honeycrisp

Today we went in for Val’s treatment and to meet with the oncologist. I’ve been worried because it seems to me that Val’s condition — especially her breathing and energy — has worsened rapidly in the last month. She’s been wheezing audibly; taking shallow breaths to avoid coughing;and her laughter easily triggers coughing. As of a few weeks ago she can no longer ride her bike at all, and even walking up a small hill or slope is a significant challenge for her lungs. Her energy is very low; a few hours of mellow hanging out with folks can wipe her out. She is achy all over. Some of the energy loss, anyway, can be attributed to the chemo she’s on and the chemo she hasn’t had time to recover from. Some is the cancer.

Some gross details: Val’s been having trouble with coughing after changing position from lying down to sitting up. On Sunday morning she had a prolonged coughing fit, maybe 20 minutes of wheezing for breath, coughing hard enough she almost puked, and hacking up both gobbets of mucus(? or flesh?) and fresh blood.

We told all this to Dr. T today, who listened to Val’s lungs and said that it still sounds like she is breathing “well,” moving air in all four quadrants of the lungs, so that was a bit reassuring. Val uses an on-the-spot inhaler right now, so we’re going to try adding a steroid-based twice-daily inhaler, in case some of the lung tightness is due to inflammation. She thinks the blob Val coughed up (the size of a pencil eraser) could be a “mucus plug” (mucus that drains into your lungs, lodges there for a while and gets gummy). She gave us some loose guidelines to help determine when coughing up blood moves from merely alarming to a call-for-help emergency. (A couple teaspoons of blood, while not good, is not horrible in this new life we lead. Unless they keep coming, or are accompanied with rapidly worsening breathing. A few tablespoons of blood, or half a cup, or bleeding that won’t stop, is real bad news. Which, you know, I would have guessed.)

Various things thin blood, such as red wine and ibuprofen, so we know to stay away from those. Some of the lying-down-to-sitting-up coughing problems may be exacerbated by postnasal drip, so we can do some things to lessen that. (Allergies and endlessly dry air have been getting to everyone lately.)

The chemo Val is on now, Navelbine, is administered in cycles of three weeks on (chemo once a week) and one week off. Val has completed one of these cycles and today had the second week of cycle two. Subjectively, it seems like this drug is really not working for Val. But there is no way to compare to the known, tested results for this drug unless you complete the standard amount, which is two cycles (two sets of three weeks). Then you scan and look to see whether and how much the cancer is progressing. However, because of Val’s worsening symptoms, it was decided today to move her next CT scan up to the end of this week. It is now scheduled for Friday.

If the scan indicates that the tumors have penetrated her bronchial tube, she may take a chemo break to do some targeted radiation to shrink those tumors and ease her breathing. (They can’t just irradiate all her tumors because the body couldn’t handle that much radiation. Also, with stage 4 cancer, the presumption is that cancer cells are present all over the place, so you can’t get them all with radiation.)

And then… we wait for results of the genetic-mutation tests. We consider returning to some drugs she was on before. We look at the toxicity of all these drugs, and their diminishing likelihood of success, and we think about a few days in a little cottage in Hawaii, or somewhere else pretty with a view. We write some letters to people we love. We relish the unseasonable sunshine. We sit on the couch and read books aloud and ply the dog with carrots and tell each other stories. Val is her ornery sweet speculative hilarious self. We laugh a lot.

Meanwhile, as Mary Oliver says, the world goes on.
Meanwhile the sun and the clear pebbles of the rain
are moving across the landscapes.

Meanwhile wonderful friends come to cook with Val and push me in my wheelchair and celebrate my increasing mobility and fill our pockets with horse chestnuts.
Meanwhile the dog got a terrible tufty haircut and became much smaller, scruffier and silkier.
Meanwhile people stand with us at the edge of the cliff and gaze with us into the unknown.
Meanwhile Val’s birthday tree, a honeycrisp apple sapling we planted years ago, is laden for the first time with apples. They are huge and perfect and red and delicious.