Ain't It Fun Livin' In The Real World?

 Entry 1     4:00 p.m.

I thought that the dog alarm clock wake up at 4:37 a.m. was going to be the nadir of my day. The Gods must be laughing. At just after 9 a.m. Leiney calls.  She is on I-5, near Mt. Vernon, having just spun out and hit another car and then bouncing into the cable fence in the median.  She stopped facing the wrong way.  Despite going over 60 miles an hour, and slamming into another car, her airbags did not deploy.  The good news is she wasn't injured, nor was the driver in the other car.  

I drove to Mt. Vernon, Jenny along for the ride. On the way, Jenny was on and off the phone with Leiney. 

Jenny and Leiney must have embraced for 10-15 minutes when we got to the Mt. Vernon SBUX, where the staties dropped her off.

I learned that when the police arrived, they suggested she drive it the car to a collision repair place. She was in no shape to do that. Nor was the car. The tow-truck driver had arrived, and told the cops that Leiney's crash was likely caused by the left-front tie rod which he could see had failed. Based on Leiney's description of what happened, that she went around a bend, and the car continued straight instead of responding to her turning of the steering wheel, it makes sense.  But for the tow-truck driver, the police may have convinced Leiney to drive her car, only for her to be unable to maneuver it safely off the freeway.  I should note, the pictures of the damage tell me she is remarkably lucky. Very little damage given the severity of the wreck, if the pictures are anything to go by.

If you ever have a collision up in Mt. Vernon, and use Dick's Towing, know that the tow-truck drivers are great, and that the office clerk isn't the best. She overcharged me by 110 bucks, which I caught, and then took 30 minutes and several phone calls trying to figure out how to undo the error. Had I not compared the bill with the debit receipt, well, I'd have been taken.  Also, fuck the tow truck business generally. Her car sat in their lot for less than 2 hours, and that amounted to a 90 dollar charge by itself. 

I found a collision place, went and completed paperwork there, we grabbed some lunch, and headed home. 

Leiney is now home with us, thankfully. She has no Tuesday classes, is skipping her one Wednesday class, and Thursday is Veteran's Day, and she has no classes Friday. She is shaken up. I still can't figure out how she managed to get the car to the shoulder before the police came, but she did.  

The day that started with Willow answering Nature's call before the birds were awake, and took me to Mt. Vernon for a redneck adventure, got even more interesting when I opened up my email to find a notice about a new journal article that just dropped.  "The Association of Real-World CA 19-9 Level Monitoring Patterns and Clinical Outcomes Among Patients With Metastatic Pancreatic Ductal Adenocarcinoma," a real page turner as you can tell from the title, brought nothing but confirmatory bad news.  A massive longitudinal study, it looked at CA 19-9 kinetics for over 6000 people receiving first, second and third line chemotherapy to see if there is any correlation between the change in the antigen and overall survival of patients. I have, as anyone reviewing my journal could tell you, presumed an increase in CA 19-9 means disease progression.  Even the lit says the same.  But there has not been a study done to confirm this--or if there has--it wasn't such a large retrospective look at patients with metastatic disease, and did not look into overall survival/CA-19 level/and line of therapy for correlates. 

The first thing I will note is that there were only 790 third line patients.  One doesn't have to be a doctor or statistician to understand why.  Less than 13% of patients made it to third-line.  But, it is more stark than that.

The median duration of therapy at 1st line was 10 weeks --the range spanning between 3 and 22 sessions.

The median duration of therapy of 2nd line was 8 weeks--the range spanning from 3-18 weeks.  

The median duration of therapy of 3rd line was 12 weeks--the range spanning from 6-23 weeks.

On the outside, combining 1st, 2nd and 3rd line therapy end points, the longest anyone may have received therapy in the total cohort used in the study was 63 weeks (22+18+23 weeks).  People didn't stop because they got better. You don't get better or spontaneously go into remission with metastatic stage IV pancreatic adenocarcinoma.  

For persons like Jenny, who receive multiple CA 19-9 tests and who are on 3rd line chemotherapy, the median overall survival is 6.5 (5.7-7.4 months range).  Jenny started on third line the first week of August, 2021. This is the start of month 4. No one in the cohort most closely matched to her lived longer than 7.4 months after starting 3rd line.

Entry 2

I missed something in Dr. P's biweekly report on Jenny's health.  When you have cancer, they measure your overall health using something called the ECOG performance status. More specifically, it measures the progression of the disease.  ECOG stands for Eastern Cooperative Oncology Group--they created the metric.  The score ranges from 0-5. Zero would mean you have no symptoms and are able to carry on all pre-disease activities without restriction. 5 means you are dead. Jenny has received an ECOG 0 or ECOG 0/1 score since we began chemo. Dr. P. has moved it up to 1.  At ECOG 1, a patient is "restricted in physically strenuous activity, but ambulatory and able to carry out work of a light or sedentary nature, e.g. light house work, office work."  I'd say she is closer to an ECOG status of 2, but it is interesting that he has moved the needle.  It is all based on self-reporting, btw, at this time. That may change as the disease progresses. I think many, if not most, patients have a tendency to downplay symptoms, and Jenny is no different.