Wednesday, February 1, 2012

Whacked with a stick

With assembly-line efficiency, my surgeon removed three more mets from various limbs yesterday while we had a discursive conversation about the peculiar aspects of my case and melanoma science in general. A nurse directed the prep, Dr. V did the cutting, and a young resident sewed me up. Bang, bang, bang. Being a cancer patient never ceases to be a loathsome business, but when you disassociate yourself from what’s actually being plucked from your flesh, an outpatient surgery like this isn’t so terrible.

While it's happening, that is. The days and hours leading up to surgery are spiritually oppressive, as the possibilities of where this all might end up engulf me in a malignant darkness. My lizard brain takes temporary control of things. Today, my life once again seems manageable. The lights have been flipped back on.

Dr. V shortcircuited several of my questions by suggesting firmly that I get another PET/CT scan. It’s been almost 11 months since my last one and I think I could die content with never having another. But that’s the rub: he believes the scan might help in some abstruse way to keep me alive. In his mind, whatever psychological asphyxiation I suffer leading up to and immediately after the scan is no match for the consequences of finding melanoma in unwanted and multiple places in my body. The research on his point is not persuasive, as there may not be a survival benefit to whole-body scans with positive findings for stage 4 patients. Dr. V didn’t push his point and simply left me with an Rx. We’ll talk again, he said, after he reads the radiology report. I remain ambivalent. In the absence of symptoms, ignorance feels a lot like bliss.
The melanoma harvest yesterday included a couple of rogues. Like most of the previous ones excised over the last 24 months, these were all about the size of a pencil eraser. The nodule removed from my right shoulder was “friable,” however—a word I last heard applied to asbestos removal from a home we once owned in Oakland. He had to pick at fragments to get it all out. The met in my left thigh was deeper than normal and somewhat larger, requiring a double injection of local anesthetic. I’m not enthusiastic about how a sharp knife feels cutting through microscopic nerve endings. The little devil lay on top of muscle instead of being tucked in just below the skin, as usual.

Dr. V is sanguine about where research on melanoma treatment is headed. He trained at the National Cancer Institute and in addition to being a surgeon, does research in tumor immunology. He’s been through melanoma’s recently ended Dark Ages, when there was a very limited menu of therapeutic options for patients like me.  In the past few years, drug companies have funded dozens of clinical trials for new drugs and combinations of drugs with some (relatively) promising results. The commercial opportunities created by a steady increase in the incidence of melanoma have not been overlooked, nor the marginal effectiveness of most approved drugs. By attending surgically to my melanoma for now, it’s possible that some form of drug therapy will emerge that suits its specific genetic profile. The science is astonishing, if well beyond my capacity to fully understand it (mitogen-activated MEK inhibitors, anyone?).

Both thighs and my right shoulder feel at the moment like someone whacked them with a big stick. To avoid blowing out my sutures, I've been advised to take a break from running. I won't feel back on track until the stiffness subsides and I crank up my immune system again with a good workout. Beyond that, there's this niggling notion of a follow-up scan that's lodged itself uncomfortably in the back of my mind. It's decision time, whether I like it or not.

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