CT Reveals Problems

 

Here are some updates. First, I made a command decision to stop taking Orgovyx. My last dose was on 3/20. I’m choosing QoL over longevity. But really, that drug was not right for me and may in fact have hastened me to the grave. I see my oncologist on Monday to sort things out.   

Second, I had a comprehensive CT scan on Thursday and met with my doctor on Friday. There are some problems. I had a pleural effusion in my left lung. This is fluid that accumulates in the space between the lung and the chest. The doc wanted to drain it immediately. He called a surgeon to do the procedure, right then and there. Fortunately it’s not complicated and can be done in 20 minutes in a normal procedure room. I sat up and leaned forward to rest my arms and head on an elevated table. It’s liking trying to sleep on an airplane by pulling out the tray and laying your head on it. The procedure is accomplished by inserting a large needle through the chest wall until the tip reaches the fluid. A suction device is applied and the fluid drains into a flask. I looked at the fluid. There was 350ml of the stuff and it looked brown/amber, like a beer, which is the normal color. The surgeon put a small bandage on it and told to take it off after 24 hours. The overall idea for this procedure was to improve my breathing and to analyze the fluid to determine if there is any sign of cancer in the fluid.

The next problem is that my spleen has grown larger and now has more lesions on it than it did in December. These could be benign but could also be some kind of cancer, which is probable given the many cancers I’ve grappled with, including some within the abdomen. The doc wants a PET scan to better understand what’s happening. That’s where it stands right now. Suffice it say that Friday was not a great day.

Zap! The Radiation Phase

On Friday, 3/14, I had my last day of SBRT high dose radiation treatments, a total of five altogether. The treatment is painless and generally easy, but it leaves me with fatigue and general malaise. I'm hoping that clears up in a week or two and also hoping that taking Orgovyx doesn't slow things down. 

On Thursday, 3/20, I'll have a CT of my chest and abdomen to follow up on other health issues, including the status of mesothelioma, any changes in the mysterious lesions previously reported, or anything new and suspicious. I'll meet the doctor (thoracic surgeon and mesothelioma specialist) on Friday, 3/21, to go through it all.   

It's known that cancer patients with co-morbidities (other illnesses) have a generally poorer prognosis. They have more problems to deal with. In some cases there are iatrogenic problems. This means that treating one illness can actually make the other illness worse. What is one supposed to do? In my book I repeatedly mention the goal of achieving your best possible health outcome. It’s a good idea, but it requires you to define your “best possible health outcome.” Some people want to live as long as possible and will accept any and all treatments, in spite of whatever side effects they will experience. Other people may want to maintain the highest level of quality of life (QoL). What do we give up when making these decisions? If you’re after QoL and turn down treatment, will you die sooner? There is no way to know. If you’re after longevity and accept treatments and their side effects, will you live longer? Again, no way to know. Let’s say that you do live longer but are miserable the whole time and then face your imminent death. Was it worth it? Do you gain substantially more life than if you had chosen QoL? No way to know. If you have co-morbidities more questions come up. If you can only treat one illness, which one should it be? Which one is likely to kill you sooner? What if one treatment is more tolerable than the other? If you’re close to your imminent death, you may want to skip any treatments for the other illnesses, because, well, why bother? Unfortunately there is no good way to quantify this. I always try to gather a heap of data and think it through. It's just as important to listen to your own body and consider what you really want to do over the next 6 months, one year, etc. Then you just have to take your best shot at it.