Clinical
Trial:
I'm now in the 14th
week of my clinical trial. Last week I had a CT scan that showed
that the two immunological drugs do not seem to be reducing my
tumors. It appears that my tumors have increased in size by about
10%. If they increase by 20% I will not be able to stay in the
study. My oncologist and the oncology fellow who was with him didn't
come out and encourage me to stop the trial, but they seemed to favor
quitting and going back to chemotherapy. I had read that sometime
the tumors seem to increase in size before shrinking. They did not
think that was the case because in only happens rarely. After
discussion, I decided to stay in the trial for two more cycles when
I'll have a CT, and we will see if the drugs have failed.
I
am not excited to try a new chemotherapy. I'm not sure I can
psychologically or physically take another chemo drug. My treatments
have extended my life far beyond what is normal in mesothelioma, but
they also take a toll on the body and mind. My oncologist said there
is no way to know, but I might live one or two years if I stopped
treatments entirely. Of course, my health would deteriorate during
those months.
Emergency
Room Visits and Hospital Stay:
On Tuesday evening (Jan 24th)
while watching a movie, I noticed that I was feeling funny and
checked my oxygen level and heart rate. My heart was beating in the
mid-130's while just sitting on the couch. When the movie was over,
I called the Phase I Trial Clinic oncologist on call and was told to
go to the emergency room. They diagnosed me as suffering from
supraventricular tachycardia (SVT), a condition in which the signal
to start a heart beat comes from an abnormal location in the heart.
The result is a rapid heart (tachycardia) rate and an abnormal ECG
wave form. To correct the problem,you might say they had to punch my
heart's reset button by stopping my heart and bringing back the
normal rhythm. The procedure has the possible side effect of
stopping the heart completely, so they attached pads from a
defibrillator on my chest and back in case my heart did not restart
and the shock were needed. I was not thrilled at the prospect of
having my heart restarted by a defibrillator. To stop the heart they
gave me a dose of adenosine, a substance that is normally in the
body, but not in large concentrations.
It
was a little like medical theater because of the size of the group of
people gathered around to watch. In addition to the doctor and nurse
doing the procedure, there were several others who may have been
medical students or residents. The doctor told me that there would
be some discomfort as my heart slowed down and stopped. Some people
describe it as being kicked the the chest. The setup was such that I
could hear my heart beat through a speaker. A couple of seconds
after the injection of the adenosine, I could hear my heart rate
decrease. As it neared the bottom, I was very short of breath and
had to breath quickly. It was unpleasant but not like being kicked
in the chest. Perhaps it was like having your breath knocked out.
Then for a fraction of second there was no beat, but it returned and
sped up in a normal non-tachycardial rhythm. There were smiles all
around. The doctor asked if I'd noticed their concern as the heart
rate dropped. I apparently hovered around 30 bpm for a few seconds
before stopping. I hadn't noticed because I was focusing on getting
a good breath. We then had to wait around for a while to make sure
things were going well, and they cut us loose. No one wants to go
through something like this, but I found the experience to be very
interesting. I had no idea that doctors had such a method of
resetting the heart rhythm.
On
Thursday, I ended up back in the ER. In response to the tachycardia,
the Phase I Clinical Trial Clinic scheduled an echocardiogram for
early Thursday morning. I also had two other appointments scheduled
for that morning. First I was to have my eyes measured for cataract
surgery, and then a meeting with a nurse practitioner in the Phase I
Clinic to go over ultrasound results. While in the waiting room for
the cataract measurement, I got a call from the nurse practitioner
telling me to hie myself to the ER because of a pericardial
effusion—fluid in the sack surrounding my heart (pericardium) was
putting pressure on my heart and needed to drained.
The
doctors in the ER did another bedside electrocardiogram to verify the
extent of the effusion, and scheduled me to have a pericardiocentesis
which involves inserting a tube into the pericardium and draining the
fluid. They drained about 10 ounces of fluid, and admitted me to the
hospital for observation. The next day, I had another
echocardiogram, they removed the tube, and I was released.
The
cause of the pericardial effusion is unknown. The extracted fluid
has been sent off for analysis, and it is likely that the effusion
was caused by my mesothelioma. If that is the case and it returns,
they would likely go back in and cut out a piece of the pericardium
to create a drain hole to let the fluid out into the chest cavity.
All
in all, it was not an uplifting week, but it was interesting. I am
going to put off my cataract surgery until I've seen my cardiologist,
and see if I will be removed from the clinical trial. I need the
surgery, but I have too much on my plate to have it now.
David
David
