ddMVAC chemo Day 8: A talk with my doc

The past two days have continued to be rough.  I've continued to feel weak, with roiling nausea and constant exhaustion.  I've barely slept the past two nights -- not due to my nocturnal incontinence, I think but rather due to the effects of the chemo.  I have been hopting that I'd start to climb out of my chemo-induced hole, but so far it doesn't seem like I'm making any progress. 

Dr. Aragon-Ching quickly replied to the email that I sent her on Monday night (and copied in my post).  She invited me to come into GW at around noon, get my lab work done, then we'd be able to talk about our options.  Jennifer and I made our way in, and my lab work showed that my blood counts were doing reasonably well.  In fact, my red blood cell count was a bit high, suggesting that I has not sufficiently hydrated.  I had lost eight pounds since last Wednesday morning, right before I started chemo, further suggesting that I needed more fluids.

We met with the doctor for more than a half hour.  She commiserated with me about the difficult time I was going through. I said that, if the next 11 weeks were going to be like this last week, I didn't want to continue the chemo.  She noted that my counts were ok, and what I was feeling was the totality of the chemo-induced side effects.  She said that she hoped that I had hit the nadir of this round, and that I should be feeling better in the coming days.  She acknowledged that it might not be until next Monday or so that I could be feeling close to 100%, and that the prospect of plunging into another round of chemo-induced fatigue could be overwhelming.  I said that, given the limited palliative purposes of this chemo (not curative, but to try slow the spread of my cancer), I didn't want to lose 3 months now by feeling lousy, only for the possibility of gaining a it more time before the cancer spreads.  She agreed that it was a difficult decision, and ultimately one that was mine to make.

She did offer a few options to consider, however.  These are not necessarily mutually exclusive.  1) Stay the course, do the second round of ddMVAC next Wednesday.  2) Do the second round over two days, with the M drug on Wednesday (with lots of fluid), and the VAC drugs on Thursday (with more fluid).  3) Postponing round 2 by a week or so, to let me feel better.  She said there was no hard and fast rules to the individual treatment I was getting, since I was not in a clinical trial with specific rules.  She also said there was little evidence one way or the other of what effect a week delay would have on the efficacy of the therapy.  But she agreed that quality of life in both the short and long term was the most important criteria.  4) Suspending chemo after 3 rounds, do a CT test, and see if there is any disease progression.  If so, then we know chemo failed.  If not, then maybe it worked, or maybe the cancer was going to spread slowly anyway.  She noted that three rounds is a lot easier psychologically than 6 rounds.  5) Stopping chemo now and taking a wait and see approach.  She didn't support that option at this point, but understood if I chose to do that.  

She encouraged me not to make any decisions today, but to wait and see how I was doing early next week.  We agreed to reconnect early next week and decide then.  In the meantime, I'm going to see how I'm doing, consider and pray about what I should do, and make the decision when I need to. 

Dr. Aragon-Ching suggested that I have an IV hydration infusion, along with an anti-emetic, to help settle my roiling gut.  So Jennifer and I toddled over to the Cancer Center where Nurse Meg was happy to fill 'er up.  I cranked up the heat in the chair, got a blanket, and closed my eyes for an hour.  I've been so tired. 

We then went upstairs where I had an echocardiogram of my heart.  Dr. Aragon-Ching wanted a baseline to see if the ddMVAC was having an adverse effect on my cardiac function.  The tech rolled the sonogram sensor all over my chest and took lots of pictures.  This must be what an expectant mother feels during the fetal sonogram.  We found the heartbeat and confirmed it's a boy.