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This is one of several essays from my private cancer journal. It is not intended as anything than a record of my states of mind as I struggled with the disease and the effects of the treatment.
One sick pumpkin
10/31/02
It is Halloween and that pumpkin is exactly how I feel.
My oncologist called to say that my lab tests of last week were a "mixed bag."
The good news is that my liver function improved, so the ketoconazole wasn't doing any damage.
The rest of the "bag" was that my PSA has climbed to 830 from the 199 in August.
"It doesn't appear the ketoconazole is working," he said. "If anything were to happen, it should have happened by now. But the climb to 830 shows it isn't working."
Although I have gotten bad news many times during this three year journey with prostate cancer and come through each of them (my actual anniversary will be 11/23), it doesn't seem to prepare one for the next blow.
As we talked, I typed some notes. It gave me something else to do.
"What do you recommend?" I asked. "Chemo?"
"We talked about it before and, yes," he answered. "I think you should discontinue the ketoconazole as I don't see it helping." Then he gave me a schedule for coming off the prednisone that I take with it.
The words on my computer screen had a strange sense of disconnection from me.
"Which chemo were you recommending before?" I asked, my mind having gone blank.
"Estramustine plus Taxotere or Taxol," he said.
I looked at the words on my screen. At the moment, I couldn't remember how to spell estramustine and it came out wrong.
"I guess I will have to go to my own glossary and look them up again," I said, in a feeble attempt at humor as my stomach continued to fall. "Why don't we do what we've done each time: I'll get some more feedback on this from some friends and let you know."
"Okay," he said. "If you decide on the chemo, I can have you set up in a day or two."
I hung up and looked at my notes, filling in a few missing words. Then I looked up estramustine and corrected it, writer/editor that I am to the end, before telling Caren. I need to absorb this some more before I can ask her how she is really taking this. We were supposed to finish the wedding invitations and mail them today. Then I went out on the front porch and stared into empty space.
Learn from the past, I told myself. Each change in regimen has been tough to take, but then I adjust to it and get my stomach and wits back and I can do it on this one.
Chemo. The word (albeit slang) has a note of finality that I had hoped to avoid with the ketoconazole. At least I've been to The Room a few times and handled that apprehension. Last time was a week ago when they switched me from the pamidronate (Aredia) to Zometa but treating bone loss doesn't seem as important as it used to be. Maybe I'll get some use out of my new haircut after all.
When I came back in, I put a summary of the call into a message to a PCa-Advanced mailing list, asking for some feedback. I spend most of my day offering advice or pointing people to material but when it comes to my own situation, I prefer to ask. Meanwhile, I can't avoid those inevitable "end stage" thoughts. I've had them many times in the last three years but their reality seems closer now.
The last paragraph of the message pretty well summed it up: I'm definitely disappointed. If I come off the keto, maybe I can go back on the scotch. I could definitely use one now.
In that absence, the VH1 channel is playing The Rocky Horror Picture Show for Halloween. I think I'll go watch some TV and get off this keyboard.
I would prefer the scotch.
Robert
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