I could not be more excited about our meeting with Dr. Dan George today. It is so nice to be in the presence of a super doc who doesn’t act like one. He is approachable, nice as hell and Jill says (and I have to admit) he’s a fine specimen of a man. We had the chance to meet a Duke Fellow, who is here from Singapore, who preceded and accompanied Dr. George during our 30-minute meeting.
Since I did an audio recording of the meeting on my iPad, I have some excerpted some quotes from Dr. George:
“You’re a lot earlier on than many of my patients, Mike. Although, HD-IL2 is a great therapy, it is still a crap shoot at the end of the day. HD-IL2 has a lot of collateral side effects. You’re going to be sicker than you have probably ever been in your life. There is a 30% chance at a partial response. The partial responses from this therapy last, on average, for about three years. Complete responses happen about 5% of the time.
“For this cancer to spread to the adrenal gland and to the other kidney, there is no direct line there. This cancer had to get into the bloodstream, go up into the heart, go around the heart and into the lungs, back out the lungs, back into the heart, down the aorta and into the adrenal glands and kidney. To take that route — and there is no shortcut in the body — these cancer cells must have dispersed to lots and lots of other areas. The fact that the only place we’ve seen it grow is in that one spot in the bone of your spine — that we took care of early on and we have not seen it come back — and now we’re seeing it in places that are not random spots. The adrenal glands and the kidney share something very much in common. They are endocrine glands. They secrete proteins that have effects on different parts of the body. Your fight or flight response, muscles, brain and heart. Your kidney secretes a hormone, erythropoietin (EPO) that goes into the bone marrow to make more red blood cells.
“To me it is not random that the three spots where we’ve seen this cancer are in endocrine organs. What that tells me is that this cancer is not totally self-sufficient. It can’t grow in a lot of areas in your body or it would have done so by now. It can only grow in these areas that have rich soil. The bone marrow is a rich source of nutrients and growth factors, because that is where we grow all our red blood cells. The endocrine glands are highly vascular. The fact that this grew in the other kidney and is only in these three spots tells me two things: 1) It is not fast growing and 2) These are not totally self-sufficient tumors. And, if we can stimulate your immune system enough for it to recognize that it is different than itself, I think we have a chance to kill this. The time to do this is now. We’ll know very quickly whether the hell we’re going to put your through is working. If this cancer doesn’t respond, it is not going to explode on us. It is telling me that it is not that kind of cancer.
“We’ll do what we have to do to give you a chance at a complete response.”
Then, he looked at me and paused……..and said…….”Can you do me a favor and take it a little easier on the staff?” “What staff,” I said. Then BAM, I got it. My very direct emails and the tone and tenor of my phone conversations have apparently ruffled some feathers up here at Duke. Particularly, the feathers of the person who fielded my phone calls and emails while Dr. George was on vacation. I found out, this very nice person is not a scheduler. She is, in fact, his nurse practitioner, a very skilled and competent right hand to Dr. George. She had the presence of mind to see my anxiety rising and took this on, and I appreciate that. I, in effect, tried to kill the messenger. I will find a way to let her know that I am not a lunatic, but a scared out of my mind cancer patient.
But I’ll have to admit, it thrilled me to be asked to back off. As we left there, I told Jill that I hadn’t even unleashed the full Mike on her. The power of the pen is a very real super power.
Tomorrow morning at 9:30 I have to do a stress echo test and then at 1:30 we meet with Dr. Michael Morse, who runs Duke’s HD-IL2 treatment program. Dr. George says he’s brilliant and will be able to answer any question I throw at him. I hope he’s ready. I’ll post again tomorrow afternoon or evening.