Status Report February 4

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medical      *

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On Thursday I visited Dr. Palchak my local oncologist who practices out of an office in Arroyo Grande, about 25 miles down the coast from Morro Bay. He has been very helpful right along. He was aggressive in persuading me to begin radiation of my my ribs and spine for pain and he has always been straight forward with providing information.

I am a big believer in finding the most experienced, cutting edge physicians and facility for any "bad" illness. I've spent most of my professional life in rural settings. Practice makes perfect. In general, I want the surgeon who has done two hundred procedures rather than the surgeon with ten under his belt. With bad illnesses, I'll opt for the large center that is specialized for the treatment of that particular disease entity. It also makes sense to go there from the start. I was particularly fortunate. Within an hour or two of the CT that showed my tumor, I had an appointment with the thoracic oncology service at Stanford for the 2nd business day. 

In my previous posts, I have provided an accurate picture of the wonderful treatment that I have received to date at Stanford and I have been particularly pleased with Dr. Neal.

However, my tumor has not responded to the chemotherapy in the hoped-for manner and the disease is progressing as indicated by the increase in bone destruction from metastases. I have related the very miserable time since my last chemo round and my thoughts about abandoning chemotherapy. 

Finally, Stanford is 200 miles away and treatment there is a 14 hour day when the drive is considered. Dr. Palchak is 30 minutes away and treatment done here will be much easier. 

The bottom line is that I've had the advantage of treatment at the Mecca (Stanford) and it seems to have made little difference to me physically. However, I am secure in the knowledge that I have received top-notch care and that my failure to respond has nothing to do with the quality of my care and everything to do with the fact that I have a tumor that is minimally responsive or non-responsive. So, I have no residual doubts about my medical care having failed me.

In addition to close proximity by car, Dr. Palchak appears to be in his early 50's. Dr. Neal is in his mid to late 30's. I think it would be hard to find anyone more knowledgeable than Dr. Neal about the science that is being applied in my case. However, I have reached the point where science must take the back seat to my end of life considerations and preparations. So, I want to tap into Dr. Palchak's many years of experience with patients who fail chemo or have particularly difficult times.

I saw him Thursday morning. He reviewed my case and examined the most recent CTs. He was very surprised that I had such a difficult time with Alimta, particularly in view of the mild previous round. However, when we reviewed the medications, I also received Zometa on my last visit to Stanford. Dr. Palchak pointed out that this could have been the real culprit.

So, on Thursday I walked into Dr. Palchak's office expecting to stop the chemotherapy. I walked out agreeing to repeat the Alimta for another cycle on February 10.

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psychological   *

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Yesterday I was chopping some onions and dropped a scrap on the floor. I knelt down to pick it up and found that my leg strength was barely sufficient to get me back up. As I look at myself in the mirror I see the loss of muscle mass in my arms and legs. The cancer is consuming me from the inside. I will need to be much more careful about walking because I'm not so confident about being able to get up from a fall.

People are aware of my sickly appearance. I catch them glancing at me sideways. Some smile warmly and even joke at one of my hats that has fake hair. Most pretend to see nothing.

I know that Jasmine is under a lot of stress. She works full time and has been ferrying me back and forth to my appointments. While I am getting radiation to my bones, I have to appear daily at 8:45 A.M. 

She never complains. "It's a chance for us to spend time together."

So, I am more aware of things slipping away. For most of my life, the practice of medicine was an essential central theme and provided a sense of meaning. Today I am looking at the renewal paperwork for my medical license in California. Do I want to spend $800 to renew it for another two years?