A Blue Sky Cancer Cure

New treatments for cancer are being discovered at an ever increasing rate. Unfortunately, no single treatment can yet successfully treat all cancers that arise in the lungs, much less cancers that arise in all parts of the body. Cancer is not one disease, but many, featuring many types of cancer cells with different (and sometimes several) mutations in those cells, originating in various parts of the body with different cell structures, and threatening different bodily functions. A single tumor can even contain more than one type of cancer cell. There are as many different cancers as individuals who have cancer.

Here’s a science fiction concept:

Let’s invent a artificial intelligence device that enters the body via a single small injection, travels through the blood stream, locates all cancer cells, determines their characteristics, surveys them to determine how many are susceptible to drug A, drug B, surgery, radiation, or nutritional supports, then reports out to the doctor on the optimal treatment for this individual’s cancer.

Or, better yet, the device completes the cell inventory, instructs the immune system how to eliminate each type of cancer cell without harming healthy tissues, and reports out to the patient and their doctor on whatever assistance the immune system needs to do it. Maybe an alert shows up on the patient’s wristband or Google glass and reads, “Drink 0.25 liters of green tea with 3 ml lemon juice daily for 2 weeks, avoid shrimp, eat an oreo before bed, and get radiation treatment for your liver.”

Yeah, that should be easy.

Yes, Sheldon Cooper, that’s sarcastic.

Coping with Side Effects

I have a 20-pound lifting limitation on my right arm from radiation damage. My right brachial plexus — the nerve bundle that controls the right arm — took a full dose hit last summer.

I take an engineering approach to such limitations. I find myself looking at boxes I need to move and thinking, “If I take out these books, then the box is only 40 pounds, and if I divide that by two arms …”

I do not tell my radiation oncologist about these moments.

I hope he’s not reading my blog today.

The Hazards of Trial Travels

I've been flying between Seattle (Washington) and Denver (Colorado) once or twice a month since late October to participate in a Phase I lung cancer clinical trial. Flying frequently exposes lung cancer trial patients to all sorts of hazards. The most obvious, I suppose, are the airborne respiratory viruses which spread so easily in cramped TSA security lines and airline cabins. Another is the long walk from security to the gate, which can tax those of us with compromised lung function. And travel for a cancer trial is inherently stressful, with embedded concerns about time away from family and home, negotiating an unfamiliar city, and the possibility of side effects occurring when you're hundreds or thousands of miles away from your oncologist.

But these hazards pale in the face of the unknowable threat that looms over the entire flight and infuses dread in the hearts of all airline patrons, no matter how healthy.

I'm talking about seat partners.

Please don't misunderstand me. I've sat next to pleasant SPs during trial travel: college students going home for winter break who slept through everything, business people occupied with a project, even some articulate folks knowledgeable in a subject of interest to both of us (I'm actually sorry to part company with them). And once, my SP was a Harvey-style pooka with laryngitis, who I especially appreciated after a sleep-deprived week.

Other flights are more ... interesting.

There was the 9-year-old boy traveling alone, a creative and verbal lad, who explored scenarios that might cause a plane to crash.

SP: "What if two guys had a sword fight in the aisle and broke a window?"
Me: "That's why we can't carry pointy objects onto airplanes."
SP: "What if the pilot forgets where the airport is?"
Me: "The airplane has a GPS system that tells her where the airport is."
SP: "What if the GPS fails?"
Me: "She has a big book with maps of all the airports as backup."
SP: "What if she forgets how to read?"
Me: "So what do you want to drink?"

I received a free glass of wine from the cabin crew on that flight.

On another trip, a science geek occupied the middle seat next to my aisle seat. I would have loved to chat with him, but our window SP babbled nonstop about her hobbies, grandchildren, and assorted afflicted body parts. I empathized with him, silently.

The most memorable SP to date was a twenty-something conspiracy theorist who shared his wisdom while crossing three Western states (Western states are very wide). I learned so much from this young man. Big corporations are suppressing cheap clean energy (engines can run on water). Congress wants the US economy to fail. Our government is hiding the cure for cancer – never mind that cancer is not just one disease, the cure exists. Also, perpetual motion machines work. Being an engineer by training, I couldn’t resist the urge to correct that last misconception. I set about explaining entropy and physics. I managed to emit all of three sentences before I was corrected. I was surprised to learn we don’t really understand physics yet. But we will Someday, when we know The Truth. And there is only one Truth.

As I was told more than once on that flight, all we need is The Truth.

I'd settle for a good set of noise-cancelling headphones.

Why a Clinic Visit Takes All Day

One thing I learned early in this cancer journey: Never schedule ANYTHING else on a clinic day.

Why? Because cancer clinic appointments have a way of expanding to fill the time available (or more).

Today is a good example. I had two appointments scheduled at the University of Colorado Cancer Clinic today, a PET/CT scan at 9:30 AM, and a brain MRI at 11 AM. I am not allowed to eat anything for 4 hours before the first appointment. I should be done by 11:45 AM. Two hours and fifteen minutes of clinic time total. Pretty straightforward, right?

Not in the slightest.

I’m to report 15 minutes early the PET/CT scan. I can’t predict Denver’s morning rush hour congestion, so I leave my nephew’s house at 8 AM, aiming to arrive at UCCC at 9 AM, which leaves time to park, walk into the clinic, and stand in line to register. I arrive at the radiology registration desk at 8:55 AM.

While standing in line, I realize I don’t have a water bottle. This is an occasional side effect of flying to a distant clinic for care–TSA doesn’t allow liquids to pass through airport security, so I usually buy a water bottle in the airport. Cancer patients need to drink lots of water, especially when taking diuretics. This flight, however, I accidentally left my empty bottle on the plane. I remind myself to watch for water stations while at the clinic.

I check in at Radiology, then go to the nurse’s station to have my chest port accessed, which means they insert a specialized needle into my port so I can receive IV tracer and contrast during my scans. I finish that step on time.

Then Murphy takes over. The PET/CT department is running 15 minutes late. I get my blood sugar tested; it’s higher than normal (123) but still acceptable. However, my March lab results showed my creatinine (a measure of kidney health) was too high; I may not be able to get the CT contrast because it’s hard on the kidneys. This would be a disappointment, since the contrast makes tumors show up better on the scan.

The tech takes a blood sample for creatinine testing, gives me the injection of radioactive glucose (the tracer used for the PET scan), and has me rest in a dark, quiet room for an hour. Later she tells me my creatinine was low enough to allow contrast. **phew** I doze a bit.

When the tech gets me up for the test, I’m supposed to void my bladder to clear excess radioactive tracer. Whoops! THAT’S why I should have guzzled a quart of water early this morning. Off we go for the 45-minute scan.

The tech gets me up from the scanning machine, reminds me to drink plenty of water to flush out the tracer and contrast, and tells me the MRI folks are running an hour late. She suggests I go get some lunch. I happily comply. I try to find bottled water, but the cafeteria doesn’t carry it. I eat in the nearby UCH Outpatient cafeteria and use the free UCH wireless connection to check email.

Back to Radiology an hour later. I find a water cooler in the waiting area and down two cups of water before the MRI tech comes to tell me they’re running even later than before. Despite that, he takes me back to the waiting area and tries to convince me to change into one of their gowns. I tell him I carefully chose my clothing to ensure I had no metal on me anywhere, and these clothes keep me warmer than a gown. While waiting, I finally manage to void my bladder a little and stash my stuff in one of the lockers–no sense exposing my iPad, phone, and credit cards to intense magnetic fields in the MRI room. Another tech comes to collect me and again tries to coax me into a gown. I again explain why I chose these clothes. She seems mollified. Off we go to the scanner.

I get the usual foam earplugs and noise-cancelling headphones with a limited selection of music. The bed slides into the scanner, and I discover this machine has a smaller interior than the scanners back home at Virginia Mason in Seattle. My elbow bones are hard against the sides. The dry Denver air makes my nose plug up, so I breathe through an open mouth, which quickly becomes parched. Halfway through the twenty-minute scan, the tech taps my leg to let me know she’s administering the contrast. I adjust my screaming elbow slightly, hoping I succeed in keeping my head still. I don’t want to ruin the images by moving and have to do this scan again.

The scan ends. The tech says I kept my held sufficiently still. **phew** I’m directed to the nurse so she can deaccess my port (a fancy way to say “remove the needle”). Uh oh. She can’t draw blood from the port. The tracer and contrast have probably clogged it. Not an uncommon occurrence, but this nurse’s station is not equipped to inject the “drano” (OK, it’s called cathflow, or TPA) into my port to clear the line. I’ll have to go back to the cancer center lab for the TPA.

On my way out of radiology, I remember I need to order the CDs of today’s scans to take back to my home clinic. I detour and spend 10 minutes at the file room filling out forms.

En route to the cancer center lab, I remember I need more water, and go looking for a refillable water bottle. I check the lobby coffee shop, but they’re out. Maybe I can find a vending machine. I check in the pharmacy. Nope, nothing here. But I remember I need to pick up my prescription refill. I wait in line 10 minutes before I’m called to the counter. My transaction takes another 5 minutes.

I discover the cafeteria has an Aquafina vending machine. It doesn’t accept my credit card. After 15 minutes of scouring fine print, I learn the machine has a slot for $1 and $5 bills. I go to the cashier, break a $10 into two $5s, and go back to the vending machine. The feeder won’t accept the bills. No water here. Onwards.

I get to the cancer center lab, explain that my port clogged after this morning’s scans, and ask to get TPA from a nurse. The receptionist asks if I have an appointment. Yes, I have one in the morning for lab draws. However, I need my port cleared now. She doesn’t know how to accomplish this without a scheduled appointment for TPA. She asks who my scheduler is. I tell her R*** is my scheduler, but she doesn’t know how to contact R***. She leads me to the desk of a scheduler named S***, but S*** has left on a personal emergency. She leads me to S***’s supervisor, who says B*** can do it. But the receptionist decides instead to lead me to the cancer clinic desk and ask them to make me an appointment. The desk calls one of the oncologists to order an appointment. I’m told to have a seat in the lab waiting area until the oncologist comes out. Ten minutes later, the oncologist comes out. She says I don’t need an oncology appointment, I need a lab appointment, and directs the receptionist to make a lab appointment to get TPA. This evidently breaks the logjam. Ten minutes later, a nurse calls me in to get the TPA.

We discuss the best approach to clearing the clot, and decide to inject the TPA and wait 30 minutes to see if that clears the port (as opposed to leaving the TPA in the port overnight). I get the TPA injection and sit in the lab’s lobby for another 30 minutes.

Right on time, the nurse calls me back to remove the TPA. It worked! My port is cleared.

I then remember tomorrow’s AM commute is projected to be a mess due to snow. I’m supposed to be back in the lab early tomorrow morning for blood draws. I mention to the nurse that no one else is using lab services at the moment, and that my appointment for lab draws tomorrow will be at 9 AM, their busiest time. The nurse agrees drawing my labs now is a good idea. She goes to her computer station to look up which labs to draw. The lab orders have not been entered yet. Another nurse places a call to my oncologist (who happens to be in today) to request lab orders. He calls back within five minutes, and the orders are entered. The nurse takes about five minutes to draw the lab samples.

She mentions that I also need to give a urine sample. I can’t. ANOTHER reason I should have been drinking water. I thank them for their efforts, and leave with my urine sample kit to continue my search for a water bottle. I hear the inpatient cafeteria two buildings away should have one.

On my way to that cafeteria, I notice the lobby coffee shop now does have water. I wait in line and FINALLY get my 20-oz refillable water bottle. I also order coffee. I realize a split second later that I have to void my bladder. I head to the nearest restroom. In the stall, I remember I could collect my urine sample now. I pluck the sample bag out of my tote, then notice the nurse did not give me the required wipe to use for a clean catch. I dig through my purse and find a Wet Wipe, and produce my urine sample. I drop off the sample at the radiology lab (saving me the walk back to the cancer center lab), grab my cooling coffee from the coffee stand, and go sit down in the entry lobby to drink water. It tastes really good. I can tell from my drying hands that I need it.

In the lobby, my phone finally has enough bars to download voicemail and tell me I missed a call from my husband back in Seattle. I call him and we chat about who will call whom tomorrow after I get my scan results from the doctor, and when my son and I will talk this evening to discuss his Geology assignment. When I hang up, my phone grumps that it only has 10% battery power left. I pack up, button my coat, put on my hat and head into the blowing snow for a two-block walk to my car.

At the car, I plug my phone into the charger, program the GPS for my nephew’s house, drink half the bottle of water, and get moving.

It’s 3:45 PM. Rush hour traffic. I arrive at my nephew’s house at 5 PM.

And that’s why a clinic visit takes all day. Aren’t you glad you asked?