Last post?

On October 14th I visited my oncologist for my yearly surveillance exam. As usual, nothing unusual.

Because it had been over seven years since my remission date, and because nothing interesting had happened health-wise during that time, I proposed ending my surveillance. My oncologist agreed. She has now ended the 2009 referral from my primary-care doctor and sent me back to the general pool of unremarkable patients.

I feel fine. I’m taking care of myself. Life is good.

More evidence antioxidants and cancer don’t mix

Article. And relevance to me.

My status is unremarkable. I’m healthy and fit.

Five years

I made it!

Five years ago today I started my chemotherapy. On Monday, August 24, 2009, my doctors started the “you’re cured” clock with the first etoposide infusion. Now that the clock has made it to the five-year mark, it becomes the “now get out of our office and never come back!” clock. No more surveillance. No more blood work. No more chest X-rays. Hooray!

But I will go back. First, for one last round of surveillance just to confirm I really did get past five years without any evidence of recurrence. Then after that, my doctor recommends an ongoing yearly exam. She says it’s just to be sure, but I suspect it’s because I’m such a pleasant patient. No, really, I must be the happiest person she knows.

Fall 2013: Blood work normal

• AFP 3.1 (down from 3.4)
• BHCG 0
• LDH 151 (up from 150)

I also had a CBC/A1C done while I was there (unrelated). All normal. A1C implied glucose of 110, which isn’t great, but it gives me a goal to pursue: lower carbs, more exercise.

Spring 2013: Blood work normal

• AFP 3.4 (down from 3.5)
• LDH 150
• HCG 0

Like last time, they continued their high jinks with a phone call instead of an email. But the nurse’s tone of voice was consistent with normal results, so I wasn’t alarmed.

Chest X-Ray Normal

Funny story (warning: not funny).

For the last zillion times I’ve gotten test results from my oncologist, she’s used the Kaiser online messaging system to notify me of the results. I get an email notification that I need to sign in, I sign in, I see things are fine, back to normal life.

Well, this time the day after my x-ray I get a telephone call from Kaiser. It’s my doctor’s assistant:

• “Hello, this is Dr. ____’s assistant. [heart begins racing] Just wanted to tell you that your x-ray is normal.”
• [Worried that I’d misheard her]: “Ah, OK. So good news, right?”
• “Yes, good news.”
• “OK, bye.”

Because I’m now in my fourth year of remission, I think they’re just messing with me to liven things up.

Blood work normal

I was getting blood drawn for something else, and the technician suggested doing my AFP/HCG/LDH since it’d be due soon. Fine with me. They just came back normal. AFP 3.5 (a bit up from 3.3, still in normal noise range), HCG 0, and LDH 195. The LDH is a little bit high, but still well within normal, and explained because I recently started strenuously exercising for the first time in three years. Exercise squishes cells and brings up LDH.

X-Ray Heebie Jeebies

This morning I had my twice-yearly chest X-ray. The normally brusque technician behaved very slightly differently this time. I admit I’ve managed to take this observation all the way to freaking myself out.

Every time in the past, he’s been like a drill sergeant, impatiently yelling instructions. When the final image taken was confirmed to be in focus, he’d practically shout “You’re done! Put your shirt back on! Goodbye!” from the other side of the glass.

This time, he was mostly the same before the imaging, but afterward he walked out and said words to the effect that the radiologist would transmit the results to my doctor within a couple hours. Then he held the door for me on the way out.

I strongly prefer the version of the guy who doesn’t give a crap about me except that I’m the patient who needs to get the hell out of his x-ray room ASAP to make room for the next patient. And it’s hard not to deduce that his kinder, gentler behavior was directly caused by his recent observation of a spot on my chest, also directly causing him to think “Poor bastard. At least I can let him know to expect a phone call, and hold the door for him on the way out.”

As I always think loudly to myself at this point during Blog Posts About Worrying, it’s probably nothing; in fact, no, it’s definitely nothing at all. I feel fine. My blood work three months ago was normal. I’ve been cured for two years, 296 days, and I’m far out of the zone of danger. There is absolutely no predictive information contained in the technician’s ordinary brusqueness versus his occasional compliance with the minimal bedside manner of explaining normal x-ray procedures. In fact, maybe he typically runs through the spiel at the end, but in the past I’ve shown up on busy days when he couldn’t be bothered.

I could keep writing. Or I could get back to my normal life right now and get the email on Monday with the subject line “cxr normal.”

Update 11:27am Friday: “cxr 6/15/12 is normal”

All clear, 31 months and counting!

My AFP is down to 3.3. From my most recent post, readers might remember my concern about an apparent upward trend since mid-2010. As of today, it’s near the lowest it’s been since my chemotherapy began. That’s good! A few factors that might have affected the number:

• I took the test at a different hospital, which likely meant a different lab. My HMO opened a new branch closer to me, and it’s more convenient to go there.
• I didn’t drink in the week before taking the test. I usually have one beer every evening, but abstained before this test. There are at least a few studies showing a correlation between serum AFP and alcohol consumption.
• The most likely factor is randomness. I am in remission, and my number is well within normal range. I’m trying to extract meaning from noise, which is no better than superstition.

bHCG and LDH are normal. Only the chest X-ray remains from my semiannual exam. I’m not worried about that.

Two years

It’s been over two years since I started chemotherapy on August 24, 2009. I observed the two-year mark quietly because I hadn’t yet had blood work or a chest x-ray after that point, and didn’t want to celebrate an unmeasured milestone. The milestone is significant because the medical community considers the patient cured if he makes it to two years without a relapse.

Today I got back my results from yesterday’s tests, and they’re mostly good. CXR normal. LDH normal. bHCG not yet complete but sure to be normal.

The “mostly” is AFP. It’s 4.1, which is still well within my lab’s normal 0-15 range, but it continues a trend for the last three tests of rising results:

• 2009-11-04: 5.3
• 2009-11-30: 4.4 DOWN
• 2010-04-13: 3.3 DOWN
• 2010-06-29: 3.1 DOWN
• 2010-10-04: 3.7 UP
• 2011-02-23: 3.8 UP
• 2011-09-13: 4.1 UP

It’s easy to see patterns in noisy data. In all likelihood everything’s fine. But I’ve sent a message to Dr. Nichols to gauge his level of concern (update 9/16: yes, he agrees it’s just noise), and I’ll of course raise the issue with my local oncologist at our next appointment.

As always, I’ll try not to worry, and either way, I won’t let tomorrow interfere with my enjoyment of being alive today.