Tuesday, September 20, 2005

I feel like I’ve won the lottery today! First of all, the Redskins won an unbelievable game against Dallas last night, scoring two touchdowns in the last 4 minutes of the game. But even better, last night I got a call that my chemo would be moved to the bone marrow transplant unit, since infusion had an overload of patients. The bone marrow transplant unit is shear “chemo heaven”. If one has to undergo chemo, the environment is as pleasant as it can be. I have a private room with high speed internet access, a desk to work on, a private bathroom, and I’ve just been served a full hot breakfast and lunch. The privacy allows one to escape into one’s own thoughts and avoid the tough reality lessons that the more public atmosphere of the infusion center makes so evident about the relentlessness of this disease and the side effects of the chemo (which the nurses are always explaining to first-time patients). The only improvement is that pharmacy could get faster in making up the infusion packs. I waited for 3 hrs today to get started on my first bag of Avastin! But hey! it seems to be working! Now only 48 hrs and counting until I am freed from my pump!

Sunday, September 18, 2005

Near misses don’t count….. Looking back, probably each of us realizes that we have had many “near misses” in life. As you know, Bob is working very diligently at getting himself ready for walking around Paris mid October – doing probably twice the exercises he is supposed to do each day to try to get his “bionic man” ankle functional again. Today, we had a rather stormy day at the beach. For my part, I figure that the “powers that be” have already deemed to spare me for the moment, so, despite thunder and a threatening sky, I pushed Bob into taking the boat out so that Kiara (our golden retriever) could have some fun swimming and retrieving. Well, no more than 10 min out, Bob told me that I was nuts not to heed the heavenly warnings and, to my dismay, turned the boat homeward. Actually, I must confess that like my inability to sense directions, I have also never had any fear, or possibly respect, for lightning. The two instincts (or lack thereof) must have a similar locus in the brain – something that possibly was a developmental error in my creation! Anyway, after one misfire, I was even more determined to get out in the boat. So, after having convinced Bob to go out again about 2 hrs later, I heard a scream from the dock. Bob had lost his footing on the slippery bulwarking (it had rained quite a bit in the afternoon) and fallen, bending his metal crutch at about a 30 degree angle, but managing to stop himself from falling in between the boat and the dock. In my usual strange calm, I assessed the situation, and despite his claims of pains in his arm and foot, declared that “near misses don’t count”. So – I brought some cold beers on board and we set off for a wonderful ride in the calming seas and post-storm sunshine, watching a lot of bird life and letting Kiara “retrieve” to her heart’s content! Tonight we ate dinner on the deck overlooking the canal and watched the rising of the pumpkin-orange full moon. Life continues to be very good!!

Saturday, September 10, 2005

This will probably be difficult to understand for those of you who are not scientists, but a lot of things have come together in my mind this week to make me realize that whether by design or, in part, by good fortune, I am on a particularly effective treatment regimen. In addition to my biweekly regimen of Avastin, leucovorin, and 5-FU, I am taking 3 other drugs, each of which is now known to have properties that may be benefiting me in many ways.

Protonix – this is a drug that was prescribed for me immediately after surgery and which I have been on continuously since that time. It is a proton pump inhibitor which means that it decreases the amount of acid secreted by the stomach. Besides completely eliminating my heartburn (excess stomach acid) which had been plaguing me for years, a Korean colleague today made me aware of his research showing that this drug, that is activated in the acid environment of the stomach, selectively induces death of stomach cancer cells, because these cells, more than normal cells, need to be able to get rid of their acidic metabolic products via the proton pump in order to survive.

Celebrex – this drug is a cyclooxygenase-2 (COX-2) inhibitor similar in action to the now infamous Vioxx. It was initially prescribed for me about 14 months ago based on the ever stronger connections between inflammation and cancer. Now, in addition to that, there are publications that Celebrex has a direct inhibitory effect on new blood vessel formation (necessary for tumor growth and metastasis) and strongly synergizes with other chemotherapeutic drugs such as 5-FU in mouse models of gastric cancer. There is now a wealth of literature attesting to its efficacy in a wide variety of cancers (despite our insurance company’s stance that they can’t pay for Celebrex since I don’t have arthritis!).

Doxycycline – this is a long-standing tetracycline antibiotic which more recently has been shown to inhibit enzymes called MMPs which facilitate local tumor spread and metastasis. Various inhibitors of MMPs had been tried as cancer therapies several years ago, but were unsuccessful, possibly because they also blocked formation of natural inhibitors of blood vessel formation. But now, in combination with Avastin, which itself alters tumor vasculature, doxycycline may possibly be effective as an adjunct therapy in inhibiting tumor spread.

Vaccine therapy – even though I had to exit the NIH clinical trial on the PanVac vaccine directed against two of my tumor antigens, I will likely have life-long immunity to these proteins based on my 6 months of treatment. This, I believe, may also be synergizing with my other therapies to give the cancer cells the “kiss of death”.

Positive attitude – NOTHING will ever stop me from enjoying to the fullest each moment that I have conscious thought.

So for right or wrong, from both the scientific standpoint and the more ethereal, I think that I may have a very effective combination of drugs which, together with my present chemotherapy regimen, are contributing to my present state of well-being. I am beginning to enjoy thinking of myself as an “experimental animal” and am once again eagerly delving into the scientific literature concerning my treatment.

Wednesday, September 07, 2005

I continue to be so unbelievably fortunate. Today I got the report of my CT scans which showed not just stable disease, but a slight reduction in the ascites fluid and reduction or resolution of the impairment of my left kidney function. This is the first time I have had a report that actually showed movement in a positive direction! Then tonight Judah Folkman called me at home to tell me that after only 19 days of treatment on the antibiotic doxycycline, enzymes in my urine called MMPs had decreased from a “disease state” to close to normal. MMPs are an indicator of new blood vessel formation (a sign of cancer) and generally correlate with metastasis, so this is also incredibly good news. I will continue to carry my bag of good luck charms to every treatment, to wear my Japanese temple frogs around my neck (together with Gregory’s seagull), and to look incredulously at the “1000 origami cranes” from my Japanese colleagues and the various “dream-catchers” I have been given, and know that for whatever reason, I have been truly blessed.

Friday, September 02, 2005

“Somewhere in my youth or childhood, I must have done something good” (Sound of Music)…To my total disbelief, my CT scan again showed “no progression”. I was so apprehensive when I went to the clinic after the scan that I had the highest blood pressure reading of my life! So my disease course continues to defy the odds. This has made my life so intense that sometimes I cannot believe that it is only 18 months since my original diagnosis – 18 incredible months of living life to the fullest. Bob and I will celebrate tonight and start thinking ahead to wonderful celebrations in October in Boston and then in Paris. Let the good times roll!

Thursday, September 01, 2005

Apprehension….Tomorrow I have a CT scan. This will determine whether I can stay on the rather benign chemotherapy regimen that I am currently being treated with, or whether I will have to go back to “kick ass” therapy. I know that eventually my disease will progress, but I am hoping that this is not the time. In mid October we are going to Paris for an award that I have won from the French Cancer Society. Karl and Stacy are going with us and I want to have a blast. So I am hoping for clear sailing for another month or two. The apprehension over this scan has got me feeling aches and pains all over for the past week or so and has occupied my thoughts through the sometimes sleepless nights. Last night I finally took a sleeping pill and had a great night’s sleep. This morning dawned cool and crisp and I had a great run with Kiara. Then Bob and I had breakfast on the patio just soaking in the warmth of the early morning sun. Tonight we had a delicious dinner in an Italian restaurant. Whatever happens tomorrow, it cannot rob me of today!

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