A cancer treatment primer

Hi! Yesterday I had my second cycle of Ipilimumab, the antiCTLA-4 drug that is part of the clinical trial I'm doing right now. My friend, Colin Hutt, served as my chauffeur through some rough winter weather and kept me good company for the day. It was his first time in an oncology clinic--I told him that was a good thing--and he asked some good questions about the different cancer treatments I've done. I thought if he had questions, others probably did too, so I'm posting a quick primer in case anyone else has trouble keeping all this stuff straight.

1. surgery -- surgery is usually the best option for cancer treatment. It is most effective in early stage cancers or when a tumor is causing problems with a bodily function. The removal of a mole, a masectomy, and my craniotomy are examples of surgery.

2. radiation -- radiation is the use of radio waves to target and kill a tumor or tumors. It is typically used in areas where surgery is not an option or when a large area of the body needs to be treated. The radiation is harmful to healthy tissue as well as cancerous tissue, so it has to be done very precisely in high doses (as was the case with my gamma knife procedure) or applied to a wider area in low doses (as was the case with my whole brain radiation) to minimize damage to healthy tissue. Receiving a dose of radiation is very similar to getting an x-ray or CT scan. The patient lays on a table, everyone leaves the room, and the radiation is applied to the affected area. Side effects of radiation vary depending on where it is applied. In my case, the whole brain radiation damaged most of the hair follicles on my head so I lost large patches of hair on both sides of my head but no where else. That's why I have a goatee and a stubbly mohawk right now.

3. chemotherapy (aka chemo) -- chemo is the use of toxic drugs to kill cancer throughout the body. Chemo drugs may be administered orally or infused through an IV. Chemo drugs target fast-replicating cells because cancer cells replicate faster than normal cells. Unfortunately, the drugs also affect healthy cells that normally replicate quickly, such as hair cells or the cells that make up the intestinal lining. This explains the common chemo side effects of hair loss (over the whole body), nausea, and diarrhea (among others). The main thing to remember about chemo drugs is that they are poison. A person who is on chemo treatment is being poisoned. I tell people that you cannot understand what chemo is like unless you've done it yourself. In many cases, it is a horrible experience for the patient.

4. bio agents -- what I call bio agents are drugs that boost the immune system. Usually infused through an IV, these agents work with the body to help the body's natural disease-fighting components to destroy the cancer. Interferon and interleukin are the two bio agents that were part of my biochemo treatment in Houston. The antiCTLA-4 drug I take now is a bio agent. Because bio agents work with the body, they tend to have mild side effects compared to chemo. Rashes, diarrhea, and fatigue tend to be the most common, although autoimmune disorders are a possibility. Here is something that might help you see the difference between chemo drugs and bio agents: When a nurse accidentally drips a chemo drug on the floor, the area around the drip becomes a toxic waste site. People have to wear protective gear and use special methods to ensure the area is safe. When a nurse accidentally drips a bio agent on the floor, however, she simply wipes it up with a kleenex and throws it in the trash.

That's a very broad overview of four common cancer treatments. It doesn't cover everything and it certainly isn't complete. Hopefully it gives you a little better understanding of the whole cancer treatment process.

Finally, on an unrelated note, I've got to send out props to Colin for his help and companionship yesterday. He made the day much more pleasant than it should have been. Thanks also to our good friend Dale Cox for snow blowing the six inches of snow off our driveway last night after what I'm sure was a long day at work for him. We are so blessed to have neighbors who take good care of us!

Jeff

PS. What kind of an uncle am I? I forgot to mention the best news of the past week: my brother, Michael, and his wife, Victoria, are the proud parents of Timoree Jade, a beautiful little girl born Dec 26. You can see pictures of her on Michael's My Space page.

Merry Christmas!

Hi! I've always liked the tradition of Christmas cards. They let the people who matter to us know they matter to us, even if we don't see them very often.

With that in mind, we decided to post the Dodd Annual Christmas Letter on the blog this year. There are just too many of you who matter to me! As is usually the case, this year's letter is in the form of a song ("The Twelve Days of Christmas"), and I expect all of you to sing along (you can ignore the parts in parentheses; those are just for clarification). Hopefully, our letter will bring you a moment of merriment.

Please know that I appreciate all of your prayers, encouragement, support, and offers of assistance in the past year. You all deserve to have the best Christmas ever!

Merry Christmas!

Jeff, Kelly, Aubrey, Regan, Jack, and Finn

PS. Just click the images to enlarge them.

Brain Scan All Clear

Hi! I met with my neurosurgeon and neurooncologist today. They both were very happy with the results of last week's MRI; the scans, which evidently were done in thinner slices than previously so to show more detail, showed that my brain was free of active mets (metastatic tumors). What a relief.

I told the doctors about the incessant fatigue and low-grade nausea I've been experiencing since late October. They said it's probably related to three things: the after-effects of the whole brain radiation, the medications I'm taking, and the cancer itself. The neurooncologist recommended that I try taking a drug they normally give people with narcolepsy. He thinks it might take away some of the fatigue. That would be nice. I missed Aubrey's Christmas concert last week because I was sick, and I missed Regan and Jack's concert tonight because I'm so tired. All I have to do is check with the doctor who is administering the antiCTLA-4 clinical trial to make sure this other drug won't interfere with the trial.

That's all there is to report from my doctor visits today.
Jeff

It's snowing all over (except where it's not)

Hi! For those of you in Phoenix, Houston, and other warm weather locales, I wanted to share these pictures of our front (top) and back (bottom) yards that Kelly took on Saturday. We've had 23 inches of snow so far this month (December). Fortunately, we've avoided much of the ice that struck so many of you in Kansas and Nebraska. Even more fortunately for us, my good neighbor, Mark Murphy, and his industrious sons, Abe and Ben, have stayed ahead of the weather and kept our driveway clear of the drifts. Thank you, thank you, thank you Murphys!



I meet tomorrow with the neurosurgeon and neurooncologist to discuss the brain scans I had last week. I'll keep you posted.

Jeff

What the @%#&, God?

Hi! Anyone who knows me knows I pray frequently. If prayer is simply conversation with God, then I would say I'm in some sort of informal prayer for a good portion of the day. I don't say this to boast but merely to state a fact and to perhaps justify why sometimes the only prayer I can say lately is 'What the @%#&, God?' Consider it the crass modern equivalent to Christ's prayer on the cross: "Eloi, Eloi, lama sabachthani” (My God, my God, why have you forsaken me).

I never prayed this prayer before the last year. It's not the kind of prayer you say casually. It means little when you say it because you caused a car accident or didn't get a job or were involved in some other relatively minor mishap. The first time I found myself praying it was while crying on my knees in the bathroom of the oncologists office back in January. I didn't know what else to say to Him at the moment, and it really didn't matter what He had to say in return. I was just mad and confused and hurt, and it seemed like that brief ejaculation (that's what the nuns in grade school taught us to call short prayers) pretty much covered everything.

I've said the prayer many times in the past year. And I found myself saying it again last night, though not on my own behalf. I had just heard a story about a local pastor, Gary, and his wife. Pastor Gary is minister at St. Matthew's Lutheran Church here in Wauwatosa. We have several friends who belong to the parish, and even though we're not parishioners there the church has been supportive of me and my family during the past year. Two of the parishioners made me prayer shawls, I have received letters of encouragement from some of their prayer groups, and Pastor Gary came to visit me while I was in the hospital after my brain surgery. He was a very nice man, easy to talk to, and he seemed very happy. Then last night I heard that his wife had been diagnosed with uterine cancer three weeks ago and that she died two days ago. Can you imagine that? Less than three weeks from diagnosis to death? Maybe in other years I would have found myself saying a quick prayer for her soul and thinking little more about it. But as I lay in bed last night, all I could think was 'What the @%#&, God?' I'm guessing Pastor Gary is saying the same prayer--probably in nicer language--himself right about now. If he is, he probably knows he won't get an answer that clears up his confusion or brings him comfort. But sometimes that isn't the most important thing. God just needs to know what we're thinking.

Trial started, one cycle down

Hi! Today I completed my first cycle of ipilimumab, the antiCTLA-4 clinical trial drug. It really was as easy as promised. I was indeed able to eat during the infusion, we watched part of a movie on our laptop computer, and the only noticeable side effect I've had so far was sudden fatigue right at the end of the infusion. I felt like I could just close my eyes and go to sleep. But I can deal with fatigue. I have three more infusions scheduled once every three weeks: 12/28/07, 1/18/08, and 2/8/08. Those are all Fridays, which means I'll have a full weekend to recover if necessary after each one. After that I get scanned and, if it looks like I've responded to the treatment, I go into the "maintenance" phase of the trial, which means continued infusions but at less frequent intervals.

A couple things made me feel good about my treatment today. One was that the other melanoma patients I saw at the doctor's office all looked better and older than I did (none of them had canes, all had full heads of hair, and they were all a bit overweight). I take it that's a sign that ipilimumab can work. I also was glad to hear the nurse say every patient they've treated on this trial at their office has gone on to the maintenance phase, which means everyone has responded at least in some degree to the drug. Again, I take it that's a sign that ipilimumab can work. I hope I'm not the exception.

Kelly and Finn came with me today. The nurses all loved Finn, of course. I was just an afterthought really! : ) My sister, Mary Margaret, stopped by to say hi while I was there, too. All in all, it was a good experience and I'm already looking forward to the next one.

Thanks to everyone who helped out with the kids today, especially the Due's and the Murphy's (and to Mark for shoveling us out once again!). I don't know what we would do without such wonderful friends to help us!

Jeff

PS I wonder if anyone can give me an answer to an unrelated question: do you know of a place where a person can buy movies that have been edited for content for presentation on airplanes, cruise ships, or even TV? I ask because Kelly and I were watching "Love Actually" during my treatment today. It's one of my favorite movies. The first time I saw it was on one of my brother's cruises, when it had been edited for content. Then when I saw it on an actual DVD, I was shocked at some of the content and for that reason I always hesitate to recommend the movie to anyone else. I wish I could get a cleaned-up copy of the movie so I could share it with others.

Bring on the trial

Hi! Well, I finally received confirmation from Dr. Richards' office in Chicago that I will be starting the antiCTLA-4 clinical trial this coming Friday. My understanding of how the trial drug, which is called ipilimumab (try saying that three times fast), works is still quite limited. All I have been told is that the first infusion will take approximately 90 minutes and should have limited side effects. In fact, the chemo nurse who called to set up the appointment said I could bring lunch and eat during the infusion. I'll believe that when I actually do it! Subsequent infusions are, I believe, every three weeks for only sixty minutes.

I don't think I'll need any help getting to and from this first appointment. Kelly happens to have an open calendar Friday, and my appointment is at 11:00, which gives us plenty of time to get the kids off to school before we leave. I may be contacting a few of you to see if you're able to keep an eye on Regan and Jack after school until we get back from Chicago. Thank you to everybody who responded to volunteer to help me with these trips to Chicago. I have taken your names and may be contacting you to take you up on your offers when I go down for future infusions.

I also want to extend a big thanks to our wonderful friends and neighbors who have helped keep our driveway clean of snow and ice following a couple of messy six-inchers in the last week. I don't know how we got so lucky to live near so many great people!

In other news, we decorated our Christmas tree this past Sunday night. My dad put it up for us when he and my mom were here last week. The kids had a good time. Normally it's my job to hang the lights, but I didn't think I should be walking around and around a Christmas tree dragging long strands of electrical wires behind me and my cane. Aubrey did the job instead and the results are fantastic. Now we've got lights twinkling on the tree, Christmas music on the radio, kids outside sledding in the snow; it's definitely feeling like the holidays. If I remember, I'll take a picture of the kids around the tree and post it on the next blog.

Jeff