October 24, 2024
The nurse told him he didn’t have to have his port accessed today and could opt for a regular blood draw. He jumped at the chance to skip the port. He is so tired of having it act up and them having to work with it. He was happy to have labs like a regular person. We were also happy to see Dr. B today, and after chatting about his trip to Italy, we jumped right in. Hemoglobin is up 9.3 and Iron was “you have plenty of iron”. Dr. B said if we went by the book, the next step would be the Lonsurf chemo drug we discussed months ago, but he said he was about 75% sure it would not work. He said he didn’t have much confidence in it working when the FOLFIRINOX didn’t work last Fall. Based on the neuroendocrine features of the liver tumors that were tested in February, he suggested we try a chemo protocol for neuroendocrine cancer in hopes it may do some good toward shrinking the tumor and giving David some relief from some of the pain. He said if proved effective, it would help with the mets elsewhere in his liver and lungs as it was a systematic approach. He said we could start as early as Monday if David chose. David said we might as well get started as there was no reason to wait. Dr. B agreed. He said like before, lab work would be done regularly to determine his tolerances. He went ahead and had the scheduler get us set up for next week while we were there. This protocol will be carboplatin and etoposide (vp-16) given three days in a row and then skip three weeks then repeat, etc. David will receive carboplatin and etoposide on the first day and then just etoposide on day two and three. He said we would need to have patient education but basically all the classic side effects were the same as before with maybe a few worse ones including a higher chance of hair loss with the etoposide than with the previous regimen. He said he would monitor the CEA level and our hope is that the CEA number will go down. We discussed the possibility of doing two rounds and then assessing the progress. We talked about pain and how that was going (not well) and Dr. B said David may have stable disease where the tumor in his colon isn’t getting any bigger but still presents problems. Not getting any bigger sounds good but going away all together sounds even better. If only….
Leaving the office David wasn’t saying much, and when we went to get dinner, he got increasingly anxious. We talked about how it felt different this time and there didn’t seem to be the optimism we had going into chemo last October. We guessed knowing now it didn’t work and there is a possibility this will be the same outcome. Of course, we are hoping for the best for him and don’t want to feel pessimistic, but things just haven’t improved yet and we would really, really, really appreciate a break for him.
It did dawn on me earlier this month that last year, we didn’t know if he would see another Fall or Thanksgiving and here we are about to start another November. We are certainly grateful for that. Later this evening, we checked the labs, and his CEA has gone down some since the last one in September. So maybe the Y90 did something. We are trying to be optimistic and hopeful for the liver scan on 11/20.
