Friday, November 11, 2016

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!

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