Cancer Blog #106
By Brian Zimmerman
Begun on July 31, 2021
Email: dyingman1@yahoo.com
My Dying Words
Entry #106– Medical Update
Medical Update (05/30/2024): I met with my oncologist last Tuesday (May 28, 2024) to review my status CT scan, done on Monday, May 20. He confirmed what I had told people privately, viz., that the cancer has been virtually unchanged (in size or number of nodules), and that there has been no sign of metastases. As the oncologist said: “I was surprised when I saw no growth after 4 months of no chemo tx.” Him and me both.
So, what next?
1. He stated also: “You have earned yourself another 3 months without chemo tx.” My next status CT scan will be August 14.
2. He says it’s gotten so on the CT scan that it’s hard to tell the difference between scarring and CA. And, if you look back on the last several radiology chest reports for the CT scans, you will see that he (same radiologist) mentions that the area looks like a lot of scarring. Previous radiologists, however, measured the nodules (seeing the nodules as the cancer; they were what was originally biopsied by needle in April, 2021) and compared them to see if they had increased in size or number. If not, the radiologist reported no change in the cancer.
Because of this emphasis on scarring in the recent radiology reports and the lack of CA change, the oncologist is sending me to a pulmonologist to see if he can increase my lung function. Count me among the skeptics as I think that lung scar tissue is too stiff to stretch (unlike scars in soft tissue like skin, ligaments, etc.) Nonetheless, knowing how ignorant I am of lung scar tissue, I am more than happy to visit the pulmonologist to hear what he has to say. Maybe there is something that can be done. That would be nice.
3. He wants me to continue to try to decrease the amount of prednisone I’m taking. On February 7, my most recent chemo tx, I was on 15mg/day. He told me, as I’ve mentioned before, that his experience is that when you hit 20mg/day (of prednisone), you’re functionally immunosuppressed and more apt to get illnesses. Since then, I’ve lowered my intake to 10mg/day. Though I was able to go down 1mg/day every two weeks initially without too much trouble, in my drop from 11mg/day to 10 mg/day, I’m having a lot more trouble. Now I’m feeling very weak, and shaky at times. This last drop has been much more difficult than all the others. I’m not sure why. It could be that as I get down further, the change of 1mg/day becomes a larger percentage of the total. I was so tired yesterday that I finally broke down and took a 30-minute nap. It didn’t help much. I feel better when sitting and resting, but I don’t want that mode to become a lifestyle. I spoke with a PCP (primary care physician) today and he suggested another strategy for lowering it. He told me, as I’ve heard many times, that stopping chronic prednisone use is extremely difficult. He is so right. But, I’ll try his new approach and see if that helps.
4. I have another problem that I would never have guessed. It is my gout. When the podiatrist performed the PNA (partial nail avulsion) on my right great toe, he inadvertently set off a constant low grade attack in that toe. It will on occasion wake me at night from the pain, but not every night (none last night, but twice the night before). I had no idea how much colchicine to take as MD’s and most reputable online sites (like Mayo Clinic) warn against taking too much. I spoke today to a PCP (same one as suggested a way off the prednisone) who told me to try half a tablet of colchicine (they’re 0.6mg tablets) in the morning and one in the evening to get the toe to calm down. And, I went ahead –at his prompting- and My Chart’ed the podiatrist about the gout problem. I hope when the toe completely heals from the PNA, this gout issue will disappear.
Still, all these problems are minor compared to the plain fact that after 4 months without chemo tx, my cancer has been unchanged. God is very good. I am not –nor ever will be- cancer free. Nonetheless, as of today, I am experiencing relief from the CA growth and unrelenting chemo tx. I could die of the CA by the time of next status CT scan. But, I am grateful for God’s kindness in extending my life these last three years.
Let me just encourage you not to lose sight of the wonderful things that God does for you no matter what problems you face. As the apostle Paul said:
16 Therefore we do not lose heart, but though our outer man is decaying, yet our inner man is being renewed day by day. 17 For momentary, light affliction is producing for us an eternal weight of glory far beyond all comparison, 18 while we look not at the things which are seen, but at the things which are not seen; for the things which are seen are temporal, but the things which are not seen are eternal. [2Co 4:16-18]
What could be a better or more important view of life?
Medical Update (06/12/24): I wanted to put one more update in this entry before posting the reports.
I have 3 good things to report:
1. My blood pressure (BP) has dropped from ~150/90 in the morning at my last chemo (February 7) to ~125/85 daily. An amazing change. My heart rate (HR) is still tachycardic (>100bpm), but at least the BP is much better. I’m continuing the Losartan (the lowest dose, 25mg) as you cannot just stop the medication. You have to be tapered off (much like steroid). If I continue at this BP level, I may talk with the PCP to see about doing just that.
2. My itching is basically gone. I can’t tell you what a relief that is.
3. My gout attack (on my right great toe) is gone. The tophus no longer hurts though it looks funny. Regardless, another blessing, for sure.
The only bad thing I have to report is my breathing. My 02 saturation throughout this time of treatment of the esophageal cancer in my lungs has always been normal – upper 90% (like 97-98%). Even when I was exercising in the garage using dumbbells, it almost never dropped below 90%. Now it regularly sits in the low 90% (91-93) (though as right now sitting here it’s up to 97%), and when I do curls or lunges with dumbbells, it has – in the last three sessions – dropped to 85%. 85% is the level I was taught as a PT to stop exercise as it was at that point that many people would pass out. First, mine doesn’t stay at 85% for than a few seconds. Second, I’ve been completely asymptomatic (other than being short of breath (SOB)). So, I’ve just ignored the level up till now. I have increased slightly the time between sets to permit better recovery. But, if I get symptomatic, or the SOB gets worse, I’ll have to let the oncologist know. Of course, at the last appointment the oncologist had said he wanted me to get in to see a pulmonologist, but I’ve heard nothing yet about that appointment (and I did message him in My Chart several days ago, which would have been exactly 2 weeks since my Status Review appointment).
And, as always, the prednisone dose (as I mentioned above) is an ongoing problem. The last PCP’s suggestion was to go from 10mg to 9mg by alternating for a week (10-9-10-9 etc.), then finally dropping to 9mg. When I get the nerve I’ll try that and see if I can avoid the “slug on the couch” syndrome. It’s hard. Trust me.
“…we do not lose heart…”