I Have a Cold

I Have a Cold

(with a description of what exactly “maintenance therapy” is)

Okay, every day people are getting colds…no big deal.  But Saturday I slept from 4 p.m. to 11 a.m. Sunday (19 hours for a person who has always needed 6).  Then, went back to sleep from 3 p.m. Sunday until 10:30 a.m. (19 hours. 30 minutes) on Monday.  When I was much younger and pulled all-nighters at bars and libraries, I could do that.  These days, no.

Yesterday morning (that same Monday), I called Doc Onc1 (I’m supposed to do that if something odd happens).  Here’s the odd thing that was happening:  bad headaches, flatulence and belching (gross, I know), sore joints, sore lower stomach, sneezing, low-level fever. (Plus, my sister-in-law was visiting--that's a good thing, by the way)  The doc called back within five minutes and had set up an appointment for me to get a chest X-ray at STRIC, had set up an appointment with my superb PCP, and had set up an appointment with him.  My medical life was flashing before my eyes!  Everyone except my pulmonolgist, my nephrologist, my urologist, and my gastroenterologist).

The X-ray was negative.  Even trained X-ray technicians can no longer see the lung cancer, but the X-ray did pretty much rule out pneumonia.  Next, to the PCP's office:  a nose swab.  I hate those!  I sneeze for thirty minutes afterwards.  That ruled out the flu!  Everyone is listening to my lungs...clear.

An hour later, I dragged myself into the START Center for Cancer Treatment.  No pneumonia, no cold.  Doc Onc1 said, “H. Palmer Hall, you have a cold.”  *sigh*  But they also did a Complete Blood Count (CBC) and my platelets were down to 77 after last Tuesday’s maintenance chemo.  Not so low as to be dangerous (I was at 21 two weeks earlier!), but low enough that they wanted to do something about it.  What?  An IV drip of Saline Solution to rehydrate me.  That took an hour and a half!

A couple of you have asked precisely what “maintenance therapy” is.  So:

About five years ago, oncologists got tired of watching their lung cancer patients die.  Two of my friends died of lung cancer that year:  Carla Saenz and Cynthia Harper.  Carla was the Community Relations Director for the largest Barnes & Noble in town and that store donated $1000 to Pecan Grove Press each year plus readings to all of my San Antonio authors.  Cynthia was a superb poet and dear friend.  As editor of Chili Verde Press, she published my first two chapbooks:  From the Periphery and Deep Thicket & Still Waters.  We had lunch every Wednesday at the Blue Star Brewery.  I continue to miss them both very much.

So, when I found out that I, too, had lung cancer, I became almost fatalistic.  Until I met the oncologists at the START Center.  For the past five years, oncologists have been debating something called “maintenance therapy.”  It works like this:  They give you large amounts of chemotherapy (in my case carboplatin, limta, and avastin) for six visits (one each month in my case) and then they check you out with MRIs, PetScans, blood workups.  If there has been sufficient shrinkage of the tumors, they give you two additional rounds of major chemo.   This brings you close to death, but should kill off most of the remaining bad cells. And then, they move you to maintenance.  An additional series of scans prior to maintenance showed that the brain cancer was gone, nothing left but scar tissue (oh, yes, plus the original gray mass that passed for a brain).

Maintenance, in my case, includes similar treatment to pre-maintenance, but the carboplatin is left out.  The IV drip last for 2.5 hours and not 4.  The after-effects are supposed to be neglible, but “H. Palmer Hall has a cold!”

Maintenance remains a fairly new therapy for oncologists and is still debated.  Some maintenance patients have been on maintenance for all five of the years doctors have been doing it.  There is no guarantee, but I feel pretty good abut it. 

There are two possible goals, neither with guarantees:  1) remission and 2) new therapies coming along.

So, there it is.  I have a cold.  But with chemo reducing my immune responses, colds are a bit harder on the body than they used to be.

Post Number 30 (I think): first maintenance chemo

One ought, every day at least, to hear a little song, read a good poem, see a fine picture, and if it were possible, to speak a few reasonable words. --Johann Wolfgang von Goethe (1749-1832)

I was back for the first round of maintenance chemotherapy yesterday.  Before starting, they did another CBC (complete blood count) to ensure that my platelet count had improved.  It had:  from 24,000/deciliter to 31 to 54 and now, all the way up to 109,000.  The ideal is 120,000 – 150,00 (file this under trivial info you just don’t need to have!).   At 109, I was okay for the IV to be stuck in my arm.  Quick note:  at last week’s endoscopy to ensure that I had not developed an ulcer, the PA jabbed my vein so hard that the wound “leaked” for three days afterwards.  So, they switched arms this time.

Since they had to wait for the doctor’s approval after the new CBC to start, I sat there for an extra hour waiting for Doc Onc1 to return from an emergency at the hospital.  The maintenance chemo (minus the Carboplatin--Carboplatin is a slow drip) only took two hours as opposed to the normal four.  Afterwards, I received my B-12 shot and returned to work.

This morning, I was back for a Neulasta shot (not the sleeping drug with the cute little psychedelic butterfly).  I get one of those the day after each chemo treatment to charge up my white blood cells.

The maintenance chemo leads to less tiredness but continues to work against the pesky, reduced, lung cancer.  With luck it will reduce itself into total remission.  Or, I will continue on maintenance until some new breakthrough occurs.  Whatever:  I should still be around for some years to come.  That’s according to Doc Onc1 who has a few people on maintenance now for more than two years.

So, there’s a path set:  once a month for maintenance chemo and the day after for Neulasta.  As Nurse Maggie, who does all of my chemo treatments, says:  "there is no expiry date tattooed on your foot."  Good news, I think.  I mean the IV drip every month is not too bad.  I take my iPad and check email, read books or watch old movies downloaded from Netflix.  Could be worse.

And I keep reciting poems I once sang into the valley between Engineer Hill and Pleiku ("big town" in the Jarai Monragnard dialect).  "The Lake Isle of Innisfree" (I will arise and go now, and go to Innisfree") and the first lines of "The Love song of J. Alfred Prufrock" (Let us go then, you and I, when the evening is laid out against the sky / like a patient etherized upon a table....").  Poetry has always been a great consolation as philosophy was for Abelard and others.  I remain grateful to my high school teachers who had us memorize thousands of lines.

Problems with Platelets

We Never Know What the Little Buggers Are doing, Do We?

It’s been a bit cool in San Antonio lately but the medical profession soldiers on and takes those of us in their grasp with them.  Don’t get me wrong:  that’s a good thing.  I spent last Friday being poked and prodded and mechanically moved into the core of various machines.  Here’s the schedule:
 
   PettScan at South Texas Radiology (STRIC) on Sonterra Blvd.  8 a.m.
   Blood draw (CBC) at the START Center for Cancer (this was a result of my previous encounter with 

             Stone Oak Methodist after my low platelet incident.  9 a.m.  [CBC=complete blood count] 
         MRI at STRIC on Hardy Oak.  12 noon.

At least STRIC provides donut holes since so many of us have to fast prior to going into the bellies of their machines.

The Thursday before, I had an appointment with my PCP for my routine, annual physical.  Everything looked fine:  A1C (3-month blood sugar test), normal; cholesterol, normal; triglycerides normal.  I am, in terms of a general physical in extraordinarily good health.  But there is that tiny little problem of being a Stage 4 Cancer Patient.

I wait for the results of the blood draw on Friday.  My platelet count has gone all the way up from 24 to 27 (24,000/deciliter to 27,000/deciliter).  It should be at about 120,000/deciliter (120).  The carboplatin, which I no longer take has decimated my poor little platelets.  There is talk of transfusing me, but Doc Onc1 says wait until we draw blood again on Tuesday.  Tuesday’s blood draw shows that my platelet count has risen again—this time to 31.  I am on the mend again!

That afternoon, I have my meeting with the oncologist (AKA, Doc Onc1).  Some good news.  The cancer in the brain has gone; nothing left but some scar tissue.  And more good news:  the lung and lymph node cancers have shrunk markedly.  I am now ready for maintenance.  Maintenance means that I am now having only two chemotherapy drips every three weeks instead of three every four weeks.  The bad boy, though, was the carboplatin, which I will no longer take.  That means my bad days will be reduced dramatically, possibly to none.

But, and there’s always a “but,” isn’t there?  I could not start the new maintenance regimen yesterday because of that little jaunt to the hospital and the low platelet count.  Doc Onc1 wants to find out why there was blood in my stool (gross!) on Saturday morning.  It could be, he opines, an ulcer developing.  It could be something else.  We need to find out.  We know that it is not caused by cancer, but it could be caused by the cancer treatments.

To make an already too-long story as short as possible, tomorrow at noon I go fasting to see my gastroenterologist.  Not, thank God!, for a colonoscopy, but for an endoscopy to look at the upper GI tract.  My colonoscopy doctor is a good guy who buys all of my books (punishment for putting me through all those colonoscopies! (I have one every three years because my mom died of colon cancer at 85.)

So, I’ll be at the San Antonio Gastroenterology Center tomorrow and next week will begin maintenance therapies for the remaining cancers.  If you have read this far, I can tell you that Doc Onc1 thinks I’ll be on “maintenance” for at least a year and that my outlook remains incredibly positive.