I’m one of the multitude of Gen Xers now pushing the limits of middle age. Growing up I remember the fear mongering days of the Cold War when everyone thought we were all going to die from a Russian nuclear strike. Our generation didn’t get the hard hitting satires like Catch-22 or Dr. Strangelove that were prominent in the 60s. We got WarGames, which made nuclear proliferation seem painfully easy to thwart; just have Ferris Bueller hack the system and haul Ally Sheedy along for the ride, and we’d all be safe. Simple, no?
On a side note, one of my all-time favorite movie quotes appears in this movie. Spoken by Barry Corbin as General Jack Beringer. “Goddammit, I’d piss on a spark plug if I thought it’d do any good!” Classic. Kudos to Lawrence Lasker and Walter F. Parkes who wrote the script…and received an Academy Award nomination for that efforts. Probably for that very line.
Anyway, nuclear. I’ve never believe in fearing anything. It really doesn’t do any good. And if you’ve followed this blog, you know that I’m a cancer patient. I have several neuroendocrine tumors (NETs). Some small, some medium, and a few bigger than medium. For nearly 15 years I’ve been visiting Mayo Clinic–first in Rochester, MN and now in Scottsdale, AZ–because these tumors are so rare that few people have them, so naturally just a few people study and treat them.
When you’re first diagnosed you think, oh boy, at least they’re slow growing. And then they just keep growing and keep growing and they start to wear you down physically. I had my first surgery in 2005 and a second in 2013 to remove tumors. And they just keep coming back. So in 2019 I started Sandostatin injections once a month. They’re a serious shot in the buttocks once every 28 days. After one year, I was thrilled to learn that for the first time in seven years no new tumors arrived on the scene. However, the existing tumors were still growing. So my team at Mayo decided the time was ripe to explore other options. Yep, it was time to go nuclear!
Lutathera is a peptide receptor radionuclide therapy (PRRT) for somatostatin receptor-positive tumors. In a nutshell, some good scientists have created a way to attach use Lutathera (aka Lutetium (Lu177) dotatate) that when infused becomes a tumor-seeking missile. It’s way more complicated than that, but essentially the Lutathera seeks out the tumors and nestles in with them, and then releases the radiation to kill the tumor. Pretty crafty. This limits the need to blast the body with radiation generally applied to an area. The old days was the sledgehammer. Today is more like a scalpel.
Anyway, so I was approved for Lutathera. But in order to actually get the infusion, you have to pass some basic tests, such as exhibit that your tumors are in fact willing to receive this nuclear medicine. There’s some bloodwork involved and a PETscan, where they check to see if your tumors are receptor-positive. Well, guess what, mine were! There was only one problem.
They actually found a neuroendocrine tumor in my heart. In my heart! I was told that in Mayo Clinic’s records there are only 15 known cases of NET actually in the heart wall. I was number 16. I’ve always thought I was rare, but this seemed too much. The discovery halted the Lutathera infusion. This was done by my choice, but also the doctors at Mayo are pretty good, and they advised slowing the process down to learn more. More tests were ordered and I met with an oncology cardiologist at Mayo. The additional tests determined that the tumor was small and moving forward with the Lutathera shouldn’t be a problem. Of course, there are risks, but we decided to move forward. When I started this process, I had actually been more concerned about damage to my heart valves, which is very common with NETs. But my valves were in good shape. So, again, we moved forward.
A few weeks ago, I went in for my first round of Lutathera infusions. There are four rounds, each eight weeks apart. I met several times with my oncologist and the radiation oncologist to review what the process. Fortunately for me, this process has been refined over the last two years, and that made all the difference.
Before you can receive the nuclear medicine, they have to coat your kidneys (best way I can describe it) with amino acids to protect your kidneys from the radiation. The people who originally had this treatment complained of nausea caused by the amino acids, and since then anti-nausea medication has been a big part of the process. In fact, after the two IVs are inserted and you’re in the infusion room, the first 40 minutes (or so) are dedicated to anti-nausea. Then the amino acids are introduced in the same IV line. Whatever they have done to improve the process works, because I never felt sick to my stomach or even close to it. Side note: I had a Quest Bar for breakfast. That’s it.
All this is done under the watchful eye of seasoned professionals, including a medical health physicist, radiation oncology nurses and a Nuclear Medicine technologist. This group brings the heat, as it were. The Lutathera is administered in the second IV. This process goes on for an hour or so. I don’t remember because you start to get a little sleepy at this point. I brought a book to read, but didn’t read too much. My wife was sitting in the corner and read a fair amount of her book. Typically, others should maintain a six-foot distance from you while you’re ‘hot’.
After the Lutathera is administered. It’s a wait and check situation. The physicist takes a couple readings to make sure you’re under the legal radiation limit before you leave. All I really noticed at that point was that I was very sleepy. That was round one. I’ll post more follow up after round two in a month or so. That is, if I don’t get COVID-19. After all these years of worrying about nuclear war and then having to go all-out nuclear with my medicine, I’ve got to worry about a virus. But hey, that’s life.