Class is in session! Everything you never wanted to know about ECHOs and cancer vaccines. (Post #49)
I went back to work as planned last Monday (March 13) and had a wonderful day! Yes, I was tired, but I think I was flying high on adrenalin, caffeine, and prayers. No, I didn't need to lie down on the banquette, though perhaps I should have. 🤷🏻♀️ I was amazed at how much I remembered...and how much I had forgotten. Thankfully, my passwords appear to be lodged in my muscle memory, so I was able to get into my computer and the necessary programs, something I was unable to do during chemo. As a matter of fact, back then I couldn't even remember how I was supposed to access my computer, let alone the passwords necessary to do so! However, just before I went on medical leave, I set up a scanner by my desk as my job description involves filling out patient forms like AISH, CPP, and DTC. These need to be scanned into the patient's digital file before they're sent off. Right. Before they're sent off...in the mail...in a sealed envelope. 😬 Oopsie. Apparently, the things I learned just prior to my medical leave were not buried deep enough in my memory...like how to complete invoices. (Pssst - I don't work for free! 🤑)
So while last Monday was my first time back at the office to actually work (and not just distract everyone... 😇) since June 10, 2022, that evening I attended my last board meeting. I've been on the Board of Trustees of my church for the past 6 years, and what an experience it's been! I allowed my name to stand back in 2017, as I was told that I was just the token female, and as this was the first year a woman was nominated for a trustee position (It had just never occurred to anyone before!) I was assured that I would not be voted in. Surprise! I should have known that having the vote on International Woman's Day was a bad idea! 😏 Honestly, it was an amazing ride, not unlike a roller coaster, complete with a triple loop! I had sat on political boards before, but I didn't consider myself old, wise, or grey enough to be on the church board. It was an honor to serve on the board, however, 6 years is a long time and new people need the opportunity to serve, even if I am certainly grey enough now. (Board members serve 3-year terms, with a limit of 2 terms.)
While writing this blog entry, I realized that I hadn't explained what an ECHO is. Basically, it's an ultrasound of the heart. The Cleveland Clinic describes it this way:
An echocardiogram (echo) is a graphic outline of your heart’s movement. During an echo test, your healthcare provider uses ultrasound (high-frequency sound waves) from a hand-held wand placed on your chest to take pictures of your heart’s valves and chambers. This helps the provider evaluate the pumping action of your heart.
There are several different types of ECOHs; I had contrast transthoracic echocardiograms.
My ECHO was done at the Mazankowski Alberta Heart Institute, which is attached to the University Hospital. I registered at the main desk and then waited 🥱...and waited 😴... as you're required to register 30 minutes before your actual appointment time. I was brought back to a tiny room where I changed into a gown, then lay down on a very unique bed. The tech attached electrodes (small stickers) to my chest (I had 3), which are attached to an EKG (electrocardiogram) monitor which recorded my heart's activity during the test. The tech then used the sound wave transducer (wand) on various areas of the left side of my chest. He applied a little gel on the end of the wand to improve conductivity and take clearer pictures and yes, it's yucky to wipe off! 😝 The transducer transmits and receives sound waves that bounce off the heart. (The sound waves don't harm the heart in any way.) A computer compiles these returning sound waves or echoes and turns them into a picture of the heart. During the process, I was asked to hold my breath, take a deep breath, breathe normally (phew!), and switch positions, all while laying on my left side with my arm above my head. At one point, the tech removed part of the bed, allowing them to access the underside of my ribs. (The first time this happened I was slightly alarmed!) Then I was given contrast through an IV in my arm (yes, I'm looking rather polka-dotted these days), and the whole procedure was done again! The contrast used was not a dye as one might expect, but an "activated saline solution" called Definity. "This echocardiographic enhancing contrast agent is made up of lipid-encased gas microspheres that reflect sound waves from the ultrasound machine enhancing the details of your heart." 😳 Or in other words, Definity is made of tiny little fatty bubbles suspended in salty water.
My first echocardiogram (considered my baseline) was done on the morning of the day I was released from ICU after my surgery. The report mentions not being able to do a very good job, as I was in pain. No kidding! 😄 My first, second, and third ECHOs were performed by females, while the one done last week was by a male. I only mention this because the male was completely amazing in that he draped me with a towel and completed the entire test beneath it without seeing any skin. I was quite impressed! Not that I'm fazed by that sort of thing anymore...medical exams and maidenish modesty are not compatible! 😏
I had blood drawn while we were in Hinton recently. The techs at the hospital lab are so slick! This time they were almost done before hubby was finished asking them to do it. 😆 My oncologist wanted to check if my various levels had returned to pre-chemo levels. Almost! I am happy to report that other than a slightly low ferritin level, things have almost normalized. My white blood cells could still use a bit of a boost, but no one seems too fussed about it. Thankfully, other than my hospital-acquired Covid, I haven't had as much as a sore throat in the past 3 years. I'm so very grateful. And so is my husband. (I may be an awful patient, particularly if I can't breathe through my nose! 😬)
If there's a thought that runs through my mind at least once daily (though often more), it's gratefulness that God created our bodies so well. We are truly "fearfully and wonderfully made" (Psalm 139) The more I learn about the human body, the more my mind boggles, especially regarding our immune system. The role of the immune system in the treatment of cancer is an exploding area of research, based on the fact that our immune system regulates every substance in our body. Any introduction of a foreign substance raises alarm and causes the immune system to attack it. Getting the immune system to recognize cancer as a foreign substance assists other therapies in getting rid of any cancer cells. 🔫
I had no idea that everyone's body is constantly trying to grow tumors and that our immune system just annihilates them before they become problematic. Yup, everyone could be "battling cancer" at any time, though this is totally overcalling it, as our bodies deal with it without our notice. 😁 Phew! This is called the "eliminating phase." The process of cell division doesn't always go according to plan, so our body's T-cells, a critical part of our immune system destroys these deviants before they become problematic. (Well, that's what usually happens. 😬) As the tumor cells continue to grow, they may match the activity level of our immune system called the "equilibrium stage," when our immune system is still keeping up. ⚖ Unfortunately, as time goes on, cancer cells may develop genetic changes, allowing them to escape the immune system; they go incognito, our immune system can't keep up with their mutations, and/or the body no longer recognizes them as a threat. This is called the "escape phase" and it's when tumors become problematic. Cancer cells can also produce molecules that make our immune system stop working. They change the cells in their immediate environment, rendering any circulating immune cells inactive. It's like the cancer cells set up an electric field that flips the fight switch of the "good guys" to off and they are no longer able to fight. ⚡
Did you know that they use vaccines to fight cancer? One type is similar to the vaccines most of us received in our childhood, such as the measles vaccine. A small amount of inactivated or weakened virus is introduced to the body, which prompts the body to develop antibodies. Basically, vaccines are like mug shots; they help our bodies recognize the bad guys. 🕵🏻♀️ These cancer vaccines prevent the viruses that can cause cancer, like the HPV vaccine. HPV may not only cause cervical cancer but can also infect the precious parts of men. 4/10 cases of cancer caused by HPV occur in men! The Hepatitis B vaccine protects against the virus that can cause liver cancer.
The second type of cancer vaccine is a therapeutic or treatment vaccine also known as immunotherapy, given after a diagnosis of cancer has been made. These vaccines work by destroying cells with a tumor-specific antigen (TSAs) that is only found on cancerous cells. Just as we are given a particular antigen in a vaccine, causing our bodies to remember it as bad and seek to destroy it when it appears, so it is with these cancer vaccines. They try to annihilate the bad guys!👮🏻♀️ This is necessary since cancer cells can blind the immune system to cancer-specific antigens, effectively turning off its ability to fight cancer cells. Remember those bright pink disclosing tablets the dental hygienist would hand out after we brushed our teeth in class? Cancer vaccines are kinda' like that. (I never did like those, for quickly apparent reasons...😁) Unfortunately, these vaccines aren't foolproof, as in some cases a cancer patient's immune system is already exhausted or doesn't have enough neoantigens to attach to the cancer cells and fight them. (Neoantigens are cancer-created antigens that flag the cancer cells allowing the body to find and destroy them. Just regular Benedict Arnolds, they are. 💂🏻♂️)
Now here's the part that almost made my head explode: they can develop a cancer vaccine specific to you, using the cells from your tumor. 🤯 Talk about bespoke medicine!
Daniel Pinschewer, a Swiss scientist, made a benign virus (similar to the common cold) suitable for immunotherapy by attaching a protein unique to the patient’s particular type of cancer to the virus. The immune system’s T-cells then read the cancer as part of the virus, alerting an immune response that seeks and destroys the cancerous cells.
“[The virus] has to get to the immune system or the body’s ‘defense system,’ which has its ‘training camps’ in the lymph nodes and spleen. That’s where our ‘soldiers,’ our T-cells, are educated, and it’s the soldiers that will patrol the body and seek and destroy the tumors.”
There is also a possibility that multiple strains of the virus carrying different types of proteins could help a person whose cancer has mutated and metastasized in other parts of the body.
Moreover, because viruses can lie dormant in the body for years after infection, this particular immunotherapy might provide long-lasting protection, igniting an immune response whenever the cancer recurs.
The reason that these immunotherapy treatments are so exciting is that, with time, they may replace the more side-effect-intense therapies such as chemo. I'm so glad God created people smart enough to come up with these ideas, and then turn the ideas into workable solutions! 👩🏻🔬 Cancers that used to be death sentences (breast cancer and melanoma among the many) are no longer automatically terminal, provided they are discovered in time.
Okay, class dismissed! 👩🏻🏫
So life goes on. 😊 I was at work again this past Monday (March 19) and while I enjoyed myself, I didn't experience the same adrenalin buzz of the previous week. I started to flag in the afternoon, so I went shopping instead! 🤷🏻♀️ (South Common is dangerously close to the office.) While at work on Thursday, (yes I know I was initially only going to work Mondays...🤫) I almost felt like the old Heather. It turns out that all that is required for me to feel normal is copious amounts of caffeine! Did I have difficulty sitting still? Well, yes. Did I almost give myself a needle stick while mixing Botox for a migraine patient due to a caffeine-induced tremor? Well, yes, that's true. Did I crash on the couch when I get home, barely able to eat due to fatigue? Unfortunately, this is also accurate. Some day soon I'll be able to go more than 10 hours without requiring a period of horizontal rest. But until then, I'll keep thanking God for each hour, and try to remember that it was the tortoise that won the race, not the hare.
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