Cancer Blog #100
By Brian Zimmerman
Begun on July 31, 2021
Email: dyingman1@yahoo.com
My Dying Words
Entry #100– Medical Update
January 18, 2024
Medical Update:
Wednesday, Jan 17: I had my penultimate treatment yesterday (Tuesday, Jan 16). It was the usual treatment (2 drugs: Ramucirumab (the immunotherapy drug), and the irinotecan (the old school chemo drug) on an unusual day, viz., Tues. They’ve done it on Wednesday for a very long time, but I made the remark in passing to a scheduler that I liked an early appointment when possible (it was already scheduled for Wednesday, Jan 17) at 11am), but the next thing you know I’m on Tuesday at 915am. Of course they had to check with the insurance to get permission from the insurer so I can get this frequency with this drug. So, it was kind of them to move it to earlier in the day for me. And, apparently the insurance approved pretty quickly.
The oncologist and the oncology nurse practitioner discussed with me my new treatment to start at the end of Feb, and they were very engaged. The oncology NP told me that I was absolutely right about the chemo drug trials. With most meds, e.g., antibiotics, they run drug studies that start with the lowest dose to see how little of the drug they can use to get the desired effect and still be safe. With chemo drugs, it’s the exact opposite: the studies work to see what is the maximum dose that could be used with patients still being able to tolerate it long enough for the drug to be effective against the cancer. The problem with high doses is that they are more likely to cause side effects.
So, now he’s kicking around this idea: if my status CT looks okay, then maybe stop all chemo for 3 months at the end of Feb, or else continuing only the Ramucirumab for three months and stop the irinotecan completely. His theory is that the irinotecan is giving me the most benefits but causing the most side effects. He thinks the Ramucirumab may continue to hold the cancer in check for the 3 months. Of course, who knows?
On this treatment (Tuesday, Jan 16), he said there were good studies to show that the irinotecan can be reduced by 25% and still maintain its benefits. I asked if he got that info on Wikipedia, and he said no. There is a google doc (MD) app and that’s what he used. Ha! What a hoot! Anyway, so he reduced my irinotecan dosage by 25% on Tuesday.
Well, how’d I do yesterday (Tues, Jan 16)? Fine with the Ramucirumab (the immunotherapy drug). It takes only 30 minutes to infuse, and I hardly felt it. The irinotecan is very different. Takes an hour to administer, and as it progresses, I get more nauseated, unsteady, and chemo brain fog. Rough evening, but I was able to eat a modest (but delicious) dinner, and drink a couple of beers beforehand. For some reason the nausea seems to increase slightly when I eat, but not nearly as badly as I would get from nausea from a stomach bug. I may be miserable from the nausea, but I can still eat without making it much worse. I was moderately nauseated (in my parlance that means I was thinking about it constantly). The big problem was I slept only about 2 hours because of all the steroids they gave me to enable me to tolerate the treatments. So, here’s the quandary: they have prescribed me Zyprexa that helps with the nausea, and is to be taken at bedtime as it makes patients drowsy. Sounds perfect unless you look back at my treatment side effects. One of those is that I was moderately unsteady – dizzy. If I take the Zyprexa, it is likely to increase that unsteadiness. So, which matters more: suffering nausea and losing sleep, or risking increasing my unsteadiness with the possibility of falling. I chose to avoid the increased dizziness, but accepted the nausea and lack of sleep. I got about 2 hours sleep with moderate nausea. But, no falls.
Wednesday, January 17: I downgraded my nausea to less than moderate (a very good thing.) In other words, I have it but not constantly thinking about it (in my parlance, mild nausea). As the day has worn on (it’s noon at this point), my steadiness and brain fog have continued to improve. If my nausea worsens, I feel safe in the taking the Zyprexa tonight to help with the nausea and the sleep, but not suffering an unsafe increase in the unsteadiness. As I often say: if you take a drug chronically (all the time), you should know not only the effect(s), but also the side effects. You will likely fix one thing and break something else. Beware!
Thursday, January 18: Well, I gave up and took a Zyprexa to help with the nausea and increase the likelihood that I would sleep. This morning my nausea had improved and I slept over 10 hours (something I haven’t done in a long time). Both good things! I was not terribly unsteady, but my shakiness (tremors) was much worse, and I’m very hoarse. I called about a car repair and the guy said he couldn’t understand me, so my wife had to get on the phone to explain what we needed. I’m hoping the reduced irinotecan will improve my recovery time from the immediate side effects from treatment. We’ll see what happens this weekend.
Friday, January 19, 2024: I awoke this morning with no nausea, mild unsteadiness, bad hoarseness, and bowel issues (okay, constipation, probably caused by the chemo drugs (especially the irinotecan) and the dose of atropine I requested. The constipation was fixed by fluid intake (hot tea for me), a docusate pill (stool softener), and a single prune). I feel better as the day has gone on except for some weakness, and the hoarseness, which is not life threatening, but is a pain for me and everyone around me trying to talk with me.
Overall, I don’t see a great deal of change from last time though I’m taking 25% less irinotecan. I’m hoping that the lower dose will lower the side effects the longer I’m on it.
I’m profoundly thankful for the Lord’s mercy in helping me with this small change, as well as the prayers and encouragement of so many brothers and sisters.
One more treatment session on these meds (Feb 7), then the status CT scan, followed by the review appointment when the oncologist and I will settle on the next treatment regimen. May God grant my oncologist, his nurse practitioner, and to a far lesser extent me, wisdom and help in planning this next step. I’m confident He’s in charge and rest in His plan for what comes next.