Monday, February 28, 2011

Spring in Georgia

I forgot to say that it is that glorious time in Georgia that arrives every year just as spring announces itself. As I drove off to get labs tested last Thursday i noted the first bloomed out daffidil of the spring in my back yard. After returning from the swamp as I drove out to get my AVastin today I noted 5 blooming daffidils or narcissis of various types in the front yard, as well as 3 clumps of blooming crocus around the mail box. What a beautiful time of year this is!

Penultimate dose down, one more to go...

Got my last set of labs for monitoring chemotherapy last Thursday, after which I took Friday as leave and headed to south Georgia and the Okefenokee Swamp. What a great place to spend the weekend! The weather was terrific - warm with a little misting rain off and on throughout the day but nothing prohibitive.

On Friday I explored the east entrance of the park - an area characterized by swamp prairies since most of the old cypress groves were cut out years ago. I spent the morning sleeping, the after noon walking (about 2.5 hours worth) around on trails and boardwalks, including the old restored swamper homestead, and the evening taking a sunset boat tour. That was wonderful - the guide loaded us onto a motor boat and drove us up the canal and into a meadow. The water was low due to drought, and the canal was crowded with alligators all over the place. After watching the sunset over the priarie, we headed by in the dark. We were each handed flashlights to shine on the water. If you got the angle just right gator eyes lit up bright red. By this method I recognized that there were in fact far more alligotors in the swamp than I had realized on the way in. Many were hanging out with just eyes tipping over the water and during daylight I had mistaken them for cypres knees or floating debris or logs or some such.

On SAturday I drove around to the western entrance to the park where I had hoped to take another group motorboat tour. But I arrived just after the morning tour left and the next would not go out for another 3-4 hours. So instead despite having no experience whatsoever with driving a motor boat I decided to rent a boat for 2 hours and take myself out. Turns out is is not so hard to steer a motor boat if you have someone else hook up the gas and start it for you. I was a little wobbly on the steering but as long as I went slow most people could figure it out and get out of the way, and I got better as the day went on. Being alone in the boat was not so bad as there were enough people in the water that i was in sight of another boat most of the time and I kept my life jacket on all the time. Which might not have been so helpful if i feel overboard in front of a hungry gator but I tried not to think too much about that.

The western side of the swamp was cypress forest - and beautiful in a slightly different way from the eastern side. But again incredibly full of gators - way more it seemed than in the east - and that was only partly explained by my ability to recognize gators by their eyes poking over the water instead of having to see the whole thing now. There were also a lot of turtles sunning themselves, and a few birds. I only really noticed one, but it was lovely - a large blue heron that appeared to be stalking a fish or something in the water at the base of a tree right at the point where the canel emptied into the large swamp lake. Nearby was a gator that was lying as still in the water as the crane was standing at the base of the cypress, and was as intently focused on the crane as the crane was on whatever it was stalking in the water. I had a feeling I was watching a progressive chain of predators, and if I had enough time to hang around I would eventually see the crane catch and eat a fish or the gator catch and eat the crane, or maybe both.

The only problem was that I realized, out on the water, that I knew how to steer and change directions and speed up and slow down, but I was uncertain how to stop (and restart) the boat. So that was a bit limiting. I had to only drive places where I could turn around instead of having to back out, and could not risk stopping the boat altogether and getting out. Although the thick coating of gators disguised as logs along the side of the water did not frankly inspire me to want to get out and walk around. And toward the end I was driving along heading back toward the canal and dock when I noticed I was passing through an area that seemed particularly thick with gators. I was concentrating on one ahead of me and debating whether I ought to deviate toward the right to avoid it when it solved the problem by sinking down below the water out of the way. But something caused me to glance a tad to the right and I registered that the sunlight was creating an interesting pattern on the water right next to my boat - sort of looked like a long set of little ridged under the water - then I realized that what I had seen was the pattern on the back of a very large gator that was apparently just under the water directly to the right of my boat - lined up nearly side by side with it and extending, I suspect, longer than the lenght of my boat. I am not exactly sure because when I realized what I had glimpsed I was not inspried to slow down and lean over the water to see exactly how big the gator that was cuddled up along the side of my boat might be. I confess i was instead inspired to jump a bit off my seat, then settle down, speed right up and hurtle forward keeping my eyes rigidly to the front. IF the gator was curious about whether I would be a tasty meal I felt no need to find that out. shiver.

It was beautiful. I need to do it again soon. Although it may be less fun once bug season strikes. I recommend the Okefenokee Swamp to anyone who has not visited it and who has a liking for the interesting variety of things supplied by nature.

I returned to Atlanta late Saturday and spent most of Sunday just sitting around recovering from all the exercise.

Then today I drove to Gainesville GA again for my next to last dose of Avastin today as well as physical exam. In 3 more weeks I get the last dose of the investigational maintainance schedule of Avastin that I have been receiving. After that - a CT scan, followed by CT scans every 6 months for 5 years, and physical exams every 3 months for 2 years, followed by every 6 months for the next 3 years.

It feels really really good to be close to finishing. Although there is a slight voice in the back of my mind that wonders if it will be a good thing to stop getting doses of drugs intended to keep the tumor at bay. Still it will be a landmark of sorts.

What a fascinating world - what interesting creatures, what a great swamp.

Thursday, February 10, 2011

Another one down, two to go....

Last Monday i received my 3rd from the last dose of Avastin. The penultimate dose will be Feb 28, and the last dose March 21. Great to be nearing the end of the protocol.

With excellent timing, a friend sent me another news release from Roche (the manufacturer) stating that Avastin combined with chemotherapy has now been shown to significantly increase disease free survival in 3 large stage III trials. Stage III are the final trials where safety and efficacy have been established and these enroll large numbers to see if the efficacy findings hold up and the safety profile remains stable. This is excellent. There was discussion in the news clipping about whether Avastin would get FDA approval for the indication of ovarian cancer, because it is expensive and while it has been demonstrated to prolong disease free survival (the duration of time before disease recurs or comes back), it has not apparently been demonstrated to clearly extend overall survival.

For me, I know what I would argue for if the FDA wanted to bring me in as a patient representative. What I am focused on is disease free survival, as I continue to wait for my chemotherapy-induced neuropathy to receed and my strength to return. I don't think in terms of time to death or wonder how long I will survive. I think in terms of time until recurrence and wonder how much time I will have before I have to return to chemotherapy again. And I hope it will be long enough to regain my strength, complete the organizational, planning and other tasks that I need to prepare, have my neuropathy go away at least enough to allow me to travel and maybe dance and scuba dive again with out excessive limitations. There were many blessings and lessons contained within the experience of chemotherapy. But I think I learned them the first time around and am less optimistic that a second round will be a time of learning and progress rather than a time of ... marking time and resting because i can do little else. The ability to be productive, to travel, to take care of business or to just go out to have fun that I measure is the time between now, when I have finally reached a physical point where I can begin to do intentional exercise (half hour at a time and very very mild, but still...) and the point where disease recurrence will push me back onto chemo. It is not the time between now and the point when I cease to breath.

So I would argue that an increase in disease free survival is more meaningful than an overall increase in survival, if FDA wanted to ask.