Tuesday, March 28, 2017

Round 4 Updates

This one will be filled with some wonky medical terminology, I'm afraid.  Don't say I didn't warn you.

So, to start with, my occasional reader here might have noticed my whining since my last chemo treatment.  Workouts were terrible, fatigue was terrible, and I had one truly bad workout week.

I talked this over with the doctor yesterday.  She said she fully understands my workout goals and applauds them.  She said I'm very unusual to be so devoted to fitness even through chemo.  At the same time, with my hemoglobin dropping by point or so every 2 weeks, my weight going down about 4 pounds every 2 weeks, and some kidney issues that have cropped up, she would like to see changes.

She thinks consistency should outweigh intensity for right now.  Tell that to the CrossFit gods.  They don't like pronouncements like that.  But, I think I'd already seen that the intensity has been too much, and I did literally cross the line last week.  Twice.  So, it's time to slow down a bit, be consistent, but always live to fight another day.

The biggest concern right now is that my one remaining kidney is not currently functioning very well.  The main blood test is called Serum Creatinine, but to look at kidney function, creatinine goes through a formula (I do this all the time at my job) to measure something called estimate Glomerular Filtration Rate (eGFR).  Ideally, eGFR should be greater than 120.  It really shouldn't be below 60.  My last two readings were 50 and 44.  Those are not good and suggest some sort of injury to my kidney.  If I had 2 kidneys, this might not be as big a deal, but I only have one.

So, what could be causing the problem?  The obvious answer is a kidney stone, but I have no symptoms.  The second is a new tumor close to my kidney, and pressing on the kidney.  So far, all of my tumors have been on the right side of my abdomen and the remaining kidney is on the left side.  I'm certainly hoping the tumors aren't on the move, especially during chemo.  Lastly, and most worrisome, would be that the cancer has invaded the kidney, which could be very bad news.

Plus, there are other options - infection, blockages of any sort, and some other esoteric things.

So, this week, we are going to do an ultrasound of the kidney.  Next week, we are going to do a full body torso CT scan to look at how well the chemo is working, and they will pay extra attention to the kidney in that scan.  Between the two scans, they hope they can find something definitive and hopefully minor.  In the interim, I wait and worry.

The chemo, round 4, was yesterday.  It went off without a hitch and I worked out at CF a couple hours later.  I did scale the workout though.  And, I still feel human today.

We came up with some modified plans to help me in between treatments.  I'm going to do some extra IV hydration a few days after chemo.  I'm going to get some extra anti-nausea meds that day as well.  Hopefully, those two things, plus a reduction in workout intensity, will make things go a bit easier the next two weeks.  I'm going to really focus on hydration.

The CT scan will be next week.  It is pivotal.  I'm now halfway through my treatments.  The CT scan can find one of three results.  First, the tumors can be growing unabated.  Secondly, the tumors can be stable - no growth and no shrinkage.  Third, the tumors can be shrinking.

The first possibility is by far the worst.  It means that the past four treatments have been in vain, and we need to start over, looking for a better option.  Each new option has a lower response rate than the one before, so the odds get worse over time.  I try not to think about this option.  Even the current option has a success rate low enough that I'm not optimistic.

The second possibility is better, but not great.  The tumors are small enough to be removed if stabilized.  But, if they are removed after chemo, will there be other new small tumors in there?  Will there be cells untouched or unfazed by the latest chemo?  I don't really know the answer and if this happens, I don't know what we will do.

The third possibility is ideal.  If the tumors are shrinking, it means four more treatments.  Another 8-10 weeks of feeling like crap.  Surgery at the end of chemo.  But, the possibility of a clean excision, and a longer remission in the future.  This is obviously the preferred choice, although 8 more weeks of these side effects won't be fun.  But, if I know it's working, I will tolerate it.

If the first scenario happens, there are still many options.  I can think of half a dozen drug combos that we can try.  Some have response rates lower than 10% - not very inspiring.  Some are higher, but are more typically used in a palliative setting.  However, in some cases, those palliative drugs create enough remission that surgery is possible.

Another possibility is the middle result, still followed by surgery, with hope that the underlying cells took a hit as well.  It's harder to tell after that one.  Will it recur quickly or slowly?????

The absolute worst case is trying and failing a number of drugs, or finding out that my left kidney is now involved.  So, we just won't worry about that for now.  I will hope that the kidney issue resolves quickly, that the left kidney is uninvolved, and that my current chemo is working.  It's my best hope, it's what I'm in the middle of, and I've got to cling to that as my best path forward.

Some of the other options are just too much to deal with so soon.

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