NOTE: This post will be my last on this website. Please continue to follow me at www.bryantwieneke.com/blog. Thanks - Bryant

On a sunny day in May 2016, my urologist called with the results of my precautionary CT scan. Spluttering with emotion, he explained that I had spots on my kidney, liver, lungs, pancreas, and brain. They were on my colon, along my spine and in my lymph nodes.

It was metastatic melanoma. Stage 4 cancer that no surgery or chemotherapy could cure. I suddenly had numerous doctors, but none could identify the source of the disease. It could have originated last month or been in my body for decades. I still don't know and probably never will.

The immunotherapy drugs held great promise, but we had no idea whether or not I would qualify for them and, if I did, whether they would work. For unknown reasons, they worked for some patients and not for others. We were thrilled when I was approved for a regimen of four combination treatments following by biweekly infusions of Opdivo.

 A month later, I was sitting in a small room with my wife, Elvira, and an IV in my arm. I was receiving my first infusion of the immunotherapy drugs, Yervoy and Opdivo, a combination treatment approved by the FDA only two years earlier. It was like they were pumping hope into my veins, reinforced by the support and love from my family and friends.

I could tell that my epidermal tumors began to shrink almost immediately. The side effects hit after my third treatment, when I suddenly lost 30 pounds and was so nauseous that I couldn’t hold down water. I was being hydrated in the hospital when the oncologist, Dr. Kendle, asked Elvira and me if we wanted to go ahead with the fourth and final infusion. He said it could make all the difference.

We did not hesitate.

“Do it,” we said.

Dr. Kendle, by the way, had worked with James Allison, who along with Tasuku Honjo of Japan, was recently awarded the 2018 Nobel Prize in Physiology or Medicine. Their research led to the development of a groundbreaking new class of drugs, including Yervoy and Opdivo, which activate the immune system to attack cancer cells.

My next PET/CT scan and MRI revealed that my epidermal tumors had disappeared and there was greatly reduced melanoma on my organs. A precise radiation procedure seemed to have rid my brain of cancer as well. The immunotherapy was working.

When we began, we were told the treatment would last forever or until the drugs stopped working. Earlier this month, however, after two years on Opdivo, Elvira and I met with Dr. Mark Abate, who has been the lead oncologist in my treatment. He looked at my latest scans and reviewed the assessments from the melanoma expert and neuro-oncologist at UCLA.

“Congratulations,” he said with a smile. “You are officially in remission. I’ll see you in three months for a check-up.”

Yes, Doctor. You will.

In the meantime, we’ll keep hoping that all cancer patients will soon be as lucky as me.

Just To Be Safe

The picture associated with this post shows Elvira taking Olive into waves for the first time. It has nothing to do with our visit to UCLA on June 11, but it does give an idea of how we've been spending our time between visits, enjoying our puppy as well as our life here in Santa Barbara.

I could say the UCLA reports were ambiguous because the melanoma expert and neuro-oncologist agreed that, just to be safe, they wanted to wait until I had a full 52 Opdivo infusions before recommending that I be taken off treatment and declared "in remission". But there was no real ambiguity. The scans and the MRI were clear. The esteemed doctors stated categorically that I showed no sign of cancer either in my body or my brain. They reaffirmed that I was on the right path. No hiccups or problems found.

So, why did they recommend I should have eight more infusions? The answer is a technical one. The protocol for immunotherapy used to be to take it until it didn't work anymore. Then, about a year ago, the research suggested that in cases where the drugs are working, they only needed to be taken for two years before the patient's immune system could take over on its own and protect the patient's body against melanoma.

The protocol was clear except for pinpointing when the two-year clock starts. Was it two calendar years that the patient needed to be on the drugs? Did the four combination treatments at the beginning count, or was it just the Opdivo-only treatments?

On June 11, the melanoma expert's "instinct" was that I should be on the bi-weekly Opdivo treatments for 52 weeks before they stopped. Elvira and I looked at each other, and like so many other times when we've had to adjust our expectations and accept a reality that is not perfect but is awfully doggone good, we agreed with a smile. Eight more treatments to be considered cancer-free and not needing treatment  is an easy adjustment to make, given where I was two years ago. We're planning on more beach visits with Olive, more bike rides with her in the trailer, and more great visits from Michael and Brian like the one we had yesterday on Father's Day.

I think we can take it.

Eight Days a Week

The pic shows Elvira on a walk with the newest member of our family, Olive the Corgi. They both bring great joy to the household, where we had a flurry of medical events between March 19 and March 26.

I had a follow-up MRI at UCLA on Monday the 19th. After my September MRI in Santa Barbara showed a spot on my cerebellum, I have been down to UCLA several times to see the neuro-oncologist, who concluded - along with the UCLA tumor board and melanoma expert - that the spot was necrosis, a kind of scar tissue from my radiation procedure in 2016.

While Elvira stayed with the puppy, I traipsed down to UCLA and received good news from Dr. Pouratian: no change in the necrosis. If it was cancer, the spot would almost certainly have grown. Was it disappointing that the spot wasn't gone when they checked? Of course. We want everything that could be cancer to be gone immediately. But that's not realistic, so we will gladly accept "no change".

Feeling good about my brain, I had the rest of my body checked on Tuesday with a CT/PET scan. The Nuclear Medicine Unit at Sansum was very busy, and it took most of the day to complete the scan. That turned out to be okay because Elvira remembered to ask about the prescription glasses I'd lost about the time of my last CT/PET. The employees finally had an answer to who belongs to the glasses that had been sitting beside a time clock for three months.

More importantly, Dr. Abate interpreted the scans for me the next day. Once again, the magic phrase: no change. Once again, it was good news. The bottom line is that they found no new cancer, no melanoma sneaking off to some hidden recess and starting to build up its momentum again. There is still the residual spot on my kidney picked up by the CT but not taking any PET. Presumably, if it was cancer, it would take the PET. As with my cerebellum, we don't know for sure, but no change in this instance is a very good thing. I went upstairs for my Opdivo infusion a happy man.

I had a dermatological exam scheduled for Thursday, but the dermatologist called in sick. I did my own exam that day and found nothing suspicious, but I saw nothing suspicious in 2016 when this whole mess started, so what do I know? In any event, the expert will see me in April and - hopefully - confirm that there is no change.

On Friday, I saw Gayatri for my acupuncture session. It was a total-body mellowing experience as usual, but the highlight was that Elvira brought Olive to meet her. They hit it off splendidly, though on the walk afterward, Elvira said Olive was unnerved by two barking Chihuahuas. The only rational explanation is that they were in a yard above the sidewalk, so Olive probably thought they were about 12 feet tall.

Finally, to finish my eight-day week, I had a colonoscopy/endoscopy yesterday, the 26th. I was due for both exams, but the timing is good here because it's another check that cancer has not meandered into another part of my body. Dr. Hahn said everything looked good afterward, but I won't hear the official results for another few days. We're hoping for no change.

At this point, Dr. Abate believes I'm still on track to be taken off the immunotherapy drugs in June. As always, we'll take it one day at a time and remain thankful for each one of those days, as well as Elvira and Olive and all those who bring joy to my life.