Saturday, August 20, 2011

Health report

My father died of a very similar pulmonary embolus to mine 33 years ago. I had diagnosed the problem and got him admitted to the local hospital for appropriate treatment. Unfortunately, the local physician did not accept my instructions and my father died the next day. The physician was sorry afterwards but that horse had bolted.

My embolus was silent, but my own fault in that I didn't was to be on lifetime injections of clexane. I should never have stopped them. The embolus has left me breathless after walking 50 yards on the flat and won't resolve for some time. I am reducing the steroids again since I think that the proximal myopathy is only making things worse.

I had a consultation with the oncologists yesterday and while the clinical trial of cetuximab versus a TKI attacking the the EGRF receptor is on, it has to be entered within 6 weeks of failing chemotherapy, so I have to have another regimen before I am eligible. I therefore need to start capecitabine and mitomycin C. Here is the abstract recommending it.

Protracted venous infusion 5-fluorouracil (5FU) combined with mitomycin C (MMC) has demonstrated significant activity against metastatic colorectal cancer. Owing to potential synergy based upon upregulation of thymidine phosphorylase by MMC, the combination of capecitabine and MMC may improve outcomes in irinotecan-refractory disease. Eligible patients with progressive disease during or within 6 months of second-line chemotherapy were treated with capecitabine (1250 mg m-2 twice daily) days 1–14 every 3 weeks and MMC (7 mg m-2 IV bolus) once every 6 weeks. A total of 36 patients were recruited, with a median age of 64 years (range 40–77), and 23 patients (78%) were performance status 0–1. The objective response rate was 15.2%. In all, 48.5% of patients had stable disease. Median failure-free survival was 5.4 months (95% CI 4.6–6.2). Median overall survival was 9.3 months (95% CI: 6.9–11.7). Grade 3 toxicities were palmar-plantar erythema 16.7%, vomiting 8.3%, diarrhoea 2.8%, anaemia 8.3%, and neutropenia 2.8%. No patients developed haemolytic uraemic syndrome. Symptomatic improvement occurred for pain, bowel symptoms, and dyspnoea. Capecitabine in combination with MMC is an effective regimen for metastatic colorectal cancer resistant to 5FU and irinotecan with an acceptable toxicity profile and a convenient administration schedule.

I found the report on the pulmonary embolus shocking and depressing as if the Angel of death had passed over my lintel and seen the mark of safety there; yet I was extremely grateful to be spared. I am humbled by the fact that with all my knowledge and precautions, I made a wrong decision about prophylactic anticoagulants. I can really believe that someone is watching out for me. I am writing this at 5 am; being alert at that time for the first time in several days. Perhaps that is a sign of things (or my my mood improving).


Anonymous said...

Dear Terry,

If the embolus had not appeared you could have been congratulating yourself on your right choice just as you are now blaming yourself for a wrong one. It was a reasoned, considered choice that you believed was entirely right for you at the time you made it. Cause and effect is rarely straightforward. Paradox is always there. Jesus confronted it continuously and the gospels are so very compelling because of it.

Perhaps God is asking you to let him do the driving and you can tag along for the ride.

Anonymous said...

Terry, I'm sorry you are having a miserable time right now. I'm wondering if you have read about "hot chemotherapy" on Andrew Schorr's blog? No harm in checking it out.
I will say a little prayer for you.

Anonymous said...

Dear Dr. Hamblin and child of God,
I too believe that God is watching over you and protecting you. I pray you will have better health very soon.

Anonymous said...

Nice cliché’, Anonymous 1. You seem to be inferring that God is orchestrating this whole thing, that the embolus is all part of His detailed plan. I don’t believe God works that way. Rather we are told "My grace is sufficient for you, for my power is made perfect in weakness" (2 Cor 12:9). Instead of subtly reprimanding him, why not try following this directive: Rejoice with those who rejoice, weep with those who weep (Rom 12:15).

Anonymous said...

Thanks very much for your comment, Anon 4. It was definitely not a subtle reprimand nor does it imply God caused the embolus. It was a plea for Terry not to be too hard on himself becasue of what happened.

I was sad and shocked at the news. Terry I wish you a speedy and full recovery. Your faith and courage are an inspriation.

Anon 1