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Posts Tagged ‘Avastin’


Three bags.

September 4, 2011

(NOTE: I had my monthly maintenance last Tuesday, August 20.)

counted three bag…one…two…three. Half-dazed from the “happy cocktail” (combination of benadryl and zantac) that my nurse gave me, I saw three IV bags hanging for infusion.

It should be a relatively short session at the cancer infusion center without the fourth chemo drug, Avastin. As much as I wanted to stay awake, I was fading to my drug-induced sleep. These drugs only make the time go faster and the effect to me is not a restful sleep. It is different unlike when you sleep after a long hard run.

I am back in the hole again.

It would be interesting to see if I will be able to run faster without Avastin. As planned, I am being weaned out of Avastin in case I need surgery. Avastin prevents new blood vessel from forming (to choke off tumors); if I have surgery, I will not heal. With no new blood vessel forming, I am handicapped each time I run or train. It also mean my muscles are not getting fully oxygenated and require longer time to heal. Thus, I am prone to injuries.

Not this time, my Kenyan brothers. I will be on your chasing you guys this coming October. You better be ready.

I found this video on cancer by Sal Khan.  A simplistic way to understand cancer.

http://www.khanacademy.org/video/cancer?playlist=Biology

Cheers.

P.S. My CEA level (tumor count) had an incremental increase from 1.6 to 1.8. It is still within the limits. I hope it levels off.  Over the weekend we did 12 miles this weekend.  It was a struggle for me since I have not fully recovered from my treatment.  But it is done.

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The plan.

August 13, 2011

ore than a week ago, my wife and I met with my oncologist to come out with a plan for my disappointing PET scan. Still not convinced about the threatening presence of the six nodules in my lungs, he wanted to observe them first.

“The nodules are less than a centimeter. It is difficult to determine if they are cancerous. However, I had consulted with another radiologist and he seems to agree that it is metastatic cancer.” Dr. M said.

I sense his dilemma. He sees me as healthy with no outward sign of lung cancer and yet he cannot dispute the scans. My tumor counts or CEA level are within threshold levels too. He asks about my recent trip to the Philippines if I had cough, fever, and lost weight.

 “I lost weight due to traveler’s diarrhea and had coughs due to my allergies.” I replied. He wants to rule out if it is fungal in nature.

In any case, after thinking it through he suggests the following;

  • Continue with my monthly chemo maintenance this August but remove Avastin from the series. Avastin inhibits the growth of new blood vessel that chokes off blood supply to cancer tumors. I need to be weaned out of Avastin in case I undergo video-assisted thoracic surgery (VATS), otherwise I can have bleeding complication.
  • For September, skip the chemo maintenance to see if the nodules grow in numbers and size.
  • In October, we do another CT scan of the chest to determine if there are any cancer activity. Should there be cancer activity, we put you on intensive chemo for six-months.

The idea of another six-months of chemo did not exactly go done well with me. I hate this poison. I hate it. I hate it. Its bad enough I had to do it once a month but to take it weekly or every other week for several days is not exactly exciting.  And oh, the side-effects is another one: the vomitting, nausea, chills, diarrhea, constipation, and others. You think after going through this twice for six-months and once a week, I would get use to it. N-O. No.

Did I tell you I hate it.

And yet I would do it again, if needed.  It is all for you. It is for a chance to still be here and enjoy another day, run another marathon, a 5k or a half-marathon.  Yes, I would do it again for the third time.

Tomorrow, I will run the Chicago Rock n Roll Half-marathon and get to see some of my American Cancer Society friends and athletes. For the next three hours I forget I have cancer. It will be another adrenaline rush moment and the plan is to enjoy every painful moment of it. Ha!

Cheers.

Notes:  Surgery is not an option because the nodules are present in both lungs.  You cannot take out both lungs.  Radiation carry a high risk of damaging good tissues since the nodules are small, less than a centimeter in size.  The best option is systemic chemo.

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A Glimpse of the future.

August 25, 2010

caught a glimpse of the future yesterday.

Yesterday, was my first chemo maintenance treatment. It was no different from all the other chemo treatments that I have had since 2008, but somehow I expected this to be a different experience.   Why is that?

One distinct difference is that I did not come home with a portable pump attached to my my hip. My family calls it my personal “iPod.”  Before I was attached to my “iPod” for two-days.  You could imagine how difficult for me to sleep with it and go to the bathroom.

Another difference is the maintenance doze is suppose to be milder according to my oncologist, lower toxicity, but it will still be the same regiment of FOLFIRI plus Avastin. I don’t know about that. Perhaps, I have a different definition of what is mild.  I would rather not do this again.

But there I was bright and early at the hospital.

“Are we ready, Bo?” Nurse Edith greeted me.

“Uh..huh.” I replied enthusiastically.  (Maybe I would rather have a root canal).

I was alone this time around when normally my mom (in Canada) and wife (still at work) would accompany me.  I brought my laptop and plan to do some work or see if I can do some work, since the hospital has wireless.

Drip…drip…drip.  It started and I was out again.  Those darn happy cocktails always do the trick.  I started waking up three hours into the infusion with still two bags more to go.  My wife is beside me now sleeping occupying more than half of the bed. Poor girl, must be another busy night at the ER.  I did managed to get some work done while waiting for the rest of the treatment to complete.

Later at home, I experienced the side-effects.  First the runny nose, then the hiccups, and a queasy stomach bordering on nausea.  I tried working through it but later in the day I was wasted.

I even had a scheduled a conference call and the people on the call did not realize I was all buzzed up with chemo juice.  Chemo on the rocks, baby, shaken not stirred.

“Uh, huh. Sounds good to me. Ok.” I would hear myself say, but I did managed to say it intelligently and not barf on the phone. No sobriety test for me.

So this is how it is going to be from now on. Once a month, I am reminded of reality. Just when I am slowly building my confidence I have this once a month reality check.  I imagine myself living normal a cancer-free life, then the ‘pause’ button is hit.  This pause is long enough to shake my confidence.  Can I do this for the rest of my life?  How am I going to finish the marathon or much less complete the 18 mile training this weekend?

At the same time, it gives me periodic renewal of how I look at life.  It is precious.  Sometimes we get blinded by the success we have in life forgetting it is just borrowed time.  Then it happens, somebody hits the ‘pause’ button.  Why?  Because shit happens.

The future also tells me that I may need to lower my expectation of running future marathons. Marathon training is grueling as you get to double-digit mileage.  Now, I am entering a different phase wherein I have to manage the high mileage and chemo.  That darn ‘pause’ button.

Nonetheless, life is good.  I am still here given the chance to run and do my best.

Cheers.

First chemo maintenance. Working at hospital while nurse Edith infuses me.

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The epilogue.

August 2, 2010

just finished a kidnap-mystery book by Harlan Coben, titled “No second chance.” The epilogue told me what happened in the end when the main character got her daughter back. It reminded me of my own epilogue to my cancer story. For me it was a mixed ending; my regular chemo treatment has ended and now I begin the chemo maintenance phase.

Congratulations on finishing your treatment” Dr. M, my oncologist greeted me during our consult.

He tried to lift my spirits up because the last time I finished my treatment I was in a graduation toga. Don’t get me wrong, I am so glad I have completed my treatment with very side-effects and no hiccups along the way, but it is not the same.  Anyway, Dr. M explained to me the pros and cons of undergoing chemo maintenance. He concedes that there is no study to support chemo maintenance prevents recurrence of cancer. However, considering my case and the type of cancer that I have, he recommends it for me.

How did you handle your chemo treatments? Did you have many side-effects?” He asks.

I did not have diarrhea from Irinotecan (one of the chemo drugs). I had constant nausea and limited vomitting.” I replied

Based on this feedback, he created a plan for my chemo maintenance. The plan was to have chemo once a month with the same regiment FOLFIRI plus Avastin, but lower toxicity.  He said, the maintenance should not interfere with my lifestyle or work. If I have severe reactions to the lowered regiment, he will adjust it.

We do the chemo maintenance for the next two years and from there assess your progress, and perhaps stop it for good. Is this ok with you?”

What can I say? I thought we had a good plan and willing to try it. He has been very good to me and I trust him fully. He told me to coordinate with Edith, my nurse as to the schedule of my first chemo maintenance.

You know with this treatment plan, I will surely fail the drug test when I win the Chicago marathon this October.” I joked. Oh, well.

Cheers.

PS:  Over the weekend, my wife completed her first half-marathon she dedicated for me.  I am proud of you, babes.

She finished!

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First day at school…chemo school

January 12, 2010

Some people dread the first day of school others look forward to it.  Mine was mixed.  It is not always you get to repeat your chemo regiment.  I thought I graduated ‘Suma cum laude’ last October 2008 but here I am again on the first day of school (see my graduation picture below).

I arrived at the hospital cancer center at about 8:45 am but my day had already started at 5;30 am getting ready for first day of chemo.  However, this is morning was going to be different.  I had a slip from the principal’s office (Dr. M the oncologist) that I need to go to the ultra-sound center first before going to class.  They needed to rule out if my stomach pains was “contagious” (to other students) by performing an ultra-sound to the liver.

So, with my shirt up and on top of the ultra-sound table, Ibbie (from Iraq) dabbed a healthy swab warm gel on my belly.

“You like that, huh?” she said and I said “yes.” Hmm…so this is how it feels like when mothers have ultra-sound scans of their babies.

“I had to get that warmed up gel from the other room because somebody messed with the one I left here last night” she adds.  Later she said, she could not see the lesions in my liver  (maybe is it gone, I thought).  I told her that I have a PET scan on file dated November 10, 2009.

I like Ibbie.  She managed to track the lesions took lots of pictures of my liver and even my gallstones.  My only regret she did not give me a copy of the pictures like expectant mothers of their babies after coming out of their scans.  Oh well.

So off to class I go.  But first got to eat breakfast.  With all this excitement I have not eaten…er actually, I was not allowed eat since the night before in preparation for the liver scan.  I had breakfast with my wife, who just got off her nursing shift, and my daughter, Talia, who drove for me.  You got to eat something for you to vomit something I always say…opps, sorry.

“The place has not changed.”  I thought while walking through the cancer infusion center (classroom).  The people working there are the same but the patients are different.  Most of them in their chairs hooked up to their chemo pumps while their families sit and wait for them.  They have glassy eyes, while some are asleep trying to dream away the time.

There is the rhymic drops of chemo as it hangs beside them, the intermittent beeping of infusion pumps signaling the end of one chemo bag, only to be interrupted by the sounds from the individualized TV in your chair.  And how about that smell.  I don’t think normal people (those without cancer) can smell it.  I call it the smell of chemo, so distinct, toxic, and at times nauseating.  It sticks to my shirt and pillows when I have chills.

My nurse (teacher), Edith sees me and hovers over me.  You see I am the teacher’s pet.

“Your normal chair is occupied but I think I have something better for you sweetie.” See,  what did I tell you!  She sets me up in a room with a bed, TV, and a private bathroom.  Yes!  Maybe the wife and I can have some private time too, you know.

Today’s lesson requires about 6 hours of study time.  I will be taking the FOLFIRI regiment again plus another chemo drug called Avastin.  FOLFIRI is a combination of three chemo drugs Leucovorin, 5-FU, and Irrinotecan.  With Avastin, that make four chemo drugs.

Edith gave me first my happy cocktail of Benedryl to make me sleep and Zantac to calm my stomach.  And we now proceed with my studies.  After one subject down, Irrinotecan, she gave me Avastin, then Leucovorin.  I struggled with this drug and I felt the compounding heaviness of each doze given.  I told her I felt heavy, tired, and starting to feel nauseated.  The infusion was long and I was losing spirit.  I look at the infusion bags and I still have two bags to finish it is like being at mile marker 20.  How can two bags feel like mile marker 20 of a marathon?  But it does give you that feeling of hopelessness.

I think of the all other cancer patient going through this ordeal.  I need not look far since a lot of them are here with me, just outside the door.  Everyday they are here since the time I ‘graduated’ October 2008.  I think I look like them now, glassy-eyed and getting tired.  My walk is slower going to the bathroom.  I refuse to vomit and try to contain it in the next breath to then next until it passes.

With all the infusion bags done, no vomits, and six-hours of infusion completed at the hospital, Edith send me home with a take home exam.  One last doze of 5-FU inside a portable chemo pump that I have to wear until Thursday, a three-day/two-nite infusion.

Bell rings, school is out.  Thank God!

Cheers.

October 2008 Graduation Day!

October 2008 Graduation Day! With my wife, Dr. M, and me

January 2010 First day at chemo school. Go ACS!

At home hooked up to the portable chemo pump

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