Chemo Six and the MRI

This week really began last Friday, May 22, with the taking of two MRI tests, one on the cervical spine and one on the thoracic. I may have mentioned my oncologist is a stickler for detail, and when my left arm pain did not subside, he wanted to see what was going on.

The MRI gave us perhaps more than we bargained for, but I’d still rather know what was happening than not.

On the weekly bloodwork , he ordered the tumor markers be run, to see if there was change. There was, to the good.

The good news after this first six weeks of chemo:

Leane’s most recent blood work (Friday) shows her tumor markers
decreasing. One of them is down from 736 to 690.9 (CA 15-3), and another is down from 1006 to 865.5 (CA 27.29). For a great article on the value of CA 15-3 in the cases of metastatic lobular breast cancer past Stage II please read this.  This marker will track disease regression in cases like mine, so I was pleased it’s value went down.  My lab reports the norms for this value should be0.0 to 31.3 U.ML so there is a way to go!! The CA27.29 Marker, especially when used in conjuntion with CA15.3 and others,

The CA 27.29 test is used to monitor your:

• Response to treatment
• Status of your cancer
• Possibility of early recurrence.

This marker dropped131 points. I was delighted. The oncologist says he’s seen it higher in others, and isn’t scared of the value. That gives me a great deal of confidence, especially in light of the newly found involvement with bone. I have faith in the zometra bone med and calcium to help control this. In fact, I would be satisfied in a few months with “stable disease”. It is very hard with this cancer to assume you know where in the body it all is — so it’s best to assume it is everywhere. By careful monitoring, we hope to get the very best out of the chemo treatments, and I’d like to avoid local treatments and stick to systemic as long as possible in my case.

The bad news — well, not really because we have better knowledge now — came from the MRI where it appears more spine is involved than first thought.

Here’s the report that came back from Leane’s MRI last week, which they
did because she was complaining about pain and loss of muscle mass in her
*left* arm (opposite the cancer side) (thanks to my husband Mark for this part of the report):

Report
15 mL Magnevist

FINDINGS:
There is abnormal signal and enhancement at C5, C6 and C7. While this may
be due to degenerative disease, metastatic disease is not excluded. There
is no pathologic compression fracture. There is C5-6 and C6-7 central
canal stenosis due to disk bulging and posterior osteophytes.
There is no abnormal cord signal, mass or enhancement.
There is a known large right neck base and right apical soft tissue tumor
mass.

IMPRESSION:
C5, C6 and C7 metastases without pathologic compression fracture.
Mild C5-6 and C6-7 central canal stenosis due to degenerative disk disease.

We also ran the thoracic spine — the PET scan had indicated bone cancer in the upper thoracic area. The MRI verified this and specified exactly where.

MR Spine Thoracic w + wo contrast

15mL Magnevist

FINDINGS:

There is abnormal marrow signal/edema and abnormal enhancement at T1, T2, and T3 consisten with metastatic disease. T3 is most severely involved.
No pathologic vertebral compression fracture is seen.
While there is no frank cord compression there is sufficient spinal stenosis at T2 and T3 and to lesser extent T1 and T4 due to right dorsal dural/epidural soft tissue thickening. This measures up to 6.6 mm and may represent dural metastatic disease or extra osseous soft tissue tumor.

(NB: Dural metastatic disease is very rare.  Read about it here. Again, this is a systemic phenomenon. )
There are numerous dorsal subcutaneous nodules and masses consistent with metastases. The largest is at the T12 level measuring the 3.3 x 2.2 x 2.0 cm.
There is a large right pleural effusion.

IMPRESSION:

T1, T2 and T3 metastases. No pathologic compression fracture.

And, although the “large plural effusion” is back, it is not what it was. We are holding on another thorentecitis session for a few more weeks. The right lung is working better and I am not subject to shortness of breath like I was. I suspect natural draining is occuring.

Regular bloodwork shows the wbc to be on the low side but increasing, as are rbc and platlets.  I am adding additonal calcium to compensate for the bone medicine, and will be adding more vitamins.

Chemo Six, which was today, ran very smoothly — just like last week save for the bone meds which are run monthly. I do not have to go back until June 15th, so this will be a good rest, and give my wbc, rbc, and platelets a chance to recoup. They are all slightly down on the low side — the wbc count jumped to 2.5 from 1.06 (normal 3.7 to 11.0) so all the rest and good food has paid off this week.

Chemo Five: Smooth Sailing

Tuesday, May 19th was the fifth chemo treatment. Tagged onto this one was the bone medicine. I’m pleased to report that the chemo session (as described in Chemo Four with the addition of the bone med went very smoothly). Because this past week brought some pain in the left shoulderblade, shoulder, arm, wrist, and hand, I had to have a very  small amount of morphine with the chemo push, since it was done in that hand. This made the whole procedure nearly totally painless, and considering the session administered for nearly four hours, this was a good thing.

The arm pain, muscle wasting, and dimensional changes had been going on for months. This was the first place really that I noticed significant body changes due to the cancer, and according to Harrison’s Principles of Internal Medicine, is not uncommon with cancer (p. 642 , 15th Edition) and since we aren’t sure of the etiology, the oncologist has me scheduled for an MRI of the cervical and upper thoracic area on the 22nd.

Overall, the oncologist and I am pleased with the treatment so far. I am feeling better, eating more, and sleeping better. Nausea and vomiting seem to be under control with the medications he’s prescribed. I did lose a few more pounds, at the morning weigh in I was 149, down from  155 last week. I went over this with him and got more suggestions on how to increase calorie intake. Basically anything goes at this point, and that includes any fast foods I want.  For once I am grateful that when this process started I was holding at 183 (age 60).  And grateful too for the years of bodybuilding, because in spite of the wastage, there is still muscle.

My hair is completely out now and in fact stubble is already growing in. I picked up a few cute knit caps at the Center, courtesy of the Bartlesville Fibre and Knitting Group to keep the pate warm and cozy, and my sister-in-law has a care package on the way, as well as my cousin.

The oncologist points out again that we have a lot of cancer to kill, and I know the disease is widespread in my body, however, I’m not afraid of it. We have numbers for the two biggest tumors, 736 and 1006, and he’ll be checking those once this round of chemo ends. We can see the visible shrinkage at least at the tumor on my right neck axilla area, and many of the areas affected under the skin (like lymph nodes under my arms) have shrunk.  We’re using the PET scan as the major “map”.

At only five weeks in treatment, I am pleased that there have been palliative effects, in spite of the fact that chemo is very rough, and always difficult for each and every patient in some way or another.  It’s always a balancing act with cancer anyway — it translates out as try to do no further harm while trying to ameliorate the harm that’s already done by the disease process itself, especially tumor burden.

Tumor burden isn’t really talked about much, but that is the effect the tumor and it’s presence is having on the patient, the idea being that when it gets to be “too much” (defined in various number scales) the tumor kills the patient.  Most commonly talked about in lung cancers, tumor growth, invasion or obstruction of adjacent structures, growth in regional nodes through lymphatic spread, growth in distant metastatic sites after hematogenous dissemination, and remote effects of tumor products, are all areas the oncologist and patient need to address. In addition, peptide hormone secretion by the tumor, or immunologic cross-reaction between tumor and normal tissue can produce a variety of signs and symptoms. Cancer is a complex disease, and its byproducts and side-effects are numerous and dangerous. This, in part, is why combinations of therapies are used — chemo, radiation, surgery, etc.

In this chemo round, I have session six left next week, and then two weeks “off” in which we might do some repeat tests to check progress. This I am leaving up to the oncologist.

I’m working on increasing my energy levels by Chi Gung and meditation practices, and also more vitamins and food. Those are things I would normally do anyway when sick at this stage of the game.  Some good research papers were found by a friend on the benefits of remaining physically active during cancer. I believe this is a good thing to do, and also it is very important to maintain as stable an attitude as possible toward the disease, which is a long term problem and because of this is hard for most people to reckon with.

I have hopes that the records left in this blog will give some guidance to others who have to deal with advanced cancers, which have their own set of issues. Regardless of the time left to you, no one has imprinted a number on your feet… median prognosis of four to ten months for example, is a statistical measure, and when looking at the individual case, should not be taken as a death sentence. Various studies yeild various numbers but all of it, for the individual, will be dependent on individual factors, such as response to treatment and attitude.

My cousin Carol brought up the case of Farrah Fawcett this week on Facebook, I didn’t know she was suffering from cancer, but apparently has had quite a bit published in the media. I wish her well, she was always a favorite actress, and I hope her message will reach a lot of sufferers.

My message for the week is always remember to rest. Even if it’s just a forced rest, hanging out on a relaxing surface, no sleep involved — rest is important for the cells that have to rebuild. Chemo kills good cells as well as bad ones, so rest and proper nutrition are mainstays for the immune system and should be taken seriously. Keep up your sense of humor too, that helps a lot.

Chemo Four: Turn the Corner

Like someone once told me, it’s all in the mosh-up. Certainly that was true for Tuesday pasts’ Chemo session, Number Four. My white blood cell count had moved up from .666 to 1.08, so Four was a clear “go”.

The Witches Brew for Four included all drugs below save for the bone drug, which I’ll get again at Five.

Saline Drip

The Drugs

Aloxi 250 mcg
Decadron 10 mg
Benadryl 50 mg
Pepcid 20 mg
Ativan (syringe)
Paclitaxel (Taxol)
Carboplatin
Once a month: Zoledronic Acid (Zometa)

Since we found evidence of cancer in breast, lymph, lung and bone, its a safe bet that this protocol covers the mosh-up. These drugs do what they do and they do a good job.  Side affects notwithstanding, for nausea at home here I’ve been prescribed promethazine (mixed in a creme by our pharmacy at the hospital which happens to be a very cool old-timey compounding pharmacy), and Ativan — one of those ultimate does a lot of different thing type pills which happens to work wonders on nausea, at least for me. My appetite is increasing, which is great because sine 3/30 I’ve dropped 25 lbs. and don’t particularly want to drop any more. My sister-in-law dropped 47 during her chemo and she didn’t have it to lose.  The only other side effect this week has been the beginning of hair loss — more is coming out as I brush or if I run my hands through my hair…I have a lot of hair so this could take a week or so.

Amazingly, Chemo 4 was as smooth a treatment as I’ve had yet. Everything dripped in properly, no nausea due to the proximity of the Ativan to the chemo drugs and everything else protected the tissue it was supposed to protect. I’m at the point now where I can actually taste the drugs, and the saline. I’m trying too, to be conscious of what they do when they’re taken into my tissues and short of hallucinating I think I can report proprioceptive sensations, especially with the Benadryl — that is some fine old technology and it does a hell of a job at what its supposed to do.

I guess my favorite of the lot is the Zometa, the bone drug. Its used to prevent complications of cancer that has spread to the bone, and is a bone hardener. It pulls serum calcium out, so I have to take extra — OsCal is doing a good job twice a day. After the first session, in about seven days, I felt stronger — almost like five or ten years ago stronger. I come up for my second session with that drug next week and my poor scapula (both of which have cancerous lesions) and T4 (also affected) are looking forward to it.

In cases like mine, the word “cure” has no meaning, because when a lobulized cancer metastizises like this you don’t know where its at and it can show up years later in places you never dreamed. You perhaps can go “disease-free” as a linguistic symbol, assuming you kill all the cancer cells, but that’s about it. The tumors themselves are sources of new problems, pieces break off and cause embolisms, they put pressure on places they are not supposed to, and there is always the risk of throwing a clot, etc. Chemo, at this point, in spite of the bad rap it gets (it is a rough treatment) actually can make you feel better. And for systemic problems, it’s the only way to go. Surgery really can’t address much here at this point.

It rained like the blazes during the infusion session, but I was comfy in the corner LazyBoy, with my heating pad. There weren’t too many people there yesterday, actually, in comparision to some past weeks. One man came in with what was clearly pretty bad lung cancer although they sent him for a CAT scan, so I’m not sure they were sure. I was sure, after reading and watching for a while, and listening to that signature cough, it’s hard to miss. His GP had given him some Ambien and apparently he wasn’t doing well with it, so it was suggested that he just take an extra half-Xanax before sleep. I was dozing in and out, listening to all of it, just watching him roll his oxygen canister back and forth and argue with his sports bedecked OU wife, who was crying in frustration. The best friend was there too, offering driving and moral support. They sent him off finally to be scanned, and things quieted down, with three of us snoozing in the back corner of the room.  It must be really hard for some families. This is all a very big problem, and unless a cancer is caught early, and I mean really early, there isn’t much our current medical science is prepared to do at this point to take care of it.

Today, I’m a bit tired, as I was yesterday, but feel amazingly well in comparision to the way I felt four weeks ago. While I can do it, I’m going to study the problems and observe what’s done at the Drip Factory here, and see if there’s a way to present some of this information, tying some pieces together. This disease, such as it is, moves into mega-nightmare status the minute “in  situ” ceases to have meaning. We just aren’t prepared to treat a whole invaded body — and the actual cause of death is often a blow-by of something caused by the tumor and not the tumor itself, or in the case of non-tumorous lesions, other problems. At least now we have PETs and MRIs to give us information about where the cancer has gotten to…the CAT didn’t pick up the bone metastises, for example, but both the oncologist and I knew they had to be there because in this type of breast cancer (esp. with the inflamed breast) 41 percent of women have them…and yep he didn’t blink an eyelash when the results came back.

On the good part of all this, the inflamed breast has quieted down, shrunk almost back to normal, has lost a lot of the edema and orangeskin look, and otherwise is better. The neck tumor has shrunk as well to the naked eye, which, after just three weeks, is an accomplishment.

I’m breathing better, although will probably want another thorocentesis session before too much longer, and just hope I can get through sessions five and six without too much drama. We will be taking two weeks off, then doing session seven through twelve.

Chemo Three: Hitting the Wall

Last week’s treatment was punctuated by hitting the wall. After two weeks of  nearly symptom free chemo, I was visited by the ghosts of Christmas past present and future: loss of appetite, nausea, and diarrhea, all of which made Tuesday’s chemo a nightmare. The diarrhea hit right in the middle of the drip, so there was an interruption while the nurses got enough Immodium into me to stop it all up.  The appetite loss was a silent symptom, it took  a sound talk by my husband and several letters from my sister-in-law, who has been through breast cancer (and dropped 47 lbs), to make me realize I had to start to eat.

The oncologist added Calcium to my diet, since the bone hardener caused the serum calcium levels to fall and my hands to draw up like the Creepers, and we got some Ensure courtey of the American Cancer Society, as well as ordering high calorie instant breakfast online.  Several nausea meds have worked well in controlling the urge to throw up, which follows the diarrhea as the night the day.

Somehow session three got finished.

Session four comes up tomorrow, unless my white blood cell count dictates I get an injection. It fell last week as well, making me so tired I could barely turn the page of a book.

If this all sounds incredible, talk to someone you know about the effects of chemo. It sounds unbelieveable you could go from hale and at least semi-hardy to vegetative in just a few days, but believe me, you can. It is after all, something that is being put into you to kill wild cells. Chemo is to be respected, I have decided, and even the process of my hair leaving my scalp (which it is doing in bits this week) is to be treated with kindness. My cousin, who is something else with a needle and thread, has designed for me some nifty scarves for days I don’t want to wear my wig. Each year she does the 20 km Susan Komon run in her town, and this year she’ll be running for me.

While at the Drip Factory last week, too, I talked to a young mother, who had cancer of the cervix and uterus, if I thought I had a reason to be angry about cancer  it was nothing compared to her story.

So life gets relativized somehow in the whole process.