When Long Covid Combusts into Turbo Cancer

It's been awhile since I've updated the social universe beyond the snippets on x (formerly known as twitter) and Instagram on my cancer journey (see Feb post.) Or better named, "how much can a man take over four and half years of Long Covid and now stage IV cancer?"

So here it goes...

Yesterday was supposed to be my sixth and final chemotherapy session for prostate cancer that spread throughout my body in the bones; mainly pelvic bone pain, ribs (ironically located in the same area where I had my triathlon race accident--four broken ribs in 2014) and other areas.  I'll get back to the "supposed" part later in this post.

The last two months have presented a cumulative effect of the chemotherapy which was expected. "Virgin Territory" is treating and dealing with cancer on top of Long Covid. I'd say that the first four chemo sessions were somewhat "mild" (if that's a thing) as I was dosed with anti-nausea medications so that part was not near as bad as I'd expected.

I would say that the first night (of each session) was a challenge and best way to describe it is being poisoned which in essence I was. With the "breadth" of the spread of the cancer, radiation (directed at a particular area) was not an option so "napalming" the body with chemo along with hormone deprivation (pills and shots) where the goal is to take the PSA (prostate specific antigen) down below the 1-4 normal range has been the strategy. 

I jinxed myself by throwing it out into the universe that the first four went chemo treatments went reasonably well albeit with an added fatigue component on top of my already fatigued Long Covid body. Session number five packed a "wallop" as the normal 24 hours of poisoning was four days.

Somewhere along the way my oncologist recommended some strength training and trying walks around the block (can you say GET, or "graded exercise therapy--see my John Oliver YouTube post on that topic.) Around the 4-5 chemo round, I did try something I hadn't done in (perhaps) years and that's trying a walk around the block. Post-exertion malaise (PEM) or PESE (Post Exertion Symptom Exacerbation) was very real as it created a series of crashes that sent me to the hospital four times. So much for that feeble attempt to try mild exercise. 

I'd clarify and expand by saying I have a great deal of confidence in my oncologist, Dr Eule (eye-lee) from UC Health Anchutz campus in Denver. It's a bonus that his PA, Erin who I see on alternate dates is an elite runner herself so it's good to have a common language with her and I'm equally impressed with her approach and experience. 

One thing (that's impressive) and  unique to UC Health is they have an oncology urgent care inside the hospital with the full resources of a hospital emergency department (ED) with doctors, equipment, and radiology. Over the four visits to the specialty urgent care and ED was ultimately diagnosed as pneumonia--repeat, "can this guy get a break!"

With an already compromised immune system and inflammation with Long Covid, this puts me "behind the eight ball" as chemotherapy lowers this even further--in my case, Dr. Eule used Docetaxel which is intended to stop the growth of cancer cells by blocking cell division. 

Last week's visit to the oncology urgent care like the previous visits was tied to the most severe dyspnea (shortness of breath) I've had in four and a half years. This might best be amplified with my first Costco wheelchair shopping cart experience. I wanted to join my wife for the outing but there was no way I could walk the half mile around Costco, so "no shame in my game," I wheeled around as she shopped.

The attending PA (physicians assistant) at UC Health ordered another CT-scan of my lungs to compare to the one I had in May with the pneumonia. The interesting (and not good interesting) comparison was that the radiologist noticed an increase of inflammation in my lungs which they attributed to (or exacerbated by) my Long Covid. 

This makes me wonder if inflammation has played a part in the dyspnea that's debilitated me for 4.5 years, but alas I digress.

Dr Eule up to this point had made (as I'd expect) many of the decisions left up to me (and Mrs. SBM); to enter into chemo in the first place, to continue after pneumonia for treatment number five, but number six was different in that he recommended against it as;

1) there really aren't studies around benefits of five vs six vs seven chemo treatments. 

2) this would be considered "completed" chemo treatments that would have me eligible for future studies or treatments like Pluvicto that I'm highly interested in trying, and

3) the risk of further and permanent damage to the lungs didn't outweigh the reward of one final treatment.

4) previous CT scan showed expected "scabbing" of the pelvic area cancer lesions showing that chemotherapy was doing its' thing.

Overall, we left happy with the decision not to have one last "Putin cocktail." 

In terms of next steps, I'll go in for a full scan again in July followed by another oncology consult to review resulting benefits of chemo and what's next. What's interesting that I learned yesterday is that a continual monitoring of my PSA levels not only is a barometer of my prostate cancer but also of the cancer in the bone areas of my body as it's technically prostate cancer in the bones.

That was the other area of optimism is that my PSA went from a meteoric rate of 117 at it's highest (again normal range is 1-4) and down to a .28 yesterday.

From a macro standpoint of Long Covid and cancer, my take is that the studies on correlation between Covid-19 and cancer are too new but emerging. What I can say is that my oncologist said that my "aggressive" cancer (I'd prefer mild) was likely caused or certainly accelerated by my Long Covid; damaged immune system, inflammation, and the industry fact that up to 20% of cancers are virus-born.

I've mentioned Akiko Iwasaki (Long Covid Hero) talking about (above) the concerns and potential correlation between Long Covid and cancer in Fortune, and earlier this month Washington Post posits, " ‘Unusual’ cancers emerged after the pandemic. Doctors ask if covid is to blame." Just this week, there was an even more damning study out of Japan stating, "SARS-CoV-2 infection increases the risk of worse outcomes in cancer patients, including those with breast cancer." 

I'd suspect to see more and more studies and correlation between Covid-19, Long Covid, and cancer. 

So what does this all mean? For one, we should continue to take Covid-19 as a serious pandemic illness that we know very little about. While society has moved on, the fact is that Covid infections continue to happen and result in Long Covid. While Long Covid does not necessarily mean you will get cancer, do you want to take the chance? Live your life, but understand the potential consequences of infections or multiple infections.

I'd end with that most of videos end with "Invest, Protect, and Reform." Too many tangents and details to delve into what that means (from my perspective,) but in terms of investment (at least in the U.S.) we need to continue to push our legislators including Senator Bernie Sanders to push through his (hopefully initial) $10B "moonshot." 

June 2024 CT Scan showing inflammation of the lungs

Footnote: Fun fact. What do marathon runners and chemotherapy patients have in common? A "badge of honor" for runners is the black toenail that will inevitably fall off. Little did I know the same things happens with chemo, but I never lost a fingernail in a run race (or triathlon.)