The previous post was titled, “Next?” and offered a
cliff-hanger. The mysterious shortness of breath, caused by fluid around the
lower part of my left lung, resolved on its own over about two week’s time. By
the date that a thoracentesis procedure to draw off the fluid had been
scheduled, there was insufficient fluid remaining to complete the procedure
safely. While I was grateful not to have a needle poked through my back, absent
the procedure the nature of the fluid remains a matter of conjecture. Still, I am
glad not to have the shortness of breath.
Toward the end of October, however, “next” came in the form
of increasing difficulty walking. I found myself using my walking stick more
than occasionally. Especially over the course of about four days, my mobility
became significantly compromised. Consequently, on October 31—Halloween—my
partner took me to the hospital emergency room where, over the course of 12
hours, multiple tests were conducted, including a complete spinal MRI. By evening,
a neurosurgeon brought the conclusion that a tumor, part of the multiple
metastases of my kidney cancer, had wrapped around my spine and was cutting off
nerve sensations to my lower body. The surgeon recommended surgery the next
afternoon, November 1, to partially remove the tumor, hopefully, to prevent my
becoming a paraplegic. Complete removal was not an option, as it would have
been major surgery, which wasn’t advisable because of the advanced state of my
cancer. I consulted with two of my other doctors the next morning and decided
to go ahead with the surgery that afternoon.
Surgery was performed on Tuesday afternoon, after which I
was walking (with a new walker provided during the previous day in the
emergency room), and on Wednesday a physical therapist had me negotiating
stairs with the walker. That exercise confirmed that I could be released to go
home. Our house is on four levels, two main floors that each split. But I
preferred going home and dealing with the stairs, rather than transferring to a
one-level rehabilitation facility. I was released on Thursday afternoon, and
recovery from the surgical incision proceeded normally. Recover of mobility has
been less satisfactory. My mobility remains compromised, meaning that I must
use the walker for any more than a step or two, or cling to a wall, a railing,
or a sturdy piece of furniture. Mobility is further compromised by significant
peripheral neuropathy (numbness in my feet), which means that I have little sensation
in my feet and walk as though on pillows of unstable air.
Fortunately, I have enough control in my feet to permit
driving (an automatic transmission), although I need to be very cautious and I
don’t attempt to drive far or for a long time. I’m thankful to be able to do
routine shopping and other errands, get out to meet friends, and so forth—a
semblance of normality.
The shortness of breath episode and the spinal tumor episode
argued for discontinuing the once-promising immunotherapy using Opdivo
(nivolumab). It’s impossible to know whether Opdivo was effective in any way,
given the two problems that, in fact, could well have been caused by the
immunotherapy. In any case, they were not prevented by it. And so the
immunotherapy was discontinued, and last week I began a new infusion therapy
with a drug called Avastin (bevacizumab).
Originally, the thought was that I would undergo targeted
radiation therapy on the remaining spinal tumor. However, I opted not to do so.
In part my decision was based on experience with radiation therapy dating back
20+ years ago. While radiation might (or might not) shrink the remaining tumor,
it could produce tissue swelling and make the nerve condition worse before it
got better. It also would cause fatigue, likely for several weeks. And, because
renal cancer is radiation resistant, it might not result in any tumor shrinkage
at all.
I concluded that a better bet would be the Avastin, which
also works to shrink tumors and might cause fewer side effects. The action of
Avastin is similar to Sutent, the first targeted therapy I took in 2015, which
is to act on blood vessels to interfere with the growth and spread of tumors. Sutent
had been effective but was discontinued when it caused necrosis of the jawbone,
a known risk that was increased by my earlier radiation therapy to the jaw
area. Avastin is not supposed to have this side effect. In fact, after the
first infusion (a week ago) I have experienced minor side effects similar to
those that accompanied Sutent.
For now, I will continue to pursue physical therapy with the
hope of improving my mobility, and will (barring the unforeseen) move forward
with the every-three-weeks Avastin infusion schedule.
