The Chemo Will Be HOW Bad?

Our favorite cowpoke Willy Drennan is about to get back in the saddle again and bust out a can of whoop*** on some chemo.

That's our we-can-do-this attitude this morning, after a nice long night to NOT think about it.

Well, silliness aside, here's the deal.

TABLE OF CONTENTS

GREEN SECTION: The GREEN TEXT is for anyone who wants to know what happened with the triglyceride scare of last week, wherein Bill's LOCAL Dr office told us his lipid scores were so stratospheric that their own lab couldn't even process it, leading us to safely assume he was in some shockingly dangerous risk for heart attack, scaring us to death. If you weren't following that plot line, you can skip to the white text.

WHITE SECTION: The WHITE TEXT is for what happened yesterday at the Wake Forest Oncology center, telling us the upcoming Alfred Hitchcock scenario for Bill's next chemo, which starts right away.

GREEN SECTION:
The (as it turns out) non-issue of Bill's blood lipids: Bill had gone last week to the local Blowing Rock doctor to get a prescription refill for Crestor, and the doctor said that they'd need the lab to take a blood sample. Which the lab did. Then gave Bill the Crestor. But then the Dr's office called back, all worked into a frenzy, that the scores on the triglycerides were so out of the ball park that they'd had to send the scores to a DIFFERENT lab to try to make sense of how terrible the scores were.

Of course, scaring us half to death.

So a few days later, Bill called that Dr's office and requested a copy of those scores, because we wanted to take a copy to our oncologist.

But the local office staff said, "Oh, Oooops. Our lab guy here DID send the blood out to the lab, but he accidentally sent someone else's blood. So you have to get tested again."

So Bill got tested again, and when we went to pick up THOSE results, 5 minutes before leaving for the oncologist, the local office staff said, "We're sorry. The scores WERE here, but we lost them."

So the dog ate their homework?

I am NOT making this up!

At least we did know that Bill's supposedly shocking triglyceride score was 584 when 150 is the highest it should be. So when we told the doctors at Wake Forest, they said, "Well that simply sounds like you didn't fast before the test."

Bill said, "Correct. The local Dr's office told me to come in AFTER LUNCH, so the test was done about 2 pm, after lunch." Had the local office said, "You're getting a lipid panel," which Bill has had about a million times, Bill would have known to advise the staff that a lipid panel is taken only after careful fasting. And it's scary enough that Bill would have had to educate the staff on the protocols for lipid panel testing. But no one told him he was coming in at 2 pm for a lipid panel.

The Wake doctors just stared at us--almost with their mouths hanging open. "You weren't told to FAST?" Bill said, "No. They told me to come in at 2 and took my blood."

This present paragraph will not say the things we are all thinking, but can you even imagine all of that happening in real life, with actual licensed medical professionals? I said, "Bill, at what point do you NEVER darken the doors at that local place again?" Bill said, "Beth, I like that Doctor as a friend and as a person. He's a good doctor. It was the office that messed up, not him. I don't care what they do with my blood. I just go there to get my Crestor."

Okay, I can see that point, since Bill actually IS in the care of literally FAMOUS doctors at Wake, but perhaps some of us are left wondering about...oh...okay...I could say some funny stuff right here, but I shall take the high road and stop.

END OF STORY EXPLAINING THE TRIGLYCERIDE FIASCO, told only for those of you who read about the triglyceride thing last week and were worried about Bill's heart, as we were.

* * *

WHITE TEXT SECTION: UPCOMING CHEMO

I got an almost verbatim transcript of every word Dr. Torti said yesterday, so I'll use my exact handwritten notes to tell you the main points.

My notes say, "Tho saw good Shen possib somepl taco relapse high dose...."

I have no idea what that means, but you can be sure it means something IMPORTANT.

Just kidding. (My notes actually aren't perfectly legible. And the first line did look like the above, but here's what Dr. Torti really said.)

(Paraphrased). We are going to be very aggressive. The surgery with Dr. Shen went excellently, but we need to do chemo immediately. Due to what we now know about your cancer (from the pathology report analysis? from the blood they drew at Wake yesterday?), the cancer cells are the (something to the effect) most aggressive kind, active and alive, and are currently in your body, moving through it and "are probably" already setting up new tumors, but until they are a certain size, we don't know where the cells are, so we need to attack them immediately, while everything is small.

We will use platinum again in this regimen (Cisplatin, which Bill also got last time, and which totally failed), and you may wonder, Why go back to platinum when it didn't work before, but it's because it's the best drug we have; even if there was a relapse, you can still be responsive to it, and we will be using a much higher dose than before.

There is correspondence to dose size and response. Last time you had chemo (through Dr. Walther at Duke), you got a...(sounded like he wanted to say LOW dose)...then he thought, and said, "a reasonable dose", but this time, it will be higher and that time you had a lot of tumor, but this time less tumor so that the chemo can do more work in your vascular system. So this is much better than the other time.

Even though last time it failed, and it's not perfect, it's the best regimen we have.

You'll have Cisplatin (that's the platinum drug), along with two other chemicals your tumors "haven't seen before": methotrexate and vinblastine. [I, Beth, like the "blast" part of vinblastine.] So we'll use "something old and something new."

You can have this done in Boone, as I've worked with Dr. Flint Gray there, and he is very good. [I actually said, "His mother named him FLINT knowing that his last name was GRAY?" No laugh was evinced.] Then you'll come back here after a reasonable number of cycles, for tests.

There are serious risks. You could have permanent deafness, permanent numbness of hands and feet, hair loss, vomiting, many systems affected. We must watch your kidneys especially. VERY substantial side effects because of the very high dose.

You'll have the [I, Beth, will now switch to M and V for the "lesser drugs" and C for the Cisplatin, which is the bomber] M and V at beginning of treatment, then must wait a minimum of 12 hours before you receive the C, so the M has a chance to clear your system entirely.

I hospitalize my patients with this regimen (because it's so powerful, they need to be overseen, hydrated, and receive drugs by IV between the dosings).

[Bill and me: HOSPITALIZE? Silent Shock. Didn't see the "H" word coming! Both of us thinking, SAY WHAT??????????????]

Me: "Can he be hospitalized at Boone? Will they know how to handle this or should he just come here?"

Dr. T: "He can be hospitalized at Boone. Dr. Gray knows how to handle this, and I'm still involved."

Bill: "I'm teaching on Mondays and Wednesdays. How will this work?"

Dr. T: "You could be hospitalized on Thursdays and Fridays. We will leave it up to Dr. Gray. You could receive the M and V on Thursday morning, then the C on Friday morning and perhaps be able to teach on Monday and Wednesday."

Then Dr. T said Bill will have every third week "off" to recover, and then begin the next cycle, so each cycle is three weeks, but because of reactions, Dr. T said that almost no one stays on the schedule because there are always delays when the body gets so distressed that the next cycle has to be put off.

"If you get a temperature of 102, or feel even one chill, you must go to the hospital instantly. Do not wait even a few hours. If you waited till morning, it could be too late to recover. A temp of 102 means you have an infection, and this treatment can completely compromise your immune system, and you need IV antibiotics and treatment within hours. This scenario happens to one-third of patients who have this chemo." [That scared us, too!]

How long will we do the chemo? "If you can tolerate it, the ideal is six cycles, which takes 4.5 months, minimum. If you have a hard time, we will do only 4 cycles."

Then Dr. T repeated that some of the side effects can be permanent, but "this is as aggressive as there is and gives you the best chance. I can not give you odds on whether the cancer will return, but this is your best chance (he repeated). But be advised: Even with all this, it could come back."

Bill then started to greatly worry about fulfilling his obligation to his Department Chair at Appalachian State, since 70 students are enrolled in his British Lit course which starts in three days. But Dr. Torti said, "No, Bill. We have to agree on one point. Your health is the most important thing. Department Chairs always manage. I, myself, am a Department Chair, so I know what I'm talking about here."

[Dear Queen Elizabeth of England: Could you possibly arrange for an American named William to be knighted for courage and commitment so remarkable, that even England can't believe its ears? And when you think of Prince Charles' ears, that is SAYING something.]

Finally, Dr. T closed with, "The biggest reaction you'll have is fatigue and feeling washed out. No one really prepares you for how extreme that will be. But you need to start the chemo SOON, right away, in fact. Dr. Gray will give you a baseline CT scan before you start so that when you come back here after 4 cycles, we can scan you and see how you're doing and compare it to the baseline."

So our next appointment with Dr. Torti is April 28th for a CT scan.

I AM SO SORRY THAT THIS POST IS SO LONG! IT IS RIDICULOUSLY LONG!

But I am depending on YOU to spend ONLY the amount of time you want to spend reading it. No one expects anyone to read the whole thing. I only put the whole thing up in case someone wanted details for whatever reason.

The next time I post will be soon--after we find out what Bill will be doing in Boone. Today, Bill is printing his syllabus, buying his parking pass for App State, and proceeding as if he will make it through the semester teaching his class, despite the chemo.

How did I ever end up married to such a hero?

Love to all, and gratitude for your love,
B&B aka Cowboy Willie and Diamond Lil