Health Update #9: Lung Radiation Finished

Moon rise over Emerson Lake (5/5/2023)

Reader caveat: Keep in mind that this information is filtered through a narcotic haze and may not be entirely accurate. Or discrete. 

It's been a rough week, and I'm wiped from the radiation. I had three sessions targeting the mass in my lower right lobe, with surgery on Monday, and radiation on Tuesday, Wednesday, and Friday. And then a fairly humiliating bout with constipation on Friday morning. Thanks to Corrine for the fleet enema, if that's not too much information. 

And on top of all of that, I've had severe struggles with depression and anxiety that have grown worse since surgery. There is a heavy mantle of guilt over causing grief and hardship to others, mixed with a sense of hopelessness and despondency, and some regret over a shortened career. I hope to return to teaching in the fall, but feel a need to explore early retirement options, possibly phasing in next summer. I am fortunate and grateful to have those options, as well as potential paid medical leave (6 months) and long term disability beyond that if necessary. But all of that is getting ahead of myself. 

The nerve block on the arm wore off by late morning on Tuesday, and the pain was quite intense. More intense than pre-surgery, but somehow more bearable in a way because it was less weird, where pre-surgery I was walking around with a partially-dissolved humerus. Still, it is quite painful. Luckily, they changed my meds from Norco to Oxy and then again to Dilauded (hydromorphone) once Corrine engaged in a bit of patient advocacy and registered her dissatisfaction with the nurse navigator at the cancer center. They initially scheduled my palliative care appointment for May 22nd, which would have been no help in the short term for pain and mobility, but luckily there was a cancellation that moved it up to next week. I was feeling very frustrated about the lack of response around palliative issues, medication management, and attention to quality of life.

We won't know how effective the radiation has been for a few weeks at least when they do the next CT scan. I've barely gotten up in the past few days. In our Q&A with the radiation oncologist on Friday, he suggested that most of my fatigue is from radiation, with some additional tiredness from medication and not an insignificant amount from the depression and anxiety. He refilled my Ativan prescription and added on a script for Effexor. Unfortunately, he neglected to note a change in dosage and as a result the insurance company won't cover the refill for another week or so because I've been using the higher end of the suggested dosage. I'm sure Corrine will straighten that out on Monday. He's bound to get an earful. 

Fortunately, I have no treatments next week, though I do have the meeting with palliative care on Monday, a tele-health visit with my medical oncologist (chemo and immunotherapy) on Thursday morning, a virutal visit with my therapist on Thursday afternoon, and post-op with the oncology surgeon on Friday to check on how the shoulder is healing. Then the next week there will be 5 days of area radiation to my humerus (as opposed to targeted spot radiation that had previously been planned), with chemo starting the week afterward -- once every three weeks for twelve weeks -- and immunotherapy for the next year. The treatment team remains optimistic about the prognosis and that they can go at this with curative intent. 

I can't believe it's only been a week since the whole crew from OU came up, and I was lucky to have a visit from Les midweek. Karen stayed for several days and was a huge help, even driving me to radiation on Wednesday, though I have little memory of that. I'm looking forward to a visit from Priscilla and Scy next week, and both Barbie and Laura later this month, as well as a long weekend with Connie, Thom, and Otilia toward the end of the month.

At this point, I think we're all set on care packages of food, especially the sugary kind. It's all been delicious. Thanks for cards and treats from folks in my circle, and though I'm not religious, I appreciate all the church groups that have me on their prayer lists and friends who are keeping me in their hearts for a while. 

My therapist tells me that a lot depends on me maintaining a positive attitude and sense of hope. Just great. Now I'm also responsible for maintaining a positive attitude. That seems like a lot of pressure. But I'll try. 

I recently stumbled across Warren Zevon's final public performance -- a full episode appearance on Letterman, not long before he died at 56 of lung cancer. With this diagnosis, everyone seems to look for a specific cause, often something that the person did to themselves, maybe so that it makes them feel better about "not me." Zevon said that in his pre-sober days, he lived like Jim Morrison, then got sober and lived for another 30 years. But he suspected it had to do with those earlier indiscretions. Maybe my own cancer has something to do with my 10 pack-years of smoking prior to 30 years ago when Pris was born, or the 2-3 pack years relapse in the last decade.  They later discovered that Zevon's particular form of lung cancer is often a result of asbestos, and family members pointed to childhood exposure as a possibility. For me, my history of smoking doesn't particularly match what the oncologists typically see -- 30+ pack years with a more recent quit date, or even still currently smoking (not that they deserve cancer either). Maybe my cancer is related to my past indiscretions; maybe not. In the end, it doesn't matter. 

Zevon's takeaway from all of this? Enjoy every sandwich. Indeed. Every sandwich, every grape, every cup of coffee, every sunrise, every friend, every small moment.