Here, just take this little pill......

So, today I just started after circling around the little brown pill, my brave knight which will (hopefully) do battle with the unwelcome visitor. ("Sir Chemo"....??) Of course, when he slings his sword around and uses the lance, there are sometimes other impacts on the body. I think, having taken the pill, I expected an instant response and of course there wasn't one. So, like before, you have to just go on living "one day/hour/minute-at-a-time".

It's a good day to start chemo, since it is raining out and I wanted to stay home anyway. It really is deceptively easy, they tell you: "just take the pill....if there is anything that develops in your body, let us know.....we'll check back with you in two weeks" (check your blood, take CT scans, etc. etc.).

This is not quite what I had in mind when I retired.

A note: I want to thank you all for your concern and your offers of help, etc. It makes it a lot easier to go through this process knowing that you are out there. I will feel free to stay in touch and to ask for the things I need. What you can do is just keep in touch with me....that makes all the difference in the world.

I am thinking seriously about leaving this house sometime this spring. It will take a while to do it and certainly (at some point) some labor, but I think it is time. It may be that the chemo process will be just the thing to push me out of my "den".

Out of the Frying Pan....

How it works:

It was a while ago that I wrote to tell you about the tests they were running to see if I had cancer. I may have written some of this before so I hope you will be patient. Now I am on the edge of the treatment for what has been determined to be renal cell carcinoma (kidney cancer). This is the same cancer that was treated in 1988 and in 2008 with surgery. It has now reappeared in the adrenal glands (no longer in the kidney).

The treatment for RCC is a form of chemo-therapy. The drug is called Sutent and is taken daily for periods of four weeks followed by two weeks "off", so a new cycle is started every six weeks. The goal is to stabilize or shrink the existing tumors and prevent their growth. Sutent is an anti-angiogenesis drug; i.e. it works by denying blood flow to the tumors. The progress of the treatment is measured every 6-8 weeks by CT scans.

The obvious question (the one that preoccupied me for weeks) is whether it makes sense to attack the body (or part of it) - as chemotherapy does - in order to "save" it. (During the Vietnam war, there was a famous occasion in which a village friendly to the Viet Cong was completely destroyed by air power and a spokesman for the U.S. military justified the action by declaring that "It was necessary to destroy the village in order to save it.")

My oncologist, my accupuncturist, and my chiropractor all said the same thing: that chemo is much more "targeted" than it once was and that there are various strategies to alleviate the side affects created by the chemo. It will be a trying process - not so "simple" as surgery or radiation - and it will certainly test the spirit as well as the body. My best strategy is put together a team of medical people - both mainstream and alternative - and personal supporters to have the best chance of success.

There is a lot of research and traditional knowledge teaching us that a positive attitude and a strong spiritual and psychological makeup can have a measurably positive influence on recovery.

How it feels:

First, of course, it is scary as hell. We're talking issues of life and death here. I have had parents and other relatives pass on, even sisters and other people of my own generation. Now I am the oldest person in my blood family.

Luckily, I am retired and I can concentrate my energies on living my life and (in the process) strengthening my immune system and my body's capacity to resist the effects of the tumors and the chemo.

(More later......)

Swallow the tube

Bottom line: we don't know any more than we did before we did the biopsy, but we have something to test and will know in a week or ten days. (Blessed relief: for ten days I don't have to think about all this stuff. I will, of course, but I don't have to.)

So here is stage two (or three, or four, depending on how you count). After the apprehension and the awkwardness of trying to internalize both the possibility that the adrenal gland is "clean" and the possibility (probability) that it is cancerous, the biopsy took place yesterday, Thursday at El Camino Hospital in Mountain View. They had some emergencies, so the wait was very long: Noon for the preliminary checkin, 2:00 pm for the Endoscopy unit, 3:30 pm for the actual "procedure". The procedure actually took place beginning at 5:00 pm and we did not get out of the hospital until 8:00 pm. "Nothing by mouth after midnight" is the rule so I was dehydrated and beyond hunger. I could not have done this with any equilibrium without the help of a friend who calmly and quietly went through the process with me and waited. That human touch (and the good humor of the nurses and hospital staff) really helped.

Of the "procedure" I remember nothing. They give you a tranquilizer and then something to put you to sleep. The anesthesiologist says he will ask me to count to 10 and then I will be out. I don't remember even counting to ten. The doctor (very good, competent, and gives a lot of information) reported that he could not reach the main mass on the right adrenal because of an intervening blood vessel, but that he was able to take a sample for biopsy from another spot right next to the mass.

I guess that is enough, but now there are three spots and I don't know how they think about this: if the sample is clean, does that mean the other spots are also clean? If it is cancerous, does that mean that the others are also cancerous? And what about new spots they haven't even seen yet?

Two impressions of the hospital: (1) it is so beautiful, quiet, calming; I wonder at the difference between this and the large public hospitals where most people are treated, the amount of money that goes into these buildings and the art that is in them and the names of the (rich?) people who have given money to support the hospital. V says that one massive blown-glass hanging sculpture probably cost $150,000. (2) the whole process is very "industrialized": each step in the process is monitored, requires its own paperwork, and the functions are routinized. There were three people waiting for this procedure when I arrived all waiting in one big room (with curtains between), each one gowned and hooked up to an iv. They guy next to me had colon cancer and the doctor was explaining how it could be treated. Each patient (odd word applied to people in the hospital for health reasons: "patient"; what if they are "impatient"?) is moved and tested and returned to the recovery unit. Felt a little like an auto assembly line.

I don't feel like a "victim" (a "cancer victim" as the term is used) or even as "unhealthy". I am actually pretty healthy, except for this little problem.....Is there a way in which we have created a system that separates the "sick" from the "healthy"? Maybe it is because sickness makes us uncomfortable and speaks to our vulnerability and the certainty of life ending.

p.s. In the first post, I said that my left kidney was taken in 2008; actually it was 1988.
p.p.s. The procedure itself: Turns out, this is a common procedure, a way of getting at organs from the "inside" as it were. You put a flexible tube down the throat and into the stomach and the intestines with a camera and an ultrasound thingy that "maps" organs roughly like sonar. Then they use a needle to go through the wall of the intestine to take a biopsy sample from the tumor on the adrenal gland.

How it begins

Well, really it began about a month ago when I went in for a routine CT scan (part of my regular checkup after having surgery for renal cancer in October of 2008. Without looking at the report from the radiologist, I can't remember the medical terms, but basically they found "spots" on both my left and right adrenal glands. They sit just "on top" of the kidney. I have no kidney on the left side having lost it to cancer in 2008. The kidney on the right has been "resected" and is now about 40% of its normal size. It seems to be working fairly well.

So, in December, they found these two spots, the one on the left being small and the one on the right (the more recent cancer site) being about 3.5 centimeters square - big! The oncologist (Glenn Wong) ordered an MRI and they did that and confirmed the existence of the spots (read "tumors").

On January 4 of this year, they tried to perform ("perform" - seems like a strange word, used medically) a biopsy of the right tumor. They were not able to do the biopsy due to the intervening organs (kidney, liver, etc.). They don't like to put the biopsy needle through other organs. The organs could recover from the "poking" (as the radiologist called the procedure), but there is a greater chance of "seeding" - recovering cancer cells in the target organ and seeding them into other organs when the needle is withdrawn.

After a week of consultation (doctor to doctor; I was not in on it), Glenn called me and said they thought I should have a procedure called endoscopic ultrasound - putting a tube down the throat into the digestive system with an ultrasound thingy on the end and taking measurements of organs. They combine this with "fine needle aspiration", which means putting an needle through the wall of the digestive system into the adrenal gland to obtain tissue for the biopsy.

All this on Thursday, this week at 9:20 am. More than the procedure, which sounds very uncomfortable (Glenn sez the alternative is surgical), is the feeling that having taken this step, I am now on the road to another course of treatment (chemo?) and recovery if that is possible. Having been here twice now (1988-1989 and 2008-2009), my remembrance is that it delays (if I allow it to) my life. And then I remember that this is my life, with its own twists and turns, its own lessons, its on joys and sorrows, and that (really) I (and you) have no alternative but to live it out for as long as it lasts.

That is centering and comforting. I am not a "cancer victim". I am a person living out his life and the things that happen are happening to me in real time. "Dailyness" as they say. I have had cancer, may have cancer again (could be the same cancer; cancer is very crafty), but so long as I am alive, I have the option to live.