Had chemo yesterday. This morning, sitting in my recliner with a big mug of coffee, sun streaming through the windows.
Carol and I feel really lucky, we really expected this cancer to go a different direction, but here I am over two years past my initial diagnosis, beating the odds, still kickin'.
I had a CT scan yesterday, the first since January and the first since I started therapy with Keytruda. We got some good news and some bad news. The good news is that my cancer has not changed significantly since January. The bad news is that the scan shows the continued deterioration of my lungs. It is difficult to know the cause of the additional lung scarring, it could be a virus, or perhaps from inactivity during the winter months or it could be due to the Keytruda.
Keytruda is not a chemotherapy per se, it is an immune system stimulant. The doctor described it as putting a supercharger in your car... lots of horsepower, but one of the side effects is that the brakes are disabled. One of the common side effects of checkpoint inhibitors, like Keytruda, is that they can also stimulate the immune system to attack the body, especially the internal organs. To enable the brakes on the immune system, it is necessary to discontinue treatment with Keytruda and administer a steroid, such as Prednisone.
So the doctor, Carol and I discussed our options. One was to stop the Keytruda and administer 30 days of Prednisone, followed by another CT scan. Then if things had improved, restart Keytruda. The second option, the one we chose, is to continue with the Keytruda, monitor my breathing VERY CLOSELY and if there is any change for the worse, however insignificant, to call the Cancer Center immediately and then start the regimen of Prednisone. If there are no changes in lung function, I will have another CT scan at my next Keytruda infusion.
If it appears the lung problems are due to the Keytruda, then it will be discontinued. There are not any options beyond treatment with Keytruda at this time. There is a chemotherapy agent, called Taxotere, which has worse side effects than the Pemetrexed that I struggled with for over a year. Carol and I both decided that going back on a drug like that would be an unacceptable loss of quality of life, just because of the chemo brain fog.
Personally, I think a big part of my lung problem was the winter weather. When the temperatures were below about 50F I couldn't take but a few steps out the door and I would be breathing hard and start coughing. And when the temperatures got down in the single digits I would have a hard time catching my breath after only a couple of steps. And unfortunately, our winter this year was a cold one. So we stayed indoors a lot. The temperature here today is about 70F. Carol and I went for a walk around the house, looking at our gardens and landscaping, then we walked out into the woods, we were out for about an hour and I didn't have to sit down or stop because of shortness of breath or coughing.
So hopefully tomorrow will be nice enough for another walk.
Thanks to all of you for your continued thoughts and prayers as we navigate this strange world we find ourselves in.
Love,
Van
