Monday, I saw an oncologist in Kalamazoo to chat about where I go from here. Today, I saw an oncologist at the University of Michigan Cancer Center, William Ensminger, for a second opinion.
Unlike Vemuri, the Kalamazoo doc, who handles all types of cancer patients, Ensminger specializes in gastrointerestinal cancer. So while Vemuri has certainly seen his share of colon patients — colon being one of the most common cancers around — this is Ensminger’s specialty, and he also benefits from working at one of the preeminent cancer hospitals in the nation.
It was worth the drive.
Where Vemuri is very personable, Ensminger is gruff and curmudgeonly. But I liked them both, and it was interesting to hear another perspective.
Ensminger asked about Vemuri’s recommendation, and made several observation.
The gist: Chances are excellent that I’ll survive the cancer, so my bigger issue now is making sure that the cure isn’t worse than the disease — i.e., the recommended chemo treatment can have some “devastating” side effects, he warned.
Specifically, the neurotherapy in the hands and feet caused by one of the main drugs, Eloxatin, can be crippling and permanent, he said. He recently treated a teacher who had to retired after her chemo because she lost use of her hands.
The way to avoid that scenario, he said, is to closely monitor the tingling in the hands and feet. It’s a common side effect for several days after the drug is administered, but it should go away at some point between treatments. If the tingling lasts more than four or five days, he said, than Eloxatin should be pulled entirely from my chemo cocktail because my body can’t handle it.
He said that Fluorouracil is the most important drug in the mix anyway, and provides about 80 percent of the benefit from the chemo treatment. When everything is said and done, he added, Eloxatin lowers the risk of cancer reoccurrence about 5 percent — adding that’s not worth permanent disability.
Ensminger’s other points:
— He advised against taking the Fluorouracil in pill form because it seems to heighten the side effects. Better to take that drug intravaneously along with the Eloxatin. (Incidentally, I misunderstood Vemuri yesterday. The intravaneous part would happen in once a half-day every two weeks, not every three, over a six-month period.)
— Ensminger seemed very, very skeptical about the benefit of getting a PET scan. From his standpoint, PET scans are a perfect example of why American health care is so expensive — somebody invents an expensive test and everybody else feels the need to use it. He said that CT scans are more precise in finding tumors, and PET scans generate too many false-positives. He also threw in the observation that the quality of CT scans can vary a lot, but that U-M’s CT machine is so clear “that people come here from Boston to use it.” Rather than get a PET scan in Kalamazoo, he said, it would be better to get a CT scan at U-M — if I can convince Aetna to pay for another CT scan this soon after the one done in October.
— Although it was clear that Ensminger views U-M as a superior facility, he said that my case was standard enough that getting treated at the West Michigan Cancer Center should be fine. However, if the cancer reoccurs, than I should hightail it to U-M.
He also said that I should know “sooner rather than later” if the cancer was going to spread. If I have a clean bill of health in eight months, he said, there was a pretty good chance that I’m cured. What does that clean bill of health entail? A clear CT scan and low numbers on the CEA blood test.
Incidentally, Ensminger retrieved the results of my CEA blood test from Monday. (This test is one marker that cancer is somewhere in the body.) Before he made that phone call, he said the number should be below 3. Above 5 is “worrisome,” he said, and above 10 “you should be really worried.” My number: 1.5.
Finally, Ensminger offered some perspective on how quickly colon cancer treatments have evolved and improved. If I been diagnosed with Stage III cancer at the beginning of this decade, he said, “we would have told you that you have a 50-50 chance “of being alive after five years. By mid-decade, that had improved to about an 80 percent five-year survival rate, assuming chemotherapy. But for someone like me who is diagnosed now, he said, “I’d say you have about a 5 percent chance” of dying. (He pointed out that official mortality rates by necessity lag medical advances; the numbers quoted to me on Monday by Vemuri are based on people first diagnosed at least five years ago.)
One reason is not just better strategies in preventing reoccurance, but also better treatments for those who have a reoccurrence in the liver and/or lungs and move into Stage IV. “That used to be a death sentence,” Ensminger said, but U-M is now doing a new bioradiation treatment that seems to be doing a remarkably effective job at zapping out those liver/lung spots if caught early enough.
Bottom line: Even if my cancer moves into the liver or lungs, I shouldn’t call hospice — instead, I should call the University of Michigan Cancer Center ASAP.