Our local pharmacy needed a few days to stock the fentanyl pain patch, so I had been continuing on the Vicodin every four hours. Yesterday afternoon we picked up the patches. You unpeel one and stick it high up on the arm, near the shoulder. It has an adhesive backing. Because the patch takes about 12 hours to become fully effective, I continued to take Vicodin until last night. The skin absorbs a constant dose of pain medication, so that your pain is constantly controlled and there are no times when pain increases at the end of one dosing period and before ou can take another pill.
I woke up this morning and my hands felt a little itchy but not the burning, stinging pain I had been experiencing. Even the tender tissues of my mouth and the sore in the back of my throat are less bothersome. I was able to wash without feeling pain while I held the bar of soap, brush my teeth, swallow pills and eat breakfast with much less discomfort. Asking for this pain patch might have been the smartest thing I've done so far in regard to managing the side effects of Doxil.
Showing posts with label Doxil. Show all posts
Showing posts with label Doxil. Show all posts
August 05, 2010
August 03, 2010
Quick update
I saw Dr G yesterday and he decided to treat whatever is going on in my mouth in three ways: continue the anti-fungal meds; take valcyclovir in case it's a viral infection; swish and swallow Magic Mouthwash and GelClair for pain. M Mouthwash didn't work too well. It numbed my lips before it got to my throat!
He also prescribed a Fentanyl patch when I asked. I'm already taking the maximum daily dose of Vicodin and I wanted to avoid the ups and downs of pain relief as it wears off before I can take the next dose. The patch delivers a constant stream of pain relief directly through the skin. I also received a prescription for morphine in case of breakthrough pain.
The hand-foot syndrome is causing the skin on my palms to blister in several places, like third-degree burns. No blisters have opened yet. I really don't want to take DMSO (the chemical solvent) even if it helps with the pain because it is so highly absorbed into the skin. So onc gave me permission to "cream the living daylights" out of my hands. I'm using Udderly Smooth hand cream.
It appears that I will not have chemo again until the hand-foot thing resolves and then when I do, it will either be a lower dose of Doxil or another chemo with less risk for hand-foot syndrome.
Oy.
He also prescribed a Fentanyl patch when I asked. I'm already taking the maximum daily dose of Vicodin and I wanted to avoid the ups and downs of pain relief as it wears off before I can take the next dose. The patch delivers a constant stream of pain relief directly through the skin. I also received a prescription for morphine in case of breakthrough pain.
The hand-foot syndrome is causing the skin on my palms to blister in several places, like third-degree burns. No blisters have opened yet. I really don't want to take DMSO (the chemical solvent) even if it helps with the pain because it is so highly absorbed into the skin. So onc gave me permission to "cream the living daylights" out of my hands. I'm using Udderly Smooth hand cream.
It appears that I will not have chemo again until the hand-foot thing resolves and then when I do, it will either be a lower dose of Doxil or another chemo with less risk for hand-foot syndrome.
Oy.
August 01, 2010
More pain
My pain from the hand-foot syndrome increased a lot over the weekend and so has the discomfort in my mouth and throat. After spending most of Saturday and Sunday on the sofa and taking close to the maximum daily dose of Vicodin, my plan is to try to get in to see the onc tomorrow if possible. Plus I will call the naturopath. Someone ought to take a throat culture and treat whatever is going on in my mouth, and I'm hoping to get moved onto different pain meds. My left hand is also puffy from lymphedema and the hand-foot thing and I am reluctant to bandage for fear of making the H-F syndrome worse. It's a vicious circle.
Of course my fear is that if I can't manage the side effects after only two rounds of Doxil, how will I handle four more treatments? Maybe I can persuade Dr G to reduce the dose or maybe he has other ideas.
Of course my fear is that if I can't manage the side effects after only two rounds of Doxil, how will I handle four more treatments? Maybe I can persuade Dr G to reduce the dose or maybe he has other ideas.
July 30, 2010
Kvetching
The thrush and painfully tingly hands were so much worse today that I called both the oncologist and the naturopath to see what they could recommend.
Dr G said that the fluconazine should have worked immediately to relieve the thrush and sore throat, so he wonders if this is indeed a fungal infection. He recommends stopping the fluconazine and trying the Mycelex lozenges again. He also says the literature recommends DMSO 99% solution, applied topically to the hands. BUT it is absorbed into the body and gives one a fishy breath odor, so I think I will wait and see how I fare on Dr. B's recommendations.
Dr B the naturopath recommended increasing the L-glutamine powder to two teaspoons, taken three times a day, dissolved in water to treat the hand-foot syndrome. He also wants me to dissolve Pau d'Arco drops in a half-glass of water and rinse, also three times a day for the thrush. Dr G says the Pau d'Arco can't hurt.
I'd never heard about Pau d'Arco, but this is what Memorial Sloan Kettering Cancer Center says about it. I hope it does the trick!
Scientific Name
Tabebuia impetiginosa, Tabebuia avellanedae, Tabebuia heptaphylla
Common Name
Ipe-Roxo, lapacho, purple lapacho, trumpet bush and taheebo
Clinical Summary
Pau D'arco is a tree native to South America. Preparations derived from the bark have been traditionally used to treat bacterial, fungal, viral infections, and cancer. In vitro studies of compounds isolated from Pau D'arco demonstrated antibacterial (3) (4) (5) (6), antifungal (7), antipsoriatic (8), immunomodulatory (9) (10), anticancer (11) (12) (13) (14), and antimetastatic (14) activities. Quinones, the main constituents, have been shown to be the active principle (11) (12) (13) (14). In a small single-arm study, Lapachol, a naphthoquinone isolated from the tree bark, did not show any effects on patients with non-leukemic tumors or CML (chronic myelocytic leukemia) (15). Reported adverse events from use of Pau D'arco include nausea, vomiting, dizziness and anemia (16). This herb may also enhance the activity of anticoagulants (17).
Purported uses
Cancer treatment
Antibacterial
Antifungal
Constituents
Quinone compounds: Lapachol, beta-lapachone, xyloidone (naphthoquinones) and tabebuin (anthroquinone)
Flavonoids: Quercetin
Glycosides: Iridoid, lignan, isocoumarin, phenylthanoid, phenolic
Cyclopentene dialdehydes
(1) (2) (3)
Mechanism of Action
The anticancer activity of beta-lapachone, a quinone compound isolated from Pau D'arco, may be due to down regulation of COX-2 (cyclooxygenase) and telomerase activities (11). Beta-lapachone also induces apoptosis in cancer cells via mitochondrial-signaling (12) or by activation of caspase (3) and (9) enzymes (18). The anti-metastatic activity of beta-lapachone was shown to be due to decreasing the invasive ability of cancer cells by inducing Egr-1 that is known to suppress metatstasis (14).
Warnings
Some constituents may have toxic effects. The effectiveness of Pau d'arco for the treatment of cancer in humans remains unproven.
Adverse Reactions
Reported: Nausea, vomiting, dizziness, anemia, bleeding, and discoloration of urine (16).
Herb-Drug Interactions
Anticoagulants: Pau d'arco may potentiate effects (17).
Literature Summary and Critique
Block JB, et al. Early clinical studies with lapachol. Cancer Chemother Rep 1974;4:27-8.
Twenty-one patients with non-leukemic tumors or chronic myelocytic leukemia were given Lapachol at a dose range of 250-3750 mg daily for 5 days and up to 3000 mg daily for 21 days. Researchers reported that Lapachol did not have any effect on the clinical status of the patients.
References
1. Warashina T, Nagatani Y, Noro T. Further constituents from the bark of Tabebuia impetiginosa. Phytochemistry. 2005;66(5):589-597.
2. Koyama J, Morita I, Tagahara K, Hirai K. Cyclopentene dialdehydes from Tabebuia impetiginosa. Phytochemistry. 2000;53(8):869-872.
3. Park BS, Lee HK, Lee SE, et al. Antibacterial activity of Tabebuia impetiginosa Martius ex DC (Taheebo) against Helicobacter pylori. J Ethnopharmacol. 2006;105(1-2):255-262.
4. Anesini C, Perez C. Screening of plants used in Argentine folk medicine for antimicrobial activity. J Ethnopharmacol. 1993;39(2):119-128.
5. Park BS, Kim JR, Lee SE, et al. Selective growth-inhibiting effects of compounds identified in Tabebuia impetiginosa inner bark on human intestinal bacteria.J Agric Food Chem. 2005;53(4):1152-1157.
6. Pereira EM, Machado Tde B, Leal IC, et al. Tabebuia avellanedae naphthoquinones: activity against methicillin-resistant staphylococcal strains, cytotoxic activity and in vivo dermal irritability analysis. Ann Clin Microbiol Antimicrob. 2006;5:5.
7. Portillo A, Vila R, Freixa B, et al. Antifungal activity of Paraguayan plants used in traditional medicine. J Ethnopharmacol. 2001;76(1):93-98.
8. Muller K, Sellmer A, Wiegrebe W. Potential antipsoriatic agents: lapacho compounds as potent inhibitors of HaCaT cell growth. J Nat Prod. 1999;62(8):1134-1136.
9. Bohler T, Nolting J, Gurragchaa P, et al. Tabebuia avellanedae extracts inhibit IL-2-independent T-lymphocyte activation and proliferation.Transpl Immunol. 2008;18(4):319-323.
10. Son DJ, Lim Y, Park YH, et al. Inhibitory effects of Tabebuia impetiginosa inner bark extract on platelet aggregation and vascular smooth muscle cell proliferation through suppressions of arachidonic acid liberation and ERK1/2 MAPK activation. J Ethnopharmacol. 2006;108(1):148-151.
11. Lee JH, Cheong J, Park YM, Choi YH. Down-regulation of cyclooxygenase-2 and telomerase activity by beta-lapachone in human prostate carcinoma cells. Pharmacol Res. 2005;51(6):553-560.
12. Lee JI, Choi DY, Chung HS, et al. beta-lapachone induces growth inhibition and apoptosis in bladder cancer cells by modulation of Bcl-2 family and activation of caspases. Exp Oncol. 2006;28(1):30-35.
13. Kung HN, Chien CL, Chau GY, et al. Involvement of NO/cGMP signaling in the apoptotic and anti-angiogenic effects of beta-lapachone on endothelial cells in vitro. J Cell Physiol. 2007;211(2):522-532.
14. Kim SO, Kwon JI, Jeong YK, et al. Induction of Egr-1 is associated with anti-metastatic and anti-invasive ability of beta-lapachone in human hepatocarcinoma cells. Biosci Biotechnol Biochem. 2007;71(9):2169-2176.
15. Block JB, Serpick AA, Miller W, Wiernik PH. Early clinical studies with lapachol (NSC-11905). Cancer Chemother Rep 2. 1974;4(4):27-28.
16. Foster S. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. New York: Haworth Herbal Press; 1999.
17. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy (OR): Eclectic Med Publications; 1998.
18. Woo HJ, Park KY, Rhu CH, et al. Beta-lapachone, a quinone isolated from Tabebuia avellanedae, induces apoptosis in HepG2 hepatoma cell line through induction of Bax and activation of caspase. J Med Food. 2006;9(2):161-168.
Dr G said that the fluconazine should have worked immediately to relieve the thrush and sore throat, so he wonders if this is indeed a fungal infection. He recommends stopping the fluconazine and trying the Mycelex lozenges again. He also says the literature recommends DMSO 99% solution, applied topically to the hands. BUT it is absorbed into the body and gives one a fishy breath odor, so I think I will wait and see how I fare on Dr. B's recommendations.
Dr B the naturopath recommended increasing the L-glutamine powder to two teaspoons, taken three times a day, dissolved in water to treat the hand-foot syndrome. He also wants me to dissolve Pau d'Arco drops in a half-glass of water and rinse, also three times a day for the thrush. Dr G says the Pau d'Arco can't hurt.
I'd never heard about Pau d'Arco, but this is what Memorial Sloan Kettering Cancer Center says about it. I hope it does the trick!
Scientific Name
Tabebuia impetiginosa, Tabebuia avellanedae, Tabebuia heptaphylla
Common Name
Ipe-Roxo, lapacho, purple lapacho, trumpet bush and taheebo
Clinical Summary
Pau D'arco is a tree native to South America. Preparations derived from the bark have been traditionally used to treat bacterial, fungal, viral infections, and cancer. In vitro studies of compounds isolated from Pau D'arco demonstrated antibacterial (3) (4) (5) (6), antifungal (7), antipsoriatic (8), immunomodulatory (9) (10), anticancer (11) (12) (13) (14), and antimetastatic (14) activities. Quinones, the main constituents, have been shown to be the active principle (11) (12) (13) (14). In a small single-arm study, Lapachol, a naphthoquinone isolated from the tree bark, did not show any effects on patients with non-leukemic tumors or CML (chronic myelocytic leukemia) (15). Reported adverse events from use of Pau D'arco include nausea, vomiting, dizziness and anemia (16). This herb may also enhance the activity of anticoagulants (17).
Purported uses
Cancer treatment
Antibacterial
Antifungal
Constituents
Quinone compounds: Lapachol, beta-lapachone, xyloidone (naphthoquinones) and tabebuin (anthroquinone)
Flavonoids: Quercetin
Glycosides: Iridoid, lignan, isocoumarin, phenylthanoid, phenolic
Cyclopentene dialdehydes
(1) (2) (3)
Mechanism of Action
The anticancer activity of beta-lapachone, a quinone compound isolated from Pau D'arco, may be due to down regulation of COX-2 (cyclooxygenase) and telomerase activities (11). Beta-lapachone also induces apoptosis in cancer cells via mitochondrial-signaling (12) or by activation of caspase (3) and (9) enzymes (18). The anti-metastatic activity of beta-lapachone was shown to be due to decreasing the invasive ability of cancer cells by inducing Egr-1 that is known to suppress metatstasis (14).
Warnings
Some constituents may have toxic effects. The effectiveness of Pau d'arco for the treatment of cancer in humans remains unproven.
Adverse Reactions
Reported: Nausea, vomiting, dizziness, anemia, bleeding, and discoloration of urine (16).
Herb-Drug Interactions
Anticoagulants: Pau d'arco may potentiate effects (17).
Literature Summary and Critique
Block JB, et al. Early clinical studies with lapachol. Cancer Chemother Rep 1974;4:27-8.
Twenty-one patients with non-leukemic tumors or chronic myelocytic leukemia were given Lapachol at a dose range of 250-3750 mg daily for 5 days and up to 3000 mg daily for 21 days. Researchers reported that Lapachol did not have any effect on the clinical status of the patients.
References
1. Warashina T, Nagatani Y, Noro T. Further constituents from the bark of Tabebuia impetiginosa. Phytochemistry. 2005;66(5):589-597.
2. Koyama J, Morita I, Tagahara K, Hirai K. Cyclopentene dialdehydes from Tabebuia impetiginosa. Phytochemistry. 2000;53(8):869-872.
3. Park BS, Lee HK, Lee SE, et al. Antibacterial activity of Tabebuia impetiginosa Martius ex DC (Taheebo) against Helicobacter pylori. J Ethnopharmacol. 2006;105(1-2):255-262.
4. Anesini C, Perez C. Screening of plants used in Argentine folk medicine for antimicrobial activity. J Ethnopharmacol. 1993;39(2):119-128.
5. Park BS, Kim JR, Lee SE, et al. Selective growth-inhibiting effects of compounds identified in Tabebuia impetiginosa inner bark on human intestinal bacteria.J Agric Food Chem. 2005;53(4):1152-1157.
6. Pereira EM, Machado Tde B, Leal IC, et al. Tabebuia avellanedae naphthoquinones: activity against methicillin-resistant staphylococcal strains, cytotoxic activity and in vivo dermal irritability analysis. Ann Clin Microbiol Antimicrob. 2006;5:5.
7. Portillo A, Vila R, Freixa B, et al. Antifungal activity of Paraguayan plants used in traditional medicine. J Ethnopharmacol. 2001;76(1):93-98.
8. Muller K, Sellmer A, Wiegrebe W. Potential antipsoriatic agents: lapacho compounds as potent inhibitors of HaCaT cell growth. J Nat Prod. 1999;62(8):1134-1136.
9. Bohler T, Nolting J, Gurragchaa P, et al. Tabebuia avellanedae extracts inhibit IL-2-independent T-lymphocyte activation and proliferation.Transpl Immunol. 2008;18(4):319-323.
10. Son DJ, Lim Y, Park YH, et al. Inhibitory effects of Tabebuia impetiginosa inner bark extract on platelet aggregation and vascular smooth muscle cell proliferation through suppressions of arachidonic acid liberation and ERK1/2 MAPK activation. J Ethnopharmacol. 2006;108(1):148-151.
11. Lee JH, Cheong J, Park YM, Choi YH. Down-regulation of cyclooxygenase-2 and telomerase activity by beta-lapachone in human prostate carcinoma cells. Pharmacol Res. 2005;51(6):553-560.
12. Lee JI, Choi DY, Chung HS, et al. beta-lapachone induces growth inhibition and apoptosis in bladder cancer cells by modulation of Bcl-2 family and activation of caspases. Exp Oncol. 2006;28(1):30-35.
13. Kung HN, Chien CL, Chau GY, et al. Involvement of NO/cGMP signaling in the apoptotic and anti-angiogenic effects of beta-lapachone on endothelial cells in vitro. J Cell Physiol. 2007;211(2):522-532.
14. Kim SO, Kwon JI, Jeong YK, et al. Induction of Egr-1 is associated with anti-metastatic and anti-invasive ability of beta-lapachone in human hepatocarcinoma cells. Biosci Biotechnol Biochem. 2007;71(9):2169-2176.
15. Block JB, Serpick AA, Miller W, Wiernik PH. Early clinical studies with lapachol (NSC-11905). Cancer Chemother Rep 2. 1974;4(4):27-28.
16. Foster S. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. New York: Haworth Herbal Press; 1999.
17. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy (OR): Eclectic Med Publications; 1998.
18. Woo HJ, Park KY, Rhu CH, et al. Beta-lapachone, a quinone isolated from Tabebuia avellanedae, induces apoptosis in HepG2 hepatoma cell line through induction of Bax and activation of caspase. J Med Food. 2006;9(2):161-168.
July 28, 2010
And the doc says....
I saw Dr G today and he was extremely pleased with the way the Doxil appears to be working. First he said I "looked good," then he reviewed last week's labs and had more blood drawn from my port. I didn't stay long enough to get those results but they will be mailed to me.
The plan is to have an ultrasound of my abdomen next week to check on the liver mets. If they don't appear on the ultrasound, which Dr G says is possible even after only two treatments of Doxil, he will order another CT scan after my fourth treatment. (Ultrasounds and CTs give different information. He doesn't want me to have too much radioactive contrast, which is given with CTs and not ultrasounds.) If that future CT looks clear, then I will have two more rounds of Doxil for a total of six altogether.
This assumes that I continue to tolerate the Doxil well, with manageable side effects, and that it is indeed very effective.
I am also going to have a bone scan some time in August, date tbd. I haven't had a bone scan in more than a year and of course bone mets wouldn't show up on a CT, which looks at soft tissues.
Dr G also gave me a tip on managing hand-foot syndrome. He told me that the Doxil won't enter a chilled area as easily, so I should rest my hands and feet on ice packs while getting the chemo. Ice packs are now on my bring-to-chemo list.
In the meantime I have some mouth sores, a sore throat and pain swallowing (more drugs for that), and stinging hands (Vicodin helps, as does the glutamine and B6). All of these side effects are manageable at this level, if annoying. Even more annoying is that I have lost almost all my eyelashes. All the lower ones are gone, and the upper lashes I can count on the fingers of one hand each. So a lot of dirt is getting into my eyes, which eyelashes would normally filter out. Wearing my glasses only keeps some of the stuff out. And of course I am trying not to rub my eyes so I can keep the remaining lashes.
Still: Doxil is turning out to be manageable, well-tolerated and apparently very effective.
The plan is to have an ultrasound of my abdomen next week to check on the liver mets. If they don't appear on the ultrasound, which Dr G says is possible even after only two treatments of Doxil, he will order another CT scan after my fourth treatment. (Ultrasounds and CTs give different information. He doesn't want me to have too much radioactive contrast, which is given with CTs and not ultrasounds.) If that future CT looks clear, then I will have two more rounds of Doxil for a total of six altogether.
This assumes that I continue to tolerate the Doxil well, with manageable side effects, and that it is indeed very effective.
I am also going to have a bone scan some time in August, date tbd. I haven't had a bone scan in more than a year and of course bone mets wouldn't show up on a CT, which looks at soft tissues.
Dr G also gave me a tip on managing hand-foot syndrome. He told me that the Doxil won't enter a chilled area as easily, so I should rest my hands and feet on ice packs while getting the chemo. Ice packs are now on my bring-to-chemo list.
In the meantime I have some mouth sores, a sore throat and pain swallowing (more drugs for that), and stinging hands (Vicodin helps, as does the glutamine and B6). All of these side effects are manageable at this level, if annoying. Even more annoying is that I have lost almost all my eyelashes. All the lower ones are gone, and the upper lashes I can count on the fingers of one hand each. So a lot of dirt is getting into my eyes, which eyelashes would normally filter out. Wearing my glasses only keeps some of the stuff out. And of course I am trying not to rub my eyes so I can keep the remaining lashes.
Still: Doxil is turning out to be manageable, well-tolerated and apparently very effective.
July 26, 2010
Hand-foot syndrome
The hand-foot syndrome seems to have stopped with stingy pain on the tips of the thumb and first two fingers of my left (dominant) hand, which is also the lymphedema hand. Vicodin is taking care of the pain and reducing it to manageable levels, but it still feels weird and tingly. I notice it when trying to open a jar, tear a piece of masking tape, or use other small motor skills.
The soles of my feet feel less red and painful. I actually walked the dog and stood for an hour yesterday at the Gilda's Club Dog Walk in Magnuson Park. There were many booths from vets, groomers, and other dog-oriented businesses, as well as an agility demonstration area and 1K and 3K walks. (We just wandered around the tent area.) N came with their dog and the five of us had a jolly time meeting other dogs and their people. Bobber was not particularly enthusiastic about other dogs but extremely well behaved at the $5 dog nail trim tent. He jumped straight into the arms of the groomer and made friends.
I am hoping that the B6 complex and glutamine powder are working to reduce or at least halt the hand-foot side effects. Last night I bandaged my hand for the first time in a week and it was not especially red in the morning despite the tight wrappings. I will go for more tonight and hope in this way to manage my lymphedema despite the hand-foot syndrome.
The soles of my feet feel less red and painful. I actually walked the dog and stood for an hour yesterday at the Gilda's Club Dog Walk in Magnuson Park. There were many booths from vets, groomers, and other dog-oriented businesses, as well as an agility demonstration area and 1K and 3K walks. (We just wandered around the tent area.) N came with their dog and the five of us had a jolly time meeting other dogs and their people. Bobber was not particularly enthusiastic about other dogs but extremely well behaved at the $5 dog nail trim tent. He jumped straight into the arms of the groomer and made friends.
I am hoping that the B6 complex and glutamine powder are working to reduce or at least halt the hand-foot side effects. Last night I bandaged my hand for the first time in a week and it was not especially red in the morning despite the tight wrappings. I will go for more tonight and hope in this way to manage my lymphedema despite the hand-foot syndrome.
July 24, 2010
Much better
After a night and a day, the nausea has calmed down quite a bit. Although I spent most of Friday lying on the couch, I feel much better today. The anti-nausea meds made me very sleepy, so one three hour nap turned into a second one after I took a break to eat lunch.
We had been invited to have Shabbat dinner with friends and I felt well enough to go. It was a large crowd of about 12 people, with much laughter and telling of jokes and stories. Not to mention plenty of delicious food, including home-made vanilla ice cream. It was good for my soul to be with people only a few days after chemo.
The hand/foot syndrome is bugging me now. The sole of my right foot and the thumb of my left hand are tingly and just at the edge of painful. At the naturopath's and oncologist's suggestion, I started taking vitamin B6 supplements and have increased the amount of glutamine powder. (I was measuring inaccurately. One of my teaspoons holds two actual teaspoons.) I hope this is as bad as it gets, because I really need to address the lymphedema issue again. After almost a week of doing nothing, my left hand and arm are okay but would benefit from bandaging at night.
Today is supposed to be warm and sunny and I look forward to catching up on a good book and taking it easy!
We had been invited to have Shabbat dinner with friends and I felt well enough to go. It was a large crowd of about 12 people, with much laughter and telling of jokes and stories. Not to mention plenty of delicious food, including home-made vanilla ice cream. It was good for my soul to be with people only a few days after chemo.
The hand/foot syndrome is bugging me now. The sole of my right foot and the thumb of my left hand are tingly and just at the edge of painful. At the naturopath's and oncologist's suggestion, I started taking vitamin B6 supplements and have increased the amount of glutamine powder. (I was measuring inaccurately. One of my teaspoons holds two actual teaspoons.) I hope this is as bad as it gets, because I really need to address the lymphedema issue again. After almost a week of doing nothing, my left hand and arm are okay but would benefit from bandaging at night.
Today is supposed to be warm and sunny and I look forward to catching up on a good book and taking it easy!
July 23, 2010
Day 5 post-treatment
On Tuesday I had the Neulasta shot to boost my white blood cell count. On Wednesday evening I developed some back pain that may or may not be related to the joint pain side effect I was told I might experience. So I called the onc, and took Vicodin, and took Vicodin, and took Vicodin. Even on Thursday evening my neck was stiff and uncomfortable. Today it seems better.
I felt the beginnings of nausea last night and this morning as well. They tell you to take the anti-nausea meds at the first sign of an upset tummy so that it can act before you feel really ill, which I did promptly as soon as I realized that what I was experiencing was nausea.
Yesterday I met with a new shrink at the Cancer Institute (my former psychiatrist is no longer in practice). Thankfully Pacificare Behavioral Health allowed an exception for me to see Dr. Dobie, and now I believe she is on their list of preferred providers. She asked me five pages of questions from her "get to know you" assessment. We agreed that she would be a good fit for me, and that I need one more tool in my cancer toolbox.
I wanted to see a shrink because no matter how wonderful a support group can be, you still have to share the focus with the other people in the group. In our 45 minute sessions, Dr. Dobie is there only for me. I don't have to worry about hogging the limelight or talking too much.
She recommended increasing the Zoloft by another 25 mg in order to improve my sleep (insomnia is a problem with depression) and told me that I could take Ativan to get better sleep any time.
Last night, between the Vicodin, the anti-nausea drug and the Ativan, I got the best night's sleep I've had in days. That's certainly a step in the right direction.
I felt the beginnings of nausea last night and this morning as well. They tell you to take the anti-nausea meds at the first sign of an upset tummy so that it can act before you feel really ill, which I did promptly as soon as I realized that what I was experiencing was nausea.
Yesterday I met with a new shrink at the Cancer Institute (my former psychiatrist is no longer in practice). Thankfully Pacificare Behavioral Health allowed an exception for me to see Dr. Dobie, and now I believe she is on their list of preferred providers. She asked me five pages of questions from her "get to know you" assessment. We agreed that she would be a good fit for me, and that I need one more tool in my cancer toolbox.
I wanted to see a shrink because no matter how wonderful a support group can be, you still have to share the focus with the other people in the group. In our 45 minute sessions, Dr. Dobie is there only for me. I don't have to worry about hogging the limelight or talking too much.
She recommended increasing the Zoloft by another 25 mg in order to improve my sleep (insomnia is a problem with depression) and told me that I could take Ativan to get better sleep any time.
Last night, between the Vicodin, the anti-nausea drug and the Ativan, I got the best night's sleep I've had in days. That's certainly a step in the right direction.
July 20, 2010
Doxil round #2
Yesterday I had the second treatment of Doxil. I was much less stressed than the first one, and my blood pressure was suitably lower. I received 8 mg oral Decadron (steroid) and 1 mg oral Ativan (anti-anxiety), plus IV Emend (anti-nausea) as pre-meds, all exactly the same as last time. I was relatively relaxed and the Ativan actually made me doze a bit.
The Doxil went smoothly. I also received my monthly treatment of Zometa, the bone building wonder drug that also has cancer fighting properties. L the charge nurse was so on top of things! Last Friday she was looking ahead and saw that I was due for Zometa this week, called Dr. G and got him to order it. Everything was ready when I arrived, although it did take a while to get all the drugs.
I asked Rik to take me to Molly Moon's for ice cream afterwards. (I needed the sugar hit to counter the Ativan drowsiness.) With a half scoop each of salted caramel and ginger covered with hot fudge sauce in me, I felt so terrific that I didn't need a nap and was able to bake a pizza for dinner. And I slept well at night without any sleep aids.
This morning I took the second of three doses of Emend. I also went back to the Cancer Institute for a shot of Neulasta, a drug which builds white blood cells. Because my white count was down a bit (but not too much to cancel treatment), and because the Doxil will continue to lower my white count, Dr. G prescribed Neulasta to help my body build neutrophils (immature white blood cells). Increased white counts should keep me from getting an infection. The shot hardly stung when administered in the fatty part of my upper arm. I may have bone pain in 12-18 hours that might last for one day, but this is hardly new to a woman who has had bone mets in more than 20 sites for the past almost eight years.
The Doxil went smoothly. I also received my monthly treatment of Zometa, the bone building wonder drug that also has cancer fighting properties. L the charge nurse was so on top of things! Last Friday she was looking ahead and saw that I was due for Zometa this week, called Dr. G and got him to order it. Everything was ready when I arrived, although it did take a while to get all the drugs.
I asked Rik to take me to Molly Moon's for ice cream afterwards. (I needed the sugar hit to counter the Ativan drowsiness.) With a half scoop each of salted caramel and ginger covered with hot fudge sauce in me, I felt so terrific that I didn't need a nap and was able to bake a pizza for dinner. And I slept well at night without any sleep aids.
This morning I took the second of three doses of Emend. I also went back to the Cancer Institute for a shot of Neulasta, a drug which builds white blood cells. Because my white count was down a bit (but not too much to cancel treatment), and because the Doxil will continue to lower my white count, Dr. G prescribed Neulasta to help my body build neutrophils (immature white blood cells). Increased white counts should keep me from getting an infection. The shot hardly stung when administered in the fatty part of my upper arm. I may have bone pain in 12-18 hours that might last for one day, but this is hardly new to a woman who has had bone mets in more than 20 sites for the past almost eight years.
July 16, 2010
Thrush
I seem to have developed a mild case of thrush, a fungal infection of the mouth that can be caused by a lowered immune system due to chemotherapy.
My tongue, throat and mouth felt a little sore, like when you're coming down with a cold, and my tongue got white and coated. At my new support group I asked if this might be mouth sores (also due to lowered immunity from chemo) and was told it sounded like thrush.
Thrush is common in babies and young children, as well as cancer patients on chemo. Dr. G prescribed clotrimazol (Mycelex), dissolving lozenges. You place one on your tongue and let is slowly dissolve over 15-30 minutes -- five times a day. It might take seven to ten days for this infection to clear up. Like antibiotics, the symptoms may disappear sooner but you have to finish the whole dose.
So far it's just annoying and hasn't stopped me from swallowing or eating. But it's a symbol that the chemo is doing something, and that makes me feel hopeful it will be very effective, have manageable side effects, and be very tolerable. The next dose of Doxil is scheduled for on Monday, if my counts permit.
My tongue, throat and mouth felt a little sore, like when you're coming down with a cold, and my tongue got white and coated. At my new support group I asked if this might be mouth sores (also due to lowered immunity from chemo) and was told it sounded like thrush.
Thrush is common in babies and young children, as well as cancer patients on chemo. Dr. G prescribed clotrimazol (Mycelex), dissolving lozenges. You place one on your tongue and let is slowly dissolve over 15-30 minutes -- five times a day. It might take seven to ten days for this infection to clear up. Like antibiotics, the symptoms may disappear sooner but you have to finish the whole dose.
So far it's just annoying and hasn't stopped me from swallowing or eating. But it's a symbol that the chemo is doing something, and that makes me feel hopeful it will be very effective, have manageable side effects, and be very tolerable. The next dose of Doxil is scheduled for on Monday, if my counts permit.
June 30, 2010
Doxil day 3
Although I really overdid it yesterday, I am satisfied with the way I feel so far on Doxil. The Emend has successfully prevented any nausea. (I took the last pill today.) I'm experiencing a little tingling in my right palm, a possible early warning of hand-foot syndrome, and have called the naturopath to ask about taking vitamin B6 pyridoxine to treat and/or prevent this from worsening. I am a touch paranoid about getting hand-foot syndrome in my left arm due to the potential impact on my lymphedema.
The orthopedist said yesterday that I had increased extension in my left arm from 50 degrees to 35 degrees, a significant improvement. We don't know if this is due to sleeping with the plastic brace gizmo for the past three weeks; NOT wearing it on Monday night with the lymphedema bandaging as part of hand-foot syndrome prevention; or the 8 mg of Decadron steroids I received on Monday as a chemo pre-med. Evidently steroids have some positive affect on joint issues. At any rate, Dr W is allowing me to stay out of the brace for two weeks to see if I continue to improve.
I wish I could say I slept better without it, but at least I wasn't forced by the gizmo to extend my arm as straight as possible all night long. I still awoke several times with severe hot flashes, the kind that leave sweat standing on my head and neck. And having Bobka's furry dog butt pressed up against my back may not have helped. But he is so cuddly.
The orthopedist said yesterday that I had increased extension in my left arm from 50 degrees to 35 degrees, a significant improvement. We don't know if this is due to sleeping with the plastic brace gizmo for the past three weeks; NOT wearing it on Monday night with the lymphedema bandaging as part of hand-foot syndrome prevention; or the 8 mg of Decadron steroids I received on Monday as a chemo pre-med. Evidently steroids have some positive affect on joint issues. At any rate, Dr W is allowing me to stay out of the brace for two weeks to see if I continue to improve.
I wish I could say I slept better without it, but at least I wasn't forced by the gizmo to extend my arm as straight as possible all night long. I still awoke several times with severe hot flashes, the kind that leave sweat standing on my head and neck. And having Bobka's furry dog butt pressed up against my back may not have helped. But he is so cuddly.
June 29, 2010
The morning after
Either my anti-depressants have really kicked in, or I am still getting benefit from yesterday's steroids, because I slept well all night (except for three hot flashes that were borderline night sweats at 2 AM, 5 AM and 7 AM).
I have no nausea this morning; took my second of three Emend tablets and they seem to be doing the job. I even asked Dr G to give his hopefully positive opinion on taking our planned beach vacation, if I continue to feel well.
I feel back to my normal routine today. Walked the dog (sigh... only one dog), hope to be able to see the orthopedist, meet with an estate planning attorney, and attend an afternoon meeting. That would be a lot for me on a regular day, much less the day after chemo.
Even my left arm feels more extended after NOT sleeping in the black plastic orthopedic gizmo. We'll see what the orthopod says about that. Remember, I'm not bandaging for three nights to prevent hand-foot syndrome from starting.
Say it with me. Doxil will be::
I have no nausea this morning; took my second of three Emend tablets and they seem to be doing the job. I even asked Dr G to give his hopefully positive opinion on taking our planned beach vacation, if I continue to feel well.
I feel back to my normal routine today. Walked the dog (sigh... only one dog), hope to be able to see the orthopedist, meet with an estate planning attorney, and attend an afternoon meeting. That would be a lot for me on a regular day, much less the day after chemo.
Even my left arm feels more extended after NOT sleeping in the black plastic orthopedic gizmo. We'll see what the orthopod says about that. Remember, I'm not bandaging for three nights to prevent hand-foot syndrome from starting.
Say it with me. Doxil will be::
Very effective
Manageable side effects
Well-tolerated
June 28, 2010
First Doxil
Today I received my first treatment of Doxil (doxorubicin). First they gave me a new anti-nausea drug called Emend (given by IV), then i took Decadron (a steroid) and Ativan (for anxiety) orally. Then they finally set up the Doxil. Two chemo nurses sat with me to monitor how well I reacted and to make sure there were no problems. They gave it very slowly at first, then began increasing the speed. It took about 90 minutes - two hours for the whole infusion.
Doxil is a bright peach color, or as one nurse put it, exactly the shade of peach Jello. I don't eat too much Jello but I liked her softer imagery.
I felt quite chatty, especially compared with my morose behavior of the past few days. Either the Zoloft (anti-depressant( is kicking in quickly, or the steroids gave me just enough lift. D and C came to visit and I was able to have good interactive conversations with them both. D called me "perky." Either way, I rose to the occasion and provided the nurses with information they needed.
One bit was about the interaction of lymphedema with hand-foot syndrome. Evidently, if you get this, it comes on for a few days immediately after treatment and then eases. You can help prevent it by taking tepid showers; not using knives or tools; not kneeling or leaning on your arms. So far none of the providers recalls treating anyone with hand-foot syndrome who also has lymphedema. I have left a message with my physical therapist asking about her experience and I'm sure she will call back if she has a solution to offer.
Meanwhile we have decided that for these first three or so days post-Doxil, I will cease all lymphedema management to avoid putting undue pressure on my palms, and then return to night-time bandaging more loosely (if I can do this). At least I have a plan.
We came home with two prescriptions: Emend is given via IV on treatment day, and then via oral pill on each of the next two days. I have oral Zofran to manage additional nausea, should I experience any. And despite his not wanting to order me additional Ativan last week, Dr G wrote a new scrip for Ativan today, so I am covered for both anxiety and nausea.
It all went very smoothly. I was surprised that my counts were high enough to permit starting this treatment, but Dr G thinks it's best to start asap and he's the boss of my cancer. And last Thursday he said in plain words, "Your cancer is going to get better."
Doxil is a bright peach color, or as one nurse put it, exactly the shade of peach Jello. I don't eat too much Jello but I liked her softer imagery.
I felt quite chatty, especially compared with my morose behavior of the past few days. Either the Zoloft (anti-depressant( is kicking in quickly, or the steroids gave me just enough lift. D and C came to visit and I was able to have good interactive conversations with them both. D called me "perky." Either way, I rose to the occasion and provided the nurses with information they needed.
One bit was about the interaction of lymphedema with hand-foot syndrome. Evidently, if you get this, it comes on for a few days immediately after treatment and then eases. You can help prevent it by taking tepid showers; not using knives or tools; not kneeling or leaning on your arms. So far none of the providers recalls treating anyone with hand-foot syndrome who also has lymphedema. I have left a message with my physical therapist asking about her experience and I'm sure she will call back if she has a solution to offer.
Meanwhile we have decided that for these first three or so days post-Doxil, I will cease all lymphedema management to avoid putting undue pressure on my palms, and then return to night-time bandaging more loosely (if I can do this). At least I have a plan.
We came home with two prescriptions: Emend is given via IV on treatment day, and then via oral pill on each of the next two days. I have oral Zofran to manage additional nausea, should I experience any. And despite his not wanting to order me additional Ativan last week, Dr G wrote a new scrip for Ativan today, so I am covered for both anxiety and nausea.
It all went very smoothly. I was surprised that my counts were high enough to permit starting this treatment, but Dr G thinks it's best to start asap and he's the boss of my cancer. And last Thursday he said in plain words, "Your cancer is going to get better."
June 25, 2010
Help for depression
Today I was diagnosed with moderately severe depression and I start sertraline (Zoloft), an anti-depressant tomorrow morning. I also had an echocardiogram to discover if my heart is healthy enough to tolerate the Doxil.
I realized how fortunate I have been to have bone-only disease for the past seven and a half years which responded well to aromatase inhibitors and other anti-estrogenic, oral meds. How quickly I forgot that I felt well most of that time. (Aside from the pain of a broken leg, new bone mets, back pain...)
Chemo freaks me out and yet I read every day that so many of my mets-sisters manage to live well on it long term. Still, having Abraxane fail after only two months scares me.
This evening I suddenly realized that I have dealt with cancer for 20% of my life -- 11 years. I barely remember the other 80%: it flew by when I wasn't paying attention. Or maybe that's the depression talking.
I realized how fortunate I have been to have bone-only disease for the past seven and a half years which responded well to aromatase inhibitors and other anti-estrogenic, oral meds. How quickly I forgot that I felt well most of that time. (Aside from the pain of a broken leg, new bone mets, back pain...)
Chemo freaks me out and yet I read every day that so many of my mets-sisters manage to live well on it long term. Still, having Abraxane fail after only two months scares me.
This evening I suddenly realized that I have dealt with cancer for 20% of my life -- 11 years. I barely remember the other 80%: it flew by when I wasn't paying attention. Or maybe that's the depression talking.
June 24, 2010
Liver lesions
Yesterday's CT scan revealed seven liver lesions which did not appear on the last scans in 2008. We have no way of knowing how recently they appeared. I have no symptoms, but these are the first active soft-tissue mets since one lung met at time of diagnosis in 2002.
The plan is for me to switch to Doxil, scheduled for Monday. It can be hard on the heart, so I am having an echocardiogram on Friday. Usual side effects of hair loss, nausea, low blood counts, etc. plus a risk of hand-foot syndrome. I immediately worried about the impact on my lymphedema. Both Dr G and Dr B basically said we'll deal with that if it comes up. I should get Doxil every 21 days. It is both more powerful and more toxic than Abraxane.
After finishing with Dr G the oncologist I saw Dr Bufi the naturopath, who came up with a plan for keeping me healthy while on Doxil.
Dr G made a joke: "Sometimes the first boyfriend (meaning Abraxane) just isn't the right one." We laughed out loud. Who among us had the right first boyfriend?
I coped as long as I could and got into bed for a few hours, then ate a bowl of cereal. (I wasn't hungry all day long.)
Say the medication mantra with me (note the new prioritization and phrasing):
The plan is for me to switch to Doxil, scheduled for Monday. It can be hard on the heart, so I am having an echocardiogram on Friday. Usual side effects of hair loss, nausea, low blood counts, etc. plus a risk of hand-foot syndrome. I immediately worried about the impact on my lymphedema. Both Dr G and Dr B basically said we'll deal with that if it comes up. I should get Doxil every 21 days. It is both more powerful and more toxic than Abraxane.
After finishing with Dr G the oncologist I saw Dr Bufi the naturopath, who came up with a plan for keeping me healthy while on Doxil.
Dr G made a joke: "Sometimes the first boyfriend (meaning Abraxane) just isn't the right one." We laughed out loud. Who among us had the right first boyfriend?
I coped as long as I could and got into bed for a few hours, then ate a bowl of cereal. (I wasn't hungry all day long.)
Say the medication mantra with me (note the new prioritization and phrasing):
Very effective
Well-tolerated
Manageable side effects
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