Update details

My last update was oversimplified. I was surprised to learn from the oncologist that the cancer develops a resistance to chemo over time. (To be honest, I was a bit annoyed that he'd never mentioned this before.) Furthermore, he says, the worst thing to do is to take a break and then restart it; apparently this only helps the cancer cells to regroup and defeat the cisplatin/gemcitabine. But restarting the chemo sooner is also of dubious value, so I saw no need to do so, and he didn't argue. But he was adamant that it would be pointless to return to chemo after the next scan in three months. The upshot, in other words, is that I am now done with the chemo but not with the cancer. It looks like I have two options left.

The first is the atezolizumab immunotherapy discussed in an earlier post. Contrary to what I thought, I would definitely be eligible for this. Regarding the nasty side-effects, he said that urinary tract infection, described as occuring in fifty percent of patients in some of the online literature, has nothing to do with the therapy and is (unsurprisingly) caused by the bladder cancer itself. The one side-effect he emphasized was colitis, which can be serious and occurs in ten percent of patients. There is no guarantee that the therapy will work, or if does work, for how long.

If it doesn't work, the possible remaining option is (as I understand it) to join a different research study with another immunotherapy agent. This is the one that is only an option if I have the right PDL's or something like that. If I don't, I guess it's on to voodoo or snake-handling.
I remain optimistic, and don't worry about any of this. But at the same time, I can't avoid being realistic. I find it much easier, almost comforting in a perhaps strange way, to face the facts directly. The tumor in the bladder is still there, and in view of what happened last winter leading up to the TURBT in spring, it seems unlikely that it is going to just go away. Whether it is in three months or six months, or whatever, I expect further treatment will be required. If the atezolizumab yields a so-called ``complete response'', a misleading term that in no way implies a permanent cure, great. It is possible, although apparently rare, for it to achieve a complete cure. If it doesn't work, and the third option doesn't pan out, I may have reached the end of the line. But why worry? We all reach the end of the line, sooner or later.

It was also stressed that if I have any symptoms before the next scan, I should report them immediately. Duh. But I still don't have any. I'm asked regularly: ``Do you have any pain? Do you have any pain?'' Sometimes I get the impression they're surprised I'm still alive. No, I do not have any pain. Never have. Yesterday a nurse wanted me to come in for yet another blood draw. But why?
I'm done with the chemo. Maybe my platelets are still low, so I should avoid stabbing myself with sharp objects. But I've never had any problem with it. Yesterday, in this oddly warm weather, I did my beloved bike-and-hike and felt great. Clearly the other red blood cells are back, why not the platelets? Besides, my platelets are of exceptional quality. Seriously, I think it's been proven.
So I'm not going in for the draw, although I will have to have the old chest port flushed once a month. (Taking it out is a major project, and so isn't worth doing as I may need it again.)

In short, the future is still very uncertain. But that's always true, is it not?

There's a Chinese student in my class who in his first email to me addressed me as ``Dear Old Steve''. Maybe I already mentioned this. In a more recent email he said ``You are the cute and affable professor''. That's not a comment I get often!

A dark day for America

It's official: Our country has declared to the world that it represents hatred, bigotry, racism, sexism, xenophobia, and most of all, ignorance. The know-nothings have finally succeeded in electing a candidate who knows even less than they do. Early attempts---Reagan, George W.---came close, but now we have a president who knows absolutely nothing about government, foreign affairs, and the world beyond Trump Towers. The bigger difference is that in Reagan and George W. one could, under close examination, detect a core of decency. Trump, on the other hand, is nothing but a con man---a self-centered, egotistical, greedy, vulgar con man who cares for no one but himself, tells nothing but lies and will likely betray even the poor suckers who voted for him.

With congress too under their control, the Republicans will now set about gleefully destroying America: attacking a woman's right to choose, ensuring that health care in America remains astronomically high, screwing the poor, destroying the environment, wreaking havoc around the world and all the while pursuing what has always been their highest priority: cutting taxes for the rich. As always under Republican administrations, spending will meanwhile be increased, preferably on a war such as George W.'s on which their rich friends (Haliburton, e.g.) can shamelessly profit. Then they will act surprised that the deficit has gone up.

The grotesque hypocrisy exposed by Trump's campaign will continue. ``Character matters'', a favorite maxim of conservatives, is now seen for what it is: a lie. Character, apparently, doesn't matter at all. The hypocrisy of the Christian right, including especially Pence, is now laid bare for all to see. If one were to seek the anti-Christ personified, one can scarcely imagine a person more antithetical to the Christ portrayed in the gospels than Trump. In Trump we have a serial adulterer who denigrates and abuses women, incites violence, openly insults entire nations, peoples and religions, mocks war veterans and the handicapped, cheats, lies almost every time he opens his mouth, and has never in his life lifted a finger to help the less fortunate. Yes, character matters.

I don't like to make facile comparisons with Hitler, but he and Trump do have one characteristic in common--that of being a petty, mediocre person who discovered relatively late in life his true talent: rabble-rousing. Trump is the classic demagogue, that is, to quote the dictionary, ``a politician who gains power and popularity by arousing the emotions, passions and prejudices of the people''. We like to think that ``it couldn't happen here'', and I'm not saying it will. But ``it'' definitely could. One can only hope that enough decent Republicans are left to rein in Trump's worst excesses.

My cancer is of no significance, compared to the cancer now metastasizing in the United States of America. I don't really even want to talk about it. I'll just say that the CT-scan results were what I expected, namely that the cancer in the liver has been slightly reduced, that of the lymph nodes is either reduced or stable, and in the bladder itself the tumor is also stable. I won't be getting any treatments for at least three months, so I'm happy about that. Maybe later I'll post a more complete run-down, but in the big scheme of things none of this matters.

To end on a more positive note: In the main lobby of the Med Center there's a piano, and as I was leaving a young woman was playing Debussy's famous Arabesque, which to me is one of the most hauntingly beautiful piano pieces ever written. Despite having an important party to get to (see below), I had to stop for five minutes and listen. I don't know why, but it gave me hope.

As to the party, Kaia turned seven today! A splendid time was had by all. Her little brother, who is not known for his patience when it comes to such things as birthday cake, ice cream and presents (even his sister's), came out with many memorable lines. As dinner  plates were being cleared, cake was being readied, and the adults were vainly attempting to have an adult conversation, Finley interrupted with ``Guys, guys!! Would you please stop talking so we can get on with the birthday party?''

Life goes on.

Brief update

The latest (and tenth) cycle of chemo was the worst I've had yet. I was definitely not a happy camper, and even cancelled my classes on the post-Cisplatin Monday. You don't want to know the details.
As the last day or two I'm finally on the upswing, and it is a great feeling! Today's blood draw, however, showed I am at my lowest hematocrit level ever (no wonder I've been tired). Platelets very low too, prompting the nurse to give the canonical warning--no sword juggling, alligator wrestling, etc. But the counts can only go up from here. There is another suite of lab results involving potassium, sodium, creatinine etc. and on these my results prompted superlatives such as ``stellar'', ``perfect'' etc. I think I'll post them on the refrigerator with a big gold star. Then again, maybe she's an easy grader.

Speaking of grading, while waiting around for the lab results I graded the first problem on today's topology midterm. The results were disappointing, even depressing. This was the easiest exam I've ever given at this level, and the first problem in particular was supposed to be a freebie. Only 8 out of 45 students got it right (including of course that sophomore they wouldn't let register for
the class). This was the one problem where they didn't have to prove anything but could just give the answer. These are senior math majors, but some of them couldn't even draw/visualize the graph of a simple function appearing in the problem, and even those that could seemed to have almost no intuition for the concept of ``limit point'' that we've been studying all quarter and
is not even a new concept; they see it in a simpler context in earlier courses. In the worst cases they wrote total nonsense.

What do I do? I'm really at a loss. Maybe they'll do better on the other problems, which I'll start grading tomorrow. But I'm not optimistic. I suspect I'm going to have to suggest to a large number of students that they drop the course, as they are headed for the D/F range. I'm an easy grader up to a point, but this is ridiculous. As I keep saying to the department, we need to raise the standards for the math degree.

 On a happier note, I had fun visiting Finley's preschool yesterday. They speak Spanish for much of the class, which is fun for me; I can compare vocabulary and grammar points with Italian. I understand Spanish more than I used to, but there's plenty of vocabulary that's completely different. Finley seemed to get a big kick out of having grandpa in his class.

 And finally, Kaia is about to turn seven! We have the ``kid party'' on Sunday at a gymnastics venue, then the ``family party'' on the actual day, Wednesday. Fun!!