Do You Feel Lucky, Punk?

Everything old is new again.

K/BWE and I went to Wicked Famous Cancer Institute to visit Dr. Famous Squamous today. 

I have a long history with that place. In the summer of 1983, when I was on chemo and got an infection while vacationing on the Cape, I went to the cancer ward of their affiliated pediatric hospitaI for IV antibiotics for a few days. 

From 1993-1995, I worked there as a labgrunt, extracting DNA from blood drawn from people who had a family and personal history of multiple tumors.(1), (2)

In spring 2004, I went to the hospital where they send their inpatients, Ben and Jerry's, for removal of a cute little tumor on the roof of my mouth.  That summer, hungry for more Ben and Jerry's, I went back so that the Jedi Master could take out an itty-bitty little tumor tucked snuggly under the left temporal lobe of my brain.(3) 

But I wasn't through with them. I went back in the spring of 2005 and got chemo for my osteosarcoma. That was a real barrel of monkeys!(4)

Since then, I have been back and forth with various freakouts and false alarms, the last and most hilarious one in 2016.(5)

So today was like old home week. We drove down into a garage under a building right across a little street from the one where I used to work.  We were almost running late, so K/BWE gave the key to a valet, and we took the elevator to the 11th floor.

After a short time in the waiting room, Famous' Squamous's NP brought us into a room and we updated him. A short time later, in walked none-other-than Famous Squamous.

He's a tall, lanky man with deep voice and a slow, easy Texas accent.  He wears a cowboy hat, a vest, and elaborately braided cowboy boots. No, wait. That's Sam Elliott.

No.  Famous is a somewhat short, soft-spoken man neatly dressed in a fine suit and tie. Anyway, he is still Famous Squamous, and he is the law in the little town of Head and Neck in La Carcinoma Valley.

"Hi," I said, "we have to stop meeting like this!  Maybe the third time's the charm, though."

He gave a quiet laugh. Then, he said, "do you feel lucky, punk?" Oh, wait.  That's Clint Eastwood, and not even in one of his westerns.

Anyhoo, he laid down the facts.  Whether this is the slow-growing kind or the fast-growing kind, this is squamous cell carcinoma (SCC).  SCC is generally an aggressive, nasty tumor. So, assuming that the Wicked Famous pathologists agree with the City of Steel pathologists, it needs to be treated.

There is a relatively new drug called pembrolizumab (pembro for short).(6) It pins a 'kick me' sign on the back of the tumor cells, and, if it works, your immune cells kick it for a field goal. It has a great effect on some patients, suppressing the tumor indefinitely, and usually without much in the way of side effects. If pembrolizumab works for me, they don't know for how long it would work, but some patients have stayed well for two years and running.

Sometimes they can give pembrolizumab alone, without any of the traditional toxic chemo drugs. Sometimes they can't. It seems to depend on some testing they are doing right now on the juicy bits of tumor they sliced off in the City of Steel.

If I am super lucky and my tumor tests just right, I might be able to get pembrolizumab alone. Aside from an infusion at the clinic every 3 weeks, life might go back to 'normal' for some unknown amount of time. It also means that I might be able to go back to work as soon as next month.

If I am not so super lucky, Famous will talk to us about regular, fun chemotherapy.

We will find out more in a few days when the test results comes back.  And so will you.

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(1) This was some of the first work on the genetic roots of cancer.  Some cancer fans may recognize such stars as p53, BRCA1, and BRCA2--very exciting, if you're into that stuff. 

It was great job, and I loved my boss, Sig, and co-workers Li and Stasia.  I lived in an apartment two towns over.  I would get up early, and, in all wheather, I would bike all the way down to the Chuck River, taking a path along it and then crossing to go through the back streets all the nine miles to work.  I would lock the bike on the rack and run up all nine floors.  There was actually a shower, so I would shower and dress. 

I would work all day and often into the night.  I had optimized the DNA purification process, so Sig and I had time to run an experiment on the side that we should have published but never did.  I was as sleak and as organized as I would ever be in those years. So I have a certain love for that place.

(2) At some point during that time, I went to a talk about the effect of cyclophosphamide (a chemo drug I was given as a kid) on male fertility.  It was bad and got worse the higher the dose was.  My dose was way off on the flat end of the curve.  So I got tested.  Not to brag, but I deflattened their curve.  

Still, it meant that, in 2002, when K/BWE and I decided to have a child, we knew to get help immediately.  That was a wonderful bit of luck.  Given the tempest that was soon to follow, we might never have had a child, and Little Lord Chaos/the Professor would not have been conceived and born.

(3) For more on those two adventures, see http://www.tumoriffic.org/Part%20I.htm.

(4) And for more on that huge adventure, see http://www.tumoriffic.org/Part%20II.htm

(5) For those many good times, see this blog from March, 2012 through 2016.

(6) The way I remember it is thus: 'Pem [is the] bro[ther of] Liz Umab.  See?  Easy Peasy.  Actually, it's a good idea to know the names of the drugs you're on.  It can be hard, since those names are complicated, but you can make up tricks like that.

Many of my troubles are due to radiation I received for cancer in 1981 and 2005.  To give you an idea of the effects of radiation, this was once a normal rubber ducky until she received 120 Grays of radiation.