Out with Melanoma, In with Hepatitis
If you’ve been following this blog, you’ll know that Dena and I have been doing a little disease shopping lately. We’ve gotten bored with kidney cancer and are checking out other life-threatening diseases in order to put a little spark back into our marriage.
We flirted with melanoma, but the dermatology surgeon who performed the biopsy confirmed for us that the lesions were not malignant but were SKs – lesions that have many of the characteristics of melanoma but are harmless. Our oncology team was delighted by this news, not to mention Dena and me. Not only do we not have to deal with a second primary cancer but we get to stay on the MDX-1106 trial.
Or so we thought. But, today, I decided to dabble in hepatitis.
I know, right?
I was just doing my own thing, minding my own business, getting needled up this morning at Johns Hopkins when Fabulous Alice, my trial nurse, showed up at the infusion center with bad news. Evidently my “aspartate amino tran,” which sounds like some kind of Latinate curse, is sky high. The normal range for people is between 0 and 37, and for the previous months mine has ranged around 20ish. Today it was 254. This is a “Grade 3” something or other, according to the trial’s protocol. I guess it’s like DefCon 3 without the shock and awe. Maybe just a little shock. It could result in hospitalization.
And there’s the old “alanine amino trans.” (Seriously, who comes up with these terms? Clearly a drunk, which, I guess, is appropriate for liver disease.) Normal range here is between 0 and 40, and mine is 91. This is only a Grade 1 kerfuffle. (I enjoy the word kerfuffle. You should try it sometime. Why can’t I have a Grade 3 Kerfuffle? That would be awesome.)
So when Alice showed up talking about aspartates and alanines, I did what any reasonable person would do: I slapped her around a couple of times and told her to go sober up. But she wouldn’t leave. So I asked her to translate.
“Basically, your liver is inflamed. You have hepatitis.”
“Have you been drinking?” she asked.
“You’re the one blathering on about ala-thingies.”
“Seriously. These kinds of numbers usually indicate heavy drinking. The kind that abuses the liver.”
“No, no, no – you’re thinking of my wife.”
“No drinking then?”
I think she actually wanted me to say yes. That would just mean that I’d just need to dry out and the numbers would go back down. However, as most of my friends now complain, I hardly drink at all anymore. An occasional bourbon on a weekend evening, a beer after a round of golf or something. Nothing to cause this. Which means we don’t know what is causing this surge in liver enzymes. A potential culprit, which could be disturbing, is the drug – MDX-1106.
You may remember that when I started this trial, one of the more dangerous (though rare) side effects listed was autoimmune disease. MDX-1106 is a drug that, in a nutshell, kicks the immune system into high gear to fight the cancer. Sometimes this goes awry, and the immune system goes a little berserk and attacks your body’s healthy organs. This could be what’s happening here. Which could be serious, as it could shut down my liver, which is in itself a potentially fatal development.
However, there are treatments to deal with the hepatitis. If my enzyme counts don’t go down, they will hospitalize me and begin these treatments as soon as next week. Unfortunately, should it come to that, I will not be able to continue the trial, as the hepatitis treatments are steroidal in nature. Any steroids would interfere with the immune system, and therefore interfere with the MDX-1106.
Our concern over the past few weeks about the melanoma was, in some ways, less about the melanoma and more about the potential to be forced off the trial. Caught early, the melanoma could have been cut out and, likely, that would have been it. Similarly, although hepatitis can be dangerous if not addressed, I feel confident that we can take care of it. The concern is at what cost.
At this time we don’t really know if this will play out negatively. The enzyme counts spiked overnight; maybe they will go back to normal overnight in a similar fashion. The oncology team canceled today’s MDX infusion, and scheduled a new round of bloodwork for Monday. At that time, the counts need to drop by at least half. If they do, we’ll likely move forward with the treatment on Thursday. If they don’t, then we’ll have to consider our options.
So we’re trying not to stress too much about it at the moment. Until we know what Monday’s blood draw shows, there’s no point. Besides, I have bigger problems. Congressman Anthony Weiner keeps leaving angry messages on my answering machine and Twitter account due to Dena’s last blog post.
And for the record, I did not have tweets with that woman.