Free to eat

Today was not nearly as bad as yesterday.  It’s amazing how well one can endure several days of fasting,  Today, I felt stronger than yesterday and was more lucid.  My legs hurt a bit, as if my body was chopping down the protein in muscles to use as energy, but I achieved more during a day of home office than the previous day.  It was the third day without any calories, but I wasn’t hungry.  I frequently thought of food, though.

For lunch, I went for a walk.  It took me to town and to a budget grocery store where I sometimes buy certain things.  They have good pralinés and tasty peanut flips.  I doubt anyone outside Germany or Switzerland knows what these are.  This time I bought a few bags of different nuts, to give me energy without too much sugar over the next few days.  The nuts were my downfall.  I broke my fast an hour early when I opened a bag of walnuts before picking the girl up from daycare.

I should have broken my fast afterwards.  That was the plan.  It probably doesn’t matter, and I don’t consider the exercise a failure.  Seventy hours, 71 hours, 72 hours, who is counting?  Dinner was a relief, a release from strict abstinence, a return to normality - but less of a pleasure than I had expected.  In spite of the nuts, my belly was unprepared for the feast.  It wondered about the bread, the cheese, the poke bowl, and the store-bought tiramisu later on.  I realized a bit late that I would need lots of liquid with the food.  Now, late at night, I’m fine and ready for ten days of normal eating.

Will I start my second chemo program in ten days?  This is not clear yet, though it would fit well.  It depends on what the doctors think is best.  I can’t start early enough.  Why wait and give the cancer time to grow and spread?  Maybe I shouldn’t worry.  If research is right, I’ve just done the equivalent of a chemo session by fasting for three days.

Tomorrow, Flucha and I will go to Zurich for a consultation with the visceral surgeon we saw at the beginning of this journey.  This was suggested by my oncologist.  I agreed, though I’m not sure what we’ll get out of it.  What can a surgeon contribute?  My oncologist told me another surgery was out of the question, with the cancer dispersed rather diffusely in the liver.  Maybe the surgeon in Zurich has another opinion or fresh ideas.

Here are some of the questions I will ask him:

• Should I get an EGFR-inhibiting antibody instead of a different VEGF inhibitor?  The first chemo program was not really such a resounding success that its elements should be retained.  The KRASG13D mutation that I have should allow working with an EGFR inhibitor.
  → The type of antibody is not going to change a therapy from failure to success (which makes me wonder why I’m getting a different anti-VEGF antibody).
• Does my tumor overexpress VEGF?  This is apparently a thing.  It would explain the repeated use of the anti-VEGF antibody better than its effect, a general weakening of angiogenesis.
  → I didn't ask.
• How about Trifluoridine?  I’ve seen this mentioned as an alternative to the 5-fluorouracil-based therapy I’ve received and am going to receive again.  It can only be good to change the therapy I’m receiving.
  → Highly regarded by some with little justification.
• How about fasting during chemotherapy?  Does it make sense, and how to go about it - periodic fasting, caloric restriction or a ketogenic diet?
  → Fasting is dangerous (but I knew this already) and unlikely to be a panacea.
• Are there any trials of CRISPR-based T cell therapy I could enlist in?  This is something I plan to read up on but haven’t yet.  Are other experimental therapies available?  I’m ready to try anything.
  → This has been shown to work in blood cancers and is not relevant for me at its current state.

The consultation tomorrow is at a quarter past eleven.  By 12, we should be back out of the hospital, a good time to go for lunch somewhere in a recently reopened restaurant in Zurich still reeling from the lock-down and avoided by fearful patrons.  I’m not afraid.  I’m looking forward to eating out for the first time in many months.  Plus, I need calories to rebuild what I’ve lost over the last three days.