Category Archives: ALK mutations

Profanity and profundity

At the age of ten I possessed a diary; red, covered in naugahyde, and secured by a lock and key. Its primary function was as a repository for each notable expansion of my vocabulary. Wonderful words like twat, that curled my tongue and piqued my imagination.

My classmates were one reliable resource, but I also scoured books that I pulled from my parent’s shelves. A quick study, I became incredibly adept at skimming until I got to the juicy parts.

Although I understood the need to be discreet per my prurient interest, it never occurred to me to be ashamed. I was curious, and frankly fascinated by not only what was being described, but the words themselves. There are so very many forms of human expression.

I also grew up in a strict and fairly repressive household, those books on the shelves notwithstanding. It would take a good long time before I became comfortable enough to simply be myself. Rather a bit of a randy (turning an adjective into a noun for my own purposes).

Or, as I was described (to my delight) by some young women: ‘dirty but elegant.’ A sentiment recently echoed by my friend Kate B: ‘so regal but can still tell a person to fuck off.’

My self description would be dignified but profane.

Megan Rapinoe just publicly apologized for using the word fucking. ‘“I stand by the comments that I made about not wanting to go to the White House, with exception of the expletive,” she said. “My mom would be very upset about that.’

Now I hear her. My mother would be upset if she heard me speak. However (and I am not representing a franchise like Megan is and my mother is deceased), I do not feel the apology was warranted.

I just made a presentation to GE where I used the word fucked three times. It is possible that some in the audience felt offended, but fucked belongs in my narrative. It describes actual words I used (communicating to my oncologist) and at the time seemed like the most expedient, honest and (yes) elegant way to describe how I was feeling.

What we refer to as ‘swear’ words are valid and time proven forms of verbal expression. And, to be honest, I don’t really understand how people can find them offensive.

Cancer offends me. And if a dirty word helps me get that point across, well then I will damn well utilize it.

xo

The ugly

Ouchy.

After fourteen years and three clincal trials, my veins are as heavily trafficked as a junkie’s. And getting a needle in there is not for the faint of heart.

The first nurse who tried to take my blood in the ER simply gave up. No shit. “A new shift is coming on” she said. Several hours later nurse number two gave it a go and the aftermath is above.

Clearly all phlebotomists are not created equally. Thank the heavens I am not needle phobic or I might have given up the ghost long ago.

I share this little bit of ugliness simply to remind all that cancer is a multi-faceted disease. There is the injury but also the insult. The simple but not so simple little shit that we all put up with on a daily basis.

The collateral damage that comes from living with a chronic disease that requires both constant treatment and attendant monitoring. I mean, I can’t even fathom the amount of blood that has now been drawn from my body. Liters upon liters. Years upon years.

Just part of the price I pay to hang with y’all a little bit longer.

Never really gone

Once you have cancer a headache is not merely a headache, it’s a potential tumor.

My gallbladder issues–although garden variety in nature–were immediately suspect for liver, pancreas, metastases as sources of trouble. Some scary moments there, as each of those scenarios would have meant a further limitation of options. When running on empty, you want to keep the road as clear as possible.

Fortunately my worst fears (like that headache, always in my back pocket) were not realized.

And in true lemonade from lemons fashion, my little adventure resulted in some marvelous insights.

First, that my family is indeed my rock. Good, that.

Secondly, that underneath the me of lorlatinib, my old, true self is extant.

WTF am I talking about? Well, Alice had me hold drug once I’d been admitted. I went six days without therapy. Lorlatinib comes with a host of strange side effects and within days, some of them began to subside. Alice was the first to notice that my speech was not so slow. And suddenly I was intensely aware of everyone’s cologne–I hadn’t even realized my olfactory had been compromised.

My neuropathy in my feet is so severe I can walk around with pebbles in my shoe and not know it. My toenails have all gotten ingrown while on lorlatinib, requiring surgery on eight of the ten. One is still pretty raw but normally I can’t feel it. Suddenly it hurt like hell.

But, best of all, I started to feel like me. My ability to think in an organized and linear fashion had magically returned.

Sigh. It was but a brief visit with myself, as I started back on drug two days ago. Two sleepless nights later I am once again struggling to complete tasks and my toes are numb.

However, there is comfort in knowing that I’ve never really gone.

Hurry hurry hurry up

So. I need a 4th generation ALK inhibitor. Stat. And I’m not encouraged by the fact that it’s been almost five years since lorlatinib, a 3rd generation ALK inhibitor, became available in clinical trials.

And although no one would argue that the 6.8 years of median overall survival that is now a statistical probability for ALK+ patients is a good thing, I can’t help but believe it may have negatively impacted the urgency to identify further ALK inhibitors.

Over here in Linnea Land we are feeling that urgency thing big-time.

Today was scan reviews aaaaaaand……just as I expected the news was not cheery. Continuing progression. Not rapid and yet decidedly of the rampant variety. Upon further questioning, an estimated three to six months until lorlatinib is not going to be enough. Which would be okay if there was in fact anything else.

Symptomatically, I knew as much. A nebulizer is being delivered tomorrow and I will once again become an albuterol junkie. Breathing is some necessary shit and I need to get mine back on track.

Me.

Last weekend I was in Colorado for my niece Mesa’s baby shower. That, and a much needed break from my own reality. Yesterday morning I sat in this egg shaped chair, my sweet spot, and said to my sister Bink: ‘I’m just going to stay. I mean, why would I go?‘ Bink and her husband Greg brought me a smoothie and a latte each morning and a martini every evening. The life, y’all. But my own reality show was calling and I boarded that airplane back to Boston anyway. This morning I was at Yawkey, not eager and yet ready to receive that reality check, gently delivered by Goddess number one, Dr. Alice Shaw.

Sweeeeeet spot. Notice the empty smoothie glass. And that Colorado sunshine.

After an appointment with Goddess number two (my social worker, Mary Susan Convery), I walked to the Boston Common to meet a date because even when, maybe especially when the shit goes down this hard, you need to just keep on living. As loud and as large as life will let you. And sometimes, even larger.

The gorgeous Boston Common.

Throwing shade

Just go away, you sticky little bastards.

I talk to my cancer, and that was this morning’s heartfelt greeting.

Yes. After years of hardcore warfare, my body the battle ground, I’m trying another approach.

Not a surrender, not a truce, but rather one in which I attempt to understand where the enemy (that would be cancer) is coming from. Not go high, go low.

It’s such a bizarre concept, my own cells run amuck. Unlike a virus, which can jump hosts, when I die, my cancer dies. Lose lose. Total annihilation.

Of course, it’s wrong to assume that this is not an end unto itself; The End. I mean, we all know this planet’s getting crowded. Of course, in this particular case, it sucks to be part of the solution.

I also think that part of the genius of DNA is the possibility for error. A consistent state of stasis is one big drag. Given the rate at which DNA replicates, errors of transcription offer fresh possibilities. Mutations allow life to evolve but they certainly can wreak havoc on an individual organism.

Which brings me back to my morning conversation. At this point I am at some sort of personal ground zero. Not emotionally (I am fine, really fine) but rather at a loss per how to address these errant cells of mine.

As captain of this ship, I can’t help but feel that a mutiny is under way. “If my body goes under, you go with it.” I tell these rogue cells. “Your ways are self serving and short sided. By gobbling up everything, you shall kill us all.”

Of course I see the parallels—what we humans are doing to the earth is not so very different than what my cancer is doing to me.

“What’s the point?” I say. “Why can’t we all live in harmony?”

These little bedside chats are my attempt to stay reasonable. But cancer is beyond reason. If I am to survive, I’m gonna have to fight–probably dirty.

Hey cancer, nobody likes you.

Cancer, well, cancer don’t care. And that’s the flipping problem.

Yes to this

Imagine a health care system based on these principles:

Services are funded through progressive taxation, so access is based on need, not ability to pay, and financial contributions are based on wealth, not health.

That’s the German model, as reported in the NYT’s today.

Although I have felt blessed to reside in a country where I’ve had access to cutting edge medical research, it has also meant that I max out my deductibles in the first two months of every calendar year. The end result is that more than one third of my income has gone to healthcare. Incredibly stressful and not a tenable situation. In short, there has to be a better way.

For a more in depth look at the German model, follow this link: The German Healthcare System

Where I am and where I’m not

Lunch at Slanted Door in San Francisco

I have been an advocate for lung cancer for a decade now, beginning with a story which appeared on ABC World News with Charles Gibson on June 2, 2009. Weeks later I began my blog and that fall I became one of the original peer reviewers for the CDMRP.

Ten years ago a blog about lung cancer was an unusual thing and lung cancer advocates were few and far between. Thankfully neither of these things is now true.

As I continued and broadened my advocacy efforts I have had the privilege of coming to know and care about so many extraordinary individuals. And I have watched with amazement as they have poured their passion and individual skillsets into advocacy in ways that were often beyond my own scope.

The past few weeks have been a time of soul searching. I am, without a next treatment available, once again between a rock and a hard place. It is what it is. However, this circumstance has meant that I must reassess my priorities. And what I have realized is this: I need to focus on living.

What does that mean? I shall continue writing my blog, my most consistent form of advocacy/activism all along. And I shall selectively participate in additional opportunities. However, I am on the short end of a long stick with much yet to do. As long as I am able, I want to write, paint, travel, love. Take it all in. Swallow life whole.

So there you have it. Two weeks ago I travelled to San Francisco for my friend Kate’s sixtieth birthday bash. Nos amis Melinda and Sally were there as well and we partied for three straight days. A fabulous time. And then I headed south to Palo Alto for some time with Wendy and Cristina, who I met, gee, a little over a quarter century ago when we all worked at the Redwood City Library. They generously paid for my flight and showed me a good time as well. So much fun. So much love.

And then this week my friend Lynn gifted me with a trip to Miami. I fell fast and hard for that city–lying by the pool with the sun on my face and a warm breeze blowing–a little slice of heaven. And Lynn was both a gracious host and a fabulous tour guide; we saw a little bit of everything.

So that, my friends, is where I’m at. In, out, about, around. Living it. Loving it.