If You Give A Mouse A Cookie...

If you give a mouse a cookie, he's going to ask for a glass of milk
Laura Joffe Numeroff, If You Give a Mouse A Cookie

If you give a scientist some data, he's going to graph them.

Gracias a mi amigo madrileño for graphing the CEA levels.  Some of you are asking, "Where are the controls?"  Well, this is a case study, no controls and n=1.  But we'll still write five paragraphs of conclusions, won't we.

I searched PubMed to find correlations between CEA levels and prognosis.  The most recent paper (from Korea) concluded that patients with a decline in CEA levels after surgery fared somewhat better than patients who did not.  The study included 352 patients. It's unfortunate that, with an estimated 100K new cases of colorectal cancer per year in the US, there is no large, accessible database to capture simple clinical data for estimating prognoses - but that's a rant for another time.

I have a stack of printouts from all my blood work, going back to July.  Maybe I should send them to Madrid and we'll get really nice graphs of my blood counts, hemoglobin, etc.

FOLFOX Round 1

The first FOLFOX treatment started Tuesday and ended Thursday.  I reacquainted myself with the infusion pump and the little tricks about how to wear it and where to hang it when I sleep or shower.  Overall, this first round went well.  I had just a little of the cold-sensitivity.  My fingertips tingled a little on Tuesday evening, when I took off my gloves outside to make a phone call and again on Wednesday morning in the cold hallway at work.  Yes, I finally put in a full day of work, but I was exhausted at 3:30 PM.  The cold sensitivity didn't last all Wednesday.  I expect that to change, since the side effects can be cumulative.

To pre-empt the nausea, I'm on anti-emetics.  I get i.v. Emend during the infusion (day 1) and take it on day 2 and 3 in the morning.  I also take Kytril in the evening.  With each dose of the enti-emetics, I take dexamethasone to enhance the effect.  Dex is a steriod, so if I start breaking my keyboard, I may have to take a drug test.  I'm not sure how that helps the Emend and the Kytril.  Any pharmacologists out there?

I still have the back-up drug Prochloper, in case I still feel nauseated.  But they steered me away from the Lorezapam.  Lorezapam is the generic for Ativan, the one that gave me hallucinations in the hospital.  It's better that I stay off that.

Chemo II: Return Of The Pump

5-FU is back and he's brought some friends!

I'm about to start the next set of chemo.  There are 12 treatments in all and each lasts three days.  This regimen differs from the previous in a couple of ways: I'll be on three drugs instead of one and the treatment will be for two days every two weeks instead of five days per week.  On day one, I'm hooked up to my old friend, the 5-FU continuous infusion pump.  I'll also get an leucovarin and oxaliplatin infused over three hours.  On day two, I'll continue to wear the pump and on day three it will be disconnected.  I should be finished in mid-July.  Here's more on the drugs:

• 5-FU (5-fluorouracil), which I was on last time, inhibits RNA and DNA synthesis.
• Leucovorin is a derivative of folic acid.  It enhances the effect of 5-FU and prevents neural tube defects in developing embryos (another way colon cancer is like pregnancy).
  
• Oxaliplatin also inhibits DNA synthesis, maybe by alkylating the DNA (the FDA approves drugs based on efficacy, often without knowing exactly how they work in vivo).
  

Oxaliplatin has some miserable side effects.  There's the run-of-the-mill stuff, nausea, diarrhea, reduced white blood cell counts.  Then there's the neuropathy. I'll have an extreme sensitivity to cold, such that I won't be able to take anything out of the refrigerator without wearing gloves.  I shouldn't take things out of the fridge anyway because if I ingest something cold I'll feel like I'm suffocating.  Then, as the weeks go on, I'll start losing the feeling in my fingertips and toes.  I'll have a hard time buttoning a shirt, tying my shoes, and doing other fine motor skill tasks that we take for granted.  Basically, I'll fail a field sobriety test without drinking.  Another side effect is hearing loss.  So, if I were to have a field sobriety test, I wouldn't even hear the policeman's instructions.

I've been a little disappointed in my therapy so far - not the efficacy, but its age.  5-FU, radiation, and surgery have been used against cancer since the 1950's. In practical terms, this is like driving a car with manual windows and door locks, no A/C, and an AM radio (in other words, Pasco, like your last rental car).  Sure, it will do the job, but it's boring and unsexy.  Other cancer patients are getting interferons, interleukins, and things that end in "mab" and "ux," while I was getting grampa's chemo.  Oxaliplatin, however, was approved in 2002.  So, finally I'm getting a 21st century drug.

Declining Numbers At An Even Rate

Bonus points for knowing the song reference without using the interweb.

Before I get to the numbers, let me get this off my chest (literally and figuratively). I HATE TAPE!  I mean the surgical/medical kind.  Apparently, though, nurses and phlebotomists get AIG-type bonuses tied to the number of rolls of tape they use per year.  At my last blood draw, the lab tech used three five-inch strips of tape on my forearm: one strip to hold the tiny wad of gauze in place and the other two to hold down the first.  In the hospital, the nurses taped down the i.v. line to withstand a category 5 hurricane. And when I'm on the chemo pump, the needle going into the port is secured to my chest with a rectangular 3M Tegaderm bandage (duct tape relabeled for medical use)  that is then held in place by, guess what, more freakin' tape.  It's no surprise that now, four weeks out of the hospital, I'm still finding sticky bits of tape adhesive on my skin.

Why am I complaining about this?  Because I have hair on my arms and chest (and you wonder why I need more percocet).  Now I'm not one of these metrosexual guys who shave their bodies, but when I start chemo again, I'll have to shave my chest to minimize the tape damage.

OK. Rant Over.

The aforementioned blood draw was at my most recent visit to the oncologist.  In addition to the usual blood counts, they tested my carcinoembryonic antigen (CEA) level.  CEA is a protein that is present in very low levels in healthy people (5 ng/ml or lower is considered normal).  In colorectal and other cancers, CEA levels are elevated.  So physicians use these numbers to gauge how well the treatment is working.  Here are my CEA scores since this thing started:

Pre-chemo/radiation (August 09) - 64
Post chemo-radiation (October 09) - 12.9
Pre-operative (December 09) - 2.5
Post-operative (February 10) - 1.2

So I've been back in the normal range since December.  This confirms the results from the CT and PET scans.  Did I mention how much tape the radiology techs used for the i.v. lines?

"If there's anything I can do..."

Many of you have made generous offers of support.  I will now take you up on them.  There is something you can do - take care of yourselves. 

Today, February 4, 2010 is World Cancer Day.  So, for those of you over 40, it's a good day to make an appointment with your doctor to get a mammogram and/or a colonoscopy (guys, just get the colonoscopy).  I know this may not be what the guidelines recommend, but I can't be objective about this.  After all, I became a cancer patient at 43.

Call your doctor and check with your insurance company for coverage.  Don't be a wimpy.  One colonoscopy every five years is not a hard thing to do for your health and your family's peace of mind.  If you're reluctant to do it, just think of what I've been through: two colonoscopys, two CT scans, two PET scans, chemotherapy and radiation, and one surgery in six months.  If I can go through all of that, surely you can get one test.  Look, when you have cancer, people call you "brave" and a "fighter" and all sorts of encouraging labels.  But I really don't want you to join this club. The dues are too high and T-shirts aren't that great - they're one-size-fits-all, they open down the back, and you can't keep them.

And I'm not the only one asking you to do this, Dave Barry is too.