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Cancer Update 10: Last Chemo Infusion, First for Immunotherapy

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This is a cancer update.  Yesterday I had my last of 4 expected chemo infusions, and my first of many immunotherapy infusions.  I mentioned before that I take an anti-side effect medication for the first weekend, but I’ll be fatigued for some of next week.  There may also be some additional side effects from the immunotherapy, Keytruda.

I’ve been very cautious about getting sick up until now, since I didn’t want to have to postpone treatments.  But after next week, I’ll probably start being more free to “move about the cabin” as it were.

Writing this very blog, earlier today! Broose and his wife Penny bought me this sweet chair, which practically dumps me out of the chair if I want. Super comfy!

This last round has not been without drama.  On the Sunday right after my last infusion, I passed out twice within a few minutes of each other.  I was probably only out for a few seconds both times.  I ended up going to the ER but my visit there was actually pretty uneventful.  They couldn’t really find anything, and said it was pretty much just the chemo.  So Kathy took me home after a few hours, and I’ll just need to remember to get low right away if I get lightheaded again. We’re always thankful when they don’t admit me!

My chemo side effects have been quite mild, which I’ve been very happy about.  I threw up a lot after the first infusion, but not the others, which is great.  I have another kind of amusing side effect of chemo that I’ve never been aware of.  My skin is shedding a lot, kind of like full body dandruff!  Kathy jokes that it’s like having her own personal snow globe!  Every time I change my clothes, there’s a flurry of “snow” as I fold them!  Kathy even says that I look younger with reduced age spots!  And no, I don’t recommend this method of exfoliation! Anyone else have this side effect?

After a low weight of 165 lbs, I’m back up to 180, which is great.  I’m going to take a little pause from the weight gain until I can start meeting with my physical therapist on the 16th.  My target weight is 190 to 195, and I want to put on some muscle instead of fat!  So I’m cutting back from 2 bowls of ice cream a day to just one!!  Favorites are Mint Chip, Mocha, and Cherry from Tillamook.  This is just an interesting detail.  Please don’t leave a bunch of ice cream on my porch!

A little detail about my daily life is that we love Gospel music and I’ve have fallen into the habit of waking up to “You are the Living Word” and “Give Me a Clean Heart” by Fred Hammond. They’re great songs, with great bass lines, of course.  I try and get out of bed before the first one is over!

Back to the medical side, my prognosis remains good and my tumors are shrinking faster than anticipated.  I’ll get a PET-scan on the 30th.  For this test, I have radioactive sugar injected, then wait 45 minutes for the cancer cells to suck it up.  Cancer cells love sugar, and quickly absorb the radiolabeled glucose.  Then I get scanned in a specialized scanner and see how the tumors look.  PET scans are the most sensitive way to detect tumors and allow doctors to see even small tumors wherever they are.  My chemo oncologist expects that my rib tumor will already be completely gone, and that my primary lung tumor will be much reduced.  The chemo will continue working for awhile, and the immunotherapy will continue for to up to 2 years!

A word on immunotherapy.  As mentioned in Update 7, immunotherapy agents cause T and B cells to attack tumor cells.  Some tumor cells express a surface protein called PD-L1.  This protein causes the immune system to see the tumor as “self” by binding to the PD-1 protein on T and B cells.  Keytruda stops these proteins from binding to each other, causing the T and B cells to see the tumor as alien.  Unfortunately, this can cause some normal cells to appear alien as well, leading to some side effects.  My autoimmune disease is not expected to be impacted by all this, but I’ll need to be monitored to make sure.  My oncologist says that since my tumors have a lot of PD-L1, this therapy may work especially well on my tumors.  Depending on how I respond, I may end up being on Keytruda for up to 2 years!!

Please continue to pray that my tumors will become normal lung tissue and not scar tissue.  I’ve also had some shortness of breath for the last 2 weeks, but I’ve seen some improvement over the last few days.  Pray that my lung capacity improves!

Merry Christmas and Happy Hanukkah,
Erik

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Cancer Update 9: “Wednesday”

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Friends,

Today, I just have a brief update.

My 3rd round of chemo started with an infusion yesterday. For the first few days of a new round, I’m on some extra medication that counteracts some of the negative side-effects of the chemo agents.  So while I’m on those medications, I’m actually feeling really good!  Those medications will run out on Sunday, so starting Monday is when I start “Fatigue Week”, which for me has been just sleepiness.  Until then, I’m actually feeling good and can do my normal 2 short walks a day, and even do my stair exercises.  “Fatigue Week” has generally lasted just from Monday to Thursday or so, and then I’ve been turning a corner on Friday, which I expect to happen this week as well. 

I usually go on 2 short walks a day. Then I do 5 sets of stairs after my walk, trying to regain muscle mass after my long hospital stay. It’s already making a difference!

I caught a very mild viral infection this time, and had to be more strict on having visitors.  Fewer visitors, and always meeting out on the patio from now on.  Despite that, my White Blood Cell count remained fine for a person on chemo, so my 3rd round started on time.  I also finished my radiation treatments on Friday, November 8th, so I’m very happy to be done with that.  Now it’s just chemo, and immunotherapy starting with my next chemo round in early December.  People tolerate immunotherapy very well.

Because I’m halfway through chemo, Kathy remarked that it felt like “Wednesday”, like we just have to endure a few more days before the welcome end.  Everyone from students to adults in the workplace know what that feels like!

Right now, I’m thinking as if my chemo journey will end around December 14th, when I’ll emerge from my “bad week” for that round.  Then I’ll need to start working out, regaining the strength I lost while in the hospital.  It’ll take me a few months to get back to my ideal weight, and be ready to travel again.  So by Christmastime, I should be mostly back to normal.

Results continue to be very good, and my prognosis remains very good!

Thanks again for all your prayers!  We continue to pray that my tumor tissue will become lung tissue, and not just scar tissue, to maximize my hiking, backpacking and skiing abilities, some of my favorite activities!

Also pray that my broken rib will heal quickly! We still have no idea how long it will take, but it will be much longer than the usual 6 weeks, since the pieces are not sitting right next to each other yet, but have to grow together before they can mend.

Don’t fear, but be smart,
Erik

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Case Update, March 26th, 2024; the WHO Pandemic Agreement.

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Today I’m going to give a super brief case update, then a discuss the potentially upcoming WHO Pandemic Treaty.

COVID Update: First, we had a wave of COVID cases late last Summer and another one this Winter.  According to official reporting, both of these waves were small, with few officially recognized cases.  A lot of people in my area of San Diego County had upper respiratory infections, but most people weren’t even that interested to know if it was COVID, a cold, or the flu.  Several people I know had illnesses that turned into bacterial infections like sinusitis or bronchitis.  COVID wasn’t known to generate bacterial infections, so these cases probably weren’t COVID.  All this to say, COVID is now deep into the endemic phase, with COVID becoming just another respiratory infection for most people.

Daily US New Cases, Worldometer/coronavirus/us. The recent JN,1 wave is visible on the far right.
Hospitalizations, from the CDC website.
From the CDC page on Variant Proportions for the United States, March
16th, 2024. The current most common COVID variant is JN.1, an Omicron variant.

A brief note on Respiratory Syncytial Virus (RSV).  The common cold is causes by any one of several classes of viruses, including Rhinovirus, Adenovirus, some Coronoviruses, and RSV. Everyone has had RSV several times in their life.  While infants can have severe symptoms because of RSV, for adults, RSV infection will result in just a cold, although some can produce a bacterial infection. In my informed but not expert opinion, no adult, except perhaps new parents, needs an RSV vaccination. I’m a little baffled by the push for the RSV vaccine this year.  I’ve never seen a campaign to encourage his before.  Of course, always consult your physician when making medical decisions.

W.H.O. Pandemic Treaty: The World Health Organization (WHO), an agency of the United Nations, is currently negotiating an international treaty called the WHO Pandemic Agreement (full text). The agreement attempts to standardize pandemic responses internationally. Many medical freedom advocates have criticized the agreement for forcing countries to adopt practices that infringe on individual rights and also produced poor outcomes in many nations during COVID. The UN currently plans to hold a vote on the treaty in May of this year.

The WHO was the first international body to be public about the SARS-2 virus in January of 2020.  Some of their claims at that time were demonstrably false, even when they were made, including that SARS-2 was not transmissible between humans, and that the virus was not transmissible through the air.  They adopted some of the same draconian lockdown measures promoted by China at a time when the less restrictive measures used by Japan, South Korea, and Taiwan were proving to be more effective.  Western nations, including the US and the CDC, quickly promoted the WHO as the standard for COVID practice and information. Disagreeing with or speaking out in opposition to WHO measures quickly became heavily discouraged on online platforms, and would even cause physicians, nurses, and pharmacists to lose their jobs. The California Physician Misinformation Act of 2022 attempted to have doctors lose their medical license for promoting information that contradicted the WHO.

The new Pandemic Treaty seeks to force countries to make laws enforcing the WHO pandemic plan. Aspects of the treaty include the restriction of “misinformation”, the automatic granting of licenses and liability waivers for vaccines, and surveillance of personal medical and social media information.  It would also require an international vaccine passport.

In an interview with Kim Iversen, Dr. Meryl Nass argues that the treaty would violate the 1st, 4th, 5th, 10th, and 14th amendments to the US Constitution.

Given the terrible record of the WHO and the CDC during the pandemic, especially for restricting free communication. I absolutely oppose a WHO lead pandemic treaty.

Will the US adopt such a treaty?  It’s hard to say right now.  The current makeup of Congress suggests that it might be difficult to get a treaty passed, especially since a two thirds vote is necessary to ratify a treaty in the Senate. The President can make an agreement by executive order, but a future president can reverse this order just as easily.

The US vaccine mandate suggests that the Federal Government, some states, and many companies may implement many aspects of the treaty whether or not the US agrees to it.  Remember that President Biden announced that he intended to issue a vaccine mandate in September of 2021. Details weren’t released until November that year, and the Supreme Court actually struck down the mandate before it could be implemented in January of 2022. So in actuality, the mandate never actually existed. Despite this, many states, federal agencies, hospitals, and companies implemented aspects of the mandate voluntarily, with Federal pressure never officially exerted. This is a bad sign for the WHO pandemic treaty.

The good news for some is that the 10th amendment may allow states to ignore an agreement if they want.  The 10th amendment states “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”  On the other hand, a treaty ratified by congress has the force of federal law and may bind the states.  It remains to be seen how the Supreme Court would weigh an official treaty ratified by Congress against measures that would violate the constitutional rights of individual citizens.

A note on the words “treaty” and “agreement”. In the US, a treaty has the force of law and must be ratified by congress. An agreement can be made between any 2 parties, but does not legally bind anyone else. News outlets have been using “treaty” and “agreement” interchangeably, and the official name for the draft document from the WHO is “the WHO Pandemic Agreement”. Given that the WHO wants the agreement to carry the force of law, they really mean “treaty”. The confusion may be intended.

As I have stated many times before, the censorship of physicians, scientists, and others during the pandemic crippled our ability to respond correctly to the pandemic. Many, including me, lost trust in the CDC and the medical community as a whole. I regard this as one of the worst aspects of the US pandemic response, and particularly bitter for me as a member of the medical community. The WHO Pandemic Agreement would codify the worst aspects of the US COVID response.

As the May vote nears, write your representatives, both at the federal and state levels, and let them know if you want the agreement implemented in your area.

Don’t fear, but be smart,
Erik

What went wrong with the US response to COVID?
What we should do in the next pandemic.
Science Magazine article on the Pandemic Agreement: