His disease began in a mole on his lower back that he ignored until it began to bleed. With the diagnosis of malignant melanoma, doctors removed a piece of his back about the size of a packet of cigarettes and hoped that the cancer had not spread farther from the site. Unfortunately, disease appeared in a lymph node under one arm, and he went to the M. D. Anderson Cancer Center for surgery that removed the regional lymph nodes and multiple moles on his chest and back. I’m not sure what prompted him to go to Houston for treatment, but I know his doctor, a well-respected Corpus Christi internist, was not particularly supportive.
Information about medical treatments was not widely available at the time, but as a graduate student at the University of Texas, I was able to obtain access to the Texas Medical Association’s medical library where I read all I could on melanoma and its treatment. I was very relieved when I learned that my father’s treatment plan matched the best I had gleaned from the research. He received two kinds of therapy—the chemotherapy drug dacarbazine (DTIC) and immunotherapy using Bacillus Calmette-Guerin (BCG).
DTIC is a highly emetic drug that causes over 90% of patients to become nauseated, and in the mid 70’s medicine’s ability control nausea was very limited. Nausea would begin shortly after the start of the IV and continue throughout the week. My father would return to the motel room where he would sleep and vomit, sleep and vomit. With repeated treatments anticipatory nausea is triggered by the sights and sounds of the treatment room before treatment even begins, and my father developed a deep-seated aversion to the “elevator music” he heard during treatment. His reaction to the music continued long after his treatment ended.
Melanoma cells can be recognized as foreign and be destroyed by the body’s immune system. BCG, a strain of the tuberculosis bacteria that does not cause the disease, is used to stimulate the immune system’s cellular component which is essential in killing the cells. At that time, treatment with BCG involved my mother scratching a tic-tac-toe frame (like the figure below) on my father’s skin with a needle dipped in a suspension of BCG.
The idea was that the BCG would cause a local infection, inflammation would set in, and immune cells would invade the area and kill the BCG. It was hoped that other immune cells would be stimulated to attack his melanoma cells.
The treatments went on for a number of months. The immune response was variable, and if I recall correctly, it diminished as the treatment advanced. I learned from my father that he spent the time between DTIC treatments dreading the trip back to Houston and I judged him to be “on the ragged edge” emotionally. I had seen some research suggesting that stress impacts the immune system, so I wondered if the stress of the DTIC was actually counter-productive. That is, the stress was so great that it interfered with the immune response, and it was the immune response that held the potential for a cure.
I knew my father would not tell his doctor how the treatments were affecting him, so I wrote to his doctor and told him about how my father’s time between treatments was spent in dread of the next treatment and about my concern that the DTIC might be limiting the effectiveness of the immune therapy.
A few days later, my father returned to Houston and passed out at the start of his treatment. The doctor cancelled the treatment, and he returned home with a tremendous sense of relief. Incidentally, his body’s reaction to the next BCG treatment was the strongest it had ever been, so maybe there was something to the idea that the stress of chemotherapy was limiting the effectiveness of the BCG.
In reflection, I marvel at the stamina of my parents as they worked through the treatments. Would I persist with a treatment as debilitating as my father’s? Would Jana be able to scratch BCG frames in my trunk, arms, and legs? If I were not retired, would I be able to work productively between treatments. I’m two thirds of the way through my first cycle of chemo and feeling good except for a greater sense of fatigue than I expected. My father had to work. With my uncle and another man he ran my uncle’s drive in grocery (think Seven-Eleven). My father worked two rotating six-day workweeks—a 60-hour week followed by a 48-hour week. I could go to work today, if I had to, but I wonder how good I would be, and could I keep it up as many hours as he did? No doubt he was fatigued as well. My sympathy and admiration go out to all those cancer patients who must work and fight the side effects of chemotherapy at the same time.
By the way, the melanoma never returned. The success of the treatment and my father’s positive reports on his experience at M. D. Anderson changed his doctor’s attitude about the hospital so he was more inclined to send patients there for treatment.
David
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