My Cancer Treatment: Four Months In

"Enjoy every sandwich."--Warren Zevon (2002)

"No plan of operations extends with any certainty beyond the first encounter with the main enemy forces. Only the layman believes that in the course of a campaign he sees the consistent implementation of an original thought that has been considered in advance in every detail and retained to the end."--Helmuth von Moltke (1871)

Or the TL;DR version "No plan survives contact with the enemy."

When I got my cancer diagnosis, my original intention was to keep people updated on the progress of my treatment by posting updates on my blog every month or so. It's been four months from my diagnosis, and this is my first update, so clearly my plan suffered the same fate as all battle plans.

First of all: I'm doing ok. Not a "I don't have cancer" ok, or even what I'd settled into as my "Long Covid ok." My fatigue level has gone up cosiderably. I now typically sleep twelve hours a night. On any particular day, I have the stamina to attempt one medium sized task--something along the lines of going grocery shopping or to a doctor's appointment. I can push and do more, but the cost is anywhere from needing a three hour nap the following day, or if I've over done it more a week of napping and not doing anything else.

This extra level of fatigue is a side effect of the treatments I've been on for the past couple of months (more about my treatments a little later in this post.) The possible side effects from these treatments can range from the annoying, such as intermittent nausea, to much more serious, such as liver, kidney, and thyroid damage. Besides the fatigue, I've had some stomach upset that we're managing ok with OTC prilosec. My kidney function is outside the "normal" range (but not drastically far outside), but is holding steady so far. I'm drinking a lot of water to help with the kidney function (so, who goes to pee ten times a day? This guy!) The biggest worry with side effects is having an effect that would require them to halt my cancer treatment. So, overall for me, not bad.

I've had some more tests done since I posted last: a brain MRI and full body PET scan to see how much the cancer had spread (delayed by a month from when the tests were ordered because...insurance company,) and genetic testing of a piece of my tumor to see whether I have the braf mutation, since that would affect the way we approached my treatment.

So...the news from the scans wasn't great. It turns out that the cancer had spread, so I have tumors in my liver, spleen, one lung, etc. This meant that we wanted to be more agressive with my treatment than originally planned.

At about the same time we got the scan results back, we also got the genetic test results back, and I do have the braf mutation. This actually meant we had a choice to make about how to be more agressive with the treatment. The first option would be to halt my "light" immunotherapy treatment, and switch immeditely to the "heavy" immunotherapy. The second option was to stay on the "light" immunotherapy for the time being, but add in an eight week course of drugs that have been shown to be effective at shrinking tumors in people with the braf mutation, then switching to the "heavy" immunotherapy when that eight weeks was finished.

After discussing the options with my oncologist and Janel, we decided on option two. I just finished the eight weeks, and overall that went as well as could be hoped; significant shrinkage of the tumor on my scalp, and relativily few side effects. So we're set to start the "heavy" immunotherapy on the 22nd of this month.

How has this been for me and my family? Not easy, of course, and I think it's been much tougher on Janel and Morgen than it has been on me. We're just taking things one day and a time, and not trying to put a brave face on (for example, I'm crying as I write this, so if it's a bit smudged and hard to read, that is why.)

The quote by Warren Zevon at the beginning of this post is from his last public appearance, on the David Letterman show, when Warren knew he had terminal lung cancer. Letterman asked him, given that, if he had any insights on life and death. And that's Warren said: "Enjoy every sandwich."

For most of us--even on a shitty day--there are seemingly small things that make life worth living. Spending time with friends and loved ones--or even just getting a quick message from them. Spending a few minutes reading a good book. A morning cup of coffee or tea. Playing with the dog(s). Or having a sandwich.

For me so far, those sorts of things--and especially all the supportive messages, emails, phone calls, time spent over a cup of tea--have been things have reminded me every day, that, although having cancer sucks, I still have a good life. And I'm grateful for everyone of you that have--metaphorically speaking--kept me well supplied with "sandwiches."