Big Steve Big C

Tag: fatigue

  • Get Busy Living Or Get Busy Dying

    I have to make what is probably the hardest decision I’ll ever have to make. One that could cost me my life.

    When I had the consultation for my March round of immunotherapy I asked if I could have a face to face consult with my oncologist. I wanted to air my thoughts of just having been treading water for the last year or so and whether I had to just put up with the continual chronic fatigue and occasional minor side effects or whether there was another option.

    Most of the time I’ve managed it well but every now and then it got me down and resulted in the post I made at the start of the year. I have to start living again and stop just existing and counting down the days between each round of immunotherapy.

    I knew the Nivolumab was working as well as anyone could have hoped for. It (along with 4 cycles of Ipilimumab) had killed off all the visible tumours and was stopping it from coming back (for now). It had already spread from the primary location, my right kidney, to my lungs when it was first discovered.

    Stage 4 Kidney cancer prior to immunotherapy had a bleak outlook but things have changed. The problem is my treatment is so “bleeding edge” that there is no data on survival rates or recurrence of tumours. I am the data.

    So at the end of March I sat in a small consulting room with Katie at St Lukes Cancer Centre in Guildford having a very honest discussion with my oncologist.

    I mentioned the underlying fatigue that has been holding me back as well as other minor side effects such as muscle aches, stomach cramps and diarrhoea.

    He reminded me of the crazy NHS rule in the UK where if you stop Nivolumab treatment you cannot start it again. We had to find out if it was a contributor.

    I found that a strange statement but he went on to tell us that the Ipilimumab that I had for just 4 cycles right at the start was “disease modifying”. It actually made permanent changes to cancer cells in my body and how my immune system reacted to them. It was quite possible this was causing fatigue, in which case stopping treatment wouldn’t help any way.

    We eventually decided that I would take a short treatment break. I can take up to two of these at once and then continue the treatment afterwards. I was going to miss the March treatment and the April treatment. Then after the 8 weeks we should have information to help us make a decision.

    Again, I was confused. What decision was there to make? The treatment is keeping me alive and keeping the cancer at bay. Surely if I stop treatment then that cancer will come back?

    He dismissed that as something I shouldn’t worry about. If, and it is a a big IF, the cancer came back, it would be detected quickly as I’d be on 3 monthly CT scans. Early detection would mean better prognosis, lots of other medical treatments, removal options were available.

    I didn’t say it at the time but I really DID NOT ever want to be told “we found something on your scan” again. That moment in September 2020 when I was sitting alone in A&E at Frimley Park Hospital and a rather sheepish young doctor came in to tell me they’ve found something on my chest x-ray is burned permanently in my brain. It was THE single worst thing I have ever been told.

    The feeling of dread, your pulse rushing so fast you can hear it, the cold sweats , the tunnel vision is horrible and something I never want to have to experience again.

    So regardless of what happens during the treatment break I will return to it at the end right? RIGHT?

    I had my first 4 week follow up with the oncologist today. 4 weeks since I should have had my March treatment and 8 weeks since my last treatment. He asked how things were going.

    Well the truth is I have been feeling better. I have a bit more energy every day. I’m having less side effects. This last weekend I was able to do some activity both days, morning and afternoon with a short rest in between. I couldn’t manage that before. I was limited to one thing then wiped out for the rest of the day.

    Katie has said she’s seen a difference in me. Less groggy, more “with it”

    So I told him the truth.

    He immediately said “It seems like we should stop the Nivolumab then”

    Wait! What? No. Again pulse racing, cold sweats, trying to concentrate on the phone call and listen to what he was saying.

    Good response…..no reason to worry…detected early….

    I asked if I had a say in the path forward or if it was just his decision and he confirmed I have a say but he reiterated that it seems that the Nivolumab was holding me back now and that its time to move on. There are still lots of treatment options.

    “We found something in your scan” …. I can’t do that again. Can I?

    We compromised. We will wait another 4 weeks to my next consult at the end of May where we will discuss again and then make a decision. That will be 12 weeks since my last treatment and the longest I can go and start back on Nivolumab

    Red or Blue

    Take the red pill and carry on with the Nivolumab, knowing it’s causing some of the fatigue and that I could feel better and get busy living if I stopped it. However no one knows how long it will keep the cancer at bay.

    Take the blue pill and stop the nivolumab, get my energy levels up, start enjoying life properly again. Continue with 3 monthly CT Scans. Risk the cancer coming back and having to start new treatments, new side effects, “other” outcomes. Being told “We found something…”

    I don’t like risks. With Cancer there are always risks. Its a big decision to make.

  • Goodbye 2023 hello 2024

    This will be my 4th New Year since my diagnosis and for the first time my resolution is not just to make it to 2025. That’s been my cop out resolution every year since 2020.

    For 2024 I will have just one resolution and I’ll tell you what it is at the end of this post but first I wanted to give you some background.

    Never Google your symptoms

    When I was initially diagnosed I did what I expect anyone would do. I started to search on the internet to find out as much as I could about Renal Cell Carcinoma, Kidney Cancer to you and me and the findings were terrifying. It was September 2020 and I convinced myself I wouldn’t see Christmas 2020.

    I read stories of patients very rarely making it to 5 years following diagnosis. 80% don’t make it to 5 years I was reading!

    I imagined a very bleak outlook.

    Then when I actually spoke to oncology nurses, professors and doctors I was given a very different outlook.

    Cancer stories on the internet are out of date

    Better treatment, better prognosis. Then I started treatment, and responded well and it was working.

    But in the back of my head was that initial 5 years dark cloud. I know it makes no sense but it stayed there and has been there ever since.

    Every year my goal was to make it to the end of the year. But this lead to me just waiting for the inevitable.

    Side effects are an excuse for self pity

    I had regular treatment. Every 4 weeks and regular side effects. Constant chronic fatigue, occasional joint aches, diarrhoea. I found doing anything exhausting. So I stopped doing most things. “Listen to your body” I was told. My body was saying go to bed all the time. So I did.

    I spent hours in bed every day for the first few months. Then when I was told the treatment was working better than anyone expected I was still tired all the time. The treatment was keeping me alive so this was my life now.

    Everyone still kept telling me listen to your body.

    A viscous cycle

    I stopped living and instead was just existing. So when each new year came around I really felt that it was all I could do to just survive the year.

    I was too tired to exercise so I stopped all exercise. I put on weight. Lots of weight. It took me a long time to acknowledge that I was contributing to the tiredness and fatigue because of the weight gain.

    This cycle got worse and worse but I never did anything about it. I have cancer so it’s ok to be tired I told myself.

    The year I became a hermit

    2023 has been my worst year. I’m winning the cancer battle but losing the “living” battle.

    Because I worked from home every day and had no reason to leave the house. I declined social events, when I did go out I was so tired it would take a few days to recover. More and more I made decisions to not go out. That 5 year anniversary was getting close so why bother. I went 10 days once this year without leaving the house at all.

    I know what I have to do

    I hate it. I hate the cyclical lack of energy whenever I try to go for a walk, or exert myself in any way but I have to change my outlook and way of life.

    When you have zero fitness levels any more and are carrying more weight than ever it’s extremely hard to motivate yourself and get started. But this week something changed.

    During the Christmas break our dog walker has been on holiday so I had to walk the dogs. Something I still try and do but can never do more than a couple of miles.

    The first day I found a flat route and walked the dogs and found as usual I had no energy. One foot in front of the other was hard work. But I kept going and just walked really slowly.

    The next day I did the same route. Still hard work but not quite as hard. Then a break for a couple of days as the dogs were walked by someone else.

    When I walked them again I found it quite a bit easier. The next day I chose a longer route, still flat and found it very manageable.

    So it is literally baby steps. It doesn’t have to be far or fast but I need to get moving. I need to get out.

    My resolution for 2024…

    Is to stop just existing and to start actually living again.

    I’m not setting any wild goals other than I will keep improving. My outlook on life, my fitness, my energy levels, even my social life.

    I’ve said it publicly now so will look pretty stupid if I get to the end of 2024 and nothing has changed.

  • It’s official

    “No Evidence of cancer currently”

    Straight from my oncologist on Tuesday afternoon. I’ve had a “full and complete response to the immunotherapy”

    I’m so grateful for medical science and for the whole medical team that has supported me at various stages.

    Friends and family are rightly really pleased for me, and the whole family.

    So why don’t I feel as happy?

    Probably because while I’m no longer in pain, or in imminent danger of death, my life has been turned upside down. I still have chronic fatigue caused by the immunotherapy and breathlessness caused by asthma.

    These two are severely limiting in my day to day life still. And this gets me down when I cannot do something I feel I should be able to.

    Eg: Playing which the dogs in the garden and then struggling to walk up the stairs. simple things.

    People just think cancer has gone now so why not move on and stop playing “The C Card’, and I understand that, but I’m going to be facing the knock on effects for a long time to come.

    My treatment is continuing for the next 12 months every 4 weeks with a CT scan every 12 weeks. So I’ve got to deal with the fatigue for a while.

    Don’t get me wrong, I’m managing the fatigue a lot better, I can work almost a full day and hope to get to a full day soon. And it will continue to improve as my fitness levels (very) slowly rise.

    For now, I’m extremely grateful to still be here but I still have a mountain to climb.

  • A miracle?

    I’m not in any way religious. But I’ve had news recently that seems to warrant the tag “miraculous”.

    Following my surgery in early May I’ve made a good recovery with no issues at all apart from it’s set me back a few months in my fitness journey, so basically back to zero.

    There no pain, the wound healed perfectly but I’m very tired at the slightest physical effort. So baby steps to start building that up.

    Back to work in a few days.

    But the good news initially came about 3 weeks after surgery at my follow up with the renal cancer nurse. I was told that the initial investigation of the kidney that they removed showed no obvious signs of active cancer. Just the necrotic tissue where the cancer was.

    She warned me it still needed to be looked at under a microscope but did say that when I was discussed a few days earlier in a MDT meeting the Oncology team stated they’d not had anyone respond to treatment as well as I had.

    That was amazing news, although I had lots of questions that stupidly I didn’t think of until after I left the appointment. No cancer seen? Where did the tumour go? Etc.

    Then last week I got a call from her with a promised follow up after it had been examined thoroughly.

    No sign of active cancer.

    I was silent for a moment, then asked about the tumour that was stuck at 4cm for the last 3 scans. That was no tumour, that was the remaining necrotic tissue. The immunotherapy completely removed the cancer from my kidney!

    I’ll admin to crying again but this time at the good news.

    The next steps are unknown but I’ve since had another round of immunotherapy and am expecting to keep having this every 4 weeks forever.

    Words spun around in my head, cancer free, remission, normal life. I’ve yet to speak to my oncologist and this will happen in a few weeks when they have the results of my latest CT scan, taken 3 weeks after surgery.

    I hope that shows no tumours anywhere.

    So my immediate future looks brighter. Still full of sleep and fatigue but I hope to lose weight and get fitter to aide dealing with the fatigue.

    I’ve been increasing walking distances slowly and tomorrow I’m doing some light boxing conditioning with a friend. I can moderate that as needed and hope this will be my go to regime going forwards.

    I’ll introduce work, walking further, cycling and motorbike riding in the coming weeks and aim to get close to where I was before diagnosis.

    We’ve also finally felt brave enough to book a couple of weeks in the Sun at the end of September. Something I wouldn’t have thought possible a few months ago.

  • Long time, no posts

    I’m still here. No posts since December means one thing, there’s not been much to say.

    Health wise, I’m still waiting for my operation to have my Kidney removed. This has been delayed as they have concerns over the state of my lungs and breathing and how well I’d deal with anaesthetic.

    I was given inhalers over Christmas due to breathlessness via telephone consults with my GP and the surgery team wanted me to see a chest specialist to see what’s actually happening.

    I saw him at the start of March and confirmed I have asthma and just 60% lung capacity. It’s possible its related to the tumours in my lungs but unlikely. It’s also possible I’ve had Covid without realising it and that’s damaged my lungs.

    Either way I have strong steroids by tablet and inhaler until the start of April and then they’ll see if I’m ready for surgery.

    The downside of the delay means it’s unlikely I’ll be able to go on my planned Motorbike trip in June, so that will be 3 years without a trip now. Hopefully I can sort something out for later in the year.

    I still have the monthly Immunotherapy and am happy that I now spend less time there as they’ve increased the rate of infusion so I get it over 30 minutes now, rather than 1 hour previously. The downside is that this makes me feel very tired and headachy for a few hours now. But I’d still rather that than spend any more time in hospital than needed.

    The fatigue is still there and some days are better than others but I can still only manage just over half a day working each day. I’ve added a bit more time each day and I finish work and then sleep for 2-3 hours straight after. I still then sleep 8hrs at night too.

    I had a day in the office today for the first time in over 2 years which was strange. It was a nice change and good to see people again. Felt almost normal.

    The final issue on the health side is weight, which I have to reverse. I spent over a year not caring what I ate as I didn’t expect to be around but now I’m planning for things 2,3 and 4 years away. The fatigue and tiredness make exercise really hard and walking and cycling are the only things I can manage currently. Having an e-bike helps with the hills 😅

    I’m ashamed of where I am now weight wise and know it’s not going to change quickly so I’m giving myself until the end of the year to get back to somewhere reasonable.

    In other news we’ve taken advantage of the crazy second hand car prices in the UK (due to long lead times on most new cars). We’ve said goodbye to the Tesla Model 3 Performance.

    It was a lovely car for the 2 years we had it and it was great having supercar performance (0-60 in 3.2 seconds!) in an ordinary 4 door family saloon. I used to frequently tease drivers of fancy German and Italian cars. But common sense has now prevailed and we’ve changed to a Tesla Model Y. It’s a lot more practical, just as clever and cheap to run but also much easier to get in and out of as we’re not sitting inches off the floor any more 😂

    We were able to change cars and even get some money back because of the high trade in on the Model 3.

    It’s not as fast as the Model 3 so my drivers licence should be a bit safer now.

  • A wake up call

    Gotta lose weight. A lot of weight.

    I’ve had the best part of a year doing little activity and suffering chronic fatigue but have eaten as normal.

    I knew I was putting on weight but didn’t care, “Might as well enjoy myself” was my thoughts if I’m not going to be around for long.

    However with recent acceptance comes acknowledging that I cannot continue waiting without exercising. So I stepped on the scales for the first time in 2021…and wish I hadn’t.

    So..

    I’m still in no state to return to bootcamp multiple times a week but walking cycling and gently increasing movement is key.

    If anyone wants to join / help / motivate me you’re more that welcome. A bonus is that losing some weight can only help with the fatigue and tiredness too, win win.

  • The end of an era

    I finally admitted to myself after days of procrastination that I cannot ride my motorbike any more. I just don’t have the energy.

    I passed my bike test in 2005 and never looked back. I loved riding it and every year until 2019 I had at least one bike trip away with amazing friends.

    My current and last bike is only 2 years old and has done less than 3000 miles. I rode it last weekend, loved it but it wiped me out completely. Riding is a physical effort and one I cannot do safely any more.

    I’ve had a total of 6 motorbikes in that time and have some great memories and my bike was my drug, my release, my medication.

    But it’s just going to sit in the garage and continue to depreciate so I need to sell it and put the money to one side for when it’s needed. And it breaks my heart but I have to admit when I’m beat.

  • How are you?

    When someone says “how are you?“, and gives you “that look”, I wonder what they want to hear.

    Do they actually want to hear…

    “I have cancer and the treatment is causing horrific fatigue where I can barely make it up the stairs without stopping to take a breath..

    Also when I am awake (which is rarely) I struggle to concentrate on anything at all. There is not a moment where I’m not thinking how long have I got left and how long have I got to put up with this. ..

    I struggle to do things I like and am depressed most of the time now. ..

    My treatment is allowing me to stay alive longer but I’m not actually living, I’m merely existing…

    I more often wonder if I should just stop all treatment and just get it over with…

    Quite frankly I’ve had enough…

    But thanks for asking!”

    Or is “I’m doing ok thank you” good enough.

  • Withdrawal Symptoms

    For about 2 months now I have been slowly reducing my Oxycodone dosage. I was on 30mg slow release twice a day for pain relief but with my ongoing fatigue I wanted to do anything I could to try and reduce this.

    I’ve been increasing general activity with walking, cycling and just keeping myself busy rather than allowing myself to constantly sleep. If I’m physically active I seem to be able to keep going a little longer but as soon as I stop and sit down then its like my body takes it as a sign to rest and wants to shutdown.

    The main cause of fatigue is my Nivolumab monthly immunotherapy treatment but a lot is also coming from the opiates. I’ve not had any pain that I believe is associated to my Kidney cancer for a while now so it seemed logical to reduce the Oxycodone dosage and find out if I still needed it.

    I hadn’t realised quite how dependent on it I had become. I’m not addicted to it and am not showing any signs of addiction but I have had some unpleasant withdrawal symptoms as I’ve slowly reduced the dosage.

    I initially dropped from 30mg to 25mg twice a day for 2 weeks. That went fine so I then dropped from 25 to 20mg twice a day. It’s fair to say that was not so good. I guess because the actual percentage drop was bigger or perhaps my body actually noticed the drop.

    I had a raging headache, felt spaced out and disconnected, I felt even more tired and also nauseous. After a couple of days I went back to 25mg to re-think the plan.

    After another week I felt brave so I dropped my evening dose to 20mg but kept the morning dose at 25mg. This seemed to be more successful.

    I did a bit of research and found a chart that said I should be able to drop 5mg per week from morning then evening doses. So about 12 weeks to come off it completely.

    Long story short I’m now at 10mg in the evening and 15mg in the morning. This is about 8 weeks in to my tapering down process.

    I knew it would be slow but I didn’t release how crappy it would make me feel. The worst bit is more joint and muscle aches that could be a withdrawal symptom or a side effect of the nivolumab. Also, reducing the opiate intake means another immunotherapy side effect is now unfortunately present, an upset stomach. Luckily I already have meds for this and was warned it was the most likely one to get right at the start of treatment but the large dose of opiates had countered that the opposite way.

    I’ve now giving it at least a week in between dosage drops to allow myself to get used to each stage so expect this will take another 5-6 weeks+

    I’m hoping to try again to get back to some work in a few weeks and this transition is a key part of that. The fatigue isn’t going anywhere all the time I’m on the Nivolumab but I should be able to reduce the impact and deal with it a little better.

    The cancer journey is littered with things sent to challenge you and this is just another one of those things.

  • A milestone

    I’m sitting here with immunotherapy treatment number 10 slowly dripping into my veins. I’ll be here for an hour and do this every month.

    Everything seems to be running on time today and I’m plumbed in within 10 minutes of arriving and my Nivolumab, which is only made up when I call them to confirm I’m coming for my appointment was here waiting for me.

    It’s also nearly 9 months since my initial diagnosis and since then there have been a lot of ups and downs with recent months spent just “treading water”, managing fatigue as best I can and reducing oxycodone very slowly (to help alleviate some of the fatigue)