Feelin’ Pretty Good

June 14, 2015

Well, it’s Day 17 of Cycle 5, the Sunday before the next chemo session. All in all, I feel pretty good, if I dare say, almost normal. My wife and I journeyed out to Hamilton yesterday to visit with friends taking part in the ride To Conquer Cancer. They had ridden from Toronto over a wandering course of just over 100 km. There was a large tent city set up on the grounds of Mohawk College for the riders, volunteers and supporters. And the bikes riders kept filtering in. As it is not a race, I’m guessing some just took their time to enjoy the ride. One of our friends took a wrong turn and ended up riding the hill climb section twice (I think he just wanted the additional challenge). In the morning they will be heading out for Niagara Falls on another 100 km route. This event is a fundraiser for Princess Margaret Cancer Centre and apparently, the five thousand plus riders raised an amount just shy of 20 million dollars.

It was a week Friday that I received an infusion of two units of red cells. I don’t feel that my red cell levels have collapsed and have been getting more and more active. The dogs are getting longer walks with me; still fairly short compared to the walks we used to enjoy. Today we went with the dogs for the longest walk since last November and it felt really good, even though it was cool and damp, threatening rain. It was last September that I found I could no longer join my wife and friends for our weekly power walks. I really miss those walking sessions. Soon I will be back out on the road; I cannot wait.

Friday was my date with the doctors at Princess Margaret. We had arrived very, very early, beating the morning traffic managing to arrive at 7am just as the Blood Lab was opening. One thing we have learned through this process is to get here early, so the lab can do the full report on the blood drawn and then get it to your doctors before they see you. Helps to ensure a complete information session. When we were last in for our clinic appointment, the full results of the previous CT Scan were not complete so we did not have a full picture of how well the chemotherapy was going. And that is one of the deciding factors as to whether I can finish at six treatments or need to do the full eight.

Well, it turned out that number six will be my last round of chemotherapy for now. It seems that the lymph nodes are no longer a concern or if they are, they are the less of a concern. What seems to be troubling is the fact that my spleen does not seem to be shrinking as much as they would like. As I have previously mentioned, my spleen has really shrunk, but seems to have stopped shrinking. Why is the great unknown, and unknown is not where one wants to be. Is there something else going on in my spleen, is there too much fibrosis (scarring) preventing it from shrinking further, or could there be a large tumor mass in there (hopefully dead). No one knows for certain. Cue the worry.

So why not continue to hit a possible tumour with the chemo drugs? The rational is that if “the whatever” was continuing to react to the drugs, then the evidence would be in the continuing reduction in the spleen. No shrinking, no active action, then best not to continue with the chemo. As my hematologist explained, each of the four main chemo drugs does increase the chances of further damage the longer one is exposed to them. Damage to the heart, the lungs, many organs, nerves and eyes to name a few of the side effects. Plus there is the very real chance that if there are still active cancer cells, they could very well mutate and become more resistant to the chemo drugs with more exposure.

So why not perform a biopsy of the spleen to help determine what is going on? Good question that deserves a longish answer that I have put together from my readings and taking with the oncology doctors at Princess Margaret, my hematologist and much more reading. First off, the spleen is rather fragile, hence its location protected by our rib cage. It does not take well to getting poked, let along being opened. It is even more problematic now that it has effectively swollen in size. Say you take a knife to an inflated soccer ball, what happens? Bit of a bang as the air inside is released, right? From what I have been told, same thing with my spleen, it would rupture and it would be very hard to stop the bleeding, possibly resulting in the emergency removal to the spleen. To do a proper and successful biopsy of whatever is inside my spleen, it would need to be opened so that they could locate and then sample whatever mass is found, and that runs the risk of, like the soccer ball, going bang. Then how about a fine needle aspiration type biopsy? This is the more doable option, but, and this is a big but, very hard to get a meaningful sample as it would be effectively a blind poke. When I had the fine needle aspiration of a lymph node lump in my armpit; that took three separate tries to get a good sample for analyzing. That lump in my armpit was small enough that I never noticed it, maybe the size of a small grape. Whereas my spleen is the size of a smallish cantaloupe — it should be the size of a tomato.

Then why not just remove the spleen if it might be causing these troubles? Here’s the rub, the spleen is involved in the production of blood cells, and forms a major part of our immune system. It acts as a blood filter, removing and breaking down old, worn out and damaged blood cells and then recycling the iron, breaking down the cell elements. The spleen also acts as an emergency reservoir of red cells (upwards of a cup), white cells and platelets. And if that is not enough, the spleen can also become a blood production centre. In my case, there is a possibility that my bone marrow has been compromised; the bone marrow is the main factory for producing our blood. If that proves to be true, losing my spleen would mean losing a major alternative site for blood production.

So, there are a lot of unknowns at the moment. We will get through the sixth round of chemo, and then have another round of tests. Another CT scan, something called a Muga Scan (for a lark, try chanting Muga muga muga muga over and over) that measures your heart and another bone marrow sample (oh joy). And then more consultations with my doctors.

Just an observation; I have noticed that when I refer to the doctors I see at Princess Margaret, I don’t refer to them as oncology doctors. Yes, they are oncology doctors practicing in a major oncology hospital, and yes, I do have cancer. But I just can’t bring myself to refer to them as oncology doctors. I don’t think that I am in denial, too late in the game for that. Something to ponder.

For now, I’m going to enjoy feeling pretty good. And send a cheer to those riders who are braving a rather wet cold day as they make each day count. Cheers!