Cancer Blog

Tuesday, September 30, 2003

Plunging into the lemons market?

If there's one single thing I ask of an automobile, it is dependability. That's it. I don't care about anything else (although I am violently averse to SUVs). So when my car didn't even come close to starting this morning, I realized that it's time for me to face the music and accept the fact that my '93 Acura Integra is less than worthless. What to do now? Well, first of all, I will have the piece of crap checked out in order to fix whatever mysteriously went wrong as it sat there under the tree the last few days -- provided the fix is cheap (no, it's not the battery; I just bought a new one two months ago). Then I will liquidate some assets to free up some cash for the new, err...newer, automobile.

At that point I'll have a lemon and some cash on hand to exchange for a peach (note: lemon = bad used car, peach = good used car). I went to Kelly's Blue Book and found that I could expect to get $1400 for my car as a dealer trade-in or $2700 on the private market. Both numbers are too big for my particular lemon, and I don't want to buy a car through a dealer, so I'll probably just end up selling the car for scrap. If anybody reading this wants to pay more for my car than I can get by selling it for scrap, send me an e-mail and let's deal.

As for my new car... What I'm looking for is as good of a plain Honda Civic as I can find for around $7000. I'm considering going to eBay (the spellchecker corrected my initial spelling, Ebay). A cousin of mine recently bought a car from eBay and had a good experience. Of course I will do copious internet research before purchasing. Why a Honda Civic? I don't know... My family and I have had a lot of experience with Hondas (first car: '99 Honda Prelude; current car: Acura, which was great until 1 1/2 years ago) and, generally, they have been very reliable. Also, all I want out of the bloody car is to take me through grad school; just three (or at most five) worry-free years of service until I get my assistant professorship at NYU (ha... ha... ha...). For whatever reason, when I think "quality basic transportation", I think Honda Civic.

Let me be the first to congratulate myself on successfully completing a post on a subject other than my horrendous health. It was getting monotonous.

Wednesday, September 24, 2003

successful trip to Philly

Our internet has been down for the last few days so I wasn't able to post the good results from Monday's blood test. The platelets shot up to 196,000. Monday afternoon I flew to Baltimore and took the Amtrak train to Philadelphia. Yesterday I got my long-awaited chemo, Amtraked back to Baltimore, and flew back home.

By far the most exciting thing to happen on the trip was my allergic reaction to the Taxol (one of the chemotherapy drugs). This is one thing the nurses watch for closely, and after successfully taking the drugs a month ago --i.e., no allergic reaction-- I expected things to go smoothly again. Before starting the Taxol, the nurse told me to let her know if I started experiencing shortness of breath. After about 15 minutes of Taxol dripping into my vein I started to feel a little hot, and potentially nauseous, but no shortness of breath. I reclined in my chair and my nurse, seeing my face redden, hustled over from the other side of the room with an extremely alarmed look on her face. "Are you experiencing shortness of breath?" she asked, "No, not really", I mumbled through my ear-plugged haze. Then the blood really rushed to my head and suddenly a swarm of people were bustling around me. An oxygen line was placed in my nose, the Taxol was stopped, Benadryl, and then something more exotic, was injected, curtains were pulled around to isolate me. A couple of doctors, including my main doctor, were there almost instantly. It was really uncomfortable for a couple of minutes, but then as quickly as it started, it went away. The blood slowly drained from my head, the nurses relaxed, and my doctor ordered them to wait a half hour before starting the Taxol again. My nurse started the Taxol back up slowly at first, just in case, and everything was fine after that. To prevent this sort of thing from happening again I will have to take a pill 12 and 6 hours before receiving treatment in the future.

Other than that, the trip went smoothly. I feel ok today, just a little languid from the chemo. The real fatigue should set in tomorrow. Hopefully my stomach, which had been feeling particularly rough the last few days, will improve over the next week or so.

Friday, September 19, 2003

bloody platelets

I got the results from the blood test this morning and the platelet count was 94,000. I had hoped and expected that it would be comfortably above 100,000; oh well. The good news is that it has increased since Tuesday, so we can feel pretty confident that it will continue to increase. I will go in for another blood test Monday morning and if the platelets are above 100,000, fly up to Philadelphia that afternoon.

Wednesday, September 17, 2003

come back when you have more platelets

We ran into an unexpected problem yesterday in Philadelphia: my platelet count was too low to proceed with the second round of chemo. Platelets are the blood cells responsible for blood clotting and, like white blood cells, they are vulnerable to chemotherapy. Specifically, my platelet count yesterday morning was 89,000 and I needed at least 100,000 to be cleared for the chemo. The low count was a little surprising to my doctor because my platelet count from last Friday was 164,000 and my white blood counts have been solid for the last few weeks. It is a bit unusual for the platelets to drop while the white blood count remains high. It is true, however, that my platelet counts had been trending downward over the last couple of weeks. Before leaving Philly they drew blood a second time, just in case the first low result had been a sampling error. The second result, 93,000, was still too low for chemo.

So we returned to Nashville yesterday, mission unaccomplished. I will get blood drawn this Friday at Vanderbilt and again next Monday. If the platelets are above the 100,000 mark, then I will return to Philly next Monday evening and hopefully receive the chemo next Tuesday. In order to prevent this sort of wasted trip from occurring in the future we will probably have blood drawn in Nashville the day before I am scheduled to receive chemo in Philadelphia. Unfortunately low platelets now could mean that I will have platelet problems after each round of chemo and that the pace of treatment will slow down. Hopefully, since the white blood counts look so good, it's just an aberration.

One good thing did come out of the trip: we met a patient who started the same treatment program about a year ago. He was among the first group of seven melanoma patients to start the trial. Last September he had a small tumor in the adrenal gland and a fist sized tumor in his chest. After about seven months on the Bayer drug and chemo, both tumors were gone. This June, he stopped receiving the chemo part of the treatment and has, since that time, just been taking the pills. His case is similar to mine in that he is young, 27 (I'm 26), he went to stage III with disease in the lymph nodes of the left armpit, and then, after surgery, he started a year of Interferon. His disease went to stage IV after six months of Interferon. At that point, he was given biochemotherapy -- the most toxic treatment regimen available to melanoma patients -- which did little good. Then he started this trial last September and he is now disease free. Needless to say, he had nothing but good things to say about the drug. He also clued me into the real company behind the drug, Onyx Pharmaceuticals, Inc. The Bayer Corporation helped Onyx fund research and now distributes the drug. Take a look at the two year chart for Onyx. Not too shabby. Onyx, a smallish biotech company, dumped all their other projects to devote their resources to the melanoma drug and research into other, similar, inhibitor drugs. As long as Onyx's stock, and people like the guy I met up in Philadelphia, continue to do well, I can feel pretty good about my chances.

Monday, September 15, 2003

round two

Today we head back up to Philadelphia; tomorrow I will see my doctor and receive another dose of chemotherapy. The next set of ct scans will be done in another three weeks. I would actually expect these scans to be worse than the last set of scans which were done on August 1, since the cancer grew a lot from August 1-26 when I wasn't receiving any treatment. It might not be until the second round of ct scans, about 9 weeks from now, that we get a good idea about how effective this new treatment is. Until then, the best indication of the treatment's effectiveness is how I feel.

I finished up the Bayer pill Saturday morning. The rash, which had been improving late last week, has now all but vanished. Not much else to report, except that we had a nice weekend here in Nashville with my younger brother, older sister, and niece all visiting from out of town.

Wednesday, September 10, 2003

one bald would-be economist

Yesterday I noticed that if I ran my hand through the hair on the back or side of my head, a bunch of hair came out. Today, electric clippers abuzzing, I gave my doomed locks the coup de grace. So much for them. Maybe I'll see 'em again in a year or so, if all goes well.

My improvement continued until about the middle of last week when I apparently plateaued. I'm able to eat much better than before the treatment but I still have a long way to go. Then, late last week, one of the side effects from the Bayer drug kicked up. This was a rather intense and sometimes itchy rash on my hands and feet. The rash is still with me but, fortunately, it didn't get out of hand. (For some patients it can cover more than half their body and they have to suspend treatment). It should go away completely after I finish the pills for this first round Saturday morning. I will then have a couple of days with nothing at all before receiving another blast of chemo Tuesday in Philly. I'm looking forward to the chemo because, although I'm not certain about this, I suspect that the chemo does most of the tumor shrinking and that the Bayer drug enhances the effect of the chemo. So I should expect to improve the most immediately after receiving chemo before stabilizing after the chemo drops off. Each round of chemo takes another small bite out of the tumors.

Not too much else to report. The fact that the treatment has definitely done me some good makes me optimistic, but my spirits are a bit chastened because the pace of my improvement may not be as quick as I prematurely concluded last week. This is going to take time.


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