Health Update #23: Giving Thanks

Giving Thanks, November 2023

In my last update a couple weeks ago, I wrote about needing to make a decision about next steps for second line therapy -- whether to go with the Pragmatica-Lung Clinical Trial, a prospective randomized study of Ramucirumab plus Pembrolizumab (Keytruda) in a 3 hour IV infusion every 3 weeks for 2 years (or until it stops working or becomes hypertoxic) or to go with standard of care, which is Ramucirumab plus Docetaxel chemotherapy for two years or until hypertoxic. In messaging with our primary oncologist, Dr. H., we learned that if I start another round of chemotherapy, I will be disqualified from joining the clinical trial. In that case, it would make more sense to start with the Pembrolizumab trial first and then switch to Docetaxel later if that's not working. Of.course, if I end up in the control group, I'll be prescribed Docetaxel anyway. When pressed about whether to join the clinical trial at UM in Ann Arbor or one of the same trials at Corewell in Grand Rapids or St. Joseph, Dr. H. was unequivocal about going through U of M. We'll talk to him more about it on Friday when we have our telehealth appointment. 

The one downside to the clinical trial is that the University of Michigan wants to redo the MRI and CT scan through their facility before we start, and because of a backlog and down CT machines, the earliest date I can get for the scans is December 27th, whereas I was initially scheduled for chemotherapy on December 1st. I feel like it's worth the wait. There are also some logistical advantages to treatment in Ann Arbor. Luckily,  I have a dear colleague with a place in Ann Arbor near the hospital where I can stay when I go in for treatments. Also, I'll be able to take the Amtrak back and forth between Chicago and Ann Arbor to make it to appointments, and then get around Ann Arbor by Lyft or taxi. 

During this time waiting to restart treatment, the main focus is on palliative care along with some maintenance.  The cranial radiation went smoothly. They'll keep monitoring that regardless. My ribs feel better after the radiation. Yesterday, I saw the interventionist radiologist for a pain blocker for the fracture on my sacrum/coccyx. It was an outpatient procedure at Blodgett Hospital in Grand Rapids with Fentanyl and Versed. Technically, this was a pars impar block under fluoroscopic guidance to determine whether or not sacroplasty (cement injected into the sacrum) would be a viable option or if I might go with a nerve block every few months. The procedure yesterday involved an injection of Bupivacaine and Depo-Medro. Bupivacaine is a long-acting local anesthetic similar to lidocaine or lignocaine. Depo-Medrol is a corticosteroid used to treat inflammation. Used together as an injection into the lower sacrum, this drug combination serves as a nerve/pain blocker for sacrum fractures that are slow to heal. So far, there are no negative reactions to the procedure, though I wouldn't say that there is significant relief. 

While I've made a lot of progress with my shoulder through physical therapy, I've unfortunately injured my right meniscus. The Saturday before Thanksgiving, I was walking down a long, straight stretch of sidewalk (it's similar circumstances each time I torque that knee) when I suddenly felt the knee buckle and then I couldn't put any weight on it. It's an odd feeling, like I'm dragging that foot and then I feel the bones in my knee grind and twist against each other, and then a kind of snap where I can no longer walk. The pain keeps me up at night, so my palliative care team has switched my dosage of Dilaudid from 4 mg to 8 mg. The Dilaudid helps a lot with the pain, but dramatically interferes with my concentration and focus as I'm winding down the semester. I was lucky to be able to borrow a cane and rollator stroller and wheelchair from Corrine's mom and knee braces from her sister. Those have been very helpful. I'll continue to work on that knee through physical therapy for now. My PT has recommended that I get a steroid shot in that knee and has made a referral for me. 

Trivia at Stella's Lounge, Grand Rapids, Michigan, Thanksgiving Eve

In the middle of all of this, Thanksgiving was pretty special. Pris was able to fly into Grand Rapids from Philadelphia for the week, and Corrine's brother and kids and the grandbaby all came in for Thanksgiving itself. We were mostly finished with the renovations to the basement and upstairs so that almost everyone had their own bedroom and access to a bathroom. We all took Otilia, the grandbaby, to see the holiday parade in Ludington and spent much of the time watching her watch the parade. She was quite excited by the lights and horns and the marching band. 

We woke up Sunday to fresh snow on the ground. In all, I'm in good spirits and feeling optimistic. I don't know how much of that feeling is from the steroids and narcotics, but it's a nice feeling to have.