Medical update

I cancelled the chemotherapy I had scheduled for today. I feel like I haven't even recovered from the last chemo, and the prospect of pouring more poisons into my body right now was more than I could bear. Grace and I are going to Hawaii on Friday for a week, and I would not be able to enjoy our time there if I felt like I have the past two weeks. I feel like I recognize the escalating fatigue pattern from last fall. I'm so tired all the time - it feels like the blood in my veins has been replaced by glue. Speaking of blood, I had it drawn today and my CEA (marker of cancer activity) is up slightly to 22.4, which suggests that my current chemotherapy regimen (FOLFIRI + Avastin) may be starting to stop working anyway.

This may be the first step toward stopping or changing treatment or it may not be; I haven't decided yet but I am thinking about it. I have chemo scheduled for when we get back and for now I'm assuming that I will do that. But I'm considering stopping treatment, which would probably mean entering hospice care, which would mean that the goal of my medical care would shift from a balance between extending life and quality of life to an emphasis on quality of life. The irony is that patients in hospice care often live as long or longer than those who continue standard treatment, as discussed in Atul Gawande's excellent New Yorker article from last August: http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande

I could switch to the other chemotherapy drug combination available for my condition (FOLFOX), which just replaces one drug (irinotecan) with another (oxaliplatin) that has different, perhaps worse, side effects. I am also researching clinical trials of new experimental treatments, although those often have complicated eligibility criteria that I do not meet and/or are in faraway locations where I would not want to spend any substantial proportion of my remaining time, away from my kids. There are some trials in Seattle and one in Vancouver BC that I just found.

Ethan