day 110 – the year of remission

Happy New Year! I celebrate the start of 2013 as the year in which I will push my cancer into remission, as I complete the arc of my treatment. There is still a ways to go, but I’ll get there well before mid-year, all things being equal. The much needed holiday break has set me up with some reserves to tackle this next phase.

In fact I am a little ahead of the original schedule: after 11 weeks of taxol my oncologist ordered a mammogram and ultrasound to take a look at how the tumor was responding to treatment. When I met with her on the morning of the planned 12th taxol treatment, I learned that the tumor had not shrunk at all, and had grown slightly if anything. Disappointing news – after 11 weeks of treatment, it would have been nice to see a different result.

If you recall, I wrote on day 15 that one of the benefits of giving chemo first, in the so called neo-adjuvant approach that is standard practice for stage 2 breast cancer at MD Anderson, was that you got a chance to see if the tumor responded. This in turn would give you some read on whether the many dispersed cells which are no longer in the main tumor were responding. These dispersed cells are potential metastases, and so are the real target of the chemo. But being small and hidden they are not trackable with existing technology, at least routinely in the clinic, and so the main tumor’s response can be thought of as a proxy. Given the lack of shrinkage of my main tumor in response to taxol, my oncologist decided to move immediately to the next phase of chemo, FAC. (More on the details of how FAC works next time.) 

After the disappointment, and discussions with my doctor, the chemo orders were quickly adjusted, and just a few short hours later I was getting my first FAC. The experience was quite different from taxol. With taxol the main side effects for me were fatigue and neuropathy in my hands and feet, which manifested itself as numbness, feelings of cold and is accompanied by discoloration of the nails. Together these things mostly made me quite clumsy. My first FAC wasn’t nearly as bad as I had feared, going by the profound nausea I watched my wife endure 5 years ago, and I managed to get through it without throwing up once, thanks to zofran. I took this anti-nausea medicine for three days after the treatment as per instructions, and that really helped keep things under good control. I am lucky in that I tolerate the zofran well. However, zofran together with FAC pretty much shut my gastro-intestinal system down. For the first few days the idea of eating seemed pretty remote, and I restricted myself to soups and apples. Then, as the controlled nausea receded an odd combination of feeling hungry but finding food unsatisfying took over. Even now, two weeks post-treatment, food doesn’t taste that great. As you can imagine, this pattern resulted in some initial weight loss and now gain again. I also felt pretty tired in there, especially in the days immediately following treatment and around a week after. But it all beats being sick for several days – so, I am encouraged. Given that I can keep to my current time table, I am scheduled to have my last chemo before the end of February. Bring it on.


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