Cycle #3: Day 9

**One administrative note: I do not usually post on the day about which I am writing. I take notes on individual days so that when I start to write I can refer to them, but as you read this, the salient date is the title of the entry, not the day of its publishing.**

The first week following Treatment #3 has been difficult:

1. The dexamethasone that I take for the first 4 days of treatment really disrupted my sleep. For four consecutive days I woke up at 2 am and was totally unable to go back to sleep. Also, I woke-up completely drenched in sweat. I am not talking about a bit of perspiration....my spot in the bed looked like the chalk outline of a body on a murder scene, which a child subsequently coloured-in with a crayon. It was very unpleasant. Two days after stopping the dex I began to sleep normally again, but four nights of sleeplessness takes a toll.
2. My blood pressure has been very high again. Usually 200/110, even with a doubling of my BP meds.
3. My body has been quite achy in the spots where there are prominent tumours. For me this has meant stiffness and pain in my neck, left hip, back, and right femur.
4. I have had a cough that is neither worsening nor improving. It is causing a real shortness of breath that I notice when I talk and walk. While 1-3 above are definitely related to the chemo, this one I am not sure about. I have two two-year olds and they are constantly bringing colds/flus/coughs into the house, and this may just be one of those. I have already decided that if I still have the cough in 4-5 days, I will ask to be seen by my doctors.
5. Yesterday I had a fever for about four hours. I usually take my temperature at least once per day and until last night it was always normal. Last night it went from 99 to 100 to 101 in about 45 minutes, and then it stayed at 101 for a few hours. Then it subsided. This is sort of what happened during the first week after Treatment #1 but the numbers were a bit higher this time. Since it went away so quickly I probably will not mention to my doctors until I see them next.

This morning, which is Day 51, I feel better than I have for most of this week. I definitely still have the cough but 1, 2, 3, and 5 (above) have resolved. We'll see if today is the transition-day for the much more enjoyable weeks 2 and 3 after treatment.

Cycle #3: Days 1 & 2

Nothing medical to report. I felt very good both of these days and from a process perspective there was a big improvement. While there was a wait on the first day, it was just over an hour...much better than the 3.5+ hour wait during Treatment #2.

During the administration of the dacarbazine there was a slight burning in my veins so the nurses added some saline to the mix and the problem went away immediately.

The pre-chemo meds were exactly the same as last time and did their job well again (i.e., no nausea/vomiting).

Cycle #2: Day 19

Today I met with my doctors as I usually do on treatment week. This was actually the first time that I've met with my actual doctors since beginning the treatment as they were both on vacation when I had an appointment during the week of Cycle #2. From their perspective I seem to be doing significantly better than I was prior to any treatment at all. Overall, my wife and I agree with this. It is hard to be entirely objective because when I started chemo I was just over a month from a pretty big back surgery...part of me "looking and feeling better" is a result of just having had more time pass since the surgery. Despite this, though, my body is telling me that the treatment is doing something and that I am actually better off than I would be without the chemo. For Treatment #3 I think that they are going to administer the same dose as last time. They are doing so because I am tolerating it quite well and because my platelets have started to drop. I believe they are still above 50K, but not by much, and that is an overall decrease from where I started.

One of the tricky parts of a metastatic cancer, and there are many, is that tumours do not always move in lock-step with one another. For example, while someone may have disease that is generally getting better, there could always some that are worsening. This has been a problem for me in the past. While my body as a whole responds well to treatments, sometimes individual tumours become worse, requiring immediate attention (usually surgery or radiation). This may or may not be the case right now. I had a spinal and brain MRI this week and while my spine looks stable there is one spot in my brain stem where the radiologist is not sure if the disease has worsened. He has ordered a follow-up MRI in 3 weeks which will give him more information. Due to the sensitive nature of the location of this tumour, it is likely that any significant worsening would have manifested itself in physical symptoms for me. In this case the tumour is compressing the right hypoglossal nerve (the nerve that controls the tongue), which I've had problems with for years, but no real change to report.

In two days I receive treatment #3.

Cycle #2: Day 9

After a relatively tough first week after treatment, I have started to feel quite good again. The most persistent problem to report, and one that is not particularly unique to being on chemo, is the orthostatic hypotension. It continues to be very unpredictable: some days it is not at all a problem, others it is entirely debilitating. I still do not seem to have lost any hair which is weird. My energy level is quite good and I am able to participate in the daily activities that I would like to.