March 30, 2013 (Sat) – Erlotinib-Zoledronic Acid-Benzonatate (say what?)

It was a lot easier to explain my treatment regimen when I just had to use “zap.” Well, it’s a whole new ballgame now. Now we are into chemistry. The first one you’ll recognize by the more common name I’ve been using: Tarceva. Remember the $200 pill? I’ll get into the other two (or three or more) later in this blog.

Speaking of blogs, who came up with that word? Sounds more like the ’58 “B” horror film starring Steve McQueen. Or something I coughed up earlier. As some point in the future when I am on chemotherapy, I might be “blogging” a whole lot more than I want.

Sorry, digressed. Must be due to the pharmacy that used to be called my office.

So, beginning last Wednesday morning, my entire treatment switched to a single dose of Tarceva. Certainly a whole lot easier than driving over to the medical building for a lung zap. Time will tell (probably 2 weeks or so) if it is having a positive effect.

Yesterday morning, Kim and I had a ♥2♥ with my oncologist to get some things cleared up. We’ve had a bit of miscommunication (or lack of communication) since we met him the first time a few weeks ago. But we are cool now and he helped answer a lot of nagging questions that we had. One of which was our concern regarding the elephant that was sitting my my chest. OK, OK, maybe only a poodle. But Kim and I both left much more knowledgeable and feeling a lot better mentally.

We asked him about the side effects that Tarceva could cause. Of course he didn’t have another hour to go through them all. But he did indicate that I should have seen them (other than the hoped-for rash) within 24-36 hours. So maybe I’ve dodged the #2 blues. But I could use some help in promoting side effect number 1. So M2, you are in charge. Ready? GIMME A Z (Z); GIMME AN I (I); GIMME A T (T); GIMME AN S (S). Whats that spell? ZITS! I’m counting on you cheer types here.

The doc also started me on Zoledronic Acid, more commonly known as Zometa. Since cancer has a tendency of weakening bone structure, there is a risk down the road for some not-so-fun issues like spinal collapse. Of course Zometa comes with its own potential side effects such as osteonecrosis. Something about the word necrosis which reminds me of dead flesh (sorry) that does not give me comfort. But spinal collapse would be the worser (remember, I love to mangle English) of the two. But one of its possible side effects is constipation so if the Tarceva #2 side effect kicks in, maybe they will cancel each other out. I have to go in once a month for the Zometa intravenous infusion treatment which takes about 20 minutes. He also set me up with a prescription of Benzonatate which is supposed to help reduce the 1-2 minute coughing spasms that are occurring multiple times a day.

The combination of all this crap, er healing drugs, has knocked me pretty flat today with a nagging headache and minimal energy. My savior (Advil) which nailed my prior headaches, is no longer on the table since it is “contraindicated” now that I am using Tarceva. Tylenol just does not work nearly as well for me for some reason.

It turns out that the drug, Avastin, that might have been part of my treatment had I been eligible for the clinical trial, is actually still available to me since it is an approved drug. It is also given intravenously, about every three weeks in 45-60 minutes. My doctor feels that it would be a good idea adding that to my treatment plan once all of the radiation effects have quieted down a bit. During the conversation the term aggressive was used. That is not a descriptor a cancer patient wants to hear but it is what it is. It all comes down to a tradeoff on possible side effects versus potential positive benefits. OK, I’m done whining. 🙂

So I have a follow-up appointment with my pulmonary specialist next week and one with my radiologist the week after. Not sure exactly what they would be doing at this stage but they want to stay up on my treatment so I’m not complaining. It will probably be a bit before we know if my fuzzies have grown or shrunk. If Tarceva does not work for me, chemotherapy would be next on the agenda.

Unless something changes (like a zit breakout), you may not see another post for a few days. Stay tuned.

Business as usual. Day at a time.

March 26, 2013 (Tues) – Blue 32! Blue 32! Down. Set. HUT! HUT!

Football

For those of you familiar with football lingo (my sports-fan daughter being one of them), the title of today’s blog is what’s known as an audible. Or in another use, you could say my son’s rock band is barely audible. But in football, it’s basically changing the play at the line of scrimmage at the last minute. That’s what happened today. So after 11 straight plays (days) of a fullback blast up the middle (lung radiation therapy) that gained no yardage, we are now going into a spread offense (Tarceva). OK, now I’ve even confused myself. Essentially the intent behind the radiation therapy was to shrink the mass in my upper lung that has a vise grip on my esophagus or some other piece of my anatomy down there. No, not that far down. Unfortunately after 11 days, it does not appear the radiation has worked its magic and the partial lung collapse is still fully in place as is the mass.

So, the 1st audible plan was to immediately add the oral medication (Tarceva) to the radiation therapy which was to continue through next Monday. After talking with my doc today, a 2nd audible was called as he felt that discontinuing the radiation was ultimately the best plan of attack since it hasn’t shown any benefit yet and there was some slight concern about having radiation and taking Tarceva at the same time. Plus there was a fear about potentially damaging my lung further with additional radiation that wasn’t benefiting me.

So, essentially, while I graduated from brain radiation school magna cum zappa last week, I flunked out of lung radiation school today and have been kicked off campus. So much for my second diploma. Starting tomorrow I’ll just be a druggie. Speaking of drugs, here is a picture of what a $200 pill looks like.

Tarceva

Amazing. Let’s hope it works like a $200 pill. As you all are aware, I really had very few side effects of the radiation other than a squashed face from the brain radiation birdcage, along with just a little tiredness. But Tarceva comes with its own set of potential side effects. If you unrolled the list of them it would cover the length of your arm. Of course the last possible side effect is that it could kill me. But so could an aspirin. I guess they have to CYA. The most common side effect (30%+ of the patients) is a rash with what may appear like acne if it reaches the face. Apparently this is most often a good sign since it it usually indicates the medicine is working. So the next picture you see of me will hopefully look like my high school sophomore picture, looking a bit like the surface of Mars. The number 2 most common side effect (excuse that pun…not), is diarrhea. I will not be sharing any photos, thank you. Hard to believe that little tiny pill can do all of that and more. You’d think I would have to swallow a pill the size of a suppository. OK Craig, now you are over the line. But I think some of the radiation may have removed what was left of my filters.

So today is really Rx day. Kim’s mom is in the hospital as I type this recovering from hip surgery to replace one of the two that were already replaced some time ago. Apparently she received one of those hips sockets that caused problems from the metal on metal rubbing that created cobalt poisoning in her blood. She’ll have the second one done sometime in the near future. She’s one tough lady.

And Kim was just diagnosed today with a case of shingles (as opposed to cement tiles). So far a light case (so I say), but I’m not the one dealing with it. It can be brought about by additional stress in your life. Stress, what stress? We haven’t had any stress in our household lately.

Beep beep, back up the truck. So back when I was diagnosed with lung cancer as a pretty healthy, non-smoking, 60 year old, the first question out of my mouth was “how the hell did that happen?” Google, my friend and enemy, says that the most common source of lung cancer in non-smokers is from radon poisoning. Radon is a natural occurring gas (other than what our dog produces) that leeches out of the ground. So I bought one of those radon testing kits on-line, set it in our house over the weekend, and just mailed it back for testing. San Diego in general is supposed to be a fairly low-risk area as far as that is concerned. And I certainly hope it comes back in that category. I’d hate to think my whole family has been exposed to that over the years. Just wanna be sure.

Well, tomorrow brings a new phase into this battle. Let’s hope the pill is mightier than the zap.

Business as usual. Day at a time.

March 22, 2013 (Fri) – Graduation Day (OK, OK, undergrad)

My brain is toast. At least I hope a portion of it is. Today completed my 5-day regimen with both lung and head radiation. I was joking with the technician about not having a graduation ceremony for my last head-shot, and after the procedure she surprisingly handed me a certificate:

Graduation Diploma

Graduated magna cum zappa. Let’s hope I don’t have to go back to school and repeat any classes.

The day begin with a call on my cell phone while I was en route for the double-double. Apparently the lung zapping machine had gone on the fritz and they wanted to move my appointment to the afternoon when they hoped to have it repaired. OK, my confidence level in being radiated by a recently repaired machine dropped like a rock. But I guess there were several guinea pigs ahead of me. And it wasn’t the brain machine – whew.

So this time I had the brain zap first, and true to form, nodded off during much of it. But as a parting gift, since I will never ever-ever-ever need it again, I got to keep the Silence of the Lambs birdcage. What do you think?

Picture 1

This is only a portion and doesn’t really do justice to how the whole torture mask actually was used. But my prior description of a facial mammogram comes closest. But no more. 🙂

Gross-out alert: skip to the next paragraph if you are queezy. I warned you. On Wednesday night, after I made my latest blog post, I had a coughing attach and coughed up a lima bean sized chunk of tissue. I took it in on Thursday to ask them about it. Apparently this is not anything unusual. In fact it was a piece of my lung apparently. Hard for me to think coughing up a portion of one of my organs is no big deal. Learning something new every day, whether I want to or not.

OK, didja skip the last paragraph? Good move, especially if you are reading this around meal time.

So, the schedule is still the same for now. I will get a lung x-ray Monday before my next treatment since my radiologist wants to see if the radiation treatments are having an affect. Apparently an x-ray earlier in the week which they did while I was on the table showed that the lung mass is still encroaching on my lung. I guess that accounts for the aforementioned foreign body I coughed up (oops, sorry). But admit it, you read that section anyway, right?

They will wait about 30 days before doing another brain scan to see if that toasted portion has stayed fried. OK, everyone in unison now: “Toasted-Toasted-Toasted!” Thanks. That helped.

Weekend plans consist of dinner with friends tomorrow and softball on Sunday. Be nice to at least have two days of normalcy and a radiation-vacation.

Business as usual. Day at a time.

March 20, 2013 (Wed) – Same ol’, same new

Didja miss me? OK, I guess I’ve got you spoiled with my daily blogs. Didn’t mean to concern anyone by skipping last night. But Tuesday was pretty much the same as Monday, which was pretty much the same as today. Besides, you think these incredibly creative musings just roll of my tongue? OK, so I was just lazy. Let’s be real.

But in all honesty, as my treatment progresses, there will be many days where there really isn’t anything new to update. If you are interested, the best bet would be to subscribe to my blog; that way you’ll get an e-mail if something has been added. If you don’t see anything new, that means there isn’t anything new, or I couldn’t think of any new jokes. Either that, or the technician did get confused between a meter and yard.

So tomorrow (Thurs) is day 4 of my double-double. I wish it were the In-N-Out version. No such luck. Still, incredibly, nodding off during the procedure. Come Monday it’s back to just the 5-minute lung zapping, although that is up in the air a tad right now. By then this thing in my head should be toast, but we won’t know for a while until a comparison scan is done.

I’ve joked a few times about pulling the “C-Card” whenever I need an excuse for doing something stupid, on or off the field. Well, some good friends of ours had a bunch of cards printed up for fun. Very creative!

Cancer Card 2

Business as usual. Business as usual. There, that will cover the past two days. Day at a time.

March 18, 2013 (Mon) – Two, Two, Two Mints (Blasts) in One…

Certs       Fuzzy hat

OK, most of you are not old enough to recognize that jingle above. If you do remember it, you’re older than dirt. Or at least as old as me.

So today began the “two-fer” treatments. The 5-minute lung zap went as per usual. The new head blasting immediately afterwards was definitely a new experience. Of course the first thing I checked for was to see if the technician was green around the gills from yesterday’s St Patty’s Day. She wasn’t but of course I had to tease her about that possibility but she told me she was a non-drinker. Yes! And I could tell she knew the difference between a meter and a yard. OK, step one complete.

Waiting for me on the torture table was the bottom half of my form-fitting birdcage helmet. It’s really not a torture table, but it could be. Another good thing is that with this kind of treatment I don’t have to change into a butt-crack gown. I get to wear my street clothes. Small favors, right? But I digress.

So I laid (lied?) down on the table and slowly lowered my head into the cage. Imagine that, a perfect fit. Duh. That was the easy part. Then the multiple layer top half was pressed down into position and clamped down hard. And I mean clamped. And I mean hard. I really can’t compare it to anything except for how I’ve heard a mammogram described. Try not to visualize that too much. My face and head were pressed (OK, somewhat smashed) between the two sections so tightly that I couldn’t have opened my eyelids even if I wanted. Picture someone taking a full roll of duct tape and looping it over and over across my head and under the table. That’s probably a better visual example than the less PC one above. Basically I could not move my head an inch (OK, centimeter). But that is the idea. They don’t want me shifting around making for a moving target. Heck, they might accidentally zap the area of my brain that controls typing skills – then you guys would all be outta luck. Or not.

Topping off the keep-the-body-frozen process was the large rubber band they wrapped around my feet to keep my legs still, and the large rubber doughnut on my chest that I gripped with each hand to keep my arms quiet. Do you get the impression they didn’t want me moving? Heck, I was so incapacitated the technician could easily have had her way with me. But I guess that particular procedure was not on the work-order chart.

This one took a little longer – about 20 minutes for the refrigerator-sized brain zapper to work its way around me from various angles. The table also moved to help provide a more clear target. I could have sworn later that the bombardment was happening while the table was moving which blew my whole moving target theory. But the technician confirmed that yes, some of the radiation doses were administered while the table was doing a Linda Blair thing. Thank God for computers. I hope they aren’t Windows based as I have 4 more of these this week and prefer not to have a blue screen of death pop up at the wrong time.

I say the treatment lasted 20 minutes but I can’t confirm that. Why? Wait for it….You know what’s coming don’t you? I fell friggin’ asleep again! I understand that many patients have to get drugged or they go crazy because of the claustrophobia feeling of being so tightly wound. Ordinarily I would put myself in the latter category but for some reason I must have gotten over that fear I developed as a kid when I accidentally locked myself in my dad’s sea chest out in the garage. Ask me about that some day. Otherwise, just like the lung radiation, I never felt a thing.

We (Kim and I) met with the radiologist afterwards to just confirm the game plan and it still stands as of my last blog. Four more days of this double and then an additional 6 days of lung zaps. Then oral medication. Stay tuned.

I discovered a side benefit of all the radiation when I got to work. I don’t have to turn on the lights in my office anymore. In fact I think I will apply for a permanent Energy-Star tattoo on my chest. My Director of Engineering will appreciate all the energy I am saving. Plus, I’ve figured out a way to make some extra cash during the holidays. I can rent myself out to boat owners who can strap me to their masts during the Parade of Lights down in the harbor. Pretty cool, eh?

Speaking of cool, how about that hat my neighbor made for me that I am so stylishly modeling above? I love it!

Tomorrow is day two. Then Wednesday is, er, uh. Oops. I forgot. Day at a time.

Business as usual.

March 17, 2013 (Sun) – T minus one and counting

To blastoff that is. Tomorrow (Mon) we fire both booster rockets with radiation treatments for my lung and head, back to back. Get to finally try out for size the face mask they made for me last week. Reminded me a bit of Silence of the Lambs. Good thing my appetite hasn’t been up to snuff. Those technicians might have something to worry about.

Speaking of the radiology staff, I hope they aren’t recovering from too much of the green beer that they imbibed today. Wouldn’t want them to misplace a decimal point or use inches instead of centimeters in their measurements. Of course, if NASA can fail to convert from English measurements to metric while sober resulting in the crash of a Mars orbiter, I guess anything can happen. But not on my watch please. I guess if you don’t see a mushroom cloud over Kearny Mesa in the morning, everything worked out OK.

Last night I found that taking 2 Advil in desperation to try and knock down that headache, actually did the trick. So much for prescription medication. This morning I took a cocktail of Advil and Tylenol before the softball game I played in. Musta helped because I almost hit for the cycle with a single, double and triple. Remember, in this league, any time you get on base it’s ruled a base hit. You know I would leave it right there but too many Old Pros are reading this and would bust me with public comments on my blog. OK, here’s the real truth: While having a decent day at bat, I had the biggest brain fart of my career in the field. While playing rover (over 2nd base), I forgot there was someone on first so when a ground ball was hit to our shortstop and I started heading over in his direction, I was totally stunned when he turned and threw it to me when I fully expected him to throw to first. I was 10 feet off the bag and had no play at 2nd. I still might have gotten the runner at first but I just froze because I was so discombobulated. Ooh, love that word. That cost us 4 runs and we ended up losing in extra innings. Over a beer after the game I tried to blame my momentary confusion on my brain tumor. They weren’t buying it. Good for them. It was a lame excuse.

OK, headache pretty much gone, some barley soup (of course) and coconut cream pie in my tum courtesy of neighbors and friends, I’m good to go. I wore green most of the day and I plan on having some of that luck of the Irish spill over to tomorrow.

Business as usual. Day at a time.

March 16, 2013 (Sat) – Par for the course (actually 5-under)

So yesterday I participated in my wife’s fund raising golf outing to support her school. I hit pretty well (for me) with a couple 250+ yard drives. What? You’re supposed to stay on the course too? I didn’t say where the drives ended up. But I guess, like the Hulk, the radiation treatments must have given me some extra juice. Not complaining. We ended up 5 under par, which sounds good but considering it was a scramble format and the most you could take was par on any hole, well… The winners came in at 18 under. But back to golf later.

I started Friday with what is becoming a very routine stop at the medical center for my whopping 5-minute blast to my lung. They don’t even grill me for my date of birth 5 times as per usual anymore to ensure I am the right patient. Kinda like Cheers,  getting to know everyone by name. From there I continued down to the 2nd grade class in National City where I do science experiments every week. Missed last week ’cause I wasn’t feeling up to it. Didn’t want to miss another. Too much fun and I’m sure it helps in my healing process. The teacher had the students all write me get-well notes. I have to share a couple samples. Very fun!

Kid's letter 2 Kid's letter 1

Earlier in the day I had called and left a message for the specialist I’ve been working with at UCSD to ask if I could start the Tarceva oral medication at the same time as my radiation therapy. Being the eminently qualified lung cancer expert I am, I didn’t see an issue but I also didn’t want to ruin any chances of qualifying for a possible clinical trial that might open up soon. Now, I hate guys that use their cell phones on the golf course. You golf to get away from that stuff. I was going to say crap but I think I’ll save the heavier grammar for later on in future blogs. Oops. Too late. But yesterday I had to keep my phone available in case the doc returned my call. I did keep it on vibrate and in my golf bag, checking it every couple of holes.

As it turns out, she called right at the turn (for you non-golfers, the beginning of the 10th hole). I heard the phone vibrate and grabbed it. Now those of you that know me well, know that I use hearing aids. Yeah, yeah, my body is just falling apart. So with my limited hearing, on a golf course with some wind blowing, on a cell phone, with a bunch of noisy (but fun) golfers ahead of us reloading on beer for the 10th time, and my doctor’s Russian accent, it was a miracle I could understand her at all. Come to think of it, maybe it was that call I was expecting from Nigeria saying I had 3 million dollars just waiting for me in an offshore account. Hmm…

Well, the gist (what the heck is a “gist?”) of the call was that my doc said taking Tarceva and doing the radiation at the same time was not really an option, that they made bad bedfellows. Kinda describes me for the past couple of months, eh Kim? So I will be waiting until after the radiation is complete (April 1st) before starting up. Unfortunately, as least as well as I could determine given the challenging hearing scenario above, the doc also said that I really am not a candidate for a clinical trial any more. Even if I was accepted into the trial, there is a certain amount of time it takes to get it all set up and because of the recently observed rate of growth of my head tumor, they didn’t want to take the time to get me all enrolled etc.  I will be calling her to reconfirm what I thought I heard but I think it was pretty clear.

In the meantime, I’ve had the pleasure of a splitting headache for the past 48 hours, courtesy of either the sucker in my head or the after-effects of the lung radiation. The pain medication knocks it down a bit for about 3 hours but then it comes back. Without that, I would actually be feeling pretty good. But those of you that have migraines know how debilitating they can be. I hope that the upcoming brain radiation treatment this M-F will help alleviate that issue. But I had to add a picture as to what this feels like. Many of you can probably relate. And of course I had to use an Ah-nold movie for my example. There’s a reason why they call it “splitting.”

Split head

This morning, Kim and I made our way up the mountain to Julian for the Rotary Camp Enterprise final day. What an awesome program. Bunch of great kids, Rotarians and Rotaracts. Nice way to start the day with picture perfect weather and a fun drive. ‘Course we had to stop at Dudley’s Bakery. 🙂

Monday we start the double zapping treatments. Gotta whittle these suckas down to size so the Tarceva can do its thing. Can’t wait.

Business as usual. Day at a time.