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The First Day of the Rest of Our Lives

Our treatment plan changed abruptly because Dr. Kleef felt that it was prudent to begin immunotherapy right away. And to Vienna we came.

Shane relaxing during his first treatment.

Our Uber driver dropped us off on a winding, residential street at Number 4. Tentatively, we walked through the gate (could this really be a clinic?), past a horse sculpture, and lo and behold on the door, Dr. Kleef's name. With relief that we were indeed in the right place, we entered the clinic door and were greeted by Julia (pronounced Yulia--J's are said like Y's in Hungarian), our nurse and Kristina, Dr. Kleef's wife and overseer of the clinic (also a nurse). Both were lovely and kind. Julia ushered us into a clean, white bedroom with two beds (I was a little thrown by the Bambi mural on the wall but finally decided it didn't matter), a TV and medical equipment. First she cleaned Shane's port, then inserted a fresh saline lock into the port (something that is done once a week). Kristina and Julia worked together seamlessly, quietly murmuring in Hungarian to one another. Julia connected an IV drip of Taurolidine, a drug that is given to offset the effects of immunotherapy. Taurolidine is an amino acid derivative, with very low toxicity that happens to have an anti-neoplastic effect (fancy way of saying it kills neoplasms a.k.a. tumors), though it's unclear why it works. It's given before the first immunotherapy drug, then again before the second drug is started, followed by a final round after Ipi-Nivo (the nickname for the combo of drugs).

Once Shane was set-up on the Taurolidine, we finally met Dr. Kleef in the flesh (until now only on video). He was dressed in old school tennis whites (white from head to toe is his signature), with a leonine head of white-gray hair. He's handsome, fifties, with smooth skin, slender and fit. He walked in, shook my hand, bowed and then shook Shane's hand. He immediately asked Shane (who was lying on the bed) to move his legs over so he could sit beside him. (Side note: He is the first doctor to palpate Shane's belly and listen to his heart and lungs) As we were speaking he put his hand on Shane's arm and then over his liver (I swear it felt like he was sending healing energy). He was real ("You've had a narrow escape." Shane remembers it as "You've had a close call." --- boy, do I wish I had my recording app running). He also mentioned, "This is very serious." And later, "We're going to need a small miracle." He reminded us that cancer is not Shane's fault, he commented on Shane's excellent health in spite of the melanoma (anyone else amazed that Shane's liver is functioning at normal capacity, the doctor in CA said he had an athletic heart, and everything is in good working order?). And he reminded us that it's an advantage to start treatment in such a healthy state. Shane and I cried, moved by his kindness and straight talk. We both feel happy/peaceful/relieved that we are here. Dr. Kleef mentioned that he and his wife pray for their patients, and he even made us laugh several times (he's got a very dry sense of humor). His dogs run around behind the house, and one even ran into our room (made me chuckle). Right now the porch door is slightly ajar, and it's serene---foliage, birds, the occasional church bell. Shane commented that it feels more like a hotel than a clinic.

Once we settled, Julia asked if we wanted anything to eat. Shane decided on an avocado and ham sandwich and I chose the same. She made the sandwiches herself (on fresh, toasted bread) and delivered them on a breakfast-in-bed type tray (have I mentioned that the bread in Europe is out of this world?). Just another lovely part of the day.

Now the technical stuff. Immunotherapy drug Ipilimumab ("Ipi" for short, brand name Yervoy) has been administered, and now Nivolumab ("Nivo" for short, brand name Opdivo) is flowing via IV. Each drug takes approximately an hour to be dripped in. In the course of this first treatment Shane has already napped, spoken with the kids, had a video call with his mom, and listened to Les Mis. Currently, he's curled up enjoying a soccer documentary about Cristiano Ronaldo.

One piece of good news from today, Dr. Kleef said that Shane's LDH (lactic acid level---the higher the level, the harder those cancer cells are working and the more lactic acid they are producing, so you want a lower number) has dropped significantly from 2500 to 1600. We have now idea why that is, but Dr. Kleef takes it as a positive sign. So do we.

P.S. The way they speak here is so darn endearing. When Shane's port needed to be flushed several times, Julia said, "Your port is a little lazy...if you don't me saying." And when we thanked her for the sandwich instead of, "I'm so glad," she responded with,"I'm happy."

P.P.S. Dr Kleef looooves his pups. He asked us if the dogs yips outside were bothering us (we didn't notice). When we replied "no," he quipped, "Life without dogs is possible but it's unthinkable."

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