Good News, Slightly Tempered
My recovery has continued on its upward trajectory overall. In addition, I got some really good news this week, though it is slightly tempered by future treatment requirements.
The very good news is that my blood test showed an undetectable level of the EBV DNA. That is a sign that the initial 7 week phase of treatment has worked. As you may recall, this is one of the key biomarkers that the doctors will monitor in the months and years ahead. Between this test result and the improving hearing in my right ear, I'm feeling more confident that the chemo and radiation worked.
Before starting treatment, I had enrolled in a clinical trial study. With no detectable level of EBV, I was hoping to get randomized to the observation / monitoring-only part of the study. Unfortunately, that did not happen, and I've been placed in the standard of care group. The standard of care for treating NPC in the US is do to three additional rounds of chemotherapy. My understanding is that I'll get three infusions - once every 28 days for 12 weeks. The drug will be the same as the one I've received before (Cisplatin), but at double the dosage (80mg/m2 vs. 40mg/m2) as well as another drug called 5-FU. The start of this second phase of treatment would be 14 August (4 weeks after the end of the first phase). That would put the next two chemo infusions on 11 September and 9 October.
I want to talk to the doctors more about this next phase and understand how they expect it to go. I still have some ringing issues in my right ear, which previously resulted in skipping chemotherapy. Other questions include potential side effects from the higher dosage (still considered "moderate" strength vs. full strength) and how chemo only (without radiation) could impact my recovery. I seemed to be able to handle the previous low chemo dose pretty well, but this may be tougher. I had a brief follow up visit the oncologist earlier in the week, but the EBV test results were not yet available, so we didn't really discuss the options at that time.
In general, after the initial disappointment of realizing I'd have to go through more treatment, it seems like this could be a relatively small price to pay for longer-term benefit and peace of mind.
With respect to the recovery, my diet has become more enjoyable, i.e. less Ensure Plus and Boost. I'm able to eat soft, moist and mushy foods, such as certain fruits (papaya, peaches, plums, blueberries), fish, eggs and soups. Spices and acidic foods, as well as meats, will require additional time. I tried a chili marinade for a fish dish, but that irritated my throat more than I wanted. Spicy fried chicken doesn't look like it's in the cards for a few weeks yet. Same with pizza, which features not only acid but a hard crust and likely meat (yes, I've been craving both for a while now). Also, I'm able to drink water. Who knew that'd be a big accomplishment?! It allows me to get outside and resume activity. I think I'll remove the hydration needle early next week, as my reliance on the bags for fluids lessens. Food this week included some crepes, fish, and congee.
The resumption of activities included going to yoga classes and seeing movies. It's been really nice to go back to yoga classes, after about a month of very limited activity (due to dry mouth and not being able to drink water). My first class on Thursday was pretty gentle (almost exclusively sun salutations), which was perfect for me. Another class on Saturday revealed some interesting things. First, I was glad to find out I can still do inversions (forearm balance), even if I fatigued faster than normal. Second, my legs are a little tighter than normal and my core / abs felt the soreness of not being used much. Finally, my loss of weight/muscle meant some poses were a little different. For example, I could sit on my heels more easily in child's pose, and I didn't see my stomach anymore in bridge. Most surprising to me is that I could double cross me legs in twisted root / garudasana. Not sure how much of that is because I became more flexible vs. losing leg muscle. Hopefully the former!
Aiday and I went to see a five movies this week, spurred on by the impending demise of Moviepass (I'm trying to maximize value, as usual). Despite my best attempts to convince her that I'm merely closing me eyes to concentrate on the movie, she believes I'm sleeping. She would say that I saw only 85-95% of these movies. The old equation of me + seats + darkened room + screen => nap time still holds, particularly since we saw some of these in the late afternoon, when I have tended to take naps.
Mission Impossible: Fallout: definitely worth seeing in the theater. This feels like a big production, with lots of effects and great scenery. Fun movie to watch. This was the movie I saw the greatest percentage of
Sorry to Bother You: the most original of the movies. If you've seen it and want to talk about the ending, please let me know
Eighth Grade: sweet movie. Don't worry, I won't be borrowing her language. Gucci
Leave No Trace: a real sense of place, with some very fine performances
Three Identical Strangers: superb documentary but also sad
The last three films are ones that I probably wouldn't have seen in the theater if I had to buy a ticket, but with Moviepass, I'm glad I was able to see them. Also, after a one of the movies, we took a detour to walk along the lakefront before going home. It was my first time on the path this summer. I'm hoping to ride my bike soon - hopefully this week when the weather cools a bit.
Finally, I finished a novel that I'd been reading on and off for a while. "A Gentleman in Moscow" was quite enjoyable. It was a fun read that wasn't overly taxing. The ending is very satisfying well. Any suggestions for future reading - something engrossing and funny? I'm thinking Lucky Jim (Kingsley Amis), Exit West (Mohsin Hamid) or Devil in the White City (Erik Larson).
That's it for now. Another week of recovery before the start of additional treatments. Hope it'll be a good one.