20 , 20, 24 Hours To Go


 I Wanna Be Sedated


God. Scan day tomorrow. If there is an opposite of sanguine, I am that.  In between meetings and other
work, I keep reading away. The studies are fairly consistent that the CA 19-9 marker velocity--the amount of rise or fall over a four-week period, is a prognostic indicator in pancreatic cancer.  Scientists hedge so damn much, and there are so few decent studies regarding unresected pancreatic adenocarcinoma ("PDAC"), that it is still unclear to me the validity of the studies.  But I have only found one study that found that CA 19-9 isn't a good indicator, and that study hedged and said it alone is not sufficient to rely on for prognosis.  So, even it conceded it plays a role, fwiw. 
I say, "Don't tie yourself up in knots, Geoff.  She will be fine."  But, I know that the reality is she won't.  Like her, each time I wake up I wonder things like, "is this the last Easter, the last spring, the last April?" It's fucking macabre.  I would prefer not to contemplate mortality, and always planned on checking out first.  And, who knows, maybe I will. It seems increasingly unlikely.  

Our Happy Place

In the summer of our love, early marriage, pre-kids, we had amazingly wonderful times together.  We lived for a time in an 8th floor apartment, just off Broadway in the Village. Student housing, it was tiny, but the walls were all 9 foot windows looking out on the City. We could see the Empire State Building and its ever changing lights.  It was heavenly.  The HVAC unit was 3 feet high, covered the north wall. 
On Broadway, in Seattle, there used to be this shop called "The Cramp," on the 2nd story of a brick building just a block or so south of the Broadway Market They sold punk regalia, leather, Doc Martins and had a window facing the street.  The shop used to have people in leather dancing naked, or almost naked, in the window, to attract customers.  We thought it was hilarious, Jenny and I.  Well, back in NY in our apartment when we realized we could stand on the HVAC unit and do what we called, Naked Cramp Dancing, we did it to make each other laugh.  A lot.  In the day, at night. Whatever.  

The day I graduated law school, we were walking, turning off Broadway,  just east of Gristedes. Pushing the stroller with Leiney in it, I looked up and saw our apartment. I realized, at that moment, that you could clearly see everything in the window and began to guffaw.  I mean, I laughed out loud like a madman.  Jenny and I were, of course, mortified. What can you do?

Think happy thoughts. Hopes and prayers. Flowers and rainbows.  
"Finally, the change in CA 19-9 levels over a 4 week time period (“CA 19-9 velocity”) has been shown to be related to disease progression. Patients without disease progression were shown to have a slower change in CA 19-9 over a 4 week period (1 U/ml/4 weeks) as compared to those with disease progression (131 U/ml/4-weeks) (P < 0.001) [31]. These studies suggest that a decrease in CA 19-9 levels during or after treatment are predictive of disease remission and whether a patient will respond to chemotherapy.

CA 19-9 is a useful serum marker to predict tumor stage and resectability, overall survival, and response to therapy in PDAC patients, in addition to its commonly utilized function as a diagnostic biomarker."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419808/

Jenny's CA 19-9 has always been well over 37.  At its lowest, it was 10x lower than it is now.

Elevated CA 19-9 levels were associated with reduced survival when CA 19-9 was treated as both a continuous predictor and as a discrete predictor. Median survival for patients with CA 19-9 levels ≥ 37 was 284 days compared with 460 days for those with CA 19-9 levels below 37 U/ml, a difference of 176 days or approximately 6 months. 






Comments

Post a Comment

Popular posts from this blog

Life, A Cascading Series of Disappointment

Image
Jenny has cancer.  Terminal cancer.  We learned that in late July. Jenny had  dropped 25 lbs. in the spring without trying.  She had been having vague stomach complaints since October.  As a balm for her concerns, her doctor agreed to do a CT scan for her, but told her they would find nothing.  Jenny wanted to rule out pancreatic cancer, which had recently killed her dad-in the spring of 2019.  Her mother had been sick with lymphoma since February 2020.  The day of the scan, the doctor told Jenny they would get results back in a few days. When Jenny's phone rang that same afternoon, I was in the living room with Abby, where I was torturing her by playing the Rapping Duke on Youtube. Jenny shouted from the room, "Geoff, get in here, the doctor's on the phone." "You have a four cm. mass on your pancreas,"  he said. Jenny made a sound like someone had punched her in the stomach.  "There is a spot on your liver. You have a necrotic lymph nod...
Read more

Still Muddling Through Somehow

Image
At the park, I walked my dog through the rain this morning— not really proper rain— more like air that has decided to shrug water at you out of habit. It suited my mood well enough. As I walked, my thoughts kept returning to the same small universe they often do. They are not new thoughts. They orbit the same losses. They consider the same betrayals, the same questions that never resolve. They have been captured, these thoughts, never to escape, never to be forgotten, never to burn up in the atmosphere. It is simply the gravitational field of my life now. What might seem or feel like self-pity is more like muscle memory, which tells me I need more exercise. The holidays are here, and Christmas has always been central to my life, atheist that I am. It was stitched into Jenny’s life — the love of Christmas — at least as strongly as it was stitched into mine. We carried that love forward with the kids, year after year, without ever needing to talk about why it mattered; it just did. I...
Read more

Don't Do It, Don't Do It, Oh, Lord

Image
It Hurts, It Hurts So Bad.  .  . 3:44 a.m. I walked in the door last night at just before 10 to find Jenny in a ball on the floor--between the giant ottoman and sectional--agonizing pain in her hip. I had ridden to acting with the student driver.  But, let's back up. Jenny had chemo yesterday.  Her friend Jennifer took her.  It was uneventful and she received chemo.  I, as always, prepared the house for her arrival to make sure she wanted for nothing and would be comfortable as she endures the aftermath of all that poison.  Sometime before she came home, she texted, saying the doctor suggested she try Aleve for her hip pain.  Aleve.   She asked me to pick some up for her while Abby was at acting.   During the text exchange I realized she would be alone after Abby and I left for acting.  Leiney was elsewhere and had therapy at 5 and kickboxing later, and her sister Moni had bailed on chemo because she had so much to do (Wit...
Read more