Of Side Effects and More

With the rain outside as my soundtrack on this steroid-induced sleepless night, it dawned on my that I went 0-for November in blog writing. It's not that I haven't had much to say; rather, I haven't known just how to say it, and as you'll learn, I wasn't always in good enough shape to write.

Lest you worry that my typing at 0-dark-thirty is disturbing my beloved or our offspring, I have banished myself to the recliner in the living room, a full story below those-who-can-sleep. I've had a cough (which is 50/50 side effect vs cancer) that makes it hard to sleep horizontally, so Marcie suggested the recliner, having remembered from her brief sojourn there several years ago that it was "surprisingly comfortable." Perhaps it's my 8 inch longer frame, but I've come to the conclusion that my SleepNumber is not "lumpy."

Side effects. I have been set upon by them like Auburn fans swarming the field after rolling the Tide. And for the record, while beating Alabama, including that miracle of a final play, was an example of great coaching, beating Georgia was pure dumb luck. Nothing wrong with a little luck en route to a championship, but let's call it what it was. 

Side effects. Let's start with a list, each of which was a part of my November:

The familiar:

Heartburn

Constipation, lasting several days, followed almost instantly by:

Diarrhea

Fatigue, in varying degrees, culminating in last weekend's couch-fest.  

Depression

The new:

Weight Loss - my fighting weight was always 175. I now need to eat a 16 lb. Pound Cake to get back there. 

Osteonecrosis of the Jaw - Those of us who took Latin and those of you who attended Med School already know what this is. For the undereducated rest of you, it means bone death. And it hurts, badly. In fact, in my list of most painful maladies I've experienced, in which 1/3 of the score is based on intensity of the pain, 1/3 on duration, and 1/3 on the coaches' poll, I'll put exposed dying bone in one's mouth a close number 2 to a middle of the night leg cramp. The cramps get the edge because once they start there's no pill you can take fast enough to head them off. At least with the osteonecrosis, since it last for days at a time, you can knock it down from an 8 to a 4 with narcotics. Just beware, the side effect from treating this side effect is constipation (see above).

UPDATE - awesome leg cramp scene from Cosby Show: https://www.youtube.com/watch?v=0_v1phYhU3I#t=110

Where does ONJ come from, and why the jaw? It turns out that one of the drugs I've been on for years, Xgeva, does lots of good in preventing the spread of bone metastases, but leaves one open to lots of bad in the jawbone. Xgeva, and many other drugs, work by slowing down the natural cycle of bone cell death and replenishment. And that's great if you're trying to cutoff the energy cancer cells would piggyback on to take hold in a new spot. For reasons unknown, over time, these drugs tend to over-collect in the jawbone, leaving it vulnerable if, say, the gum is eroded and the bone exposed. Tooth extraction can be the culprit, or in my case, even a routine root canal during which the gum is injured by an instrument or by the clamps around the tooth. Something that minor would almost always go unnoticed, but combine a slow healing process on the gum with a little Xgeva, and boom - bone starts dying. 

It's not any one or two of these side effects that has gotten to me these last few weeks - it's the combination of them. So Dr Z and I have agreed it's time for another break from chemotherapy. In fact, after we walked out of the exam room yesterday he turned to his staff in the hallway and said "I did this, I take full responsibility for Mr. Beskind feeling this crappy."

Maybe it was that admission, but I haven't needed a pain pill since, and I ate a proper meal last night. Actually, for the latter, I'll thank my friend Rebecca, whose response to us bailing out on her latke party at the last minute (due to my aforementioned couch fest) was to bring us the leftovers. Delicious and filling! 

Meanwhile, the rain softens outside my living room window. Perhaps sleep will soon follow.