Pluvicto #2 & 3 and another surgery
And I do want to fill you in on his Pluvicto treatments. So here goes.
When Zach got his first Pluvicto injection, the medical team warned us we might see a spike or “flare” in his PSA (prostate stimulating antigen) numbers. They told us the flare would be a good sign, because it means the cancer cells are dying and being expelled into his bloodstream. But when Zach got his bloodwork before the second injection, his numbers were flat. No flare. The good news: His blood-cell counts and metabolics were all strong. So Zach went ahead and got Pluvicto #2.
It takes a couple hours for us to drive to the hospital, and the procedure takes 3 hours. So his treatments are an all-day affair for us. And all things considered, they’ve been relatively easy. The staff—nurses, technicians, schedulers, doctors—are all incredibly friendly and even take time to chit-chat. We learned that one of the doctors has a new baby, and another grew up in my hometown.
And they try to keep it light during the treatments. Zach was sucking on a raspberry Jolly Rancher, and when he stuck out his tongue, it was bright blue. I had him show one of the doctors, and they immediately exclaimed, “Bluvicto!”
Thankfully, Zach has tolerated the treatments and side effects well. He did notice some fatigue, his appetite is shitty, and he's always constipated. But it’s nothing compared to what he went through with chemo.
Six weeks after Pluvicto #2, Zach was scheduled for his 3rd treatment. He got the usual bloodwork, and they showed his cell counts and metabolics were still ok. But this time, his PSA had flared by almost 30%. That always makes me nervous. But I reasoned, maybe this is the flare they warned us about? I mentioned it to Zach’s original oncologist. He sounded a little patronizing when he said, “let’s hope so.”
At our pre-Pluvicto checkin, the doctor shot down my theory: A flare after the second injection is unusual. It might mean the treatment isn’t working. When I heard that, I felt the tension in my chest growing stronger. I can only describe it as a swarm of bees buzzing inside me. It's been there since Zach's initial diagnosis, but it gets stronger when we get bad news. It's the opposite of butterflies.
Since Zach hasn’t had significant side effects, everyone agreed to continue with the third treatment, and then do another PET scan a few weeks later to get a better idea of what’s happening to the actual tumors. If they’re progressing, we’ll know that Pluvicto really isn’t doing its job and it will be time to stop.
"Meanwhile, back at the ranch".... Zach’s hammer toe had really started bothering him. It’s been gnarly for 20 years—an angry little monster of a second toe. And lately, it had worked itself up onto his big toe as if trying to prove who's boss. Whenever Zach tried to squeeze his foot into regular shoes he was in a world of hurt. And since we had a break after Pluvicto #3, we went off to see the foot doctor.
Fixing that second toe would take at least a couple surgeries and months of recovery. So we opted to take the little monster out. According to the doc, you don’t even need that second toe. You won’t miss it a bit. And recovery would be much easier than reconstruction. Zach would be walking right away and back to normal in a couple of weeks.
The surgery went well, but the recovery did not. Sure, Zach could walk when he got home from outpatient surgery. But he wasn’t on his feet for more than a few minutes before he bled through the dressings. After that, there was a lot of time spent elevating on the couch watching “This old house” and cussing up a storm when the construction guys held their nail guns wrong.
It seemed to take forever for that nub to heal.
And then, just as his foot was starting to mend, we scheduled him for hernia surgery.
As close as we can figure, the hernia happened during a tennis court incident about 10 years ago. Zach was going for an overhead slam when he heard something rip. He said it didn’t hurt at the time, and it never really bothered him until about a month ago. And then, like that gnarly second toe, it turned ugly. So we went and saw the hernia guy: a man of few words, and literally magical fingers.
Zach was in pain when we got to the office. The doc gave him a quick hands-on exam—which was more action down south than Zach had seen in 7 years. Turned out Zach didn’t have one hernia. He had 2, one on each side of his groin. The larger one wasn't painful. But when the doc touched the smaller one, Zach yelped. The doc gave a slight nudge with those magic fingers and the pain was gone. It vanished.
After that, the doc took a seat and gave us a primer on hernia repair: Why an open surgery would be less complicated and risky than a laparoscopic one, how he’d use a light anesthesia instead of a general, where he’d make the 3-inch incision, and how he’d insert a mesh to keep the hernia in place. He went on to tell us the procedure wasn't without risk, but it would only take 45 minutes, and he expected the recovery to be smooth. But none of that mattered. The doc had already earned our trust and respect with that one little nudge. He knew hernias. We were all in.
As for the PET scan, Zach got it done a few days ago. I know the results are sitting there waiting for us in his online chart. But I can’t bring myself to look at them just yet. Because as long as I don’t look—as long as I don't find out what they saw on that scan—I can hold onto the possibility that it's good news. We sure could use some.
Zach is scheduled for hernia surgery tomorrow morning.
No wonder he’s in a crappy mood.
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