And, We're Off!

Quick announcement: 

I am back at work.  Make an appointment if you need it.

Second quick announcement:
(You may not be ready for this, and it may shock you.  Really, you might want to sit down.  Ready?)

You have more than one sphincter.  Yes, you.  In fact, you have many sphincters.  ALL OF YOU!  Ponder that!(1)

OK, no more announcements. Back to the story!

About a week ago, I got a port.  Port is a fortified wine that originates in Portugal.(2)  I am drinking some right now.  I find port delicious. 

However, the kind of port I've got in my chest is used to deliver chemotherapy.  My new port is more formally known as a portacath.(3)   It is a thin, hollow tube (about 6" long) that goes into a major vein of your body attached to a small disk (about three quarters of an inch wide) that is surgically implanted just underneath the skin of the chest.  A special needle can be inserted through that skin fairly painlessly, allowing easy access to the vein for medicine or for blood draws.  It's a lot nicer than getting a needle stuck in the arm every few weeks or having a tube hanging from the side of my arm all the time.

So, a week ago, in the same way they stabbed in the groin and inserted an arterial catheter into my artery in November, Dr. Abe Porta, Jr. stabbed me in the chest and inserted the portacath.  Then, he left it in and sewed up the wound, leaving a little disk under the skin of my chest that is attached to the catheter in my vein. (4)  

After we got home from the port procedure, in the last 45 minutes of December daylight, I took Willow to the woods up the hill, and she hopped her heart out while I took a little hike in the snow.  Then while K/BWE had her usual Wednesday night 'girls' night' with her friends, the Professor and I went out to our favorite restaurant with HB and his son for dinner.

That was last Wednesday.  My first pembrolizumab infusion was last Thursday.

My first appointment at Man's Best Hospital was at 11:30am.  K/BWE drove me into Beantown.  We hit traffic, so she had to drop me off and go park while I rushed to the seventh floor.  I was called in, a medical assistant took my vitals, and a nurse inserted the special needle in the special place (my port).  She drew some blood and left the needle device in the port with a tube attached so I could be hooked up to an IV.  I went back out, and K/BWE was in the waiting room. 

Almost before I sat down, I was called back in to see Dr. Manhattan.  This time, her pants were not leather, but, as before, she had a warm, reassuring manner.

I asked her about work.  I had already been back for a few days, but could I expect to be there for my patients long term?  "Is it fair for me to let my patients book appointments with me for a year from now?"  I asked.

"Yes," she replied.  She said that, even though it's cancer, this tumor has probably been growing for years, hidden beneath inflammatory schmutz.  It is reasonable to think that I could still be here in a year from now even without treatment. 

No one had said anything like that in all this time.  I felt like a load had been lifted from my shoulders.  Then I felt angry at myself for giving up those season tickets to Wrestlemania.

As for treatment, she repeated that most people have almost no side effects at all from pembrolizumab.  Right before my third treatment cycle, about 5 weeks from now, I will get another MRI.  If the tumor is standing still, or, better yet, getting smaller, they will continue the pembrolizumab, checking with an MRI every 9 weeks.

Building on what she had said the week before, she told us that, even if pembrolizumab fails, there are vast numbers of drugs being developed for this type of tumor.  "We have more clinical trials than we have patients."

Then, K/BWE were sent upstairs to the sweetest infusion suite of all time.  The hallway on the way has a floor to ceiling window on one side, and the view is fabulous.  I got my own infusion room.  If I schedule it, I can get a massage therapist to come in during my treatment.(5) There was a lounge singer and piano at the nurses' station, and there was a bar with free drinks.  (That last sentence is entirely false.)  Half an hour after the infusion started, they unhooked my port, and home we went.(6)

I've been feeling fine, although tired sometimes.  Still working.  Still hiking with the dog.  Still enjoying my family.  (Let's not forget the cat.  Her too.)  It's not over, but there is time, and there is hope.

P.S.  I need a name for my little companion/tumor, and I am asking for suggestions!  This tumor has been here for a long time, and he will probably continue to be here for a long time even if they eventually poison him into nonexistence.  However much I wish he had never shown up, he is truly a part of me, but what shall I call him when we have our heart-to-tumor talks?  Ideas, please!

(1) I am serious.  I have been to medical school, and they taught us stuff like this.  You have two anal sphincters--an internal one and an external one.  Try and clench them both.  Good.  But that's just the beginning.  You also have a urinary sphincter, which you might expect. But there are fifty more, such as your sphincter of Oddi.  That sphincter is named after the dog in the Garfield cartoons.

(2) The drinking kind of port was actually instrumental in getting me and K/BWE together.  Long story.  (Actually, I am going to get a glass right now.)

(3) The portacath was invented in 1992 by Dr. Abe Porta.  (Oddly enough, he is the great grandson of the man who invented the portapotty.)

(4) The vein I am talking about is my superior vena cava.  It is a giant vein into which the veins of the upper part of the body.  The veins of the lower part of the body empty into the inferior vena cava, but, really, no veins are truly inferior.  They are all special.

Regarding the procedure, technically speaking, it was more of a cut this time than a stab.  I won't go into detail, because it's gross, but it was not nearly so unpleasant as I thought it was going to be.  The oldies music that MBH has is much better than the music at Wicked Famous.  All I felt were a few lidocaine injections, none of which were bad at all.  Really, the only downside of the whole experience was that I could not make the surgeon laugh while he was putting it in.

I have to lay off upper body exercise for a few weeks after the procedure.  Prize fighting will also have to wait.

Meanwhile, that last crack just sent me into a Google deepdive into 'senior' boxing.  I don't qualify yet, but, in less than a year, I will.  Apparently, there is even something called 'chair boxing,' which sounds horrible.  This is even endorsed by the Livestrong website, usually a pretty good source of health information.  (https://www.livestrong.com/article/545699-boxing-for-people-over-50-years-old/ ).  As a primary care doctor, I'm horrified.  The whole point of this 'sport' is to give your opponent a concussion.   Not OK.

(5) Meanwhile, some of my patients can't get their insurance companies to pay for basic asthma and diabetes medications.  I was just talking to a patient with this problem today.  It is a strange system.

(6) I just spoke to a friend with cancer who recently had chemo at a hospital in a wealthy suburb near here.  So, want a short stay in a room with a view and free access to a massage?  Get cancer, and go to a fancy hospital.  It's a great deal!