Well, we got the results back from my most recent CT scan last Friday, January 4, 2013, and the results were not good! Evidently, the 3 FOLFOX treatments I'd gotten before Caroline and I left on our Trans-Atlantic Adventure were no more effective at halting the progression of the metastatic appendiceal adenocarcinomas in my abdominal cavity and on my peritoneum (the all encompassing membrane that surrounds the gut) than the FOLFIRI and Avastin treatments I've gotten since May 2012! Unfortunately, I've now exhausted the state-of-the-art standard-of-care conventional chemotherapy treatments that are used to fight colon cancers, FOLFOX and FOLFIRI, with or without Avastin! The upside of this is that I won't have to subject myself to any more IV chemotherapies! The downside is that there are no more IV chemotherapies for me to use! Medicine has made great strides in the 20 years since Audrey Hepburn was diagnosed with appendix cancer in the early 1990's when 5-fluorouracil (5-FU, the F in FOLFOX and FOLFIRI) was about the only chemo agent available that was useful against colon cancers (appendix cancers are almost always treated as a subspecies of the far more common colon cancers)! However, when you run out of treatment options, the ultimate outcomes are not all that different today than they were in Audrey's day!
Fear not! It turns out that we're not completely out of treatment options after all! Even as we write, we are meeting with researchers here at MD Anderson Cancer Center who are involved in 100's of Phase I clinical trials of promising new "targeted therapies," one or more of which may be appropriate for me and my tumors!
I promise to keep you all up to date on the latest! In the meantime, enjoy another amazing picture from our Trans-Atlantic Adventure, in front of GaudÃ's amazing La Pedrera apartments!:
Happy New Year! Thank God we've made it to 2013! I know I haven't posted since October! I guess I was busy! Life happens!
Caroline and I got back from a wonderful adventure a few days before Christmas. A few days before Thanksgiving, we flew to Rome, Italy and boarded the Crown Princess for a cruise to the Eastern Mediterranean to exotic and amazing places we'd never been to before, like Naples (Pompeii, Sorrento, Capri), Santorini, Kusadasi, Turkey (Ephesus), Mykanos (Delos), Piraeus (Athens, Corinth), Corfu, Dubrovnik, Croatia, and Venice, Italy (we'd actually been to Venice before, on our honeymoon over 15 years ago!)--we enjoyed everything we saw and did! Then, we stayed on the Crown Princess for its tour of the Western Mediterranean and its repositioning across the Atlantic Ocean to Galveston, Texas, visiting Rome (Colosseum, Sistine Chapel), Livorno (Cinque Terre), Cannes (Matisse Museum in Nice, Monaco), Barcelona (Picasso Museum, Gaudi's La Pedrera), Lisbon (Cascais), Ponta Delgado, Azores, and Ft. Lauderdale (Everglades) along the way! Here's a picture of us enjoying the many pleasures of Cinque Terre, on the Italian Riviera!
Using the insanely expensive satellite connection on board the ship, that makes dial-up Internet service seem like blazing fast broadband, I was able to take care of the patent needs of Muons, Inc. and filed several patent applications with the United States Patent and Trademark Office (USPTO) from the middle of the ocean! All in all we had a fabulous time!
Believe it or not, I was scooped in my conjecture about an analogue of Bertrand's Postulate for twin prime numbers (prime numbers separated by exactly one even number, like 11 and 13 or 17 and 19, for example)! Hard to believe, I know, but a Google search turned up a Word document by Dhananjay P. Mehendale titled "On Problems Related to Primes: Some Ideas" in which he clearly anticipates a Bertrand-like Postulate concerning twin primes: for some real number x >= 7, there exists at least one pair of twin primes between x and 2x. He gives a plausible heuristic argument supporting his Bertrand-like Postulate for twin primes, but no rigorous proof that would be accepted by the mathematical community, of course!
I go in for another CT scan this coming Thursday, January 3, 2013, and meet with my oncologist on Friday, January 4, 2013. We should be able to get some indication whether the FOLFOX chemo treatments I had gotten before the cruise were any better than the FOLFIRI chemo treatments had been at stopping tumor growth in my abdominal cavity. Stay tuned!
For some unknown reason, when posting on Blogspot using my iPad, after I've typed a few paragraphs, the editor stops scrolling and there's no way for me to get to the bottom of my post to add anything further, since there are, of course, no arrow keys ever to be found on an Apple keyboard (one of the many fascinating facts I've gleaned from reading Walter Isaacson's very interesting and well-written biography of Steve "An Enlightened Being Who Could Be Incredibly Cruel" Jobs)! So, I've given up on Blogspot's fairly useless editor and am using Pages to generate the body of my blog post! I hope you're satisfied, Google!
Anyway, getting back to the storyline, needless to say, we were all pretty dejected yesterday after our meeting with Dr. Mansfield! Oh, to finish up my ruminations about why it's probably a blessing in disguise that another round of Cytoreduction/Debulking/HIPEC surgery is not in my immediate future, I doubt that very much of the 2/3 of a colon that I have now would survive the next round of surgery, especially if there were lots of appendix tumor cells plastered all over it! Another source of gloomy thoughts revolved around the expectation of inevitable eventual bowel obstructions, some of which could be treated surgically, but which also seemed inexorably to point to the need for "nutrition by veins" at some point in the future, basically being fed intravenously forever after, bypassing the taste buds and the whole digestive system entirely, saving you some money on toilet paper, but nevertheless a somewhat unsavory prospect, all the same! Oddly enough, if I understood Dr. Mansfield correctly, even though appendiceal adenocarcinomas are treated almost exactly the same way that colon cancers are treated generally, colon cancer patients don't seem to get much of a benefit at all from "nutrition by veins" in terms of increased longevity and decreased mortality, whereas appendix cancer patients do! Even so, I'd still rather not go there unless I absolutely had to!
Today (pretending that it's still Friday, October 12, 2012, Columbus Day), we met with my wonderful colorectal oncologist, Dr. Imad Shureiqi, and came away much more encouraged, mainly because there are still many chemo options available to us! As a first step, we're going to go back to a regimen of FOLFOX, which is like FOLFIRI, except that Oxalyplatin is used instead of Irenitecan (or "I ran to the can" as some of the chemo nurses call it because of one of it's more notorious side effects!), and which I had for my first 5 chemo treatments last year before my HIPEC surgery. The FOLFOX was quite effective at stopping the appendix cancers from growing last year, helping to make me a good candidate for HIPEC surgery in the first place! We only switched to FOLFIRI after I'd recovered from my surgery last year because of the peripheral neuropathy that Oxalyplatin caused in my toes, especially those on my right foot! The neuropathy due to Oxalyplatin is cumulative and may well become an issue with my new chemo cocktail! Oxalyplatin was also used (and perfused!) during my HIPEC surgery, after which the numbness and tingling in my right toes in particular became much more evident. The one additional factor that will be added to my FOLFOX treatments this time around will be the Avastin, which I wasn't able to take during last year's FOLFOX treatments because of my broken left arm, the one I broke idiotically the day after Christmas in 2010!
Hopefully, the FOLFOX plus Avastin will successfully stop the appendix cancer tumors dead in their tracks! We'll find out after my next CT scan, which will probably occur in mid-January 2013 at the earliest! In the meantime, we'll also continue to monitor the CA19-9 and CEA tumor markers in my blood work! In the event that the FOLFOX and Avastin also prove to be ineffective against the appendix cancer tumors, fortunately there are other chemo agents to try, some of which have either just been recently approved for use by the FDA or are very near to being approved by the FDA! So, as it says in big beautiful letters on the front cover of The Hitchhiker's Guide to the Galaxy, "Don't Panic!" All is not lost, yet! I'm still not dead, thank God, and I don't intend to be for quite a while, indeed, God willing! Thanks again so much for all your wonderful and life-giving prayers for us! This sickness is not unto death, but is for the greater glory of God, in order that we sons and daughters of God may be glorified through it! Amen!
Happy Columbus Day, everyone! October 12, 1492 was a Friday, according to the Julian calendar that was still in effect then (the Gregorian calendar wouldn't be adopted in Continental Europe until Friday, October 15, 1582, 420 years to the day before my wonderful nephew Garrett Collins Greenly was born, whose first decadal or 10th birthday is only 3 days away, and who has the same middle name that I have, my Mother's and Garrett's Grandmother's maiden name!)! I suppose Columbus Day is officially celebrated on the second Monday of October for the sake of convenience!
This Columbus Day 2012 has been an interesting one for us! I had my most recent CT scan at MD Anderson Cancer Center (MDACC) two days ago on Wednesday, October 10, 2012. Yesterday, my wonderful surgeon, Dr. Paul Mansfield, went over the results of the CT scan and the tumor markers from my most recent blood work with us (Caroline, Burr, Cynthia, and me) and the results were not encouraging, to say the least! The tumor markers, both CA19-9 and CEA, continue to grow exponentially, clearly trending up up and away! The good news is that there are still no signs of tumors outside of my abdominal cavity! However, the tumors on my peritoneum, which are very hard to image precisely, definitely appear to be growing and sending out spindly processes that would eventually cause bowel obstructions if they were left to grow unhindered! It seems clear that my rather aggressive appendiceal adenocarcinoma tumor cells are no longer being kept in check by my current chemo cocktail, FOLFIRI plus Avastin! Dr. Mansfield said that he was sorry, but that there's really nothing that could be done surgically at this point, like another round of Cytoreduction ("debulking") plus HIPEC, for example! In some ways that's a relief, given that 12 hour surgeries tend to be somewhat grueling, even though I recovered miraculously well and quickly from mine of a year and a half ag !
Just a few notes to clarify Furlong's Postulate! A "twin prime" is usually taken to mean 2 prime numbers that are separated by 1 and only 1 even composite number, which must necessarily be some multiple of 6, except for the very first set of twin primes, namely, 3 and 5, which are separated by 1 and only 1 even composite number (4), which is manifestly not some multiple of 6. Just as I did before in the case of Bertrand's Postulate, we can easily verify Furlong's Postulate by "daisy chaining" up the number line: the 3rd twin prime pair (11, 13) is strictly between 7 and 2*7 = 14, the 4th twin prime pair (17, 19) is strictly between 13 and 2*13 = 26, the 5th twin prime pair (29, 31) is strictly between 19 and 2*19 = 38, the 7th twin prime pair (59, 61) is strictly between 31 and 2*31 = 62, the 10th twin prime pair (107, 109) is strictly between 61 and 2*61 = 122, the 15th twin prime pair (197, 199) is strictly between 109 and 2*109 = 218, and the 21st twin prime pair (347, 349) is strictly between 199 and 2*199 = 398, and so forth!
By the way, I have no earthly idea how anyone would go about trying to prove my postulate for all primes! It's not even known for sure whether there are an infinite number of twin primes! Almost every number theory nut worth their salt believes that there must be an infinite number of twin primes! Of course, if someone could prove that my postulate is true, somehow, then, since there are an infinite number of prime numbers, that would necessarily mean that there would have to be an infinite number of twin primes!
My previous blog post wasn't meant to end when it did, although it did make it like a cliff-hanger! I'm having some editing issues writing my blog post using 'Nother Paddy! Anyway, this will boost my overall number of posts, at least!
As I was saying, the results of my Thursday, August 16, 2012 CT scan were a bit inconclusive. There was still no evidence of disease outside my abdominal cavity, thank God! However, the tumors definitely were not shrinking, but instead had gotten somewhat bigger than they were in my June 2012 CT scan, although it was hard to quantify just how much bigger, since my mucinous signet ring cell tumors are apparently rather poorly differentiated (not very encouraging, since the more poorly differentiated the tumors are the more aggressive they tend to be!) and are spread out somewhat amoeba-like on my peritoneum, the membrane that encompasses my abdominal cavity! The very experienced radiologist was able to report to Dr. Shureiqi that none of the tumors appeared to have grown by 25%, which is good news! If the tumors would have grown by 25% or more, then we would have definitely concluded that the FOLFIRI with Avastin was not being effective, in which case we would most likely stop using Irenitecan in the chemo cocktail and go back to FOLFOX, using Oxalyplatin coupled this time with Avastin. Last year, FOLFOX definitely was able to stop the tumor growth in its tracks!
The potential downside of returning to Oxalyplatin is that the cumulative peripheral neuropathy would probably worsen. Oxalyplatin was the chemo used in my 12 hour Cytoreduction surgery with HIPEC on Tuesday, April 12, 2011, last year, and the toes on both of my feet, especially my right foot, are still numb and tingly! Not to mention the inconvenience of having to forswear for a while my favorite Starbucks iced quad espresso drink, because of the weird effect Oxalyplatin has on one's throat!
I'm scheduled to have yet another CT scan in October, so we decided to continue with the current chemo regimen until then and reassess then what we should do! Please pray for wisdom and insight so that we'll have a better idea of what to do!
And now for something completely different! My latest number theory conjecture! A mathematician named Bertrand famously postulated that there always exists at least one prime number between any number n and 2 less than twice n, for all numbers n greater than or equal to 4. That's the stronger form of Bertrand's Postulate. The weaker form of Bertrand's Postulate is more well known and it says that there always exists at least one prime number between any number n and twice n (2*n), for all n greater than 1! There is a very nice proof of the weaker form of Bertrand's Postulate given in Wikipedia! We can easily "daisy chain" our way up the number line as far as we want to go verifying either form of Bertrand's Postulate!
For example, the 2nd prime number 3 is strictly between 2 and 2*2 = 4, the 3rd prime number 5 is strictly between 3 and 2*3 = 6, the 4th prime number 7 is strictly between 5 and 2*5 = 10, the 6th prime number 13 is strictly between 7 and 2*7 = 14, the 9th prime number 23 is strictly between 13 and 2*13 = 26, the 14th prime number 43 is strictly between 23 and 2*23 = 46, the 23rd prime number 83 is strictly between 43 and 2*43 = 86, the 38th prime number 163 is strictly between 83 and 2*83 = 166, the 66th prime number 317 is strictly between 163 and 2*163 = 326, the 115th prime number 631 is strictly between 317 and 2*317 = 634, the 205th prime number 1259 is strictly between 631 and 2*631 = 1262, the 368th prime number 2503 is strictly between 1259 and 2*1259 = 2518, the 670th prime number 5003 is strictly between 2503 and 2*2503 = 5006, and the 1229th prime number (1229 itself is a prime number and equals the total number of prime numbers less than 10000!) 9973 is strictly between 5003 and 2*5003 = 10006, and so forth! Furlong's Postulate is quite simply that there will always be at least 1 "twin prime" strictly between any prime number (p) and twice that prime number (2*p), for every prime number greater than 5
Summertime, and the living is easy! Since my last post, I've continued with my fortnightly chemo treatments (FOLFIRI with Avastin), having had 9 treatments this year, and 22 total (including the 5 FOLFOX and 8 FOLFIRI treatments last year)! Other than relatively minor nausea, I'm pleased to report that there continue to be very few side effects from the chemo! Prayer works! Please keep praying! And thanks so much for all your wonderful prayers and positive thoughts and good vibes! They are all truly life-giving and continue to buoy my spirits!
My spirits have needed extra buoying lately! When I met with my wonderful colorectal oncologist, Dr. Imad Shureiqi, on Friday morning, August 10, 2012, he showed me that one of the tumor markers they've been tracking ever since my diagnosis of appendiceal adenocarcinoma in December 2010, Carbohydrate Antigen 19-9 (CA 19-9), had trended upwards and, for the first time since my diagnosis, was above the normal range. The plot looked like the classic "hockey stick" graph of exponential growth, not unlike the one Vice President Al Gore showed in his film An Inconvenient Truth that tracked atmospheric concentrations of carbon dioxide! Somewhat alarming, to say the least!
Dr. Shureiqi ordered another CT scan, which I had last Thursday, August 16, 2012. Caroline and I met with Dr. Shureiqi the next day, Friday, August 17, 2012. The CA 19-9 level had increased even further, the slope seeming to approach the vertical asymptotically! And the results of the CT scan were inconclusive, at best.
