Tuesday, December 30, 2008

What's Up With the Doc 33? - I'm Back

I'm baaaaack!

On the cancer front, I had my first Alimta treatment yesterday. My oncologist and I decided to just go with single agent Alimta and see what happens. That's how it's approved for second (really third line, in my case) treatment. Today I have a wee headache and I'm the slightest bit queasy. I'm back at work after my Christmas trip (more on that later). The pharyngitis/esophagitis from the radiation therapy is finally acting like it might eventually go away. Up until the end of last week I was requiring 800 mg of Ibuprofen every 8 hours, 10 mg of oxycodone at bedtime and another 5 when I awoke in pain in the middle of the night. Now I'm down to 400 mg of Ibuprofen every 8 hours, which is good, since Ibuprofen can increase absorption of Alimta. It still hurts to swallow but it's down to about a 6 from the worst when it hurt all the time and was probably a 9 with swallowing. My neck and back pain are gone or at least completely managed with moderate doses of Ibuprofen. Next scan is I don't know when as long as I tolerate the Alimta and feel OK. My oncologist doesn't want to rush into treatment decisions at this point, since there aren't any FDA approved treatments after third line so we want to give the Alimta the best possible chance to work.

After refusing to travel over Christmas since my oldest child was born (23 years) we were blessed with excellent air travel luck both on the 24th and 28th. No missed connections, no long delays. We got to Albuquerque early in the afternoon on Christmas Eve where we joined my brother and his wife, my sister and her SO (at her house), Lindsay and her husband and Emma for food and egg nog and good cheer. We spent the night at a bed and breakfast and went back to her house on Christmas morning for presents. Then we went back to the B&B where my SIL made a wonderful breakfast for us and then my kids all headed for Santa Fe to their dad and his family. I took a nap and then we headed back over to my sister's house where we had Christmas prime rib with my sister and her SO, my brother and SIL, my mother and stepfather, SIL's son and fiance and sister's SO's father and sister. It was heavenly (even though it hurt like hell to swallow - taste wasn't affected). Friday we pretty much just hung out and gabbed and then we headed to Santa Fe for my mother's 75th birthday dinner. The margaritas were awesome! I had a blue one called the Turquoise Trail as well as one of their 100% agave specials. The red chile was wonderful. The entire restaurant sang to my mother and we enjoyed 2 of my childhood friends and one of my sister's who were all kind of adopted by my mother. My kids came back to Albuquerque with us after the restaurant and we went to see Marley and Me. Saturday we had breakfast and then just hung out with the family. We ordered BBQ in for dinner. Sunday we got up bright and early and headed for the airport and made it home before too late Sunday night.

Now I guess I'm not supposed to challenge the Christmas travel gods for another 20 years.

Overall I'm feeling about 75% but still at work. Volleyball travel starts in 2 1/2 weeks.

Happiness in the New Year to all.


Friday, December 12, 2008

What's Up With the Doc 32? - A Better Week

Let’s just say I have become a big believer in radiation therapy. The fellow I saw before my first treatment last Tuesday told me it would be a couple of weeks before I could expect relief. In fact, every day has been a little better except for Monday when I missed a treatment because the machine was broken. I have been taking maximal doses of Ibuprofen and narcotic pain medication to sleep at night. Last night I made it without the narcotic. It's still at least 50% better than it was a week ago. What a relief. Pain makes it so much more difficult to deal with every other little thing in life.

The other thing to be dealing with right now is what’s next. I think I will probably be starting third line treatment with Alimta when I get back from my holiday trip to New Mexico at the end of December. My oncologist would like to combine that with Avastin but the insurance company has so far denied the combination. I’ve filed an appeal and we’ll see where it goes. My understanding about Alimta is that I should tolerate it pretty well and should be able to continue to work and live my life if I was able to do so on my previous chemotherapy regimen. It will feel good to be doing something to fight the cancer again.

I finish radiation therapy next week, work for a couple of days and then head to New Mexico with my family for Christmas. I am over the moon about this. I graduated from high school in New Mexico and did my residency there but moved away in 1989. It is where my heart, my sister and my best friend are. My family will all be there and my mother enjoys a big milestone birthday on the 26th for which we will all gather at our favorite restaurant in Santa Fe and celebrate the great woman that she is. There couldn’t be any better way in my mind to finish out this rotten year than with my family in the high desert

Thursday, December 4, 2008

What's Up With the Doc 31? - Overwhelmed and Disappointed but Not Dead Yet

Remember in September when my neck started hurting and I had the MRI scans of my cervical and thoracic spines and there was a metastatic lesion in my C5 verterbral body but I said that was too high to account for my pain and so I was attributing it to the degenerative disc disease and disc herniations seen at the C5-6 and C6-7 levels? Well, I was wrong. (Make sure you cut and paste that into some permanent file for posterity, Sweetie Pie, I know you don't hear it nearly enough from me.) It's been getting worse and worse. I've been treating with Ibuprofen, heat, ice, exercises and trips to my friendly onsite physical therapist and it really seemed to localize in one really sore spot on my right shoulder blade, a "trigger point" for those in the industry. A week ago I experienced a return of the right sided midback pain that was what led to the diagnosis of my cancer in the first place. Tuesday morning I went for my first acupuncture session and Tuesday afternoon I saw my oncologist. By this time the neck pain was such a problem that I needed help changing positions and haven't had a decent night's sleep in weeks. He suggested we go ahead and scan again, I said no, that I'd stick with our plans to stay on Tarceva, scan the 16th and reevaluate then. But by the time I went to bed Tuesday night that "trigger point" was pretty much gone (I've always been a believer in acupuncture in the abstract - now it's concrete.) But that let the central neck pain declare itself in full force and by the time the alarm went off Wednesday morning I had decided to proceed with scans ASAP and look into radiation therapy for pain control if that C5 lesion was growing.

My hospital was amazingly accommodating - they added me onto the schedule yesterday morning and called all over the place to get my lab results from the day before so they could give me the contrast dye. After they deaccessed my port and I got dressed the reading radiologist invited me into his office to go over the scans. The C5 lesion is definitely larger and has broken through all kinds of cortical plates since September, there is a new C4 lesion, the T11 lesion is larger (accounting for the recurrent midback pain), the liver lesion is slightly larger and the adrenal lesion is definitely larger. Pretty definitive evidence that the Tarceva is not working, which is not so great, since that's one of the few things I was pinning hopes for odds beating on after I didn't get a complete response on Carbo/Taxol/Avastin.

Even more impressive than the whole faster than fast getting the scan done and read, I was in the radiation oncologist's office at 2:00 pm yesterday and had my first treatment to the cervical and thoracic spine lesions at 4:20. I had to negotiate a bit to run back over and take care of my afternoon patients after they did the simulation and were setting the machine up to treat me but I, of course, won out. There will be 10 treatments on consecutive business days. I'm back on steroids to prevent problems from swelling in response to the radiation. They said upwards of 70% of patients get very significant if not total pain releif from the radiation therapy and it usually occurs at about two weeks. Meanwhile I'm all about Ibuprofen during the day and oxycodone at night.


Overwhelmed by the neck pain. I've been fighting with this since September and it beat me yesterday. Now that I am no longer in denial about its source and on treatment that is likely to give me significant relief I can hold the overwhelms at bay and deal with it for a couple more weeks.

Disappointed that the Tarceva gave me no benefit.

But definitely not dead yet. My oncologist will be mulling next steps and we'll move on to the next chemotherapy regimen after the radiation treatments are done. I had to cancel my two day CME trip to Boston today and tomorrow but that means I have the next five days without clinical responsibilities where I can pretty much do whatever my body feels like doing. I should get enough relief from the radiation therapy to be able to enjoy the NM trip to the fullest (including egg nog and margaritas if I time the whole chemo thing properly). I still have a low tumor burden, still have an excellent performance status, and don't feel like I'm on borrowed time yet.

That's what's up with the doc this week. You can all look forward to the radiation therapy monologues as I experience yet another piece of the cancer patient pie firsthand.

Lots of love,