So Far, So Good

Thursday was the big day. Chemo day. I am happy to say I have come out on the other side feeling pretty good overall. 

All hooked up, chemo going in, still smiling. 

Part of feeling good is probably attributable to the suite of pharmaceuticals pumped into me on Thursday. Most of these drugs are meant to help manage nausea, which is a very good thing. The nurse said that I should feel decent until sometime today, at which point what they gave me will have start to wear off. Hopefully from there the anti-nausea meds I am taking already will take over and do their job. I woke up this morning with my hair still on my head, but I imagine that whole situation will come with time. They say for some people it can take weeks before the hair starts to fall out. We'll see which of the other possible side effects manifest themselves in the coming days and weeks.

The other part of feeling good is more emotional. There is something about taking the first concrete step toward something that makes it real and calms me down. The cancer killing drugs are in my system. Now it's time just to take things (i.e., my physical state) as they come and to pray the drugs work. One foot in front of the other. One day, one moment at a time. 

I am also feeling better emotionally because of the conversation we had with my doctor. He was a lot more clear compared with previous conversations about what he is hoping the chemo is going to accomplish for me. He's hoping that the chemo, combined with some radiation we plan to do on the tumors in my back and hip, will not only kill off the tumors, but will alter the tumors themselves so that they are more detectable to my immune system. Let me explain why this is important in more detail for those inquiring minds out there:

In this (click the word "this") post I wrote about the type of melanoma I have. This type of melanoma carries what doctors call a "low mutational load" which makes it hard for the immune system to recognize that it needs to attack it with t-cells. This isn't good when we're talking about immunotherapy because the whole idea is to get the immune system fighting the cancer. In order to do this it needs to recognize that it has something to be fighting, which is a hard thing to make happen in my case.

All of my liver biopsies show that I have a very low number of t-cells in my tumors. This isn't surprising given the above, but it is discouraging. What my doctor explained yesterday is that chemo and radiation often have the effect of changing the face of tumors, which can make them more easily recognized by the immune system. He is hoping this is the case with me and that we can go back to trying immunotherapy after this season of chemo and radiation, but hopefully with more success and more t-cell activity (i.e., more cancer killing).

If we can get more t-cells to my liver tumors more treatment options will also open up to me, including a version of what is called "adoptive cell therapy." This treatment is in its infancy and very experimental, but basically what they do is harvest your t-cells, reproduce billions of them in a lab, and then put them back into your body. Pretty cool and very cutting edge. But, I am not a good candidate for it unless I can get some more t-cells of my own into the battle against this disease. 

Now we pray and hope and wait. I will have my next PET/CT scan on February 25, which is when we'll really know whether the chemo is effective. Until then it's all about managing side effects, getting the radiation moving, and finding ways to fill my free time with challenging and interesting activities, including (hopefully) more writing.