I had a triple appointment yesterday (three and a half hours, with breaks): blood draw, then the oncologist, then infusion. The oncologist meeting is to go over the results of the blood draw and to discuss any side-effects I may be having. The levels of a certain enzyme associated with the liver are again high, even higher than they were before. As to side-effects, the concerns I expressed in previous posts were certainly overblown (I must sheepishly admit, baa baa). The most prominent of these is fatigue---more on this below---but there doesn't seem to be anything you can do about it. I've had some stomach upset too, but not too bad. Then you start wondering: gosh, I'm out of breath walking up this hill; is it the pembro or am I just out of shape? However, when I mentioned to the onc that I'd done a nine-mile Father's Day hike with Jessie, he kind of laughed and said he wouldn't worry about out-of-breathness.
The other new development is that I've been having various pains on the right side of the abdomen. My theory is that these are due to too much tossing the grandkids around and/or some of my blackberry hacking, both of which could stress rarely-used muscles. But since the right side is where the liver is, it seemed a good precaution to mention it to the onc. In particular, I've been having some weird pain in and around the right clavicle. The onc suggested two possible cancer-related explanations: First, the tumor in the liver could be pressing on the bottom of the diaphragm, which can cause pain---so-called ``referred pain''---in a completely different area such as the clavicle. Second is the worst-case scenario of cancer spreading to the bones. For that reason he wants me to have a bone scan.
Personally I think this is all a very expensive wild-goose chase; I'm guessing it's just some kind of muscle or ligament tear resulting from carrying around garbage cans filled with heavy weeds. On the other hand, I've had so many blood draws, CT-scans and infusions that I'm getting bored with them, and it will be interesting to undergo a new test administered by Nuclear Medicine (that's really the name of the department!). They inject you with something, I think radioactive waste from the Hanford Reservation, then you sit around for three hours to let it fully circulate (into your bones, I guess). After that they scan in some way. It will be interesting to see. Oh, I just got some new information: For the scan part you're supposed to drink lots of liquids and then lie flat on your back without moving for one to two hours. Yeah, right. I could also walk upside down on the ceiling while juggling seven hedgehogs and playing Rachmaninoff piano sonatas on the kazoo.
By the way, I was wrong about the first infusion being a half-dose. I was sure that's what they told me, but I was certainly pleased to learn that the second dose is the same as the first. Tom and Dana were there this time. Alway fun to see them.
Back to the fatigue: Sometimes I feel like I need to lie down every two hours. But I did the 9-mile hike, and of course remain true to my motto: If you don't feel like going out for a walk, you should immediately go out for a walk. Today for instance I did a double-hiller in the park. Although I felt fine during it, by the time I got back to the house I felt ready to collapse. I've discovered though, my motto notwithstanding, that it's best not to fight it too much. It seems ridiculous to lie down for a nap when I just had one two hours before, but it makes the fatigue manageable. Surprisingly, I'm even getting some good work done. Although I've been a total has-been in research the last few years, I'm actually writing a paper with my student (``The Duflot filtration in equivariant topology'', if you were dying to know). We'll probably submit it to a top journal such as Quilter's Corner or The Bass-Fishing Almanac. In any case, it's nice to feel I'm doing something again, modest though it may be.
The most exciting recent event was Mikayla Weissman's wedding. I could write a whole blog about that, but I'm running out of steam and will just say: Beautiful wedding. Beautiful bride. Amazing family. Amazing friends. Wonderful!