Meeting the Doc, Again

The prelude to yesterdays Chemo #4 was a meeting with the oncologist.  I have to say that there role in all this treatment is very strange.  Ed has seen him maybe three times in three months and other than the first meeting in which he explained what the chemo regimen would consist of and what choices were available, he doesn't have much to say.  At the first two meetings, he did a kind of minimal physical exam, but yesterday, he didn't do any.  The nurses had already done the CBC, weight, and blood pressure.

The doc says, "How are you feeling?"  Ed says, 'Fine, but I have a couple of questions."  He lays out his questions about symptoms (which all the written materials say you must report to your physician immediately) and the doc says, 'Yes, that's pretty normal....was it extreme?'  'No."  'Well, then, that's pretty normal."

The peripheral neuropathy is lasting longer.  'That's pretty normal."
Does that mean it is more likely to be permanent? "Not necessarily; it might just taken longer to reverse."
Or, I suppose, not.

We talked a bit about 'The French Study,' which is the most recent, hot off the press research (Dec. 2009).  The French thought it might be okay to have a no-treatment interval because the toxicity of the Oxalyplatin tends to get out of hand.  So they tried 3 months of chemo, an interval of no chemo OR an interval of less toxic treatment, and then a return to the chemo when the tumors returned.  (This is a very rough description; do not use this as a basis of treatment at home.)  The study was stopped early for reasons not relating to the hypothesis that a period of no chemo might be okay or to safety concerns.  Unfortunately, however, there was adequate data to show that the folks who were getting no chemo in the middle did worse both in length of survival and in recurrence of tumor than did those who continued on the milder chemo in the middle.

We had pretty much been thinking that the CAT scan would show something definitive that would guide a decision either to continue or to stop.  But this study suggests not so much.  At least, as long as the CEA numbers continue to go down.  And Ed's do.  Last week's CEA number was 40 (from 300 at the beginning; normal is 3).  If it begins to plateau, that would be an indication that the strong chemo isn't affecting it and that would be the time for the CAT scan to see the tumor status.  But as long as the CEA isn't plateauing, and as long as the neurotoxicity isn't excessive, then the chemo would continue.

So that would appear to be where we are now.  Yesterday's chemo was pretty much like the others have been.  It did occur to me though that they could be running non-stop bingo games for the patients and you could have points for a winning bingo card, and when you got enough points, you could have your choice of either having an extra chemo session or skipping a session.  Some would take the one, some would take the other.

Here, we're (that's the royal 'we') installing a new hot water heater after the old one leaked all over the carpet.  But now it's done and we're back in hot water.  In several ways.