Monday, November 5, 2007

Plan B

After a week of keeping my mind disengaged during awake-time with
PacMan and Sudoku online, my current mind-numbing techniques of choice, and nights of poor sleep, I sat down to talk with my doctor this morning and started to cry.

“I don’t usually cry about this, but I’m so scared,” I confessed somewhat apologetically. “What was saving my life is now threatening to kill me.”

“It’s okay. I have a plan.”

I knew she would, of course, but the wait had seemed interminable.

She spoke with the
Genta research representatives late last week. They were, in fact, in New York to attend two of her presentations to cancer professionals on this research study. When she told them about my experience they weren’t overly surprised; they knew what to do. My doctor has administered over half the Genasense drug taken by melanoma patients in this country and had never encountered this reaction with “solid tumor”, but they had seen it in a handful of Chronic Lymphocytic Leukemia (CLL) patients in other trials. Their method of dealing with the situation is to “pre-treat” the patient with a high dose of a strong steroid that counteracts and prevents the allergic reaction. When they pre-treat, the patients go on to receive a full week of IV infusion without life-threatening side effects.

I looked at her skeptically. “What if I go home and pass out on my kitchen floor when the steroid wears off?”

“That’s why I want to keep you under observation for a couple of days,” she said. “We’ll start the treatment and then you can go to the hospital for an overnight stay, maybe two nights. If something happens, it will be in the first twenty-four hours. I want you here in the cancer center most of the day, where we know your treatment history, and I want you there after that, so they can monitor your blood pressure and condition.”

Which ruled out staying at my daughter’s apartment.

“This begs the question in my untrained mind. Do I possibly have leukemia?”

“No chance of it,” she said. “The major symptom of that is a very high white blood cell count. We monitor your blood all the time and your counts are normal.”

“It’s a little scary, but I’ll do it if you believe it’s worth a try.”

“The worst case scenario is that it happens again, we have to scrap the Genasense, and we continue with Abraxane and Temodar alone. In your case, there were no live tumors on your last scans, so I’d be pretty comfortable with that option. And if you have to abandon the Genasense, they’ll still keep you in the study,” which means they’d continue to follow my progress, and pay for drugs not covered by insurance.

So she sent me home to pack a bag, and we scheduled Day 1 for tomorrow.

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