While the tests were ongoing my mind was in constant turmoil, wondering what kind of cancer it was, how quickly it might kill me and what the next few weeks or months had in store. I have been in the habit of daily exercise — at least 30 minutes of activity — for longer than I can remember. One of the first questions I asked my oncologist was whether I could continue, especially with the state of my lungs. Her answer was another ray of hope: “oh yes, we encourage it!”
She went on to explain that patients often feel it is unfair to be asked to exercise on top of the symptoms from cancer and treatment, but that exercise is tied to better tolerance of chemo, better management of fatigue during chemo, and better outcomes on the whole for cancer patients. So I kept walking every day, but each day it was a little harder to breathe. I thought about riding my bike and I wondered if I could still do it. My bike, my beloved bike, who I’ve ridden over so many thousands of miles, across so many new and distant landscapes. The same bike that I crashed, breaking my hip, and eagerly went back to for my recovery. I cried thinking that we’d never have another grand adventure, maybe we’d even had out last 20 mile loop around our city. It was getting hard to breathe and I was still spending my days sorting through clinical trials, getting procedures and having a port placed for chemo, still not knowing what the regimen would be. It felt like I’d never even be able to start treatment.
I read online that as lung tumors grow it is common to start coughing up blood, and as my breathing got more difficult I started coughing more. Out of instinct I used my asthma inhaler more and more but it did nothing. Of course it did nothing, it wasn’t asthma making me short of breath, and I felt a panic that I hadn’t felt in many years. I decided that I needed a bike ride. So I rode out with Sara for a few miles and felt that same old familiar sense of freedom and joy I’ve always felt, and for a moment the cancer faded into the background. It was a beautiful day to be out riding, and cancer couldn’t take that from me.
By mid April we knew it was pancreatic cancer and had determined that there were no clinical trials open to me in our region. I was eligible for trials in other areas of the country, which would mean arranging travel and waiting a bit longer to apply, be accepted and start treatment. My other option was to start chemotherapy immediately.
I’d read online that KRAS mutations are considered “undruggable” and don’t respond to chemotherapy, and reading that I wondered often if it would be worth putting my body through chemotherapy if it was just going to be difficult and ineffective. There are so many awful stories online. My oncologist was a lot more optimistic. She pointed out that the first line treatment is the most effective treatment currently proven by science, and, while the numbers for response aren’t great, the vast majority of people with pancreatic cancer have a KRAS mutation, and many still respond to treatment. She also reminded me that the median age of diagnosis is 70 years old, and most patients are already in very poor health at diagnosis.
My lungs were heavy, but the cancer, as far as we knew, had still not spread to my liver or bones. I was tired, but I could still get out the door every day to keep my body active. I was still healthy in so many ways, so I figured that preserving as much of that as possible would extend my life. I decided to start chemo as soon as possible.