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Last night, I had the most sleep I've had in a week. It was the peaceful sleep of the<br />
ignorant. I wonder if I will sleep that well tonight.<br />
I am not in pain, and the nitroglycerine helps me drink fluids. I have had 2 bottles of Boost<br />
Plus today.<br />
I am hoping there is an experimental protocol which will offer me potential benefit,<br />
because it seems that more chemo will buy me a period of misery <strong>with</strong>out any guarantee<br />
of a period of normalcy to follow, and may preclude any effective experimental protocol.<br />
It should all come together in the next few days.<br />
Posted by David Shuster at 06:17PM (-08:00)<br />
The Short Of It<br />
Thursday, February 02, 2012<br />
Last night, I did have a fairly decent nights sleep, for me. At least I was able to sleep in<br />
bed, and not in a chair. The IV feeding ran during the night. However, today, the Boost<br />
Plus is not going down easily.<br />
I had my visit <strong>with</strong> Dr. Flam yesterday afternoon. We had conversations <strong>with</strong> Dr. Nghiem<br />
and Dr. Lewis during this visit. Dr. Flam wants me to start chemotherapy again and made<br />
a compelling case for it. He wanted me to begin as soon as today and felt that that would<br />
open my esophagus so I could begin eating again. However it would take some time for<br />
this and I am in too much distress to wait for this. Dr. Nghiem suggested injecting the<br />
esophagus tumor <strong>with</strong> Beta Interferon endoscopically and then giving radiation to the<br />
area of 8 Gy. The second mass near the gastrohepatic ligament might also be treated in<br />
similar fashion. However, my esophagus has already had 56 Gy and this is getting close<br />
to the maximum. We decided to hold that approach for the time being. I did not want to<br />
have any more cisplatin as I want to preserve my hearing and my peripheral neuropathy<br />
has not improved and at times is quite uncomfortable.<br />
The plan now is as follows.<br />
Tomorrow, Dr. Lewis will insert a removable stent. Stent Review Article On Monday I will<br />
begin chemotherapy <strong>with</strong> a drug called Topotecan. Information about Topotecan<br />
The drug will be administered by continuous infusion for 5 days, and repeated after 2<br />
weeks off. I don't know how many cycles will be used, presumably this depends on the<br />
response.<br />
The drug is available to be taken orally. Perhaps after the first cycle, if my swallowing<br />
function has improved, I will be able to do that. More on Topotecan<br />
Nobody discussed the response rate <strong>with</strong> me, but it seems to be in the 25-40% range,<br />
<strong>with</strong> only rare complete remissions.<br />
Posted by David Shuster at 10:51AM (-08:00)<br />
Too sick to post much<br />
Monday, February 06, 2012<br />
I can't put coherent thoughts together to post. Today, I will see Dr Flam and decide<br />
whether to start Topotecan today or delay a few days. The stent is working but I have no<br />
desire to eat. Lots of pain, but getting better. Nausea. No desire to eat even though the<br />
food goes down. Still on IV nutrition.<br />
Posted by David Shuster at 10:13AM (-08:00)<br />
<strong>My</strong> <strong>Battle</strong> <strong>with</strong> <strong>Merkel</strong> <strong>Cell</strong> <strong>Cancer</strong><br />
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