New chemo

Navelbine, the current chemo I've been on for the past six weeks, isn't working. Yesterday's blood work shows my tumor marker continued to grow. Dr G has decided to have another scan and change to another chemo.

I will get a CT scan of my chest, abdomen and pelvis next week and then likely start Gemzar (gemcitabine) weekly. It's supposed to be as well-tolerated as Navelbine and appears to have similar side effects. such as flu-like symptoms(muscle pain, fever, headache, chills, fatigue); fever (within 6-12 hours of first dose); fatigue; nausea (mild); vomiting; poor appetite, low blood counts and the rather odd side effect of skin rash.

The increase in tumor markers comes as no surprise to me. I'm frustrated that none of these four chemos (Abraxane, Doxil, Adriamycin and Navelbine) have had much impact on my cancer. Well, we don't really know about the Abraxane, because Dr G took me off it after a scan revealed liver mets that we didn't realize existed. Going back on Abraxane remains an option.

Evidently there is another patient with the same disease progression as mine, who has responded well to Gemzar. So I'm hopeful that this one will do the trick -- highly effective, manageable, with minimal side effects.

Meanwhile you can think of me as the Energizer bunny of chemotherapy. I just keep plugging along!

Neuropathy

Peripheral neuropathy is one of the side effects associated with certain chemotherapies. The toes and fingers feel numb or tingle. I think I'm getting this after two rounds of Navelbine. The tips of my toes feel numb. Other symptoms I'm experiencing include constipation and cramping in my feet.

I plan to report all of these symptoms to Dr G when I see him later this week. Hopefully the neuropathy will remain minimal and then disappear after I discontinue the Navelbine.

Yet one more thing to deal with in CancerLand.....

Counts down

My blood counts were again slightly down after last week's dose of Navelbine, so on Tuesday I had a shot of Neulasta to bring up my white cell count. So far I continue to have a fair amount of energy. Today I walked Bobka the dog for almost the full two mile long walk (cut short by only two blocks). Not to mention the afternoon's jaunt along West Seattle Junction. And tonight's synagogue meeting and choir rehearsal.

This week I have yet to experience side effects from either the chemo or the Neulasta. The word remains out on how effective this chemo is; more on that next week. Please continue to keep your collective "fingers" crossed for highly effective, very tolerable and minimal side effects.

Navelbine #4

I had my fourth dose of Navelbine today (the second dose in the second round). My friend R visited the whole time and because things took a bit longer, we had a lovely catch-up with each other.

I felt fine enough afterwards to go to the grocery store, come home and start a pot of lentil soup before I crashed and took a nap.

Dr G wants me to get Neulasta tomorrow since my white blood cell counts and hematocit were a bit down. That will mean four trips to Capitol Hill this week, three of them for cancer-related reasons. Thankfully this chemo has so far been remarkably tolerable, with minimal side effects, and allows me to drive and generally live a normal life. The jury is out on how effective it will be but I am still hopeful that it will kick some serious cancer butt. I get my next tumor marker drawn next week.

Sunshine on my shoulder makes me happy

It's a beautiful sunny day in Seattle (which also means it's cold out, but hey, sun is worth colder temperatures). I ran around a lot yesterday and really crashed for a two hour nap in the afternoon, then of course found it hard to get to sleep at night. Today I am planning to take it easier, only one appointment and rehearsal tonight.

I felt strong enough to take Bobka the dogka on the long walk, which is about two miles and includes a couple of hills. He really enjoyed himself. I listened to the new Dunava music I'm supposed to be learning, sang along unless I became short of breath, and went slowly. I was able to do the whole thing, but maybe pushed myself too hard on the last block. I am trying to stay in shape during the Navelbine, and this daily, longer walk is the best exercise I get. On a sunny day I don't mind trying harder.

This afternoon I will see the naturopath and find out what he recommends to keep me strong.

Navelbine Round 2

I am just back from getting my second dose of Navelbine. I'm a bit tired, so plan to take a nap, but otherwise feel fine. I also got Zometa, the bone strengthener, today, so I spent a little longer at the Cancer Institute but had lots of good company.

Now it's time to snooze!

The latest

I just realized I haven't posted in a few days. I've been well, just busy. Here's the skinny:

On Friday I woke up with some back pain, so didn't go to yoga. We enjoyed a great Shabbat dinner with friends. I went to bed with a slightly queasy tummy, perhaps related to the second dose of Navelbine.

By Saturday my back was much better so I went to shul. I felt a bit faint in the morning but fresh air helped. After a two-hour afternoon nap, we got a last minute dinner invitation from friends. Even though I wasn't hungry, it sure beat cooking! And I have to eat, to keep my weight stable while on chemo, especially if I have little appetite.

Friends joined us for Sunday brunch (Eltana bagels, lox and cream cheese; artichoke-mushroom-cheese strata; coffee and OJ and delicious fruit tarts from a small bakery in Bellevue). We shmoozed our way into the afternoon, and then I pooped out.

I was late to my Monday morning meeting. Still feeling tired, I also had my blood drawn in preparation for today's appointment with Dr G.

Today it was even harder to get started. My usual 30 minute walk with the dog took 40 minutes and I was out of breath going up hill. When I saw Dr G, he told me that the Navelbine's effectiveness is unclear: my tumor markers had continued to rise. But still, it's much too soon to make any treatment changes. I will continue onto the second cycle of Navelbine, with two doses one week apart and then a week off. Then I'll have another blood test to check my tumor markers and we will re-evaluate.

In the meanwhile, I am slightly anemic. That would explain my fatigue and shortness of breath. It's either from the Navelbine or from the Neulasta shot I had last week. I plan to increase my consumption of iron-rich foods such as spinach, red meat, dried fruit, etc. I also see the naturopath next week and he may have other recommendations.

I am still hoping for this treatment to be highly effective, well-tolerated and with minimal side effects.

Navelbine #2, day 2

Things took a little longer than expected yesterday. Due to the MLK holiday, there was very little parking in on the street and we drove around a while looking for a spot. My appointment was later in the morning, and so the lab and the Cancer Institute in general were busier. Still, the lab finished my blood work in relatively quick time, and I was sitting in the chemo chair only a half-hour later than my appointment. Then the pharmacy never got the fax from the lab, indicating that they should make up my drug. The nurse realized something was wrong and 45 minutes later, I was getting the Navelbine. By the time I was finished, many of the nurses were extremely busy with other patients, so I had to wait. All in all, we left the Cancer Institute at 1:45 PM and went straight to get some lunch at Mediterranean Kitchen. Then we ran one errand downtown.

It was almost 4 PM by the time we got home, and I collapsed on the sofa for a nice, two hour-plus nap. It was a good thing Rik and I had both eaten that big, late lunch, because I didn't really want any dinner. We relaxed for the rest of the evening and I woke up this morning feeling fine. My cold feels almost over!

I'll be off to the Cancer Institute today for a shot of Neulasta, a drug that will keep my white blood cell count up. Although my counts weren't especially low yesterday (right on the border for normal), Dr G doesn't want to take any chances that this second dose of Navelbine will drop the counts further.

Next week is the week off, so no chemo then. Here's hoping for highly effective, well-tolerated and with minimal side effects.

Navelbine + 1 week

It's been a week since my first dose of Navelbine and so far, excellent. I had only one side effect for a couple of day (constipation) and prune juice took care of that nicely.

However, I came down with a cold on Tuesday, and by Thursday it was at its worst. I spent much of that day napping, making chicken soup, and then eating the soup. Feeling better on Friday, I went to yoga, and then felt fatigued again. (More soup.) I went to shul on Saturday, relaxed for the rest of the day, but didn't sleep well. (Soup again.)

Our No-Knead Bread

This morning I was so pooped from walking the dog that I desperately needed a nap. After an hour's sleep, I felt refreshed and energetic enough to visit with a friend, make some no-knead bread, and post to my blog.

I'm assuming that my fatigue has been related to the cold, as well as the runny nose and coughing. Tomorrow's lab work will let me know if my counts are low; that could also contribute to feeling fatigued. The real reason I think this is the cold and not the chemo is that Rik has been sick also, with the same symptoms. Hopefully we are both well on the road to recovery!

Navelbine - the day after

So far, so good: The Navelbine hasn't yet affected me in any way. Although I went to bed and woke up with a scratchy throat and a cough (most likely due to a cold - Rik feels the same way), I had my usual amount of energy today.

Since it was dry this morning, I took Bobka the dog on the long walk. I went to a support group in the early afternoon and to a meeting at the synagogue later. I'm planning to make spaghetti with meat sauce and sauteed eggplant for dinner, maybe some garlic bread on the side. And on Tuesdays we watch NCIS, so it will be "date night" with Mark Harmon, Pauley Perrette, Sean Murray and Cote de Pablo in our household tonight.

Here's hoping for a similar high energy, low side effect day tomorrow, and tomorrow, and tomorrow....ad infinitum. Plus high effectiveness, of course!

Navelbine #1

We got up extra early today in order to be at the Swedish Cancer Institute by 8:30 AM. The car was frosted over but thankfully the doors hadn't frozen shut overnight. A few snowflakes fluttered around but nothing stuck.

Things went very smoothly. Charge nurse Linda handed me my lab orders not five minutes after we arrived. There was no waiting at the lab. It took only 30 minutes or so to get my results and then I was sitting in the chemo chair, getting hooked up to some saline.

Dt G had not written orders for an anti-emetic (anti-nausea) drug to be given with the Navelbine. The chemo nurse wanted to confirm this was correct, so we waited a few minutes for his answer. Of course, I have plenty of medication at home if I get a queasy tummy at any point.

After getting saline for 30 minutes, the nurse sat with me for the six minute Navelbine "push" -- injecting the chemo straight into the IV line by hand, instead of infusing it with saline over a longer period of time. I got 30 more minutes of saline and we were done -- just in time to want a second breakfast at Eltana's.

In by 8:30 AM; out by 10:45 -- now that's the kind of efficiency I like!

We came home and had a cup of tea, then I took a four hour nap. Well, I don't particularly feel as though I slept heavily, but I sure was comfortable wrapped in a blanket and with the dog on my feet, so I didn't want to move.

I've been warned to expect some constipation as a side effect of the Navelbine, and to report to Dr G any numbness or tingling in my fingers or toes (the beginnings of peripheral neuropathy). I did not have this common side effect with Abraxane, so perhaps it will pass me by again. And there is plenty of prune juice, senna and Smooth Move tea in our kitchen!

Positive word about Navelbine

An online friend told me that she was on Navelbine together with Avastin for about a year and a half with great results and almost no side effects. The Navelbine and Avastin stopped the cancer in its tracks and got her to stable disease. She found it to be very tolerable, the easiest regimen of any she'd been on.


Dr G has never mentioned my taking Avastin. You may have heard that recently the FDA removed Avastin as an approved drug for metastatic breast cancer.


I certainly hope to experience some of these same results. Please join me in my chemo mantra: very effective, well-tolerated, with manageable side effects.

PET scan results: more chemo

Today I got the results of last week's PET scan and they were as expected, active cancer in the bones and liver. I'm sad that the Faslodex didn't work, but what can you do? Move on to the next treatment.

Dr G says I will get Navelbine weekly for two weeks, then have one week off. I start next Monday at the Swedish Cancer Institute.

Navelbine is an IV push, not an infusion, but is given with saline, so will take about an hour from start to finish (plus an hour or so waiting for the labs). It's not given with sedatives, so if the first treatment goes well, I should be able to drive myself to and from treatment each time. Rik will accompany me next week for the first treatment.

Navelbine is the chemo recently studied in the Journal of Clinical Oncology that is as effective for metastatic breast cancer and has fewer side effects.

This news is what I expected to hear and I am fine with starting chemo again. As I have said many times, life with mets is a merry-go-round; I move from one treatment to the next and have been doing so for the past eight-plus years. It can be easy to focus on how well I have looked and felt for much of that time, and ignore the fact that chemo is inevitable.

Dr G says he is proud of my ability to cope so well. Better living through chemistry, I say.