The Moment

At 11AM Wednesday, Elaine called to say that she was done and on the way home. She had just finished her 8th and last chemo infusion. It seems like yesterday to Elaine and an eon ago to me that Dr. Buckley told us she needed six months of treatment and we steeled ourselves for the long haul. Now we're finished, except for periodic checks, at least unless the cancer returns and we need to go through another round of chemo therapies.


And even if that happens, we're hoping that the preparations by then won't be the current crop of poisons, but targeted genomic therapies. These approaches seek to alter specific genes without the traumatic side-effects that are now taken for granted in cancer treatment. Two weeks ago, I was in San Francisco at the Cancer Clinics of Excellence conference, where the keynote, by Harvard's Raju Kucherlapati, MD, gave a grounded but extremely optimistic view of what's coming down the pike in personalized medicine. The implications are breathtaking, and could change everything, cancer treatment included.

This moment is a dual-edged sword. We're thrilled that the last six months of chemo treatments are over, and that there is light at the end of this very difficult and dark tunnel. On the other hand, the impacts of the chemo are cumulative, with a cascade of just-barely tolerable irritations. Recently, Elaine's persistent nosebleeds, presumably associated with Avastin (which she is no longer on) were supplanted by a non-stop flow of watery eyes, presumably associated with Taxotere. She has also been fatigued much more than after the early treatments. Afternoon naps have become required.

So this is the time when the intensity of the impacts is the highest that it will be. Then we should see a gradual but relatively quick amelioration of the symptoms as the toxins leach out of her system. She should begin to feel more normal again. Her hair should grow back. Her sense of taste should return. The numbness in her fingers and toes should subside. Her digestive track should become more regular. And on and on.

Hopefully, we'll see the benefits in the degree to which Elaine's tumors have been knocked back. In early November, she is scheduled for a PET (Positron Emission Tomography) scan, which provides images of functional physiologic processes. Her most recent CA 125 value, a measure of tumor status, was 5, extremely low and very promising, but the PET will give us a more definitive report.

If all goes as hoped - and of course it is entirely possible they won't - then Elaine will join the army of women with ovarian cancer who go into remission for 12-36 months, and then the cancer will NOT recur. But in most cases it does return. If that happens, we'll have to punt to Plan B, hopefully with the new, less caustic genomic pathways that will increasingly become available. Right now, with such important medical advances in the chute, the 1-3 years that the first line therapy has bought us is incredibly valuable.

It is worth noting that, even in the face of this struggle, Elaine's spirits have been (mostly) high, bolstered by constant, endlessly inventive attention from our many friends and family members, near and far, who have shown their support in a thousand different ways. Her good nature and wit are still there, unsullied.

Finally, a huge, lasting thanks to Dr. Buckley's chemo team - Pat, Donna and Tiffiny - whose skill and compassion have made this process as painless as it could be. In fact, ALL of the staff at Southeast GYN Oncology Associates have been fabulous, and have our deep, abiding appreciation.

As positive as we feel at the moment, we know this is not a final email. We're still early in a process that is likely to have many twists and turns down the road. We'll keep you posted as things unfold.

Thanks for hanging in there with us.

(Elaine and) Brian