Another Approach

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.