Preparing for Round #2

I went to my ophthalmologist yesterday for a checkup on my right eye - the site where all of this started back at the end of last year.  He was notably mute about the misdiagnosis (the assumption that the mass was a cavernous hemangioma without looking for other possibilities, such as cancer).  But it is what it is, and doctors really do not like talking about mistakes.  The good news is that my eye seems to have made it through the radiation without any major damage.  Also, there is evidence that the radiation worked in that my proptosis (eye bulging) has reduced and my blind spot has gone away.  The blind spot, which can be seen in this image on the right from three separate exams.  The circle represents my field of vision in the left and right eye, the dark shading is where blind spots exist.  There should be one dark spot for each eye which represents where the actual optic nerve is - a natural blind spot we all have - but all else should be clear.  Back in December I could not see in the the upper right quadrant of my right eye (the shaded area).  In March, most of the upper half of my right eye vision was blurry.  But now, after Dr. Freedman's masterful work with the space-age radiation gun from tomorrow land, the blind spot is gone.  It was caused by the tumor pushing up on the optic nerve, bending it and causing light to distort in my upper field.  It apparently has decreased in size and stopped pushing on the nerve, giving me back my full sight.  Yeah!  I ordered some reading/TV watching glasses yesterday as my vision has not returned to 20/20 but does seem to have stabilized.  After I finish kicking cancer's ass I might get Lasik to correct it back permanently.  The tumor might even shrink more with the biochemo, but in reality there is not much blood flow there to get the chemicals inside so it might - hopefully - just be a a site of necrosis (dead cancer debris) I'll have as a lasting souvenir.  So, cancer, I'll have to say that I kicked your ass in the old eyeball front.  I hope the news depresses cancer, because tomorrow night the chemicals that cancer dreads so much start again.  And as treatment cycles are designed to do - even though cancer has not yet recovered from the last round of biochemo - I have.  I had a friend once that was a golden glove boxer when he was young.  In between boxing rounds he refused to take a seat, but just stood and stared at his opponent as he was attended to by the other support crew with water and verbal support.  Sometimes, if he felt strong enough, he would do push ups while his opponent sat there and caught his breath.  He said it completely demoralized his opponents.  That's me, and I love doing push ups.

Great News for Melanoma Patients

In case you have not seen the news this weekend from ASCO (American Society of Clinical Oncology annual seminar in Chicago), here is what the Wall Street Journal reported this morning:  "Major Shift in War on Cancer Drug Studies Focus on Genes of Individual Patients; Testing Obstacles Loom.  CHICAGO—New research is signaling a major shift in how cancer drugs are developed and patients are treated—offering the promise of personalized therapies that reach patients faster and are more effective than other medicines.  At the heart of the change: an emerging ability for researchers to use genetic information to match drugs to the biological drivers of tumors in individuals. Studies released at the annual meeting of the American Society of Clinical Oncology here are helping to support previous findings that personalized medicine—introduced more than a decade ago—is closer to being realized as a weapon to fight cancer.  "A pattern is developing at an accelerated pace where we are able to match genetic information about a tumor to a new agent and get results," says John Mendelsohn, president of Houston's MD Anderson Cancer Center."
“Another report featured results from an initiative at MD Anderson Cancer Center involving several experimental drugs in initial, or phase I, testing. Typically, phase I studies of cancer drugs test a single agent in patients to determine a maximum tolerable dose with the hope that a treatment effect might be seen in a couple of patients.  The MD Anderson program pooled 1,144 patients in a phase I study after profiling their tumors for mutations that might be targets of the tested drugs. Apostolia Tsimberidou, the researcher who led the study, reported that 40% had mutations in 10 molecular pathways that were targeted by the experimental compounds.  Tumors in 27% of those given agents that targeted their mutations responded to treatment compared to 5% for those with unmatched therapies.  Other researchers said such a high response rate in a phase I study was highly unusual and could help prompt other academic and corporate researchers to change their protocols to help speed the early-phase trials.  Such testing of patients is also moving into clinical practice thanks to plummeting costs of performing DNA sequencing that researchers use to identify patients' mutations.  Massachusetts General Hospital and MD Anderson Cancer Center are among institutions beginning to offer routine genetic profiling of tumors for every patient, moving into clinical practice a strategy reserved only for research just a year or two ago and unheard of a decade ago.”

Full article here and another article in the Journal "Two Melanoma Drugs Prolong Survival for Some Patients" on Ippi and the BRAF treatment can be found here.

Nadir

Well, half way through my two weeks at home and I’ll never fail to appreciate my white blood cells again.  In chemo, blood counts such as red and white blood cells and platelettes continue to decline after the chemo chemicals stop.  The low point is about day 15 (first day of chemo is day 1), which was coincidently the start of a very bad few days for me.  I felt pretty good - and was getting better - but then an insect bite on my leg got infected and the two wounds form my surgery started flaring up and threatening infection too.  On Friday my temperature hovered around the critical 101F, above which I have to admit myself to an emergency room because my body cannot fight an infection with low white blood cell counts.  Ann spent the day on the phone with nurses and doctors, but we’ve been able to keep the infection at bay this weekend and avoid a hospitalization.  Doctors predicted day 15 to be my low point, or “nadir”.  Nadir means many things including the point of the celestial sphere that is directly opposite the zenith and vertically downward from the observer, and the lowest point of a person’s spirits.  But don’t worry; I’m far from a low point spiritually – just slugging it out until I go back to Texas on Friday.  Its great to be around the kids all day, and Sabrina is learning how to be a pet doctor by taking care of me.  When I’m napping in bed she’ll sneak in and take my temperature with an ear thermometer and report back to Mom.  Both kids are handling it well, and we’ve had discussions with them about Daddy having cancer (the hardest conversation I’ve ever had in my life).  Sabrina often tells me that it makes her sad that I am sick.  But the home front ticks along in its daily rhythms and we’re all together and that’s fantastic.  Attached is a picture of my new hairdo.  The radiation on my right eye finally caused my hair to fall out along the right side of my head, which looked like a major shaving accident.  Ann told me mattor-of-factly at breakfast that my “right sideburn fell off.”  So I had a barber even it out.  I think it looks good, a proper fighting man’s haircut my old drill instructors would be proud of (minus the facial hair).  Today is National Cancer Survivor Day, and they say that every cancer patient is a survivor from the day they are diagnosed.  That was probably my spiritual nadir, the low point for me in this fight.  I feel that every day since April 1^st of this year has been a day of survival for me, a day of progress and fighting and outlasting an enemy.  On this Survivor's day I remember what Lance Armstrong told cancer - “I am a survivor.  Cancer, you will not break me.  I am a survivor.  Cancer, you can’t survive ME.”