I'm Wide Awake

Entry 1 4:00 a.m.

I'm not sleeping. "Boots of Spanish Leather" on heavy rotation in my head.  After arriving home last night, I hid away in the office with a glass of scotch. I read journal articles and worked on yesterday's journal entry. I wasn't brooding, exactly. I was just overwhelmed. This morning I am awake, sleepy and unable to get back to sleep. Jenny is on my mind. I am very worried about her. I can't stand this suffering. What comes next is worse. We are riding the train to destination fucked, with lots of stops for misery and regret along the way. After a year and a quarter, I am spent. I can't fathom how Jenny feels.

One blessing, the dogs are asleep. Damn it. They beckon. Buddy is as subtle as a hard on in stretch polyester slacks.

Entry 2     10:31 a.m.

I just can't leave well enough alone. It's a slow work day. I am reading a lyrical poem, an ode to PDAC prognosis. It feels more like an elegy for hope. It could be titled, Captain Obvious Finds An Eraser On The End of His Pencil, but it's not.   Instead, it's called, "Prognostic factors in advanced pancreatic ductal adenocarcinoma patients-receiving second-line treatment: a single institution experience." One problem with oncologists is they have no flair in naming their poems. Another problem with them is that, when it comes to pancreatic adenocarcinoma, they always have the shittiest rhyming schemes worst news. Most studies with respect to this disease are small, often limited to a single institution. So, I am taking the findings here with a grain of salt, albeit salt substitute because my blood pressure is already ridiculous. Out of 108 patients on second-line chemo for PDAC, median overall survival was 5.1 months. The outlier, on the long end of the range is 6.17 months from the start of the second-line.  Shorter overall survival was predicted by 3 things. 

1) TTP, or Time-to-progression, of less than four months.  ✔

2) Neutrophil to Lymphocyte ratio higher than 3. Hers is 4 according to the calculations I did using the neutrophil to lymphocyte ratio calculator at mdcalc.com. ✔

3) A CA 19-9 level higher than the upper limits of normal.  ✔

What does this mean for someone on third-line?  Her odds can't be better than for someone on second-line. 

Jenny is still in bed at 10:49. This is new, the last few days, as her energy level is on a downward trend. I am scared, more scared than I have been in 15 months. 

I saw a post Jenny made on Facebook back in 2015 about how lucky she was that I made her breakfast in bed every Sunday. It is true, I did, for a long time. I liked seeing it, because today she claims our relationship has been shit for as long as she can remember. There were good times. Many. 

Entry 3    2:42 p.m.

Flu shot today?  COVID booster? We shall see. 

I ran across another new journal article on CA 19-9 today. It's actually a report on the study. A single institution study, which as I go along, realize have such small sample sizes, they need to be rolled into longer retrospective studies to have any real explanatory strength.  Still, something is better than nada. The study looked at 154 patients who had their CA 19-9 levels measured before and during chemotherapy and found that "levels of CA 19-9 were highly associated with outcomes." Only 19% of patients with elevated CA 19-9 survived a year from the start of chemotherapy. Also, according to the study, patients with a CA 19-9 level prior to therapy that was less than 59x higher than normal had a greater median overall survival of 10.3 months.  Jenny's CA 19-9 at the advent of therapy was around 850, if I recall. The normal amount of CA 19-9 is anything >37. So, she was well below 59 times--2183.  That then, tracks. So, it is another piece of the mosaic, that is piecing together slowly.

An interesting consideration about studies. This cancer kills so quickly, that it has to be incredibly difficult to live long enough to get into a study. If most people die at around 4.5 months, that is the average length of first round chemotherapy, which everyone gets unless they opt to skip it and go straight to a clinical trial or do not receive treatment. So, the data may be skewed already for people participating in clinical trials--the cohort they represent may skew the length of time people survive toward more months, however few more months that may be. Jenny truly is beating the odds.

From an abstract--the article costs 39 bucks, so the abstract has to do:

 The effect of initial CA19-9 and chemotherapy contributed independently to the survival time, and every increase of 1000 CA19-9 units increased the risk of death by 9% (p = 0.0003).

What I can't know is if this intends to say the first measurement, or the first measurement and thereafter.

Entry 4

All of us got the flu vaccine tonight.  I  only need the booster now and I will be happy.