Last Chemo

TLDR: Finished last scheduled chemo today. Feeling much better overall.

I read an article recently about a European philosopher who described this post-atomic age we live in as ‘The Reprieve’. The gist is that mankind developed the means to exterminate itself, and it is only a matter of time before it happens. It’s a bleak concept for a Friday, so I’ll not dwell on it.

I’m living in a short reprieve between treatments, with the dark cloud of multiple surgeries on my horizon. My last scheduled chemo treatment concluded this morning. It is nice to have that stage behind me. Now I wait a few weeks to heal from this last chemo session, and then go in for some scans to see the state of the tumor.

Quick aside here – I was initially scheduled for 9 chemo treatments on 2 week intervals. During the visit for my 6th treatment, I told them I had decided to discontinue the oxaliplatin portion of chemo (which is the chemical with the most challenging short- and long-term effects). During that appointment, the oncologist suggested that we could do just 8 treatments instead of 9. ‘Eight, nine, it’s arbitrary’. Seemed odd to me. I was expecting a fight over my decision to stop the oxaliplatin, and instead I got agreement on the oxaliplatin and a chemo cycle reduction. Asked for a kitten and got a pony.

Fast forward to my 8th appointment this Wednesday, and they said ‘You’re doing pretty well – We could do 9 treatments’. Sure, I said, I could do 9. At Siteman in St. Louis, they are doing 12. ‘Yes, but they are doing FOLFOX and you decided to drop the oxaliplatin’. OK – So is there an advantage to doing 9 treatments? ‘Not that I can see’. OK… Well, let’s do 8 then?

Bear in mind none of this is based on any scans or data taken. There is no CT scan / blood test / MRI / colonoscopy image that suggests I need more chemo or that I’ve had enough. This drives me nuts as an engineer, as I want to see data points to help drive decision making. Instead of data, we seem to be using whim and mood coupled with gut instinct.

The good news: I am feeling a whole lot better than I was from mid December to mid March. This is mostly the result of healing of the radiation proctitis (injury to the rectal area due to the radiation treatment) and a hemorrhoid that ceased thrombosing (de-thrombosed?). My daily pain level is much lower. Sleeping 3 hours at a stretch is no longer rare. I’m able to get out of the house some, and my bowel control is much better than it was. It’s still bad enough that I crapped myself in the plumbing aisle at Home Depot – But the fact that I felt good enough to try to get out of the house (or consider plumbing) is an improvement. I even celebrated my end-of-chemo by driving 40 minutes out to Saxapahaw to catch a Todd Snider show last night. That’s as far from home as I’ve been since December.

I’m now in a short period during which I should feel a little better every day AND not be subjected to any bad news. Once we get the scans scheduled and done, we’ll know more about the state of the tumor. The goal of the radiation and chemo treatments that I’ve been through is that the tumor will be smaller (or even gone). Hopefully the scans that I’ll go thru will allow us to downstage the tumor – So instead of a T3, maybe it’ll be a T1 or T0. We’ll also be hoping that the inflamed lymph node looks better than it was. A smaller tumor makes surgery easier and local recurrence less likely.

I’m anxious about the surgeries and the associated side effects. I’m part of some colorectal cancer groups on FB, and they don’t always provide much comfort. Still, there are many factors in my favor. My CEA numbers were low during my initial treatment, and my residual tumor DNA test (Signatera) came back negative early in my chemo cycles. This suggests that there hasn’t been a lot of tumor shedding into my blood (which hopefully means metastatic spread to other areas is less likely).

I’m torn about celebrating the end of chemo. Growing up, my dad often said ‘They don’t payoff at halftime’ (sorry, UNC). I’m about 1/3 of the way through my scheduled treatments. Two surgeries are in my immediate future, which means about another 5 months of healing and reduced capability. The end of chemo isn’t nearly the end of treatment. There’s also the possibility that I’d need post-surgical chemo as well.

For today, I’ve taken myself out and bought about 5 different pastries and hogged some of all of them down. Trying to celebrate even the small victories (through my admittedly unhealthy default method, the consumption of white flour).

~Ed