled

with cars, with carcinogens that pollute our daily lives,
with jostling crowds intent on so much of so little import,
with graffiti sometimes surpassing in art what it tries
to cover up, some scrawled emblem saying “I was here”
in shrieks of color and this is no idle boast, no sport
to while away the hours, but something we all fear,

that thunders through all of us, a need to show that we are
and what we mean and that we count and that we are not
merely streaks of light against a dark and deepening war
that maims and kills, not some war between men and men, no,
but some ongoing fight that makes us cry and mark our spot
like wild packs of dogs, and like the cock at dawn, to crow.

Until next time.

--Palmer

Urologist Redux (#20)

I sing the body electric

                for Pirate Jenny

How nice to have a body part functioning properly—uh, well, no, I wasn’t really talking about that one!  I had my regular, annual checkup with my urologist this morning and did all the disgusting things one does while at one’s urologist’s office:  the little sample cup, the blood draw to check PSA, and, sliding quickly past this, the digital exam (Ha! We are in a digital age, just not that digit!).

My urologist is the man who removed my right kidney more than twenty years ago.  Why?  Because it had developed a little tumor nestled in the lower lobe–completely encapsulated.  No real problems after it went into the biowaste container.

The urologist did take a look at the PetScan the Doctors Onc had ordered before pronouncing my prostate cancer-free.  It’s nice to have a clean prostate, perhaps some day I’ll write it an ode of its own.  I mean, if Lucille Clifton could write an ode to her cramps, then it should be okay to write an ode to a prostate, no? And Ann Sexton delighted in writing poems about, uhm, penises.  Private parts have not been private in poetry since, well, since George Gascoigne sang goodbye to his little cock robin back during the renaissance in England.

And so, my lovely prostate, stand thou firm / against the winds of time / no Flomax need invade thy space / no spattering thy bowl.

Well, perhaps not.  But still it is to crow about some things, no? “I grow old, I grow old / I shall wear the bottoms of my trousers rolled.”  Younger, I might have other things let move to the fore but you’ll have to read my Vietnam blog for that!  Well, perhaps the beginning of one really bad bad poem:

A few stanzas from my epic-length, (100 stanzas so far) and yet incomplete "Jenny " poem (Part 1 is just SOOOO inappropriate for this blog!):

2.

When as in silk my Jenny goes

a diamond sparkles in her nose

and all that's known of pain and grief

in her aspect gain relief.

3.

Jenny is a joy, Jenny is a dear,

Jenny makes the boys groan

whenever she comes near.

4.

Jenny wears the tightest jeans—

they slip down to her hips

but I'm the only one who sees

her tattoos when she strips.

5.

Jenny dances in the club

and dances in the bed, but

I can only dance and sing

when Jenny's in my head.

6.

Jenny walks in beauty;

Jenny is the night. All hopped

up and in her jeans,  the music’s

made for her delight.  And

all I know of beauty’s this:

that Jenny dances when we kiss.

Jenny is a muse of sorts.  I never had a real girl friend named "Jenny," but when Allen, Don and I lived together in Austin, in a duplex off 38 1/2 Street, a young lady named Jenny lived in the other part of the house with her boyfriend Dave.  But, no, that's a very different Jenny. 

I am, on the other side, and returning to the medical trade, trying to avoid my gastroenterologist.  Digital exams are one thing; colonoscopies, my friends, quite another.  My best guess is that the chemo should make that exam moot.  How can even polyps survive Alimta and Carboplatin and Avastin.  I am not altogether certain that I shall!  What a threesome of drugs!!!!

This best blog entries are short blog entries.  Why?  Because they have nothing, no nothing, really nothing, to report.  Thanks again for reading this.

A Weekend to be Forgotten whle Memorializing 9/11

Not a great weekend.  Just one of those things:  tired all the time, low-level fever, blood sugar way high (in the 200s).  Doc Onc1 said I would have days like this…beyond the 2-3 days after chemo regimen.  Something that has always helped didn’t do that much today:  a workout at the gym.  That has almost always brought blood sugar counts down, but not this time.  In addition to that, I was taken off metformin after the last MRI since it’s not good with the chemicals they use in that process.

I see the nurse again tomorrow for regular weekly blood work and I suspect I’ll be back on metformin.  I just may have insulin added to my “as needed” cocktail of drugs.  This is, as I said earlier, something the OncDocs said would probably happen.

So, I have been watching and catching up with “True Blood” (the blood work reminds me) episodes for the past few days and screamed and shouted as UT squeaked past Brigham Young and will watch the Cowboys tonight as they take on the Jets in the 9/11 game in New York.

I have mostly been listening to memorial coverage on NPR and not watching television.  I simply do not need to have things I remember so well, images that are burned into my brain, revisited in HD.  My great hope is that we will soon end the juvenile temper tantrum that sent us into Iraq (not even remotely understandable) and Afghanistan (somewhat more understandable ten years ago…but not any more!).

The Streets of Kandahar

The sheets are rumpled, pillows ragged from the night.
"Tell me there is some end in sight," she says, "something
I cannot see or hear." We have awakened to the news:
jets dropping tons of bombs on Kandahar, two young Baptists,
rescued, confessing that they have maybe spoken a little
about Jesus, have, possibly, broken the word they gave not
to speak of the man who was a truthsayer. No irony, only
a deep-seated desire to spread some other person's truth,
to spread a "gospel" which means truth. Sly grins, such joy.

"Tell me we are bombing people for some great truth, for
more than a matter of simple vengeance." Two testaments,
so many words for truth, for gospel, so many testimonies
they ricochet across the news and through old texts searched
for single lines to support whatever we might choose. "Is He
on our side?" she asks. "Does His blood stream in the firmament
just behind the cover of B-52s? The sky seems so red, crimson."
We watch the stream of refugees, see men who look alike, some
Hunched over, dragging others. They all hold the same old book.

So many dead. Towers fall. I have no words, only images.
The pictures flicker, fade out to a voice over telling us that
we are winning, the evil ones are on the run. We see what
they run from: people wearing turbans, long beards,
flowing brown and gray robes out of those same old books.
The caves are full of scrolls, old words from the beginning
of something that stirred in the deserts and the passes long
before we crossed an ocean. Listen: birds once flew here-
ravens and doves A man lived here who brought a dream.

BMWs, low-financing, safety-tested. New cereal with old grains
blended in secret. Humongous sale, DVDs, laptops. The cows want
me to eat chicken, they appear on billboards and T.V. A woman with
a wondrous navel hawks the latest light beer, her hips move
in ways not often seen. We bomb culture on a land already
rife with culture. We are killing people. In the fields, some
young woman gleans the wheat, selects small kernels to feed
herself, her baby, her aging mother. She makes her way through mine
fields, brushes the dust away. The detritus of another war.

A small boy kicks a ball, another bounces it from foot to foot then
uses the side of his foot to send it whistling to another. They laugh,
run with joy down dusty streets, bang the ball from foot to head.
They are not yet dead. I had supposed they were, that some bomb,
smart or dumb, would land in the streets of Kandahar. Into the streets
of death, children thunder, backward and forward, screams rise to the sky,
drown out for some brief moment, the roar, the shriek, the sound
of bright machinery. The great game sweeps overhead. And I am dumb,
can neither speak nor write. Clouds of dust obscure the sun.
(orig. published in The Texas Observer) 

Adventures with the Medical Trade (#17); a new day

Went down to the corner just to ease my pain / it was just to ease my pain. I got drunk and. I got sick and. I came home again.  Hmmm, probably belongs more in my Vietnam Blog. Anyway:

A cool morning.  I put the top down on the MX-5, attach my “handicapped” (politically insensitive name though it is!) placard to my rear view and drive quickly to Stone Oak and the START Center. [Aside:  yesterday, a wildfire shot through parts of Stone Oak, but missed the new medical center there.]  When I get to the Start Center, office to Doc Onc1 when he is not at Stone Oak Methodist Hospital, I carefully put the top back up on my little convertible.  Why?  Because, last week, I left it down at my gym/club where I work out and some evil SOB stole the, WTH, disabled(!) placard.

Why I have a disabled placard:  The brain cancer:  the docs do not want the balding top of my head, yeh though I wear a baseball cap, getting too much heat during this hot spell in San Antonio.

You need to realize that I am feeling really good, quite healthy, asymptomatic for lung and brain cancer.  I go to work every day, except for day 2 and 3 after chemo when I simply feel very tired, play golf on the weekends, do minimally tortured workouts at the gym:  squats, abs work (crunches which look nothing like the crunches done by those younger people who do jeans commercials and appear in Men’s Health when they get out of their teens and can no longer pose near naked for Calvin Klein ads) ("Am I getting old?" sang Maurice Chevalier.  "Oh no, not you" Hermione Gingold sings back, (Fierst person to guess the show gets a free copy of my new book, Into the Thicket (on your honor not to use Google)), 10-20 presses and curls, treadmill (30-40 minutes at 3.6 mph)—all while listening to my iPod or watching MSNBC on one of the televisions mounted above the treadmills.  In other words, except for two days that occur two days after the chemodrip, I feel perfectly normal, perhaps even better than normal since I am eating more healthy food and have settled down at approximately 180 pounds instead of shooting up and down.

So, here’s what happened today:

After putting the top back up on my car, I run up the flight of stairs to the START Center (showing off to myself, no one else is in the area) and sign in, pay my co-pay, sit for a few minutes.  A cute phlebotomist calls me back to the “triage area”—I don’t know why they call it a triage area: “triage,’” since M*A*S*H, has always meant sorting out patients into categories to more efficiently treat them (a Hotlips Houlihan innovation left up to the nurses, as I recall).  But, that’s what they call their blood lab.  I’ll call it that, too.

In Triage, they weigh me, then draw blood from my left arm.  They take my “vitals.”  Another strange term for temperature and blood pressure.  Then I sit in a second “on-call” waiting area and check email on my iPad.  Most of my friends are not terribly active in the mornings.  That doesn’t take much time.  So, I switch to the iReader and continue reading The Six Ages of Paris, a fine book about Paris and its development over the centuries.  I just got rid of Napoleon and am coming up on Louis Napoleon and the great architect Haussman who really made the Champs Elysees, the Louvre, the Place de la Concorde, the Touilerie and much of what we consider the “City of Lights” what it is today.  I digress?  So, I digress.

I get moved to the batter’s box, next up.  This small room is filled with cute little Hallmark card (not Allen Hallmark) sayings.  It’s like a twelve-step program minus the first steps and most of them do invoke God while the rest are merely inspiring.  I don’t mind.  Doc Onc1 must have one of the most depressing jobs in the world.  Some of the patients I see there are very young:  women in their 30s and 40s with breast cancer; children with bald heads; young men wondering “why me?”; and others.  If the health insurance death panels approved them for the quite expensive chemo treatments, that means they have a chance of making it.  Many of them will not.  How awful the job must be to tell even one of them that their treatments have ended and that, no, they are not cured.  I would have preferred having one of Sarah Palin’s fictional Government Death Panel’s tell me that than to hear it from a greedy corporation.

Damn, I seem to be drifting.  Perhaps because I did have chemo today.

Doc Onc1 comes into the little room with his primary nurse.  He calls up my CT and MRI scans on his computer, looks quickly (to remind himself) at the reports and then looks at me.  Believe me when I say this: I am, at this time, incredibly nervous, even anxious, sitting on the edge of a chair not meant to have its edge sat upon.  I suspect anyone would be the same.  These are the results from the first scans I have had in the nine to ten weeks since I had the cyberknife procedure and the first week of chemotherapy.  A long wait.

You know, yesterday and today, were the only days San Antonio’s temperature has been under 100 since I got back from Paris and started all this.  Apologies for all the French allusions today.  I know some people fail to appreciate the French or Paris ("Freedom Fries" were a symptom of that!) Another digression: sorry.  But it’s almost allegorical and a story could be made of the long, hot summer and my cancer.  I am not, personally, up to that.  This blog will have to do.

Okay, okay, here are the results:

The tumors are much smaller.  The one in the brain shows no sign of activity.  The lung cancer has diminished tremendously.  Something called “cancer markers” (some oncologists disregard these) are down from 200+ to 75- (these markers are backed up by the CT and MRI).  I will continue the chemo once every three weeks, probably for a long time.  Every nine weeks, I will have new MRIs and CTs (can’t afford to retire!!!!!!!!!!!) and we will revisit whether I should move to quarterly and them semi-annual chemotherapy.  Whatever, for safety, I will be on maintenance treatments of Alimpta, probably for the rest of my life.  The alternative is far worse.  Plus, I do get 90 days of paid faculty sick leave each year.

After seeing the doctor, I almost run down to the Treatment Center (chemotherapy treatments).  I sit in my recliner, a nurse attaches my arm to an IV, Alimpta and then Carboplatin drip down into my vein.  It’s not unpleasant, and who cares?, it seems to be working.

 
More before too long.  I see my urologist again in two weeks to discuss what all this means for my prostate.  Probably good since chemo affects all organs, indiscriminately, except for the brain.