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.

Graeter's ice cream update

I brought a pint of mocha chocolate chip (my favorite) to a meeting last night and offered some to those attending. At first they didn't believe me when I said it was the best ice cream in the world. There were comments about Starbucks coffee flavor, Ben & Jerry's, even Breyer's.

After just one taste everyone agreed -- it's remarkably fine ice cream!

I challenge you, my Seattle area readers, to pick up some of your favorite supermarket ice cream and a pint of Graeter's from your local Fred Meyer. (I heard it's available at the Totem Lake store, maybe others. Call first.) Taste them and let me know what you think. Your taste buds will be very happy you did!

Scalp mets

It was the weirdest thing. Out of nowhere, I touched my head and found blood on my fingertip. The largest scalp met was bleeding! I applied pressure and after a few minutes it stopped.

This happened on Wednesday evening. I called Dr G on Thursday morning, the nurse called back that afternoon and told me he says wait until I see him on Tuesday and he will examine my head. Of course, if it happens again and for some reason won't stop bleeding, then we call.

This largest of three mets has been changing in the past two weeks. It used to be domed, like the others. Now it's flatter on one side and a tiny bit indented. If course I can't see it myself, but to my touch it feels different. Don't know if this is chemo-related and if it is, what it might mean....

Now I am off to get my brain MRI. I get the results on Tuesday afternoon.

Graeter's ice cream is in Seattle!

As an expatriate Cincinnatian, I have ordered Graeter's ice cream many times over the years. At first I would stop at the factory on the tail end of a trip home and pick up a few pints packed in dry ice. When that was no longer possible, I would order it over the telephone or, most recently, online. And of course every trip to Cincinnati included a daily stop at Graeter's for the best ice cream in the world. (Sorry, Molly Moon. Graeter's won my heart long ago.)

Mocha chocolate chip!

Imagine my glee when I was shopping at the Fred Meyer on Seattle's Lake City Way. While looking for the coupon special, suddenly several flavors of Graeter's were staring me in the face! I practically danced up and down the frozen food aisle while piling my cart with black raspberry chip, chocolate chocolate chip, vanilla and vanilla chocolate chip. coconut chocolate chip and the quintessential mocha chocolate chip. (Mint chocolate chip is not my thing, but it was there.) 


Graeter's makes its ice cream with a traditional French Pot process, just two gallons at a time. As the website says, 

"Our secret recipe of fresh cream and egg custard is gently swirled along the chilled sides of a slowly spinning French Pot Freezer. As the creamy blend thickens, a blade softly scrapes the sides of the pot, folding the ice cream into itself. Then we add the fresh ingredients to complete our unique flavors.

The gentle folding process prevents air from whipping into our ice cream and accounts for the extremely dense and creamy consistency. Where a typical pint of ice cream can weigh as little as 8 ounces, a Graeter’s pint weighs nearly a full pound! Graeter’s ice cream is so rich and creamy that we have to pack every pint by hand."

(Are you drooling yet?)

I was once told the secret to the chocolate chip flavors is adding the chocolate in liquid form before the ice cream is frozen. As the ice cream churn, the chocolate freezes into uneven sizes and shapes. It's possible to find a "chip" the size of the first joint of your thumb or larger! No other chocolate chip ice cream can compete.

For those who don't believe me, try your own ice cream taste-off. Pick up a pint or two at Fred Meyer. (Graeter's may also be available at QFC, but Freddy's on Lake City is where I bought it today.) Compare it to any ice cream you choose. I am willing to bet that Graeter's will blow your mind, especially any flavor with chocolate chips. And it's kosher under the Vaad Haoier of Cincinnati.

No chemo yesterday

My while blood cell counts were too low for me to receive chemotherapy yesterday. I need to stay away from large groups of people to prevent exposure to an infection. My friend D sat and visited for an hour while I waited for the lab results; it always feels better to have company.

After leaving the treatment center, I went straight to Dr G's office to receive my monthly injection of Xgeva, the new bone strengthening drug I've been getting instead of Zometa. I told the nurse about my week of symptoms (stupid, fatigue, runny nose and that on-the-edge-of-feeling vertigo), and Dr G came in to talk with me. Between the stupidity (which sometimes gets call "chemo brain") and the not-quite sense of vertigo, he wanted to rule out the possibility of brain metastases and ordered a brain MRI, which I haven't had in a while.

I did a little research and found that vertigo (also called Benign Paroxysmal Positional Vertigo or BPPV), can be related to treatment with gemcitabine, the chemo I just finished. Read here for more information.

So I get an extra week to recover and feel better, I'll have the brain MRI on Friday, and get the results next Tuesday.

I also learned that the Abraxane/Avastin combo is given in this order:
Abraxane on days 1, 8, 15 (of a 21 day cycle)
Avastin on days 1 and 15 (of a 21 day cycle)

I like having more information!

Trying to enjoy the moment

I woke up Saturday morning feeling great. (I think it had to do with the sleeping pill I took Friday night.) At any rate, I visited a friend in the hospital, went to synagogue, came home and CRASHED with a massive nap. Upon awakening, we ate dinner and then did a small sopping expedition. By the time we came home around 930 PM, I was wobbly on my feet again. By the time we got into bed, I was tired but could not sleep until almost 2 AM.

I guess I should report all these symptoms to the nurses on Monday when I get chemo. Maybe they can tell me if the side effects are related to the chemo combo or tapering off the antidepressants. That's been a week now and I still get the not-quite-vertigo feeling when I move my head too quickly.

I feel more energetic today but still have that creepy sense that the world is spinning even when I am not moving. Rik and I worked in the garden together, me mostly trimming hedges and deadheading the early tulips while he added compost to the raised beds and the strawberries. We have both afternoon and evening plans, a rare occurrence, and I am looking forward to living in the moment and enjoying visits with friends. Chemo planned for tomorrow.

Teacher Appreciation Week

Yet another national celebration, today is the last day of Teacher Appreciation Week.  If you know a special teacher, thank them for the work they do. 


I married a teacher: a dedicated education professional whose commitment to teaching and lifelong learning helped him earn a graduate degree in education at age 35; gave him a career in both middle school and high school teaching geography, the subject he loves; and allows him the opportunity to train more teachers through his work with graduate students in education. Rock on, Mr. Katz!


If you have fond memories of a teacher who made a great impact on you, it's not too late to thank them. I reconnected with my high school French teacher a few years ago and took her out for lunch. Merci, Mlle. Cirelli, for teaching me!

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.