Hello again, Doug fans. Here’s the latest update.
After a recent CT scan we met with Nick, our oncologist last week. Comparing the latest results with the previous full scan at the end of July, all the previous tumours are either stable or shrunk or gone. Nick says my condition has improved and has now plateaued, which is very good news. It means the immunotherapy is working.
Now that the chemo is a month in the past, my side effects have been pretty mild. I get a bit tired sometimes, requiring a (very) occasional afternoon nap. I’ve been able to stay pretty active, keeping up with my volunteer Marine Rescue work, helping with our delayed spring cleaning projects around the house, walking around the neighbourhood, and working out at the gym (more or less) regularly.
The only real problem is some swelling of my tongue and cheek, which makes talking and eating a bit awkward. (It's different from the mouth problem I had with chemo: these are not painful and not open sores, thank goodness.) Nick is puzzled about my mouth problems and referred me to an Ear, Nose and Throat specialist for an expert assessment. Is there any new cancer there? Should we suspend my immunotherapy treatments?
After a very thorough examination that involved a tiny video camera, the ENT guy could find nothing physically wrong with my mouth, nose, or throat. No sign of cancer there. He pronounced them, “dramatically normal”. So there is nothing wrong there, it just feels wrong! He suspects that my symptoms are due to nerve damage from either the chemo or the nearby tumours in my neck. Regrettably, there doesn’t seem to be any treatment for it. I just need to put up with talking funny – think Sylvester the Cat -- and eating slowly until the nerves heal on their own.
In balance, we're really happy with my progress! And I’m particularly happy that Dianne has hung in with me through all these ups, downs and medical appointments. She’s a legend!
Portacath
Here’s your next medical science lesson. Non-nerds feel free to skip down.
When you’re having regular heavy-duty drug treatments you need to have a semi-permanent access device installed that delivers the goods directly into a major vein. These devices are called central venous catheters (CVC).
A portacath is a type of CVC comprising a small plastic-covered titanium chamber or reservoir covered with a self-healing silicone cap. The portacath sits under the skin of the upper chest, connected to a catheter (flexible tube). The other end of the catheter goes into the jugular vein and threads down into the big vein that enters the heart. It’s entirely under the skin, so there’s little risk of infection and it doesn’t need regular maintenance. You can shower and swim and carry on as normal as there’s no external dressing.
The portacath looks like a bump under the skin of my chest and the catheter is a ridge running from the bump up and over my collar bone. When I need treatment, the nurse puts an L-shaped needle into the chamber – I only feel it briefly as it punctures my skin -- and attaches a drip line. All the IV bags and syringes for that session are connected to the drip line; I don’t need another jab for each one.
The portacath will stay in place for as long as I need regular treatment. One of the clinic nurses told me she had a patient who’d had his port for six years.
I had my port inserted at the end of August in an out-patient procedure at a local hospital. My lovely anaesthetist, Michelle, injected me with a bit of propofol to achieve minimal sedation. They also injected a local anaesthetic into the skin of my chest where they’d be working. I was conscious and relaxed through the procedure, lying on my back, my head turned to the left while the surgical team worked away on my right chest. There was a drape over my chest and head with a gap on the left to let some light in. From time to time Michelle would pop her head into the gap to ask me if I was OK. I always was.
As they were prepping me a female nurse, unseen to my right, complimented me on my pecs. This comment raised a few questions:
- Did I really hear that or was it the propofol talking?
- Is this a benefit from those 12 years of gym attendance – three times most weeks?
- How often is a 75-year-old man complimented by a woman on his musculature?
- With a surgeon poised above me, scalpel in hand, was this the best time for me to be shaking with laughter? (I resisted the urge. Others in the room didn’t.)
- Would a male nurse have delivered a similar compliment to a female patient? What would the reaction be?
I was vaguely conscious of the team working away on my chest but there was never any pain or discomfort. At the end, there were two tiny incisions with dissolving stitches that disappeared in a week.
After five months the portacath is working well for me. Mostly I’m not even aware it’s there.
Stay tuned for my next update in a few weeks. If you’re so inclined, you can read my earlier blog posts on this page.
Meanwhile, thanks again to you all for your unflagging support! Comments, questions words of inspiration are all welcome. I do love to hear from you.