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Dr. Phil Metzger @DrPhiltill
, 17 tweets, 5 min read Read on Twitter
Today it begins. Gigi and I are at the cancer center for her 1st chemotherapy treatment. It will take 8 hours, but the entire process takes 10 or 11 hours with lab work and consultations. Two days ago she had surgery to put a port under her skin for the frequent needles. /1
2/ Yesterday met with a surgeon about the multiple required surgeries. It is happening so quickly, it hasn't felt real. Gigi says the same.

But now it is real. She just finished lab work and we walked to the chemo center. Gigi was taken to the room. They'll call me, shortly.
3/ But Gigi is VERY encouraged. Running that marathon was vital. I dont think I mentioned it before, but Gigi got FIRST PLACE for her age group! She was worried she couldn't even finish. Her only goal was to finish, but she got first place. 🙏 (I need an emoji smiling with tears)
4/ Now I'm crying. We are in "the room" and that's "the machine" that is going to pump poison into my dear wife, my love...poison she needs to kick the cancer's butt.
5/ The instructions they give us are too complicated...chemicals Gigi must self-administer over the coming days..if this then that, and if that then this. It's bewildering. Too bad I don't have a PhD in science to help me keep it straight...except I DO have a PhD in science! 🙉
6/ 3:30 p.m. Thankfully it has been a long, boring day so far. The "bad" drug is next, the one where Gigi needs to keep ice packs on her hands and feet to reduce the risk of permanent nerve damage, the one that causes severe nausea and makes the hair fall out.
7/ (From yesterday - untweeted until now because I fell hard asleep!) We made it home from the cancer center. Here is Gigi with the ice-filled mittens & booties to help prevent permanent nerve damage in her extremities from chemo drug. She says she's kick-boxing the cancer.
8/ One chemo treatment done and 5 to go. Now some math. She has three small tumors 0.3, 0.4, and 0.7 cm in diameter. Cancer cells are about 20 microns in diameter. (I don't know about this kind of cancer in particular; this is just rough math)...
9/ So assuming they are spheres, the volume of the three tumors is 55 million times the volume of a cancer cell. That means she had about 55 million cancer cells. Chemo only kills the ones that are in the process of dividing (cell mitosis, a cell splitting into two cells).
10/ That is why multiple treatments are needed. Some happen to not be dividing during a treatment so they survive. Another treatment later can kill them, except again there are some that are not dividing so they survive, and so on. How many treatments are needed to kill them all?
11/ In between treatments the surviving cells divide & become more numerous again, so you have you do the treatments close enough together to make progress, but not so close that your body can't handle the poison. It amazes me that Gigi only needs 6 treatments to kill them all.
They say there will be less than 10% chance of recurrence after just 6 treatments. So we can do simple math to estimate how many cells are killed in each chemo treatment. I know it is far more complicated than this. This is a simple physicist's model to get a rough idea.
13/ So 55 million cancer cells times "X" (the fraction that survive) times X again and again 6 times is written (55 million)×X^6 = 10%, the chance of a single cell surviving. Solving for X we find that X= 3.5%. Thus 96.5% of the cancer cells are eliminated in each round of chemo.
14/ If we assume the cells all divided 2 times in the period between sessions, that means 3.5%÷2÷2 actually survived immediately after a chemo treatment, or about 1%. I looked in the medical literature and it is reasonable for about 99% to be killed, at least for some cancers.
15/ That astounded me. I had no idea that as many as 99% of her cancer can be killed in one treatment. So today she probably has only about 550,000 surviving cancer cells, down 99% from yesterday (if this overly simplistic model is in the right order of magnitude).
16/ We are blessed that the drugs are so effective attacking this type of cancer. It is amazing that medical research has made such progress. The oncology nurses told us that within the span of their careers the entire field has been revolutionized. And the progress continues.
17/17 And the rate of progress is increasing, too. This reminds me again of the value of scientific research, in all branches of science. More to come...
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