October 23, 2020 – This afternoon, I completed my second round (infusion) of Keytruda (pembrolizumab) at West Cancer Center’s main campus. Keytruda, as I’ve explained previously, is an immunotherapy medicine – meaning it boosts the body’s natural immune defenses in order to fight cancer.
My new treatment regimen is based on science, real science. Not conspiracy theories, not voodoo doctors who believe in alien DNA, not off-the-cuff comments about drinking bleach to kill a virus. Real science.
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| Up the steps to the unknown. |
Immunotherapy treatments are relatively new. Keytruda was FDA-approved in 2014 and by 2017 was in use for solid metastatic tumors, like melanoma. The U.S. approval and testing process is long and somewhat complex. Clinical trials can take years to complete.
I volunteer my time by working on scientific review panels that evaluate research proposals for possible funding grants. I’ve been a part of this process for a couple of years now, and it is a tremendous honor to be a “consumer advocate” and share my impressions (and concerns) with cancer doctors and researchers. This is one of the many ways I give back to the melanoma (skin cancer) community.
I want to ensure that melanoma prevention and treatment moves forward towards a potential cure and the funding of this research remains apolitical. Scientists need to be able to do their work – without threats and without undue influence.
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| A long day. |
Although the Keytruda infusion typically lasts only thirty minutes, my October 23rd visit was over three hours. Blood work, IV insertion, oncologist visit, scheduling (and re-scheduling), waiting on lab results, pharmacy prep work, a flu shot – all took place before my infusion.
Sitting in the third-floor infusion area was both odd and sad. Memories of waiting in this area while Emily received her chemotherapy treatments brought a flood of emotions. I’ve been a stage IV cancer patient for a long time, but I’ve never had intravenous treatment. The infusion area is a dull, sterile environment. It’s sad watching folks from all walks of life undergoing treatment. We have one thing in common–however–we all have cancer.
At the same time, watching other patients hooked up to IV machines and monitors reminded me that we’re fortunate to have researchers, scientists, technicians, nurses and doctors working hard to find new and better treatment options and, maybe one day, a cure.
Real research. Real progress. Not just talking points during a political campaign.
Real science.
Thanks, as always, for listening.
After confirmation that melanoma had spread to my right adrenal gland, we were faced with a couple of options: remain on Gleevec and receive radiation therapy or try something new – immunotherapy (described below).
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| Waiting on treatment. |
Initially, we opted to try radiation therapy. The idea was to target the adrenal gland, which would be – we assumed – less invasive that starting an entirely new regimen. After meeting with the radiation oncologists and consulting with some other folks, we decided against that route. There were too many outcome variables and too many negatives (potential damage to surrounding tissue and organs).
We just couldn’t get comfortable with that option.
Up until we left on our Blue Ridge vacation (see Facebook), we continued to struggle with our first option. Several online consultations, emails with others in the melanoma community, and, simply, time to reflect brought us to a new decision: no radiation therapy, stop the current oral chemotherapy, and start immunotherapy once we returned from vacation.
I feel good about the decision. Vicki feels better about the decision to go with immunotherapy. And our oncologist assures us that if immunotherapy doesn’t work, we can always go another route.
According to the American Cancer Society, immunotherapy medicines stimulate a person’s own immune system to recognize and destroy cancer cells more effectively. Several types of immunotherapy can be used to treat melanoma.
Immunotherapy medicines are given intravenously, so that’s another turn in my treatment. Today, I started Keytruda (pembrolizumab), which will help my body fight the melanoma without destroying any existing, healthy (normal) cells.
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| A new turn in my journey. |
Another positive aspect of our decision is that Keytruda will also fight the tiny melanoma tumors in my lungs. There’s no guarantee that they will be completely gone, but our hope is that they continue to stay small, or even shrink a little more.
Thanks, once again, for your thoughts and support. We truly appreciate it. As my treatment journey continues, there will likely be more frequent updates.
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| Everyone should have a view like this. |
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While, initially, this news was distressing, it didn’t come as a complete shock. All summer, we’ve been wondering what caused the sizable blood mass in and around my adrenal gland (see Doctor Doctor…). Now we know. Melanoma some how made its way to another part of my body.
Frankly, since early June, I’ve expected this outcome. It’s the reality of living with cancer.
With this sad news comes several positive developments. First, the PET scan (see The Waiting…) was negative for any additional cancer spread. That’s important because we want to keep the cancer contained as much as possible. In other words, right now, only two places inside my body have malignancy – my lungs and my right adrenal gland.
Second, the metastases around my adrenal gland, according to biomarker testing, contain the same genetic mutation (cKit) as the tumors in my lungs. That’s also important because we’re only dealing with one type of cancer (again, see The Waiting…).
Which leads to another (hopefully) positive development…we will continue my current treatment regimen – daily oral chemotherapy medicine (Gleevec) – with a new component: radiation therapy to tackle the adrenal gland.
This post will be short and sweet. Many things are coming together even as I write this. I’ll provide more details in a follow-up post (Another Twist, Another Turn).
This is yet another twist and another turn in my melanoma journey. I’m confident the journey will continue for many years to come.
I want to thank all of you who have made this journey with me. Your thoughts, your prayers, and your concerns are greatly appreciated. I’m absolutely humbled by it. Please focus your thoughts and prayers on Vicki, Emily, and Zach as they have been my guiding light in this crazy storm. In addition, prayers would be appreciated for my dad, my sister, my sister-in-law, and my entire extended family.
Thank you.
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| A thoughtful gift from Vicki’s true friends. |
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September 5, 2020 – Much of our August was spent at the West Cancer Center: blood tests, CT scans, an ultrasound, another CT scan, and, finally, a wonderful needle biopsy. Throw in a couple visits with my oncologist, further lab tests, along with a PET scan, and August was a month I’d like to do without.
Why all the visits? You may recall from my last health update on July 6th (Doctor, Doctor…) that – since early June – my doctors were monitoring a blood mass in and around my right adrenal gland.
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| September 3rd sunset: a reminder to enjoy the beautiful things life has to offer. |
Here’s an excerpt:
Now For Something Completely Different
There was, however, something completely unexpected on the scan results. A fairly large mass – about 2 1/2 inches – on or around my right adrenal gland. The adrenal gland sits on top of each kidney. The radiology oncologist called it a heterogeneous mainly low density mass. Basically, it looks like I had some internal bleeding either in or around my adrenal gland.
On August 7th I had an ultrasound to determine if there was any tissue with the blood mass surrounding my adrenal gland. The ultrasound did show tiny tissue fragments, so I immediately underwent a needle biopsy utilizing CT scan technology.
A needle biopsy is exactly what it sounds like. An area of skin is deadened and a (somewhat) long needle inserted into your body at the spot to be biopsied. Unfortunately, you remain awake during the entire procedure. It’s painful and weird – the only way to describe it.
Note: The biopsied tissue samples were sent off for detailed genetic evaluation (biomarkers).
A little over a week later, on August 18, 2020, I had a PET scan. Doctors use a PET scan to determine if any cancer – metastatic melanoma, in my case – has spread to other parts of your body, including your lymph nodes.
PET scans utilize a radioactive tracer that is injected into your bloodstream. To be effective, your body must be completely at rest for an hour or more.
Here’s a brief description of what a PET scan is like:
Plus, I had just spent the past hour sitting in a small dark room doing nothing. Nothing. Just sitting, trying to relax, while radioactive isotopes coursed through my body…I think I slept for 15 or 20 minutes while in that little room.
After being strapped down to the hard plastic “bed” of the scanner, I was inserted into the metal and plastic donut hole several times. Many people refer to CT and PET scanners as donut fillers. Another 25 minutes went by before we finished.
The waiting game began a few weeks ago and will be over soon. At that point, we’ll know the biomarker testing results and the results of my PET scan. Then we’ll know the next direction in my journey.
Thanks, as always, for listening.
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Writer’s Note – I’ll continue to update my blog on a periodic basis. No set schedule. So, I want to thank everyone who continues to stop by and check out my blog. Please leave a comment or message; I’d love to hear from you.
August 28, 2020 – Earlier today, Facebook alerted me to a memory from 2017. I’d almost forgotten about the post until today’s notice. What I haven’t forgotten, unfortunately, was the crappy comment that came from a former high school classmate.
Note: Yes, on Facebook yesterday, I mentioned the fluke that this 2017 memory popped up right after Hurricane Laura came ashore in Louisiana.
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| After Hurricane Harvey hit Houston, Texas. |
extended family, I posted our thoughts on my Facebook feed.
I received the typical Facebook feedback (see below) – Likes, Loves, and a couple of shares.
One person, however, had to rain on my goodwill. I realize it’s a minor thing – especially with everything going on right now in our world – yet, three years later, the comment angers me.
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| Never did hear back. |
One of the definitions of “thinking” is that of thoughtful reflection. In fact, another definition states that “thinking” (as a verb) is to employ one’s mind rationally and objectively in evaluating or dealing with a given situation. So, I’ll continue “thinking” about those of you in Texas and Florida who are dealing with the aftermath of hurricanes and floods.
I will also continue to hope that everyone’s situation improves and that they do not face long-term problems. I will use my words on MY Facebook feed. You are free to use your words on yours.
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