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!
May 06, 2011
May 04, 2011
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.
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.
May 03, 2011
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.
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.
April 29, 2011
Chest xray OK
I got the results of yesterday's chest xray and it was negative -- meaning there was nothing to see via xray. So I am good to go for chemo on Monday, as planned.
My shortness of breath continues to be resolving on its own. I went to yoga today for the first time in several weeks and was able to breath very deeply during the relaxation (my favorite part). Still a little short of breath while walking, but I am walking further every day.
Meanwhile I am cooking up a storm for tonight's guests, an English meal in honor of the royal wedding (and because I've always wanted to have trifle).
Challah (we are Jews, after all)
Cream of cauliflower soup with stilton
"Fish and chips": slow-cooked halibut in olive oil with my dad's recipe for roasted potatoes
Minted green peas
Sour cherry trifle
I had to go to three (!) grocery stores to find a pound cake. Silly me; I should have just baked one last night.
My shortness of breath continues to be resolving on its own. I went to yoga today for the first time in several weeks and was able to breath very deeply during the relaxation (my favorite part). Still a little short of breath while walking, but I am walking further every day.
Meanwhile I am cooking up a storm for tonight's guests, an English meal in honor of the royal wedding (and because I've always wanted to have trifle).
Challah (we are Jews, after all)
Cream of cauliflower soup with stilton
"Fish and chips": slow-cooked halibut in olive oil with my dad's recipe for roasted potatoes
Minted green peas
Sour cherry trifle
I had to go to three (!) grocery stores to find a pound cake. Silly me; I should have just baked one last night.
April 28, 2011
And a very little joke....
Ben & Jerry's Ice Cream is now available In the following flavors (if only!) --
Wailing Walnut
Moishmellow
Mazel Toffee
Chazalnut
Oy Ge-malt
Mi Ka-mocha
Soda & Gamorra
Bernard Malamint
Berry Pr'i Hagafen
Choc-Eilat Chip
and finally ....
(drum roll, please)
Simchas T'oreo
It should also be noted that all these flavors come in a Cohen.
(Thanks to my friend B for sending this one along!)
Wailing Walnut
Moishmellow
Mazel Toffee
Chazalnut
Oy Ge-malt
Mi Ka-mocha
Soda & Gamorra
Bernard Malamint
Berry Pr'i Hagafen
Choc-Eilat Chip
and finally ....
(drum roll, please)
Simchas T'oreo
It should also be noted that all these flavors come in a Cohen.
(Thanks to my friend B for sending this one along!)
SOB update
I almost forgot to mention: Although my shortness of breath seemed to ease today (I walked the dog down and up a hill!), I reported it to Dr G. Upon physical exam, I had no pain in my right side, even with him poking me in the side and my taking deep breaths. Dr G asked me to have a chest xray, which I took this afternoon. I also had the oxygen level in my blood checked with a pulse oximeter (the thing that goes on your finger) and it was at 96%, practically normal.
Maybe it was anxiety about the ultrasound report?
Maybe it was anxiety about the ultrasound report?
Scan results and treatment update
Last week's ultrasound results were neither positive nor negative. I continue to have stable disease in my liver, meaning the Gemzar didn't really work all that well for me.
Dr G has decided to put me back on Abraxane. This is where I started chemo exactly a year ago. He did not order scans before I started the Abraxane. After nine or so treatments, I had a CT scan which found the liver mets. We don't really know when they appeared.
He switched me immediately to Doxil, which I did not tolerate. In the past year I have also taken Adriamycin, high dose Faslodex, Navelbine and Gemzar, all resulting in stable disease but no reduction in liver mets and continually increasing CA 27.29.
So, since I tolerated Abraxane well last year, I will start on it again next Monday. At least I know what to expect -- low blood counts, hair loss, nausea, fatigue and maybe peripheral neuropathy (although I don't remember this from last year).
Last year I had all my hair buzzed off just as it started to fall out, but I still had stubble all during the spring, summer and fall chemos. I was never baby-butt-bald. So I think I will try to live with hair loss this time instead of buzzing it all off again, and see if it does really all fall out, or if it only thins.
It does mean I will likely be hairless when we go out of town for a family celebration in June. I still have the wig I bought last year and many, many scarves. If I am bald, everyone can just deal with it.
Dr G knows about our planned trip and hopes to see some results before we leave. I think that means I can look forward to another scan mid-June. As he told me today, "You're in good shape. We just have to find the right thing for you." We had a moment of emotional connection together and decided we are exactly the right doctor-patient team together.
(If you search through my blog for posts on Abraxane from 2010, you'll read that at the time I was dealing with a severely dislocated elbow, lymphedema, fear at starting chemo for the first time in eight years, and incipient depression. After having been on chemo for most of the last year, I can safely say that my fear is reduced, I know what to expect from Abraxane this time, my elbow has healed and I am no longer clinically depressed. But I think I will stay on the low dose of sertraline for the time being, just in case.)
(If you search through my blog for posts on Abraxane from 2010, you'll read that at the time I was dealing with a severely dislocated elbow, lymphedema, fear at starting chemo for the first time in eight years, and incipient depression. After having been on chemo for most of the last year, I can safely say that my fear is reduced, I know what to expect from Abraxane this time, my elbow has healed and I am no longer clinically depressed. But I think I will stay on the low dose of sertraline for the time being, just in case.)
April 27, 2011
SOB
No, it doesn't mean son of a bitch. SOB is medical alphabet soup for shortness of breath, which I've had the past two days, along with some pain upon a deep inhale. Nothing hurts when I press against the area, so I may be anemic (required a blood transfusion a few weeks ago). Or there may be a tumor pressing against a rib, or my liver, or a lung. I don't want to self-diagnose, so I will report these symptoms to Dr G tomorrow and find out what he thinks.
Meanwhile last night it was challenging to walk from the restaurant to the car (although I did eat a big dinner -- yay post-Passover pizza!). In order to breathe easily, I fell asleep on my back last night. Back pain woke me after an hour and a half. I couldn't get comfortable and started to grow anxious about not being able to breathe deeply. Some Ativan helped me relax and fall sound asleep until 9 AM.
I see Dr G in the morning and will report all these symptoms to him, as well as get his take on next steps in treatment.
Meanwhile last night it was challenging to walk from the restaurant to the car (although I did eat a big dinner -- yay post-Passover pizza!). In order to breathe easily, I fell asleep on my back last night. Back pain woke me after an hour and a half. I couldn't get comfortable and started to grow anxious about not being able to breathe deeply. Some Ativan helped me relax and fall sound asleep until 9 AM.
I see Dr G in the morning and will report all these symptoms to him, as well as get his take on next steps in treatment.
April 25, 2011
Ultrasound
Last week I had another abdominal ultrasound. Dr G likes to go back and forth on imaging scans. Sometimes I have a CT, sometimes an ultrasound, even occasionally an MRI. But he doesn't like me to have too much radioactive contrast, so last week's scan was an ultrasound.
My last ultrasound was in November, and my most recent CT was in February. I asked for, and have received, the radiologist's written report, since I won't see the oncologist until Thursday. However, I don't want to comment on it until I have Dr G's take on the scan and his projections on what to do next: continue on Gemzar, start a new chemo, or maybe try estrogen priming, something he's mentioned recently.
I'll know more on Thursday....
My last ultrasound was in November, and my most recent CT was in February. I asked for, and have received, the radiologist's written report, since I won't see the oncologist until Thursday. However, I don't want to comment on it until I have Dr G's take on the scan and his projections on what to do next: continue on Gemzar, start a new chemo, or maybe try estrogen priming, something he's mentioned recently.
I'll know more on Thursday....
Chronic insomnia
This not-sleeping business is for the birds. I get into bed around 11:30 PM and invariably fall asleep around 2:30 AM. How do I know this? It's the last time I look at the clock until 5:30 or 6 when Rik and Bobka the dog get up. Then I wake up again once an hour, every hour, until I give up and get out of bed around 9 AM.
Is it due to chemo? I have no answer for this one, but I haven't had treatment since April 11.
Is it due to tapering off the sertaline (anti-depressant)? I've only got a week more until I am off it completely, so we'll see what happens next week.
Is it due to not enough exercise? Even when I take the dog on a really long walk for 20 blocks, I still have trouble falling asleep at night.
Is it due to napping in the afternoon? Well, this is a no-brainer. But if I don't sleep at night, and I'm tired during the day plus fatigued from chemo, a nap seems inevitable.
Just grousing here -- I don't really want advice. But I am tired of being tired.
Is it due to chemo? I have no answer for this one, but I haven't had treatment since April 11.
Is it due to tapering off the sertaline (anti-depressant)? I've only got a week more until I am off it completely, so we'll see what happens next week.
Is it due to not enough exercise? Even when I take the dog on a really long walk for 20 blocks, I still have trouble falling asleep at night.
Is it due to napping in the afternoon? Well, this is a no-brainer. But if I don't sleep at night, and I'm tired during the day plus fatigued from chemo, a nap seems inevitable.
Just grousing here -- I don't really want advice. But I am tired of being tired.
Subscribe to:
Posts (Atom)
Posts
