My Glass, Half Full

By Limuel S. Celebria

(We are republishing some of the memorable columns of the late Limuel Sotto Celebria, one of the founders and the first editor-in-chief of Daily Guardian, as a tribute to one of the most erudite and prolific writers in Iloilo journalism. His articles appeared under two column titles: “Columny,” a play on the word “calumny,” meaning smear; and “Lemonade,” which he used for his later essays.)

There’s nothing alarming (or words to that effect), my Oncologist declared soon after taking a look at the three pages long result of my chest and abdominal CT Scan (with contrast) taken a few days earlier at the WVSU Medical Center.

Her words, accompanied by a beautiful smile, gave me much relief. The past couple of weeks, I’ve been worried sick, pardon the expression, by coughing fits that seemed to be getting more frequent by the day. With each searing cough forced out of my breath, I feared precious minutes of my allotted time on earth got blown away irrevocably. I thought my cancer was getting worse.

But Dr. Dioly Ann Arnaiz’s comforting words erased all my trepidations. She said I was no worse than I was six months ago last January when I also underwent a CT Scan. The result of that scan (albeit taken at a different hospital – IMH), became the benchmark for comparison by the latest scan. The new results showed that some previously observed unwanted growths remained the same or even slightly reduced. So did the size of the existing, metastasized nodules in my lungs. The latest report said there was a slight increase in number of nodules but Dr. Arnaiz attributed this to naked eye observation (e.g. perception rather than mathematical certainty). Otherwise, if the increase were significant, this would manifest in physical terms, like some form of debilitation. But you look fine to me, she said.

I gladly agreed. But what about my coughing!!?? You’ve got pneumonia. The coughing is caused by mucus creeping up the trachea and irritating the throat and constricting nasal passages. Nothing that cannot be managed by antibiotics, Salbutamol, and Flumocil.

All in all, there’s a lot to be thankful for. To be grateful for.  My cancer (renal with pulmonary metastasis) has been held at bay. But it’s a glass half-full.

For those unfamiliar with my case… I am a cancer warrior. In March last year, my left kidney was removed after it was overrun an aggressive type of renal carcinoma. Sadly, the operation, though successful, came a bit late. The cancer had metastasized into my lungs.

Against doctor’s advice and because of financial constraints (whatever little savings I had was wiped out by my operation), I chose to forego further treatment. In September, my condition got worse and I got hospitalized for a month – the cancer nodules are ravaging my lungs – my chest x-ray lit up like a Christmas tree. Undergoing medication, though expensive, became inevitable. The family dug deep, a lot of friends and former classmates came forward to help. As well, I was able to tap in to the DSWD’s financial assistance programs through politician-friends, which really was a great help.

In October 2022, I began an oral chemotherapy protocol taking Pazopanib (votrient), a generic drug manufactured in India. “Pazopanib is used to treat advanced renal cell carcinoma in adults. Pazopanib is in a class of medications called kinase inhibitors. It works by slowing or stopping the spread of cancer cells.”

True enough, my body responded well to the treatment. Pazopanib delivered to expectations – the Cancer invasion was thwarted and held at bay. After three months of treatment, my CT scan in January showed marked improvement, certain growths notwithstanding. In brief, the Christmas tree was replaced by softer lighting. There’s some irritating side effects brought about by the medication, however: dry skin and sores in my buttcrack, fingers, and other extremities, frequent loose bowel movement, farts so pungent it may be considered criminal if it happened in a crowded elevator. I also acquired a weird sense of taste – I cannot taste anything except sweets and anything slightly hot scalds my tongue. But, worst of all, my native complexion turned to fair and people now mistake me for some meztizo celebrity. I hate it. (Hehe)

After nine months of Pazopanib (votrient) oral chemotherapy protocol, my latest CT Scan result show everything remains cozy. Well and good. But this is also a glass half-empty situation.

The US Food and Drug Administration approved the use of Votrient “after the results of a Phase III trial showed that the drug reduced the risk of tumor progression or death by 54% compared with placebo, regardless of prior treatment. Overall median progression-free survival was 9.2 months with Votrient compared with 4.2 months with placebo.” Similar studies in Japan and Korea showed votrient’s mean progression-free effectivity of between 15 to 21.9 months. This means, at some point, or after some time of using votrient, it may cease to be effective.  In brief, on entering the fourth quarter of medication with the score tied vs cancer, my game needs to level up for the win.

However, not unlike those currently retooling NBA teams, I may need to sign up franchise-altering players with maximum contracts. I googled the cost of the new drug – lenvatinib (also a tyrosine kinase inhibitor) – and it may cost at least 90,000 a month (@ Php 3428.57/Capsule 4 mg ). Moreover, it has to be paired with an immunotherapy drug, Pembrolizumab, which is given intravenously. Bruited as the drug that cured former President Jimmy Carter from cancer in 2015, Pembrolizumab costs well above P100,000 per shot.

OMG! It’s not just a glass half-empty situation. My pockets are empty! At this point, only our prayers and an abiding in the Great Healer are what keeps us going.

My ever-considerate oncologist has extended my Pazopanib protocol for another three months. Hopefully, God and Padre Pio will send us a miracle when the time comes.

***

Time In A Bottle of Pills

My first bottle of Pazopanib – an anti-cancer drug, came through the other day after being shipped from Cebu City. As soon as I get cleared of my pneumonia and other minor ills, we will begin protocols on a targeted drug therapy program. The battle against cancer will be joined.

I have renal cell carcinoma stage IV with pulmonary metastasis. Everyone familiar with cancer knows this – it’s a journey from which there is no return. I’ve been handed a one-way ticket.

Fortunately, not all is grim. I love to travel. I enjoy looking out the window to gaze at the passing landscape and contemplate on the ever-changing horizons. This is one journey I intend – not just to enjoy – but to prolong as much as I can.

Pazopanib is considered a breakthrough drug in cancer treatment (according to the brochure). It eliminated the need for those dangerously unreliable chemotherapy machines of the past.

Wikipedia describes pazopanib as “a potent and selective multi-targeted receptor tyrosine kinase inhibitor that blocks tumor growth and angiogenesis.” Pazopanib can stop cancer cells from developing new blood vessels. This reduces their supply of oxygen and nutrient so that the tumor shrinks or stops growing. This is known as the anti-angiogenesis treatment (whatever that means).

In other words, pazopanib acts as a blockade interdicting food supplies from reaching the cancer cells and starves them to death. There’s no 100 percent guarantee but statistics are high that the drug does its job.

Pazopanib is now the coke that will add years to my life. I’ll be buying time contained in a bottle of pills.

There’s just one hiccup. The drug is not manufactured in the Philippines and has to be imported from the UK or India. Although there is a local distributor, the price is steep – P35 thousand per bottle of 30 pills @400 mg. My prescription calls for twice a day (800mg) dosage which means I’ll be consuming 2 bottles per month (worth P70,000). Which also means, if I don’t die of cancer quick, I’ll die of starvation instead. Literally, I’ll starve myself in order to starve the cancer?

Science aside, there’s one other aspect, a more heartwarming, gratifying side to this excursion, and that is the spiritual side. I am very grateful to the many prayer warriors (many of you included) who have volunteered for my cause. A multitude is now harassing St. Peter with prayer and supplication to delay my passage into the pearly gates.

While I am not, in practice, a “devout” Christian or Catholic (as the case maybe), I’m a firm believer in God our Creator and in Jesus Christ who died on the cross for our sins. I lay claim to His promise of salvation and I pray for His healing presence to cast away the demons that afflict my body and spirit. I earnestly seek His healing touch and I believe it will come my way in accordance with His plan and purpose in my life. Amen.