April 19, 2010 – Radiation 4 [31 to go] & big news!

Today, in deference to The Boston Marathon and the need to find a new route without streets closed down due to the race, Ann & I left twenty minutes early for Dana Farber.  We took I-90 (The Mass Pike – give it a name and you can charge a toll) to Natick where we picked up Route 9 for the remainder of the ride into Boston.  Traffic was light and the sun was bright.  Naturally, we made it in early to Dana Farber, before 7:15 am!  The early arrival turned fortuitous, as there was some shuffling of the five appointments I had for today.

My radiation, scheduled for 8:40 am, was completed before 8:00 am.  Today, the techs hit the ball on the nose when they arranged me on the table and no adjustments were necessary.  Music for radiation 4 was from Sara Hickman’s Necessary Angels, the following tracks: “Pursuit Of Happiness”, “The Best Of Times”, “The Place Where The Garage Used To Stand” and “Sister And Sam”.  As soon as I was out of radiation, we had our appointment with Dr. T., my radiologist.  There’s not a whole lot to evaluate after four treatments, but he talked about the full cycle of radiation.  One question I had was whether my saliva glands that need a heavy dose would grow back.  Dr. T. said it’s likely that the glands will be gone permanently on the tumor’s side, but I will have at the very least the large gland on the other side of my mouth.  There will a new normal as far as my mouth is concerned.  But hey, I’m getting real used to dry mouth anyway!  And it’s a small price to pay.

We went upstairs to have my port hooked up (both channels, they needed flushing) and blood drawn.  That appointment was for 9:00 am, but the process was complete well before that.

Our next stop was to see my oncologist and team leader Dr. H..  He reviewed the results of my post-intensive chemo CT/PET scan.  The news is exciting!  I still have one lymph node that is large but has declined in size from SUVmax 5.2 to 2.8.  It could be malignant or it could be scar tissue.  The primary tumor on my tongue has decreased in size from SUVmax 11.1 to 3.1, a significant change!  Dr. H. said the remainder could also be just scar tissue or a small patch of tumor.  Next, he stuck the hose up my nose.  Ok, the hose has a camera on it and outputs to a monitor allowing the doctor a clear view of the tumor site.  He liked what he saw, but could not determine whether the remainder was scar tissue or tumor.   So, he decided to stick his finger way down my throat and see if he could tell tactilely.  I’ve gotten real good about having stuff stuck down my throat without the gag reflex kicking in (or out.)  The tactile approach was also inconclusive.  My radiation with chemo booster protocol would be the same either way.  Dr. H. has said all along that intensive chemo is the preparation and radiation is the cure.  The goal is to be certain that 100% of the tumors/cancer cells are eradicated.  The technical medspeak for the results of my intensive chemo is a partial response.  That means they got a lot of The Alien rousted with a little more to go.  Yes!

Dr. H. looked at my blood profile and is concerned about my red blood cell count and protein level.  The former may still be recovering from the intensive chemo; my calves ache the way they have before when my bone marrow is working overtime.  For both, I need to analyze my diet carefully and push iron and protein.  If my red cell count stays low, the response would be a blood transfusion and I’d prefer to avoid that.  If necessary, I may augment my diet with fish.  We’ll figure it out.  Once I have the feeding tube in (scheduled for April 30th), they can fill my tummy directly with anything I need.

Dr. H. started me on a weekly low-level dose of Carboplatin (chemo with platinum in it!)  Its purpose is to enhance the effectiveness of the radiation.  Dr. H. has researched the interaction of chemotherapy and radiation (including the order of the treatments) at Dana Farber.  I am so fortunate to have him as my oncologist (thanks again, Rachael!)  and Dana Farber as my hospital.

We went down a floor to the infusion room and they hooked me up to a fresh blend of Carboplatin.  Half an hour later, it was done.  The nurse flushed my ports and we were good to go.

After a quick lunch, Ann & I headed back to Worcester.  Because of the marathon, we took the same route we used on the ride in.  Our travel time was less than an hour.  We’re going to try the route again tomorrow to see if the traffic level is always as fluid as today when some folks had the day off.  We took Route 9 to I-95 to I-90.  As we drove on I-95, we looked up to an overpass bridge and saw the marathoners running.  That was very cool.

Going to take the rest of the day easy.  I may nap if my body tells me to.  A trip to the market is a possibility if we decide that I need to augment my diet.  I am fully entrenched into Mariantes’ Matterhorn, so I may read all afternoon.  I am fatigued and chemo-brained, but so very up after today’s news.  Maybe I’ll put on music and dance!  Dancing is good for the soul.

Thanks everyone for the emails, cards, calls, and surprises.  Every day, I am grateful for your comfort and support.  Thanks for taking this walk with me.

Love…

Richard