Fever

I've been running a low grade fever since Tuesday night. My nose runs constantly (but that could be due to the Avastin, which causes nose bleeds, and there is usually a little blood on my tissue). My temperature hovers around 99 degrees Fahrenheit, and has gone up to 100.5, the point at which I am supposed to call the doctor.

By the time I spoke to Nurse Jacque yesterday (when my temp hit 100.5 during the morning), it had already gone down more than a degree. She told me to take my temperature regularly, and if it should peak to 100.5 or higher and stay there for a couple of hours, I should call her. A steady temperature of 100.5 or higher is likely a sign of infection, and might occasion a hospital stay.

I think I probably picked up something while at Folklife. Two of the Dunavites are sick as well, but of course for me it's more serious than a spring cold. Being exposed to others, like walking in a crowd, puts me at a greater risk for catching something than the average person. But I went to Folklife because it was so important to me to sing with Dunava. I tried not to get too close to people, and if I picked up something, I hope I can manage it at home.

Meanwhile I am taking my temperature every hour or so.....

Back to that "new normal"

I actually felt so well on Tuesday that I was able to drive the car; attend a morning meeting and be focused and present for the discussion; run an errand to the dry cleaner and go grocery shopping. That represents a HUGE improvement over the past ten days, when I could barely move my sorry ass off the couch, and needed rides to everything. The shingles are showing a good response to the treatment, but their presence will prevent me from modeling at the Gilda's Club fashion show on Friday. It's too bad, but always better to protect the health of the other models who have compromised immune systems. The third time was not the charm, I'm afraid.

Still no word on whether the chemo combo is doing anything for the cancer. I anticipate getting my tumor markers checked again, maybe as soon as next Monday.

I was truly tired after all the running around yesterday, and noticed that my feet hurt. Not just hurt like I was tired of standing, but numb and tingly all around my toes on each foot. I think this is more neuropathy from the chemo combo. I reported it to Dr G's nurse and was told I could increase the gabapentin up to 900 mg three times a day, which is quite a bit more than I am taking now. It should help with the neuropathy pain.

I also ran some errands today. Went to Dr G's office for a shot of Neulasta to build my white blood cells, then drove north to exchange a pair of shoes (size 8.5 bought at Northgate Mall) to the size 8 (only at Alderwood Mall). I was fine with all that highway driving too.

My nose is a little runny, with a tendency to bleed (that's the Avastin), I am constipated (from the gabapentin), and I've run a very low grade fever of 99.2 degrees for the past the nights. I may be coming down with a something, and so plan to take it easy tomorrow and just go to my support group. They need to hear Jill's great shingles story.

Pain relief

I finally got adequate pain relief today. While waiting to get Avastin and Abraxane, the current chemo combo, I spoke on the telephone with Dr G. He decided to treat me with Lidoderm (lidocaine trasndermal5% topical patches. These are patches that distribute medication directly through your skin. The fentanyl patches are similar.

The wonderful pharmacist at the Cancer Institute, Lanny (I don't know how to spell his name), walked over to deliver the box of 30 patches to me. Our insurance coverage through Premera charged only $20 for this medication. I put one on in the middle of treatment at Dr G's request to see how well it might work while I was still in the chemo chair. Evidently the Lidoderm works extremely well, because Rik and I had a busy afternoon.

We went to the new Skillet Diner for lunch. It was not as good as I had hoped. My hamburger, ordered medium with a specific request for pink on the inside, not red, arrived overcooked and dry. There are few chances to eat poutine in Seattle, and I always jump at the chance (and am usually disappointed). Poutine is three things: fried potatoes, gravy and fresh squeaky cheese curds. The fries were terrific! The gravy, made with chicken stock, had plenty of herbs. But given that the local Beecher's makes really good cheese curds, I was disappointed to find melted cheddar cheese on Skillet's poutine. Maybe they think Seattleites don't know or care about authentic poutine?

Here's a shot of my poutine.
At least it came as a side to the burger and so wasn't an enormous helping.

After lunch, we picked up some bagels at Eltana. A tragedy was averted just in time -- we had run out of bagels this morning!

Nordstrom was having their half-yearly sale for women, and I really wanted to stop by while I had Rik to drive me. I did find a cute pair of black flats at a really good price. They might be a half-size too big, though, and I'd have to go to Alderwood Mall to find the smaller size. I will wait and see. Of course, while we were at the mall, I shlepped Rik into Macy's where there was also a sale, and I picked up a summer belt patterned in small squares of colors and a new purse, again in multiple colors patchworked together. It was a lot of shopping, but Rik was gracious about taking me, and I found such lovely things at good prices. Rik is the one who found the purse, and it is truly a keeper!

We came home and I watered the garden (we had two days of sunshine in a row!) while Rik mowed the lawn. Then I made us dinner of spinach and mushroom enchiladas suizas, rice and sliced fresh mango.

It's now after 9 PM and I am done for the night. I just took off the 12 mcg Fentanyl patch (it had been on for 72 hours) and removed today's Lidoderm patches. It hurt to remove them!, but we will see if I maintain good pain control overnight with the bedtime doses of valacyclovir and gabapentin. I will report to Dr G that I removed the small dose Fentanyl patch.

It felt totally terrific to be this busy for the first time in a week. I haven't cooked a meal in more than five days, ran an errand or driven the car in more than a week, or even been off the sofa this much in ten days. I know I may have overdone things (that's the trouble with pain patches, you feel good so you don't realize you do still have pain and it's easy to do too much). I may pay the price tomorrow, but there is only one item on my agenda, and I can do it from home if need be.

Time for a good night's sleep!

Abraxane 2/ Avastin 2

Yesterday was another six-hour-long day at the Cancer Institute. One of the doctors was back from a week's vacation and so the lab was hugely busy, even at 9:30 in the morning. After waiting more than an hour, I finally had my port accessed and labs drawn. More than an hour after that, I was called back to the infusion chair, where eventually the nurse confirmed with Dr G that my counts, although a smidge low, still permitted me to receive treatment.

My friend G had been visiting with me until this point, and then another friend came by. We shmoozed while waiting for the pharmacy to prepare my drugs. I ordered us some luch from Mediterranean Kitchen, which J was happy to pick up.

I started the Avastin infusion around 1 PM, and it ended around 2:15 PM. (Next time the Avastin will shorten to only 30 minutes, which is where it will stay.) Then we changed over to the Abraxane (the actual chemo), which only takes 30 minutes. I was unbuckled from the chair around 3:15 and went home to crash.

I slept for three hours on the sofa, at which point I decided to just get into bed. I thought this cocktail was being given with Decadron (a steroid) AND Zofran (an anti-nausea drug), but evidently I didn't get the Zofran the first time, and there were no orders for it this time. So I toughed it out, but I was nauseous by 6 PM. I took some of the oral Zofran I have at home, and will be sure to ask Dr G today about including it in future orders.

I got up again at 9:30 and ate a piece of pizza and drank some water, then went back to bed. I was really woozy walking around the house last night, which was likely due to all the drugs floating in my bloodstream. I experienced a little abdominal pain, which is associated with the Avastin, but nothing else.

I slept until 7:45 this morning and feel better today. I took the dog for a walk and am about to head off to see Dr G and get last week's the brain MRI results. Will post more when I have info.

Still tired and stupid

I think I may have figured out the tired and stupid feelings. The day before I started the Avastin/Abraxane combo, I also stopped taking my antidepressant. I'd decided to taper down after being on sertraline since last July. It took about six weeks but I finally had the last dose last Saturday. A friend warned me that going from 12.5 mg to 0 mg would be harder than going from 25 mg to 12.5 mg, and boy was she right! So it's possible that my fatigue, insomnia, and feeling stupid is more related to stopping the sertraline than to starting the new chemo combo.

At any rate, having three evening activities in a row this week didn't help either. Somehow I got through everything (still feeling stupid) and plan to do practically nothing today. I will forego yoga so that I don't have to drive while feeling this way. Plus that will allow me to take a nap. I hear the sofa calling now!

Is this chemo combo making me stupid?

Okay, maybe I've overdone it the past few days. I had evening activities Tuesday and Wednesday (and more on Thursday and Friday). I'm trying to live my life -- stay connected, run errands, meet a friend for lunch. But I feel as though this Abraxane/Avastin combo makes me both stupid and tired, as though I am running at 50% of normal.

Stupidity

At last night's meeting I had some trouble making coherent sentences. My typing has been a little incoherent, so I've had to redo most of my computer interactions. At rehearsal tonight, I had difficulty concentrating on song words, even for the songs I know by heart.

Fatigue

It seems like I am tired all the time. Not necessarily sleepy at bedtime, but constantly run down. Last night I was so tired I stumbled around the house, trying to get ready for bed, but I couldn't fall asleep. (And then I had massive foot cramps every hour, all night long. Okay, maybe lack of sleep is affecting me too.) I hit a wall this afternoon at 3 PM and fell sound asleep on the sofa.

And Monday's was only the first dose of this chemo combo.

Abraxane + Avastin

Yesterday was a long day at the Cancer Institute. We arrived at 9 AM and after a short wait, the charge nurse told us that this very day was the first business day Swedish starting using a new consent form. So we walked over to Dr G's office (avoiding most of the pouring rain by going through the hospital walkway).


Dr G explained about the new form, we both signed it, and then he showed me the Swedish Ca Inst's usual protocol for Abraxane , which included Avastin. I'd never had Avastin, and although there has been recent speculation about its effectiveness against metastatic breast cancer, Dr G wanted me to try it. We trudged back to the Ca Inst, signed form in hand.


About Avastin: because it was studied with other chemos and never on its own, the side effects are those related to chemo (generalized weakness, pain, abdominal pain, nausea & vomiting, poor appetite, constipation, upper respiratory infection, low white blood cell count, kidney problems, bleeding problems), diarrhea, hair loss, mouth sores, headache). We'll see which ones I may get.


Because of the last minute change to include Avastin, I had to have some additional tests to check my creatinine level via blood work, take a urine sample as well. I passed all the tests, but meanwhile had to wait for the results. Then it turns out that when these two drugs were studied together, the Avastin was always given first. Since I gave the urine sample more than an hour after the blood, more waiting. We had a friend to visit with, so it wasn't so bad, but still... Dr G did not choose one of the boxes on the Avastin quantity, so the nurse had to make another call to him to determine the dose.


At 1215 PM, Rik and J went to get us some lunch. I had just taken my first bite of Mediterranean Kitchen's farmer's wings (the BEST!) when the nurses showed up to start the Avastin. I had a 4 mg dose of the steroid Decadron as a premedication. The Avastin was given this first time over 90 minutes. It finished around 230 PM with no poor side effects. Our friend J said goodbye after spending a chatty and very garlicky three hours with us.


Next I asked about the IV Zofran anti-nausea med, which it turns out Dr G had not ordered, so the nurse had to call him again. I got the Zofran, had to wait another 20 minutes for it to provide protection, and finally got the Abraxane. Thirty minutes later, we were able to leave. All in all, I spent almost 8 hours in that chemo chair and had a backache you would not believe. Thank goodness we had my iPhone and Swedish's WIFI as well as books and company!


On the way home I simply had to have ice cream, so a quick stop at Molly Moon for some ginger ice cream with hot fudge put me in a better mood. We came home, I quickly fed the dog, checked email, got into my pajamas and was asleep by 6 PM. Rik walked the dog and stayed up a while longer, but he too was asleep by 930 PM.


I woke up today feeling more energetic, with no ache in my ribs at all, even after some hard sneezes. Now it's time to walk Bob and get on with my day. I've already showered, eaten breakfast, re-ordered new prescriptions, checked email, and blogged here. More news later.