Mid-June/end of July 2019 - Cycles 9 to 12 worsen side effects

Despite all the recent positive developments, the last four cycles of chemotherapy were far from a walk in the park both physically and mentally.

From a physical point of view, the side-effects were definitely getting worse. This was particularly the case with neuropathy, which while in the first eight cycles bothered be only for the first couple of days, had suddenly become chronic. I could no longer feel the tips of my fingers, making it difficult to button up my shirts and uncomfortable to type on my keyboard. I also started dropping things due to an increasing loss of my fine motor skills. Furthermore, my feet got progressively worse, making walking somewhat uncomfortable.

Other side-effects that got worse as time went by were diarrhea, which I controlled with Imodium, and fatigue, which I did my best to continue to ignore by continuously going to the gym.

My level of platelets in the blood also kept falling – but somehow we managed to control this with an injection called Romiplostim (see more here), which I took every two weeks allowing me to continue with the chemotherapy with no interruption.

From a mental perspective, things were also getting trickier. My body felt like a time bomb: on the one hand, as the side-effects got progressively worse, I was worried about how long I would be able to continue to tolerate the treatment. On the other hand, I kept wondering whether chemotherapy would continue to work as affectively as it had done so far and, importantly, whether my tumour marker would eventually reach the famous 100 kU/L threshold mentioned by the Professor in Heidelberg.

In short, I feared that now that surgery had become a real prospect, I may never actually reach that goal for one reason or another.

During this time, the meditation practices I described in previous blogs helped me to cope. And so did the support of my parents, my sister and my old friends from Italy and Belgium Gherardo, Cristiano, Luigi, Giangi, Francesca, Genny, Theon, Jose, Joan, Ian, Sarah, Larissa, Christian, Juan, Natalia, Alessandro, Jimmy, Marco and Fiorella, who repeatedly visited me (or provided incredibly valuable words of encoragement by writing and phoning me endless times) as well as that of my London friends, many of whom (Steven, Vicki, Levent, James, Ana, Emily, Juliet, Isabel, Simon, Stephen, Nick, Bojana, Peter, Almudena, Matthew, Julie, Antoine, Thomas, Klaus, Danielle, Simeon and Jim) continued to come to each chemo cycle or to meet me for coffee, lunch or dinner to cheer me up. Just writing this makes me realise again and again how lucky I have been with the support I have received during these difficult times.

Luckily, things worked out well. Each cycle delivered a significant decrease in the tumour marker and by the end of the therapy the chart of my CA19/9 looked like this.

You may be wondering what the value after the 12th cycle was: it was 101 kU/L. Not below 100 kU/L but surely good enough for the Professor I thought!

And the CT scan I underwent on the 29th July showed no radiological trace of the more than 20 metastases in the liver that could be observed back in February. This felt like a miracle – my oncologist congratulated me on these incredible results and wished me good luck with the surgery.

I thanked him several times for his continued support and for always pointing out to me the risks associated with the surgery option, which allowed me to reach an informed decision. I understood well the risks I was taking (e.g. would the liver metastases reappear during the recovery time, making it impossible to do anything about it?) but, as already noted, I was prepared to go ahead since this was my only chance of a definite cure.

At the end of that week Jane and I left London and made our way to Heidelberg.