Lee and I have just arrived home from the hospital after my third lung biopsy in about the last four months. I’m getting pretty good at this lung biopsy business. Maybe I should write a “how to” book, Lung Biopsies for Dummies.
That last infusion of the oncolytic virus Enad certainly kicked my butt and I didn’t fully recover until Sunday. You will recall it was determined that I should have no further infusions of Enad since I had reached my MTD. Question: I wonder how much difference there is between the Maximum Tolerated Dose vs. the Minimum Terminal Dose? Just wondering. But it does not appear there was any permanent damage to little Jimmy. The worst symptom after the firestorm on infusion day was the swelling of my lower extremities, especially my polio-impacted left foot. Since I have very poor circulation in my left leg and foot, I am susceptible to edema. I found myself icing down and massaging my fat, puffy left foot and lower leg multiple times a day. Getting my left leg out of my brace was like removing a sausage from its casing. But by Sunday it was much better and I was ready to do battle again.
Monday I had my normal “day before infusion” blood draw and physical with Dr. M. This is typically a routine and uneventful few hours, so Lee elected to stay home to visit with the Air Conditioning man. I’m glad she did, it was triple digits today! However, this particular meeting was anything but routine. Evidently Dr. M had been cogitating about my nagging cough. He was now deviating from his prior pronouncement of last Wednesday when he informed us that we would go forward on the trial as scheduled with an Opdivo infusion on May 2. Now he wanted to hold off Opdivo until he had a better understanding of that cough of mine. At my ER visit they took some X-rays of my lungs, and he saw something he found suspicious. A valid concern since one of the more serious side effects of Opdivo are lung issues. He arranged for me to have a CT scan of my lungs as soon as I left his office and, after looking at the scan, called me later that afternoon with reaffirmed concerns. I wondered if Dr. M was gonna drop me from the trial. But he is not a lung expert so he had me see the head pulmonologist at the Cancer Center on Thursday.
Dr. K is the program director of Interventional Pulmonary at the University of Arizona School of Medicine. His major flaw is that he graduated from the Ohio State University. I have horrible memories of the NCAA football championship game a couple of years ago when his Buckeyes threw my cherished Ducks around the stadium like they were, well, like they were toy ducks! But he seemed like a nice guy and after reviewing the CT scan and examining me, he was confident that he can help me with my cough. He gave me prescriptions for a more powerful inhaler and some magic nasal spray. In addition he will perform a bronchoscopy to see if anything is blocking or collapsing my airway. If there is blockage he will remove it, if there is outside pressure he can put in a stent to keep the air flowing. He also felt that I should be able to continue on the trial, but that is not his call. While in his office, we asked if he could send us the CT scan report, which details tumor status. Much to our dismay there was growth in the tumors along with some new “baby” tumors since my last scan on March 1. We are now wondering if Dr. M (or the trial sponsor) will drop us because of disease progression. On Monday I have another CT scan of my abdomen and pelvis to see what is going on in the liver and other gut areas. Cancer can pop up anywhere at any time for a Stage IV Colon Cancer patient.
Although there has been significant tumor growth since March 1 in my lungs, my first and only dose of Opdivo was just three weeks ago. When did the growth occur? I wonder if maybe the growth was before Opdivo? There is also the phenomenon of “pseudo-progression” when dealing with immunotherapy. I wonder if it is a case of pseudo-progression? Sometimes it looks like progression on a CT scan, but it isn’t, and may precede a good and prolonged positive response. Isn’t cancer fun? No one knows for sure most of the time. We are not the only people wondering. So are the oncologists.
In any case, this will all sort itself out soon enough. I have a lot of wondering goin’ on, but I have no wondering about what I will be wearing and drinking tonight. I’m wearing my favorite new wine shirt (thanks Carl and Gerrie) and drinking arguably one of the finest Chardonnays in the world (double thanks, Max).
Live Life to its Fullest!!!