Note: This was actually written about 17 months after my original diagnosis. I blame the miscount in the title on chemo brain.
The world is truly going off the rails as a result of Covid-19, and I’m doing a happy dance. No, wait, that came out wrong. My happy dance is because I had a CT scan yesterday and it showed significant shrinkage in my tumors! Chemotherapy is working! I’m happy, but to some it may look like I’m fiddling while Rome is burning.
The oncologist shows us the scan before starting treatment alongside yesterday’s scan. The large bladder tumor that crawled out of the prostate, the one that tried to choke my kidney to death, is significantly smaller and around a quarter of its original size. That is every bit as good as I dared to hope for going into the scan.
My understanding of the way chemotherapy works is that it usually kills off a fixed percentage of the cancer every cycle. For example, it may kill 50% of the cancer the first cycle, and then 50% of the remaining cancer the next cycle, leaving about 25%. Conveniently this seems to be exactly what’s happening in my case. With four more cycles to go it’s not unreasonable to expect the tumor to continue shrinking to 12%, 6%, 3%, and finally 1.5% of its original size. At that point it may be too small to be visible on a CT scan, but most likely there will still be a small colony of very hearty cancer cells left.
After chemotherapy, I’ll continue indefinitely on the immunotherapy drug. The hope here is to continue attacking what’s left of the cancer with my own immune system. Any stubborn spots could also be attacked with radiation. If I didn’t have such a great response to chemotherapy, I would have been referred for radiation treatment right now. The end goal of all this in the best case scenario is to drive the cancer to such a low level that it has great difficulty trying to grow back.
And those metastases in my liver? They’ve already shrunk to such an extent that they are all but undetectable in the CT scan. That is fantastic news. Cancer in the bones and bladder and prostate can be extremely painful but usually isn’t directly fatal. Cancer in the liver or another vital organ is a different story.
The oncologist didn’t say anything about the primary tumor in my prostate or the metastases in my bones, and I didn’t think to ask (yet). The scans were studied by both the oncologist and radiologist who spoke with each other. If there were any spots in the scans to worry about, they would have told me.
This is the first bit of objectively good news for me in 2020! It shows that the improvement in symptoms are a real reflection of the state of my cancer, and not due to some combination of painkillers and wishful thinking on my part.
Photo Ops
Some photos for those of you that don't follow me on Facebook (though there are a couple of never seen before photos included!). This section should be considered the slick marketing brochure that makes cancer seem like a fun filled journey, and not representative of the overall experience.
When I started this blog many years ago, it was supposed to be about cars as much as about running, and cancer was never part of the plan. Getting back to the original intent, here's me recently changing the oil in my Prius, a surprisingly easy job for such a complicated car:
Note the amount of hair loss / follicle damage my head has endured, that will be relevant when reading the next section.
And of course, any DIY service on a car should be followed by a celebratory scenic drive:
I also took a road trip down to Barre Falls Dam and had a walk along a short section of the Midstate Trail (which goes right down the top of the dam):
And finally, the last night of indoor track for the season, only days before everything started getting cancelled.
Blood Counts and Covid-19
Chemotherapy works by killing fast growing cells. If you have an aggressive, fast growing cancer like I do, then it can actually work better than it does for somebody with a slower growing cancer. The body has a lot of naturally fast growing cells like hair follicles, the cells that line the lungs and digestive tract, and blood cells. These cells are all killed by chemotherapy, but they will recover and with a bit of luck the cancer won’t.
As evidenced in the "oil filter" photo above, my follicles have been largely decimated by chemotherapy. What's not visible in the pictures is that my lungs and digestive system have been equally affected. After a few quick steps and a jumping catch in that last photo, I'm practically out of breath. The digestive damage shows up as a tendency to have frequent and sometimes loose bowel movements. To whoever has been hoarding all the toilet paper, please think of me and return the unused rolls to the store, or things will get rather messy in a few weeks. Trust me, you don't want to see the pictures of that, and my past history shows that I will post them. That's our agreement: no hoarding TP, and you won't have to look at any messy pictures.
Most chemotherapy drugs will affect blood counts, but the nature of the effect varies with the drug. On the Docetaxel chemotherapy I had last year, my blood counts would plummet in the first week, and by the end of the cycle regularly rebounded to above normal levels. I felt reasonably safe in public because for part of each cycle my immune system would be working very well, and there weren’t any uncontrolled viruses going around killing people in significant numbers.
It’s very different this time around. Carboplatin and Etoposide both have a longer laster effect on blood counts. My counts don't bottom until the second week, and haven't recovered to normal levels yet by the start of the next infusion (but have recovered enough to make the oncologist happy). The count that really matters for immunity from infections is the absolute neutrophil count, or ANC. Before chemo, mine would vary between 4 and 7, but anything above 2 is considered normal. I've been bottoming out during chemo at about 0.5, or roughly 10% of my normal infection fighting ability (assuming it's linear with blood counts, "I'm not a doctor" disclaimers apply).
Levels below 0.5 are considered severe neutropenia, and the risk of infection skyrockets. Forget Covid-19, we're talking about being careful flossing your teeth, because if your mouth bacteria gets into a bleeding gum it could spiral out of control, leading to hospitalization and IV antibiotics. I've also heard recommendations to avoid shaving with a razor and avoiding fresh fruit and uncooked vegetables. Of course I'm only just reaching that level, and only for a relatively short time. But, my counts aren't rebounding above normal like they did last time.
The other problem is that when my counts do recover to almost normal, I'm already into my next cycle and on a high dose of an immune suppressing steroid to help control the side effects of treatment. When that wears off my counts are already dropping again. There's really no time where I have full immune function. As a result, I was becoming socially distant before it became trendy.
Enter Covid-19, and I have developed a serious aversion to people. So of course, when I went to the hospital for my CT scan, they were directing everybody through the ER entrance so they could screen people (have you been out of the country? Do you have a fever?, etc.) and immediately isolate them if needed for further evaluation. This is all to protect the staff and patients in the hospital.
And now the funny bit: Who is the one person in the entire hospital who could process my co-payment for my scan? Why, the receptionist at the emergency entrance of course. Next question: Where would somebody with a severe case of Covid-19 go for treatment? To the emergency entrance of the hospital! Did I mention that my CT scan was scheduled when my immunity was at its lowest?
This all led to the death defying “Super Dave Osborne” stunt of my life: Standing around waiting at the entrance of the ER with a compromised immune system. This was social distancing done exactly wrong. The staff had masks and healthy immune systems and talked about the guy in really bad shape who was just admitted, probably with only a severe cold. I had nothing to protect me and waited while the receptionist battled an uncooperative printer for some time trying to get my receipt. If I’m dead of Covid-19 in a couple weeks, blame the printer.
On the bright side, I had stopped worrying about what my scan might show.
And now I return to my social isolation, heading outside only to exercise or go for a walk in the woods, and maybe occasionally hang around at the ER entrance. But hey, I’m an adrenaline junkie who will happily put my life in danger for the next adrenaline rush.
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