Chemo: week 3 - and holding

Week 3 begins today.
Week 2 had been pretty mild (not too much discomfort or fatigue) so we weren't quite as apprehensive about another treatment as we drove to the chemo place yesterday afternoon. After my blood test, we met with Oncologist (my usual Dr. this time - not his 'don't do anything fun' colleague).

After asking all about the past week (symptoms, any problems, ability to work, etc. ) and checking me over ("any pain here?", "deep breaths", etc.) he was pleased with my progress. It was all good.

But when the results of the blood tests came in he was concerned that my hemoglobin had dropped so much during the past week and, although it was still well within safe range, he was afraid another dose of Gemcenobin would take these numbers down farther than we wanted. Rather than risk a protracted illness, he concluded that we take the following course:

1. Stop our first cycle at the two treatments we've already taken.
2. Take this week off to give the blood counts time to recover. 
3. Stay with our plan to take next week off as well.
4. Begin the second cycle on September 7th at a slightly reduced dose - so my counts don't drop as much.

Woo Hoo (right?)

Well, we're not sure. It's great to have a week without that stuff going into my system. Even though it didn't have much effect on what I've been able to do, it was NOT a pleasant experience. But a week off is a week that the cancer killers will not be in my system and, according to Oncologist, any cancer cells will begin to grow again (though they will be starting from a reduced level). It illustrates what a delicate balancing act this chemo treatment is.

Notes from meeting with Doctor:
This is the first time we've met with our Oncologist since the first treatment so we all had questions:

1. OLD SWICHEROO: Cisplatin VS Carboplatin. Cisplatin isn't currently available so we're limited to Carboplatin until that changes. Carboplatin isn't used as much as Cisplatin but, according to Oncologist,  it is generally considered to be equivalent. It also tends to have milder side effects but this doesn't seem to effect it's potency as a cancer killer. When the pharmacy tells us that Cisplatin is available we could switch back for the remaining treatments but there doesn't seem to be any reason to do this. Oncologist asked me if this would be something I would want to do? I say, why risk more severe side effects for no added benefit. He agrees.
2. COMFORT FOOD: I gained 3 pounds since last week (after loosing ~ 4 the week before). Wife credits this to my eating all the time (virtually) to keep food in my gut (at suggestion of Chemonurse to prevent nausea and relieve discomfort). Oncologist suggests a different tact: queasiness and discomfort  may simply be indigestion caused by the chemo drugs destroying the mucus lining to the stomach and intestines. Since there are no sensory nerves in the stomach the resulting symptoms (body's call for help), although manifesting itself differently in different people, is basically just acid refulux (which seems to be the diagnosis for everything these days - have you noticed?)  And this can be relieved by taking antacids like Tums or Prilosec (12 hour relief). 
3. BATTLE OF ATTRITION: So Wife asked Oncologist what happens to the cancer when we pause treatment like this.  He said it starts growing again, of course. Seeing our concern, he quickly added that this is quite normal. He drew a graph with the curve of a exponential decline that drops quickly at the beginning and tapers off to nearly horizontal. He said; "This is what happens to the cancer over time during chemotherapy." "But", he continued; "if you look closely at the line you will see that it is really a series of humps and valleys where each valley drops lower than the last.  So, even though the cancer recovers a little between chemo cycles, each cycle knocks it down more and more until it's so low that it will not recover." Attrition:  keep pounding away at the enemy until it just gets tired of the beating and gives up. 
4. REVISITING THE PLAN: 
   
   
   
   
   
   • We take the next two weeks off to let my counts recover and resume with cycle two as planned.
   • We will adjust the doses down to maintain count levels throughout the complete cycle.
   • Complete two more cycles (for a total of three) and then evaluate whether to stop and do the surgery or to continue with chemo for the total of seven.

So now what to do with all this extra 'feeling good' time? Tonight I umpired a Fall Ball little league game and tomorrow I will Ump a double header. It doesn't get much better than that!