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[Cancer]

[cancer] Update on cancer, surgery and chemotherapy

This morning, and I went in for surgical followups, including post-operative consult as well as oncology consult.

We began with a fresh chest x-ray (about my sixth in four weeks), then met with a P.A. in in the Thoracic Surgery unit. The P.A. discussed my post-operative course, examined my surgery sites, removed the remaining stitches in the drainage wound, and discussed my ongoing healing. The chest x-ray looked good, with lungs properly filled out and no fluid inside them. She felt the swelling of which I’d been complaining wasn’t a common side effect, but was within norms, and that the risks of draining it via needle (for example, of infection) outweighed the benefits of doing so. Otherwise she found my healing to be going quite well. She also mentioned that the pathology reports were ‘as expected.’

She did write an additional Dilaudid prescription to tide me over through my tapering off period. She also provided me with a return to work authorization effective 12/14 for part time work, with no travel and no lifting, with a full time return to work authorization effective 12/21.

We then went down the hill to meet with the oncologist, followed by a session with her chemo nurse. The oncologist examined my surgery sites, recapped the discussion with The P.A., then reviewed the pathology. The bony nodule extracted during surgery was a calcified mass not found to be malignant, and the remaining nodules in my right lung are of no worry. The tumor was confirmed to be consistent with metastatic colon cancer. The oncologist thinks it’s likely we’ve effected a surgical cure, but in order to be certain we do not have further metastases, is prescribing chemotherapy.

The course will be FOLFOX plus Avastin, as previously discussed. We reviewed the role of Avastin in this process. As the oncologist says, the science is unclear on treating metastases with Avastin. Successful adjuvant chemo (chemotherapy following surgical resectioning of primary tumor) is positively correlated with use of Avastin, and my situation is sufficiently analogous to that she and I both felt deploying Avastin would be an appropriate ‘belt and suspenders’ approach.

I will be receiving a port implant via day surgery, probably around 12/16. The surgery date will be confirmed in the next day or so. I will commence chemotherapy on Friday, January 8th. My courses will be every second Friday (unless rescheduled for some reason), with a pump being worn through the following Sunday, which they will teach me how to take out myself. This means that I may be able to miss as little as one work day out of every two week cycle, which I consider to be a good thing. I will also be having a chemo class on Tuesday, 12/15 with many of my family members and loved ones. I am encouraged to bring one or two people with me to each session.

We did discuss possible side effects, including the cold issues with FOLFOX, as well as the bleeding issues from Avastin. The side effect of most concern to me is the peripheral neuropathy, which can persist for up to two years after the chemo course concludes, and in some cases can produce permanent, minor damage to sensory and motor functions in the fingers and toes. We also talked about “chemo head”, antinausea drugs and similar issues.

So, the net is that I’m having chemo, from January to June. I have a lot of logical fears, and some illogical ones, but the big kahuna of chemo fears is my dread of the mental blunting. The effects of “chemo head” scare me spitless. Add to this my concerns about the long-term effects of peripheral neuropathy, and I have plenty to keep me occupied. I will cope with these fears as I cope with everything, by running toward them and owning them. But that’s the view today.

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