Yesterday, all my troubles . . . After a good week-plus off of chemo, a week during which I felt reasonably healthy -- I even ran in a local Tamalpa club race -- anxiety started to build as I approached my first CT scan since my diagnosis. The anxiety was largely due to not "knowing," something that has been and will continue to be one of the challenges I must deal with regularly. There are times when any news, good or bad, is better than no news at all. Although, another piece of the anxiety puzzle lies in the "waiting for the other shoe to drop" feeling that lurks behind the scenes, now and then making itself felt. If I sound a bit ambiguous, you are getting an insight into how my life works these days -- kind of, "I want to know, but . . ."
Yesterday, I met my doctor and received the results of Tuesday's CT scan and other tests. In short, after two cycles of chemotherapy, the results are "mixed" -- something of a good news-bad news scenario, but with most of the emphasis on the good. The good stuff: my CA 19-9 levels are still down, which means less tumor activity; pain levels are down and manageable without narcotics; my appetite is getting better which explains the return of some of the weight I had lost (In Jane's eyes, I've gone from gaunt and emaciated to just skinny); I'm able to enjoy life without restrictions -- well, almost. Jane doesn't want me riding my bike, crashing and bleeding out due to my reduced blood-clotting ability. The fact that I recently tripped over a waste-paper basket at home and bled profusely from a scraped shin hasn't helped my case very much. As far as the results of the CT scan go, the scan showed that the primary tumor in my pancreas appears to be responding to the gemcitabine and shows necrosis (parts of it are dying!); it also showed no further metastases, something I was concerned about. On the other side of the equation, the tumors in my liver do not seem to be responding to the chemotherapy as well as the tumor in my pancreas. While all still remain small, some have shown growth; however, all my liver tests are normal which indicates that they are not interfering with liver function. These results, while not what I had hoped for in a best-case scenario, simply mean that I've had to take the next step in the program. I knew from the start that a second drug would be added to my chemotherapy regimen as soon as there was evidence that the gemcitabine alone wasn't proving effective enough. While I had hoped that it would have been later rather than sooner, I did receive my first treatment with bevacizumab (Avastin) yesterday -- C3D1, for those keeping track. This is the experimental part of the trial. Avastin is an "angiogenesis suppressor," a bioengineered compound that interferes with the production of new blood vessels by tumor cells (and other cells in the body -- hence some side effects including increased blood pressure and nose bleeds). The result is that the tumors cannot get the oxygen and nutrients they need and the tumor cells die. It has been shown to be successful in the treatment of colon, lung and other cancers, and hopefully will be as successful in some people with pancreactic cancer, including me.
It is being given in addition to the gemcitabine, so my time in a chair in the infusion center has stretched out to 3+ hours. As oxymoronic as it sounds, sitting in a recliner alternatively reading, listening to music, praying, napping, induced a weariness in me that I haven't felt in quite a while. Part of it, I'm sure, was due to the release of the "not knowing" anxiety I had carried the past few days, and part was knowing where I stand in respect to my disease. Even though I knew and expected to be right where I am with my treatment at some point, the sobering reality of it weighs heavily on mind and spirit and rekindles the uncertainty that plagues me at times. And even that feeling is to be expected, a part of the roller coaster of emotion that I and those close to me will have to ride indefinitely.
I continue to be hopeful; there is really no reason not to at this point in my treatment since most of the results are good, and I need to keep reminding myself of that. I did meet a parent yesterday of two of my ex-students. He was at the infusion center receiving treatment for a cancer that was first diagnosed over five years ago. He has been in several trials at UCSF, each time receiving treatments that would shrink the tumors only to see them eventually resist the therapy. His attitude and spirit were inspiring. He has never lost hope, and I need to follow his example. As always, the prayers and support of so many will help me continue to play that one string I have -- an attitude of hope and optimism.
Peace,
Don
PS: For you cartoon trivia fans, the fast-talking mouse I referred to in my last blog was a Merry Melodies character named Sniffles -- he last appeared in a cartoon in 1946, the year I was born.
