This isn't the first time I have had to write a hard email but this one seems to have avoidance written all over it. Always seems to be something else to do, write or think about.
I received the results of the biopsy on Monday afternoon. Sandra, my stepmother, came down to help me hear what was being said and make sure all the options were explored. Put simply the tumour is growing in my left lung. The original tumour was in my right lung and has been treated. The durvalumab (Imfinzi) has not been effective in stopping the growth. This also means that the cancer has been restaged from 3C to 4. No longer are we pursuing curative treatment. The goal now is to slow the growth and control the side effects. Really palliative though the doctor wasn't happy when I used that word.
So in true "Dr. Johal" fashion things begin to move fast again. While I am continuing to pursue a few leads on his first treatment recommendation - Tagrisso (osimerinib) that probably isn't going to happen due to cost and not being approved yet for provincial funding. So plan B is Geotrif (afatinib).
I had a blood test to make sure that my thyroid isn't out of whack with the removal of durvalumab. That happened as soon as we were finished with the doctor. As well I'm stopping tamoxifen (yippee) because it interferes with the effects of afatinib.
Wednesday afternoon I had a one on one meeting with the cancer center pharmacist to go over the side effects of afatinib (try saying that three times fast) And as usual with cancer drugs they are numerous. The most common side effect is skin irritation, often prominent in the face. Being 16 all over again with a pimply face isn't my idea of fun but I already have prescriptions for medications to deal with that.
Diarrhea is another common trial. The advice that I was given on the first go-round with chemo comes to mind. "Never trust a fart." Imodium used in a slightly different way for chemo induced diarrhea, as opposed to bacterial or viral, is the order of the day. I have used it before given time in Panama eating things that I probably shouldn't have and suffering "Montezuma's revenge."
The rumours I had heard of lactose intolerance are just that - rumors. Not true. So I am going to be able to eat cheese and ice cream. Though if I had an existing intolerance it would be a problem. The mediciation contains lactose so it can cause indigestion for lactose intolerant folks.
And there is the usual bugbears of fatigue and insomnia. Oh and did I mention mouth sores and nosebleeds?
So I'm not excited about the side effects.
This drug falls into another category of therapies called targeted therapies. It targets a mutation that about 20% of lung cancer patients have (and I have it) called EGFR + (Epidermal Growth Factor Receptor positive). Eventually the cancer will mutate and become resistant to it. That could take two months or it could take two years.
In the meantime I should be able to carry on with most of my normal activities. Incidentally the skin irritation potential is exacerbated by the UV rays in sunshine so I'll need to slow down on the tanning. It can sensitize nails and fingertips too. So I need to stay away from activities that might be hard on my hands. Mechanic work and vigorous gardening were specifically mentioned. I think the pharmacist saw the dirt under my nails.
I came across a lovely little quote in my reading this morning that I have already shared with a few folks. "Let go of yesterday and tomorrow to focus on the that small window of miracles called today."
Several days ago I was reading in Lamentations and came across this. In chapter 3:22 -24 it says:
God’s loyal love couldn’t have run out,
his merciful love couldn’t have dried up.
They’re created new every morning.
How great your faithfulness!
I’m sticking with God (I say it over and over).
He’s all I’ve got left.
The Message
Jeremiah ( if that's indeed who wrote Lamentations) chose faith. As Sandra said "Angus you are doing all the right things. Just not getting the results you expect." And that is okay because God knows what He is doing even if I don't. Like Jeremiah I chose faith.
As always prayers are coveted. Specifically that side effects would be minimal. And also for those who are close to me. As they contemplate me not being here there is a sense of anticipatory grief. Pray that the Lord would be close to them and comfort them. That our time remaining would be precious and put to good use.