Tag Archives: gemcitabine and cisplatin

Just As Likely

My blood counts were once again too low for treatment today.  This is a little disconcerting, a little frustrating – but I understand that it’s not the end of the world.  This chemo is serious stuff and my body needs to recuperate a bit.

What was more than a little disconcerting was all the conjecture today about my back pain. When I told the nurses about it they said that maybe I’d cracked a rib, but reassured me that it didn’t mean anything, that this can happen to people who cough a lot.  However, I needed to be seen by a doctor and since my oncologist wasn’t there, I met with a resident.  I explained the whole pain-when-I-cough scenario and he, like the nurses, said it was likely a fractured rib. 

Here’s where it gets troublesome:  I asked if fracturing a rib was fairly normal with a serious cough or whether it means that the cancer has likely spread to my bones.  He didn’t even pause before saying “Yes, it’s likely that it has spread and I would expect your bone density is low.”

Okay, here’s a tip for all you up-and-coming oncologists out there:  your words are powerful – wield them with caution. You are not a mechanic, the patient is not the driver of a malfunctioning vehicle. You’re a doctor and this is my body, my life we’re talking about. If you are going to tell someone with metastasized disease that it may have further spread – in other words that the treatment isn’t working and things are getting worse – consider that this information might have emotional consequences.  Consider that it might freak the patient out a bit.  Don’t just throw it out there like you’re talking about a carburetor or a transmission that blew, because it’s not a car, it’s a human being and there are emotions attached to that carburetor; there are questions of mortality attached to that transmission.

Seriously. I was shocked. I immediately began processing the implications of yet another treatment not being able to stop this cancer. Tears started to pool in my eyes and I had to focus on breathing so that I wouldn’t suffocate from the g-force of fear pressing down on me.  The doctor began looking extremely confused and stressed out about my tears.  At the same time, my mother seemed to rise from her chair and materialize protectively at my side in far less time than it is humanly possible to cross a room.  Also, she had somehow procured a box of Kleenex enroute.

But then the voice of reason kicked in.  It said: Check out the look of horror on his face. Does this guy even know what he just said? So I dug deeper.

I asked what else could be causing the pain, whether it was possible that I haven’t cracked a rib at all, that I just pulled something?  He said it was just as likely.

Just. As. Likely.

A bruised rib or pulled muscle is not an indication of disease progression. I had to resist simultaneous urges to hug him and smack him in the head. I even managed not to shout What’s wrong with you? Why didn’t you say so in the first place?

The pools in my eyes began to evaporate and the weight of the air was suddenly more bearable.  In other words, fear left the room.  It didn’t leave the building – in fact it has maintained a respectful following distance all day – but at least it’s not sitting on my lap anymore.

Dr. Still a Little Inexperienced (Let’s call him Dr. SiLI for short) and I decided that an x-ray today would reveal either a fracture or potentially indicate other possible causes of the pain.  He would call me with the results.  Of course the CT scan on Tuesday will tell us much more, but I pointed out that waiting approximately ten days from now for those results would not be psychologically ideal for me.

Then Dr. SiLI examined me.  (Not a bad idea, since after all he’s a doctor and I’m a patient with a complaint of physical pain.)  He listened and tapped and prodded and poked around looking for the supposedly cracked rib, asking, “Is it here?  Here?” while I replied, “Um, I don’t know… maybe up a little…” and ultimately resorted to coughing in order to locate the pain.  Then, when he pressed it, I didn’t yelp or jolt my body away — in fact it felt kind of good, like a massage.  This I take to be a good sign, because the only time I ever officially fractured a bone you couldn’t even look at it too closely without causing me pain.

So Dr. SiLI gave me a ‘script for the pain & sent me for an x-ray, and then my mom and I left the hospital and did what any normal people would do after such a roller-coaster of a morning: we went to the movies.

And here I am a few hours later, eating vanilla ice-cream right from the tub as I transcribe the drama of the day from the safe distance of a few hours spent with George Clooney. And you know what?  I’m actually thinking how far I have come in this role of Person With Cancer.  It wasn’t so long ago that I would have staggered out of the doctor’s office in a state of shock and trauma, without the experience or presence of mind to stop the panic, dig deeper, and question further.  The doctor’s first comment would have immediately convinced me that the disease has spread to my bones – and who knows, maybe it has. But it’s just as likely that it hasn’t. Just as likely.

Those three words don’t get me any closer to knowing the facts, but they are enough for now.  And I know fear is still camped outside my front door, but I’m not sharing my ice-cream.

9 Comments

Filed under Living with Breast Cancer

I’d Rather Be Eating Chocolate

If Forrest Gump says life is like a box of chocolates, I say chemo is like a row of cubicles in a public washroom: You never know what nasty surprises you might find when those doors swing open – but when you gotta go, you gotta go. Alas, my most recent round of treatment was more like opening a cubicle door in a bus terminal ladies’ room than one in a high-end restaurant. In a word: vile.

The truth is, I was caught off-guard by the nastiness of this chemo. My previous two rounds with it had actually gone fairly well (relative to just how unwell chemo can go) and when asked I would say, “This isn’t the worst chemo I’ve met.”

But, to mercilessly belabour this toilet analogy, even if you’ve previously visited a particular public washroom before, there are no guarantees you’ll find it in the same condition you did the last time you were there.  In other words, just because I’d had a fairly good run at this chemo before, it didn’t mean I could expect it to go well again.  It’s a, well… a crapshoot.

So this time around the nausea has been aggressive, as were the flu-like symptoms for the first few days. But the worst and weirdest of all is a super-intense back pain behind my right shoulder. It feels like I have a little knife lodged there, and every time I cough it twists in a little deeper.  It started Friday morning with a sharp pinch on my right side every time I hack-hacked, or bark-barked.  By late afternoon I was clutching my side and doubling over a bit with every cough. By bedtime, the pain had intensified, migrated around back and set up permanent residence, and I was sleeping with a heating pad under my right side.

It seems that my evil cough, not content to torment me with mere anxiety and irritation, has now added physical pain to its roster of tricks.  So I cough on, and while the pain isn’t unbearable, it does make me stop, clutch, bend, and brace myself with every hack-hack or bark-bark. But the real problem is the psychology: every time I cough and the knife twists deeper, I’m acutely aware of my illness.  Instead of being able to amble through my days without having to think about cancer all the time, symptoms like this one serve as a little cancer reminder every few minutes.

I don’t like this. Denial is one of my oldest and trustiest friends.  Moving through my daily life without having every waking thought coloured by cancer is a state of being I’ve come to depend on for my sanity. When side effects and symptoms are front and centre (or around back to the right, behind the shoulder blade) the psychological effect of constantly being reminded that I have cancer is compounded by physical pain and discomfort… and frankly it stinks.  Really, it does.  Please don’t tell me to keep my chin up, either. You can grin and bear it, I’m going to slink around muttering obscenities and popping pills.  

On the other hand, I may just be imagining the link between my cough and my cancer.  I say this because when I discussed my worsening cough with my oncologist last Thursday before treatment, I found out that the prevailing theory continues to be that the cough hasn’t really corresponded to “progression of disease.” In other words, it has sometimes been present when no lung specks were visible on CT scans, and at other times it hasn’t bothered me much even though scans showed progression of spots or specks – so it’s hard to reason that the cough is definitely tied to the cancer.  There is still a strong belief that it could be caused by lung irritation due to something as banal as post-nasal drip (i.e.: my constantly runny nose) which itself was caused by long-term chemo side effects. Therefore, so goes the rather optimistic prevailing theory, I shouldn’t worry too much about the cough, at least not until or unless the results of my upcoming CT scan on February 23rd give me reason to. 

Okay… Still hurts though, so what’s a girl to do? Maybe if I can block out the psychological stuff, the physical experience might be more bearable. Like facing a disgusting public toilet in a desperate situation, you just hold your breath and get through it, with your eye on the prize and your nose plugged. 

Yikes. Would so much rather be dealing with the chocolates. 

  

*Ladies: A quick word, please, while I have your attention, on the matter of hovering or sitting on pubic toilet seats.  Before I had a little girl I didn’t have to think about it –  hovering was my default, whether five-star establishment or basement dive. But now that I have to actually place Georgia’s pristine backside on those seats, let’s discuss.  One hovers to avoid sitting in a nasty pee-splashed bacteria-ridden mess, right?  But consider:  how did it get pee-splashed in the first place?  I’d wager it got that way from careless hovering.  If you find it splashed-upon, go ahead and hover, but if you find it clean and you hover, you MUST wipe.  Careless hovering perpetuates the need for hovering.  If (as the saying goes) you sprinkle when you tinkle, I beg you to give it a wipe. Please, for Georgia’s sake.

 

6 Comments

Filed under Living with Breast Cancer

Long Day Ahead

Well, clearly this crowd loves to party!  The RSVPs are great – keep ‘em coming, we’ve got a guest list to tally and waive around in cancer’s face!  Also, it looks like we’ll be needing to up the tequila order.

Speaking of poisons and elixers, I am off to chemo again tomorrow.  This new schedule is a two-weeks-on /one-week-off cycle, where I get both gemcitabine and cisplatin one week, just gemcitabine the next, and a week off before repeating the cycle.  The cisplatin + gemcitabine day is tomorrow, and it’s a looooong one because they have to dose me up with so much fluid and diuretic to protect my kidneys. This is because “cisplatin can be incredibly hard on your kidneys.”  I love it when they say things like that. Another recent favourite was that “these drugs can cause permanent hearing loss.”  When my doctor told me that I said “Pardon me?”  She didn’t get it.

So, my schedule tomorrow begins at the clinic at 8AM and involves a lot of IV action until about 4PM.  Then I go home and, instead of crashing, I run rampant and eat everything in sight, since I’ll be hopped up on steroids. A day or two later, after the steroids wear off and the side effects begin to kick in, then I crash. And how!

But I don’t mind.  My friend Libby had inoperable pancreatic cancer and this combination of drugs erased it.  Knocked it down to the point where they could in fact operate and, yes, she spent six hours on the operating table getting rid of the scraps, but the point is that she got rid of it.  All of it. More than a year ago. I don’t know about you but I’m impressed.  Also hopeful.

Eight hours in the chemo ward may not be anybody’s idea of a great day, but it doesn’t mean it’s not a day well spent. Bring it, I say.

3 Comments

Filed under Living with Breast Cancer

New Chemo, New Start

Yesterday was a long but totally bearable day at the hospital, thanks to my amazing oncology nurses, Marion and Roz (I’ve really missed them, even though we all agree we would love to not have to see each other at all, except perhaps socially!) And of course the time always passes more positively and peacefully when in good company, so I was happy to have my wündermummy there, and grateful for visits from familiar faces, especially a fellow mets-warrior, The Lovely Patricia. 

So then.  Here we are: I’ve started the new chemo combo and although I felt completely wiped out last night and my bones began to ache, this morning I felt better.  The regimen of anti-nausea pills and steroids will help me through these first few days, and the steroids will no doubt result in my having the appetite and energy of a teenage boy, and possibly the temperament of a pro-wrestler (wait, is there any difference?)  Just for a few days, then hopefully I’ll completely lose interest in arm-wrestling and pizza pops.  Then I go back in again next Wednesday for another hit of gemcitabine, followed by a week off before the cycle begins again all over again in January.

It feels like a new start, although not one that I would have wished for. I’m still up and down emotionally about it; usually okay, except when I have to really think or talk about it.  The tears at this point are about on par with the laughter, and actually I think that’s a totally acceptable place to be — at all times, really, not just when you have a cancer crisis.*

Anyway, enough already about me (uh, says the person who blogs about herself all the time?)  I wanted to add a quick update on George & Deborah Warkus’ battle to get coverage for the drugs Deborah needs to fight HER-2 mets. I blogged about them recently, and below is an article in today’s globe about their continued struggle:

http://www.theglobeandmail.com/life/fighting-cancer-in-a-bureaucratic-catch-22/article1404843/

*Having said that, the comments that you’ve posted and the e-mails from friends and family are helping me like crazy, so pleeeeease keep ’em coming!

3 Comments

Filed under Living with Breast Cancer

The Plot Sickens

Apologies about that mysterious reference to “developments in development” – I was waiting to speak to my doctor, and now that I know what is going on and have shared it with family, I can finally blog about it.  Basically, the nodules in my lungs have turned out to be metastasized breast cancer.  

This means that somehow, in spite of the lymph nodes shrinking and stabilizing, the spots in my lungs managed to multiply and grow larger.  Those very same spots I saw on the CT scan in the solar system of my lungs – those tiny little flecks indistinguishable from all the other tiny little “normal” flecks – are in fact gigantically evil.

We were devastated and enraged when we heard the news, especially after having felt so buoyed by the stabilization and shrinkage of my lymph nodes.  I did a lot of crying, and a lot of raging this past weekend; a lot of fantasizing about smashing things (windows, pieces of furniture, cancer cells…) and a lot of asking the universe if it couldn’t have just cut me a little slack for once?  Really, how much hope-bashing is allowed?  How many bounce-backs do I have to make? 

But, after having to gone to some very dark and scary places, I was surprised to find that I could come back from them again.  I resurfaced.  Once again, the will to live my life and beat this thing has prevailed over the fear that it will beat me and take my life. Or prevailed for now; it’s a bumpy ride, I’m bound to fall off the hope wagon from time to time.

What helped enormously was having a long talk with my oncologist yesterday.  Apparently it is unusual that some areas would respond to treatment while others do not (of course I have to be special.)  However, it is not at all unusual that the cancer would affect multiple organs.  It is also not unusual for people live years and years and years just firing at the moving target of metastasis.  Years and years and years.  So, looks like I should continue to look both ways when I cross the street and keep wearing my bike helmet.

My oncologist’s recommendation is that we change course of treatment immediately to something that might be more effective in hitting ALL areas of activity, because she is especially concerned that I don’t become too symptomatic in the lungs, since it’s not fun to be gasping for breath and this cough is already super-annoying.

So my new treatment is a combination of drugs called gemcitabine and cisplatin, administered through IV in the chemo clinic, starting tomorrow. Off the pills and back into the veins! Actually, I’m kind of ready to abandon my current side effects and try out some new ones.  I’ve been told to expect nausea and tingling hands, but with any luck my bad dream about losing my hair won’t come true — my oncologist says there could be “some mild hair thinning or loss.” Sounds a bit patchy to me, but we’ll see.

In the mean time, onward. On Friday my friend Chris wrote me an e-mail and in it he said “The universe loves you.”  I really need to believe he’s right.  I just wish it wasn’t such tough love.

13 Comments

Filed under Living with Breast Cancer