While I was in Utah, we learned that our lake house had sustained severe damage in consequence of water damage and subsequent mold. For reasons no one can explain, the water filter in the fridge developed a crack, letting water cascade through the fridge and out the lowest, where it spread across the first ground with the exception of seeping across the basement. The carpets across the house were soaked, with the exception of the upholstered furniture, and every surface was coated with mold. The house interior will ought to be gutted down to the studs, dried, and treated until it is certified to be mold-free, then rebuilt. All the furnishings will be trashed. Fortunately, the entire payments will be covered by our homeowner's insurance; State Farm already has agreed to develop coverage, and remediation is underway. I'm driving down there tomorrow to meet with the claim adjuster and assignment supervisor. I guess this means that we won't be in a position to use our house this summer, nonetheless after it's done, we'll possibly put it on the market as essentially be getting a brand new house. It's too bad we didn't get round to selling it before this occurred, nonetheless we'll maintain it.
If that wasn't enough, while I was in Utah another water leak started in our Great Falls house. The toilet supply line valve in one of the upstairs bathrooms started leaking, staining the kitchen ceiling. My homes are like my neobladder, I've determined. I should count on unexpected leaks. Jennifer close off the toilet water line and further it to my honey-do list. It's good to have a purpose in life.
After I landed at 1 am yesterday morning, I got about a hours of sleep, then went to the downtown DC Labcorp for my blood paintings. (I went downtown because I needed to make my monthly visual appeal at my law firm, and assumed that the Labcorp was staffed by competent people.) I came upon the lab receptionist to be deeply engrossed in a conversation with another employee – something about how all men were jerks – and kept me waiting for about 15 minutes before acknowledging my existence. She demanded for my doctor's orders and huffed when I said that they were already in their components. She wearily dragged her arms six inches to the keyboard and glared on the monitor, occasionally stabbing on the mouse. When she located my orders, I asked her to confirm that the lab would be in a position to do the blood paintings that day, as the orders were marked "stat". She stared at me as if I had a enormous zit on the end of my nose, then without looking on the monitor said that my orders were not marked stat. I explained that I knew that they were, as they were standing orders, and I had gone to other Labcorp places on the same orders with no issues. She stared at me again, then summoned her fellow employee to look on the screen. No, said man-hater number two (somewhat glancing on the screen), she could not see "stat" in the orders. They could draw my blood, they said, nonetheless it would not be analyzed for many of days. Realizing that there was nothing I could do persuade these good people in otherwise, and not eager to topic my veins to vicarious revenge on behalf of women everywhere, I determined at I would just seem to be early to Hopkins to have my blood drawn by people with a semblance of professionality. Moral: never again go to the Labcorp location at 1145 nineteenth Street NW.
The downside was that I needed to fight my manner through rush hour traffic this morning, with it taking two hours as a substitute of the usually hour to get to Hopkins. The horror! Fortunately, my port directly gave a return, and the blood draws were transient. Unfortunately, the Hopkins lab was backed up, and so I needed to wait an extra two and a half hours for my nivolumab dose to be compounded on the pharmacy.
Meanwhile, I met with Dr. Hahn. He announced me to another doctor who was visiting JHUH, and called me the "poster child" for the nivolumab clinical trial. I thought of the "Save The Children" posters and thought his description was spot-on. I asked what new things he learned at ASCO about the durability of nivolumab on metastatic urothelial carcinoma. He said that no new data had been published specifically on that point. There was newer data on nivolumab on metastatic melanoma, which showed that the survival curves that had been published last November were essentially unchanged. Dr. Hahn said that he expected that the survival curves to be similar for patients with metastatic bladder cancer, i.e., of the 60% or so of patients that had an overall response, about half might be expected to have a durable response lasting for several years. But accruing that data will take some time, especially since nivolumab was first administered to mets BC patients less than twelve months in the past. But the recent sea change in how doctors are now classifying cancers (by genetic type as a substitute of location) means that the data from metastatic melanoma patients and non small cell lung cancer patients can be more readily utilized to urothelial cancer patients like myself.
Dr. Hahn further that, with regard to durability, data would accrue as patients getting nivolumab stopped getting doses, then restarted when their cancer started growing again. He said that the trial sponsor had been granting permission to some patients to "go on holiday" from therapy, with the certainty that they would go back on if their cancer came back. Now that the drug has been accredited by the FDA for melanoma and NSCLC, more patients would be getting shorter doses of the drug (possibly as a result of cost worries), and that data would ship insight as to both how long I want to get having a bet this drug, and how long the influence will last. Good news, I guess, nonetheless I have little interest in discontinuing the trial prematurely. The plan is that I will continue to get my infusions every other week for quite some time – maybe into 2017.
Dr. Hahn also talked about how the next exciting region of research was using combination therapy, such as GemCis chemo and immunotherapy, on the same time. He also mentioned how there were so many genetic mutations that we did not yet know how to treat, and expected that more immunotherapy drugs would be developed to target the damage done by those mutations. I could sense his enthusiasm and excitement at those future developments.
At 3 pm, the pharmacy finally sent up my nivolumab, and the stuff was pumped into my physique. By 4:15 I was out the door, just in time to sit in rush hour traffic out of Baltimore and on the beltway on the manner home. I am richly blessed.