Cancer Blog #14
By Brian Zimmerman
Begun on July 31, 2021
Email: dyingman1@yahoo.com
My Dying Words
Entry #14
November 29, 2021
I know you’re probably tiring of an old man talking about his symptoms and side effects – kind of like someone wanting to pull up their shirt to show all their surgical scars – but I wanted to do another update any way on my newest symptoms and talk about my medical condition currently.
One More Time
I guess it goes without saying that dying of CA is a process, usually the progression of the disease and the effects (good ones) of the various treatments take time to develop. That’s certainly the case with me. So, let’s go once again (I heard that groan) to the side effects. First, I’ve developed neuropathy, which is a problem with your peripheral nerves (as opposed to the central nervous symptoms because of your spinal cord or brain, which symptoms are appropriately called “central”). Peripheral nerves are ones out in the in your body, in my case my hands and feet. Neuropathy shows up usually as a pins and needles sensation, pain, or numbness. For me, it is primarily numbness in my fingers and toes. I let my oncologist know that it was worsening, just as he had predicted. What he said that meant was that I couldn’t tolerate any more of one particular drug in the Capox regimen (see Entry #6 for what Capox means) or else I could develop permanent nerve damage. So, he’s stopped one of the 3 drugs I was on (Oxaliplatin to be precise). He told me the neuropathy would continue for a while and probably even worsen, and then would likely improve. He has right so far; I have noticed that it continues to grow worse, and I even began to experience some nerve pain, which concerned me because I knew if it increased much more, I would likely have to go on yet another medication, this time to reduce nerve pain. There used to be only one drug for nerve pain (called Neurontin or gabapentin. Most drugs have two names, a brand name and a generic name. It can be quite the challenge when you’ve been prescribed a dozen or more meds and you ask you’re MD about drugs when you’re using the generic name and he knows only the brand names. I don’t envy them to keep them all straight), but now there are others. Fortunately, he was right again as my neuropathy backed off on the pain, and even might be slightly better (it’s very hard to tell as numbness is almost completely subjective, meaning you have to report your sensation. It’s very difficult when there’s no solid objective measure). Fortunately, I haven’t completely lost light touch sensation, which I could crudely measure using a little device I carried as a PT; it was made of a small piece of monofilament line (think fishing line) sticking out of (embedded in) a piece of plastic. You told a person to close their eyes and then you touched their skin with the monofilament line and asked them which finger (or toe) you were touching. Light touch sensation is also called protective sensation. What does that mean? Protective sensation lets you feel sensation (especially pain) if, for example, when you’ve stubbed your toe. I’ve had patients break their toe when they stubbed it, who were unaware that they had a broken toe. Or, when they had a piece of grit stuck in their foot, and didn’t become aware of it until they smelled it (yes, gross because that was a sign it was infected). It’s also what prompts you to change your gait when you walk for a long distance because, though you may not be aware of it, your feet begin to hurt and so you alter where you walk on the soles of your feet, which protects them from damage. Diabetics or lepers (!) often lose or lack sensation in their feet and so don’t alter their gait. Dr. Paul Brand, a surgeon missionary to India, discovered this phenomenon as he observed the foot prints of a leper versus those of a person with normal sensation. The leper’s gait pattern never altered while the normal person’s did (that was one observant man is all I can say!). There is a similar problem with diabetics and their gait when they acquire a severe enough neuropathy in their feet. Hence, the need for special footwear to protect their feet. If you’re interested in the positive role that pain plays in protecting your body, get a copy of the book entitled, “The Gift of Pain”, by Dr. Paul Brand and Philip Yancey.
Side Effect #2
The other side effect I’ve recently noticed is that my cuticles, which began to turn pinkish red after I started the chemo treatments, have now begun to grow up, beginning to cover my fingernails! I haven’t said anything to my oncologist as it hasn’t been anything terrible important and there is probably no treatment for it any way except the one my wife suggested, viz., push the cuticles down, which I do now twice daily when I apply cream to my feet (and, yes, it hurts to push the cuticles down).
Medical Update
Now for an update on my medical condition: after my 8th round of chemo, my oncologist sent me for another CT scan. He talked to me about it when I returned for my 9th round. The results were generally positive: no metastases first of all (always a plus!), and my lungs were clearer with less signs of CA, though my lungs are seriously scarred and so my aerobic capacity will always be significantly limited. The improvements that I personally have observed is that my breathing is easier (I can take deeper breaths), and that my resting heart rate that had been in the 60’s before the CA and went to the upper 90’s (tachycardia, i.e., rapid heart rate, starts around 100 bpm (beats per minute)) has now dropped to upper 70’s/low 80’s, which is a big relief.
The good news is that I can continue treatment with the other two chemo drugs (Xeloda (which is oral, pills that I take morning and evening for 2 weeks out of 3 of a cycle, and the immunotherapy drug (Opdivo)) for the time being. He will order another CT scan around the end of January or first of February (near my 70th birthday) to check my status. So, I’m generally feeling better (no more bouts of diarrhea, and the nausea only occasionally afflicts me), and have a little more energy (at this time of year I’m now mowing the yard with the grass catcher installed on my little riding lawn mower to let me remove/mulch the leaves (easiest leaf removal I’ve had in my entire life!). My prognosis is the same for my CA (treatable not curable), but my life has been extended, which was the primary purpose of the treatments. For that, I’m most grateful.
Next, I’ll begin a series of entries that will discuss my thoughts on death and dying more generally.