Peggy's Cancer Spreads

Peggy had a high definition MRI on Monday, blood tests on Wednesday, and saw her oncologist (Marc) on Thursday. The tests showed spots on her lungs, spots on her liver (all of which are too small to biopsy), and an elevated CA-19.9 cancer marker. Marc is trying to get her access to the new pancreatic cancer drug before its FDA (Food and Drug Administration) approval, but doing so involves a lot of paperwork and a lot of people’s approval, so it could take six weeks. 

He cautioned her that the side effects of the new drug are likely to be worse than the ones reported by the studies (which were pretty bad) because the people who were chosen for the studies were mostly young and had no health problems aside from pancreatic cancer. Marc also suggested that she go back on chemo. 

Chemo usually involves a combination of drugs, and the chemo that made her deathly ill in March is the only combination that is left to her. Neither she nor I supported putting her back on that, so Marc proposed that he only give her the less toxic of those two drugs. His thought was that it would serve as “a bridge” between now and the time that she has access to the new life-prolonging drug. 

Marc’s proposal sounded like a no-brainer to me, but Peggy’s experience with her last chemo was so horrific that she said she would have to think about it. Marc responded that the spots on her liver are likely to be cancer, and if they are, her cancer has the potential of spreading quickly. I sat hoping that she would ask for my opinion, and when she did, I strongly stated that she should take Marc’s suggestion. When she still hesitated, Marc said something about how much I love her, and how she is probably the only woman I ever dated. I don’t know if he meant to imply that she could trust my advice, or that she should do everything possible to stay alive for me, but Peggy and I got a good laugh out of her being the only woman I ever dated. However, she agreed to return to chemo. When she said she couldn’t come on Monday or Tuesday, he scheduled her for Wednesday.

Peggy worries quite a lot about what Marc thinks of her, and she often questions what he really means by what he says. I consider her suspicions groundless. Despite what she thinks, yesterday was the first time that he has urged her to take a particular course of action, and I interpret the fact that he never did so before to mean that he never had enough hope before. Right now he has ten patients with pancreatic cancer (the clinic where he works has many more), so he is well aware of how very deadly the disease is, but now that there’s hope, he wants her to stay alive long enough to avail herself of it. 

I am ever surprised by how rationally Peggy behaves under pressure, but I’ve also seen her become so stressed that her thoughts go awry. For some reason this happens in her relationship with Marc. It’s as though this youthful Asian man is her father, and she is his daughter who is desperate for approval (she would probably disagree with my analysis). What I see in Marc is a caring doctor who genuinely likes his patient, and has said how moved he is by the fact that I have accompanied her on every visit.

Right now, Peggy is terribly scared of taking chemo again because she was so sickened by her last round that she said it would be kinder to her body to allow it to die of cancer than to subject it to such poisons. I remind her that she vowed to fight this cancer with everything that is in her, and that Marc has assured her that the chemo he’s about to put her on is of such low toxicity that he “gives it out like water.” She can do this, and she must do this because the new drug that is expected to be approved in June or July is the first real hope that pancreatic cancer patients have had in fifteen years, and she must stay alive for it.

A Brief but Major Update

As you might recall, the CA-19-9 is an important blood test for the measurement of pancreatic cancer. A normal score is below thirty-seven. 

 

On Friday, February 13th, Peggy’s spleen and lower pancreas were removed in the hope that her CA-19-9 level would plummet. When it instead soared by thousands of points per month, we approached despair.

On April 1, a pancreatic malignancy in Peggy’s right hip was excised. Five days after her April 1 surgery, her CA-19-9 level reached an all-time high of 7,755 because the surgery hadn't had time to make a difference. Fifteen days later her CA-19-9 level dropped to 3,241. Our hope is that it will continue to drop.

 

Thanks to her two surgeries and to a powerful new drug called daraxonrasib that is likely to be FDA approved this summer, Peggy’s odds of long term survival are greater than they have been at any time since her May diagnosis. 

April 20, Peggy Update: Four Doctors in Three Days

 

Peggy's first doctor's appointment was her two-week follow-up with her hip surgeon who said that the site is healing normally despite continuing pain. The final three appointments were with her internist, with an OHSU (Oregon Health Sciences University) oncologist that she had never seen before, and then I had an appointment with my podiatrist.

When Peggy told her Eugene oncologist that she had rather die than take another dose of her last chemo, he said he had nothing more to offer, and referred her to two cancer centers: OHSU  in Portland, and M.D. Anderson in Houston, and in the hope of getting her into a trial study. Her OHSU doctor pronounced her ineligible for that facility’s advanced studies, but offered to recommend her for a phase one study. Peggy declined, saying that she’s not in bad enough shape to take a drug that hasn’t been evaluated for safety. 

M.D. Anderson’s representative said that Peggy would travel to Houston to talk with a doctor there because Texas doctors can’t get paid for televisits to states in which they are unlicensed. Peggy said that she was unwilling to do this.

Even without M.D. Anderson or OHSU, we have three sources of hope: (1) That the surgeon who did her April 1, hip surgery removed all of the malignancy. We won’t know for sure until she undergoes a high resolution MRI and a CA-19-9 blood test, but unless he missed something, or a previously hidden tumor turns up, she will be cancer free; (2) Another hope lies in a new, genetically-targeted, pancreatic cancer drug called Daraxonrasib for which her OHSU oncologist said she fits the genetic profile of people for whom the drug works. We are told that the FDA should approve the drug this summer; (3) The surgeon who operated on her hip gave us yet another reason to be hopeful by suggesting that we go to a website called clinicaltrials.gov, and conduct our own searches for clinical trials. Of the many doctors we’ve had, he seems the most brilliant.

As for my health news, the back of my foot hurts so much that I’ve been walking on the front of my foot, and so it hurts too. One of the four visits I mentioned was to a podiatrist who prescribed Meloxicam, gave me exercises to do, and sent me home with an insole. Still, I limp.

People sometimes wonder whether Peggy’s illness has brought us closer… Peggy’s cancer has brought me closer by increasing my belief in her courage, optimism, and perseverance, and by exposing her fear and physical fragility, thereby proving to me that my support is essential. Peggy’s cancer has brought Peggy closer by increasing her awareness of her ever-growing strength and her knowledge that I will stand by her side no matter what. 

On the downside, trauma can so stress a relationship that a couple will come to regard the misery they feel as being inseparable from their togetherness. This is why illness, natural disaster, or the death of a child, often ends in divorce. After 55-years together, I don’t see us divorcing no matter what, yet we are not unscathed by having endured nearly a year of ongoing trauma. 

It’s all so sad, all so wearisome, this being repeatedly yo-yoed up by hope only to be dashed onto the pavement by disappointment, and added to it is Peggy’s ever worsening pain. She has long been better than I at thinking positively, but now that her war against cancer is nearing its second year, her battle against despair has become grimmer, and it is I who try to cheer her, usually to no avail. We are together almost always, and sometimes it seems like too much, but I remind myself that she might die soon, and that I must cherish our togetherness. Perhaps, it’s true of most men—and women—that one of the things we love most about our partners are glimpses of the bright-eyed children that they used to be, but those glimpses have become less frequent now that the reality of suffering and the anticipation of death occupy so much of our awareness. Like metal that’s being abraded into filings, there remains less of us at the end of every day.

Men might be more likely than women to risk their lives for endangered loved-ones, but it’s women who dominate the ranks of caregivers, which is why sites like Reddit are filled with the accounts of embittered women whose husbands unhesitatingly abandoned them in their hour of greatest need. 

Another noteworthy gender difference is that aged men are more likely than aged women to die within months of their spouses. Young men glory in their greater muscle strength, and interpret it to mean that women are the weaker sex in every way. Then comes old age and the thought that this might not be so.