I am back at home now, on oral antibiotics, but recovering well. Chemo is supposed to only nearly kill you, but this time we sailed a bit too close. Most likely, the damage to my bowel lining from the capecitabine allowed bacteria into my blood. That problem is sorted but we need to let my bowel fully recover, and so, my next irinotecan/capecitabine regime, due today, has been put on hold for a week.
But look at what the la
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test CEA data is showing. As always the semilog plot is more informative. What we clearly see is exponential decay, which if continued, would see me below the normal threshold in three more cycles. But even more striking to the scientists amongst you must be a comparison of the responses to chemo of the adjuvant course last year with that of the first line course this year. Both courses involved capecitabine. So what is making the difference? Could it be the monoclonal antibody Avastin? (See blog Thursday April 22).
Of course, exponential decay means the cancer is
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never eliminated. The trick is to get the body's immune system to operate more effectively and to have the cancer cell levels reduced sufficiently for the immune system to have a chance.
I had 36 hours in planet hospital. You can holiday in the Bahamas, go walking in the Pyrenees, but if you want a total out of world experience, planet hospital is it. It started with my fast track admission through ED (what Americans call ER) with my neutropenic alert card. I was literally pounced upon by nurses and saw the ED registrar within minutes. A cannula was inserted and iv drip started, I was given a chest x-ray, blood samples were taken for culture and an oncology registrar soon appeared to brief me. He was clearly muslim, with a very islamic beard, beautifully spoken, serenely mannered, and very bright. I took an instant liking to him, and then he told me my latest CEA. It was an odd contrast in emotions-getting the best news so far on the cancer treatment, while feeling very ill. Just before midnight, I was moved to the oncology ward.
That night was a bit ethereal, the nurse (angel?) taking regular vital sign readings, using all-electronic sensors with their led displays and multi-toned electronic bleeps, the soft clicking of the peristaltic pump driving the iv, the changeover from antibiotic to saline to antibiotic, more blood samples (I had four taken in 36 hours), the musical voices of kiwi lasses down the corridor in the small hours.
The morning brought the "clatter of consultants", a team of four, with students (Wellington is a teaching hospital) and a registrar, Raj, whom I instantly recognised from last year, and greeted by name. The woman in charge made a bad start. "You'll be pleased to know your chest X-ray was fine". I am wondering, does she think I have rectal cancer (it tends to metastasize to the lung). "Do you have a bag?" Oh dear, a colostomy bag-has she read my case notes? "You have rectal cancer, right?" I explain to her about my large bowel tumour, the subtotal colectomy, and my precious 40 cms of sigmoid colon (do I sense a gleam in Raj's eye? The students are dutifully impassive. God knows what they are thinking). "How is your urinating?". "I'm an old guy, I have an enlarged prostate. My peeing is pretty dreadful, but I guess that's life."
They moved on, but on the way out, Raj broke into a big smile and asked me if I would like to try a pill to "assist the flow". I gave him the thumbs up.
In the morning, Chris rang while I was being attended to by an exceptional young kiwi nurse, Patricia, whose professionalism and dedication I will soon reveal. "What antibiotic are you on?" he asked. "What is it?", I relayed, "it's my son, he's a doctor". "I guessed", she said, "Imipenem". "I'm impressed Dad", to which she added "It's the cluster bomb of antiobiotics".
It took 24 hours to get my temperature to drop below 38.5, different nurses during the night shift, but Patricia in charge during the day. During this time my occasional diarrhea continued. "Paul", she said, "I want to come and watch you poo. I'm an expert on pooing and there is so much to be learned from watching it." " I promise to invite you", I replied (stunned). One hour later I am in the toilet, when I hear a knock on the door. "Paul, are you pooing? Let me in." Now that is dedication.
Miang is just brilliant in the hospital support role, giving me wonderful encouragement, though she was clearly concerned. I was finally able to ring her late Thursday night to tell her that my temperature was heading down and I was starting to feel much better, and to text daughter Catherine, walking in Italy, and worried about her Dad, that all was well.
Next morning the "clatter" was led by Raj. "Before we start", I said, "that little pill-I didn't pee like a 20 year old, but the flow was great!". He beamed a big grin. He did the usual examinations, invited the students to listen to my fascinating bowel, delayed chemo for a week, and discharged me. My cell phone buzzed, and I chatted with sister Jeanine, also relieved to hear I was OK, then Miang arrived with nephew Yong and drove me home on a beautiful Wellington day.
PS: I wasn't and I didn't.
PPS: Imipenem, I later discovered, is one of those serious antibiotics that are available only in hospitals. Thank goodness they keep this from our misuse so we have something effective in reserve. By the way, don't they all look the same, a ring here, a chain there, a few hundred daltons in mass?
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