There’s a bunch of news to share about both my mental and physical health. I thought I’d share it publicly here.
On the cancer side, my multi-doctor cancer team has concluded that the best course of action for me is not radiation+chemo+surgery after all, but rather a more aggressive bout of intravenous FLOT chemotherapy, then surgery, then more chemo.(See here for plenty more details: https://www.cancerresearchuk.org/about-cancer/treatment/drugs/fluorouracil-leucovorin-oxaliplatin-docetaxel-flot.) This is the new “standard of care” for my kind of tumor, as of some months ago. It’s supported by trials in Europe which suggested that i) chemo before and after surgery is as at least as effective with esophageal cancer as the older protocol, often more so; and unsurprisingly ii) it’s better in the medium and long term not to radiate the heart and the lungs to get the cancer-killing radiation to the esophagus.
The present plan, always up for negotiation, is to have the outpatient FLOT chemo in October and November. In fact, I’m starting tomorrow, Monday the 6th! Then I’ll take about six weeks to allow my body to recover, and do another suite of tests, to see how well the drugs worked. Next up will be surgery early in the New Year. Finally, I will repeat the eight weeks of FLOT — once again at London’s Victoria Hospital, which has a massive cancer clinic — to kill off any rogue cancer cells that might be circulating post-op.
All the doctors and nurses, and many kind friends, have told me that the immediate reaction to this chemotherapy regime is very individualized. Some folks seem to sail through it. Heck, given that patients are fed steroids to keep them feeling positive, I might end up with tons of energy for work! Indeed, I am to be on the lookout for manic symptoms. Other people are completely knocked for a loop.
Long-short, it could be a pretty awful winter physically speaking — but even if it is, the aim now, as I said last time, is to actually cure the damn cancer. To eradicate it entirely. So, that’s worth it.
How am I doing mentally? Mostly, I’ve continued to be paradoxically okay. I would have guessed that my Bipolar symptoms — both on the sadness and the anxiety side — would be through the roof. So far, however, that hasn’t been the case.
Then again, Thursday and Friday were totally filled with fear-symptoms. I needed to have some vaccines, before the chemo impacts my immune system, and those always frighten me. Worse, I needed to have a PICC line inserted on Thursday and then fixed up on Friday. That was terrifying. (‘PICC’ stands for Peripherally Inserted Central Catheter. It’s basically a plastic tube from my right arm to the top of my heart, which allows the medical team to bypass delicate veins when pumping toxic chemo into me over these next months. It freaks me out to have such a thing inside my body.) I felt so scared on Friday that I couldn’t really enjoy the Broken Social Scene concert that Anita and I attended that evening. It wasn’t a “melt down” day, but…
I happened to speak with my psychiatrist, Dr. D, that Friday. I told her that I was trying to be brave about the chemo, and was upset with myself for feeling so afraid. She said two really helpful things. First, she asked what I’d think of someone who was about to start a winter’s worth of cancer treatment, and who wasn’t exhibiting fear at all. Fair point: I’d think that there was something wrong with the person. So, I should be more forgiving to myself. Second, she reminded me of a discussion we’d had ages ago about the Ancient Greek philosopher Aristotle on bravery. Simplifying, he held that bravery is not the absence of fear in the face of danger: that’s more a sign of foolhardiness. No, the brave person is someone who feels the appropriate amount of fear, given the circumstances, yet is undaunted by it: the brave act not without it, but despite feeling fear. And,, Dr. D stressed, that’s exactly what I’m doing.