Back to Chemo

Where has the time gone? I don't even have an excuse for not posting since October. Well, a little excuse. I was scared to face the truth.

Like I mentioned in June, my breast lump grew back. Since then, we have been talking a lot about it, considering options. Initially my oncologist suggested that if the lump was problematic, the options were surgery and radiation. I saw my radiation oncologist in the fall. She wasn't inclined to radiate the breast unless it was causing a lot of pain. I had pain, but intermittently, and mild. Later in the fall, one of the physicians who supports the oncologist felt the lump and suddenly, a chemo trial was on the table. It was a trial with Xeloda and either Tykerb or a new anti-Her-2 drug. I will admit the prospect of chemo surprised and scared me. I didn't expect that, since I've felt quite positive about my experience with Taxol at the beginning of my treatment. Taxol and Herceptin was my first line of treatment. After a year of that, I took a short break and then started Tamoxifen with Herceptin. The Xeloda trial required two previous lines of treatment, I learned that only chemo counts as a line of treatment in the trial world, so I was ineligible. Tamoxifen didn't count.

The physician ordered another round of scans. I did a bone scan and the results showed stability in my bone mets. I was starting to think the breast mass was simply necrotic (dead) tissue. I wanted a biopsy before stating a new treatment. Then we got the CT scan results. Not only had the breast lump returned, it was continuing to grow. And, there was a second breast tumour I hadn't noticed. And there was some thickening in the abdomen that could represent new small tumours. And there is a mass next to my uterus. Chemo it is!

Ten days ago, I started Vinorelbine, with Herceptin. Clearly systemic treatment is required. Vinorelbine, which I like to call vanilla bean, is known to have milder side effects than chemos like Taxol, for example. So far, I've had some indigestion and constipation. So far, my hair hasn't gone anywhere, but it is too soon to tell if I'll lose it. I pray that the vanilla bean will be effective, with few side effects. I could use your prayers as well.

I will be in Vinorelbine for as long as it works and I can tolerate it. An ultrasound is being scheduled to investigate the uterine mass. And, I hope, I will get back to blogging, both here and on my family history blog. It has been too long between posts. Glad to be back.

What's New With Me

What's new with me? Very little, I'm pleased to report.

I saw my oncologist this past week and got the results of the latest series of tests. The Herceptin can harm my heart, so I need an echocardiogram about every three months. I did the test earlier this month and my "ejection fraction" rate is just fine. I had also had a CT scan, the first since January, I think it was. My GP likes to be able to deliver good news, so he had already let me know that my tumours are stable. The remaining liver spot appears "treated." There is nothing new in the rest of the abdomen and pelvis. The bone tumours are still there but stable. My oncologist's colleague, who I saw last visit, had ordered an MRI of my axillary skeleton. The previous MRI, to which it was compared, was from May 2012, about halfway through my chemo. As a result, there were some new spots that showed on the MRI. Nothing to worry about. More importantly, the MRI showed fatty infiltration, which in English means the bones are healing.

I asked the oncologist to check out my right breast. That is where the lump was, the lump that started shrinking after the first chemo treatment. Until recently, the lump was gone and the remaining fullness was barely perceptible. That has changed. Now it feels like a lump to me. I have had some pain in that breast as well, off and on. I was a little worried. I had always felt relieved that I hadn't needed a mastectomy. For the first time, I wish that breast was gone. My oncologist, who I trust very much, didn't think it is worrisome, he said it felt "stringy." We will keep an eye on it. If it changes further, a mammogram may be needed.

In other news, Dad and I have been busy all month dealing with financial advisors and the lawyer, settling Mom's estate. There are some forms still needing to be signed. And we haven't even started cleaning out her room.  This will take a while. Meanwhile, I try to call Dad daily and see him a couple of times a week. He is coping well, but is lonely. I miss her too.

Call Me Mabel, Stable Mabel

This morning I saw my oncologist to get the results of the CT scan I had last Friday. Everything is stable! I will admit that I really liked the CTs I had during chemo that showed my liver tumours shrinking dramatically. OK, I wish I was NED (no evidence of disease). But I am happy to be sable, Stable Mabel.

This was my first CT scan since I began Tamoxifen treatment. I had thought of this drug only for its value in preventing the recurrence of breast cancer; I hadn't realized it was used for metastatic disease as well. I thought I was going to have to do chemo for the rest of my life. [Yes, there is SO much I don't know!] My bone marrow is glad for the chemo break, not that Tamoxifen is completely benign. I have had increased joint pain, significant nausea and, most recently, hot flashes. It's almost as bad as my chemo, Taxol. But it isn't as toxic. Knowing that my doctor has so many drugs to use against my cancer (triple positive ductal breast cancer) is comforting. In fact, the doctor mentioned that it appears that cancer cells are forgetful. They lose their resistance to particular chemo drugs after about a year. That allows the oncologists to retry a drug that stopped working. It gives me hope that I will be around for a while.

I swear, I cry almost as much after good news as bad. My Sweetheart and I admitted some of our fears to my oncologist. My doctor is, and always has been very optimistic about his ability to treat my cancer as a chronic condition, rather than a life-threatening one. The truth is that right now my cancer is not threatening my life. i really should relax a little. Both the doc and my Sweetie would like it if I stayed off the Internet and forgot about median survival rates. They have a good point, but it would be hard. I feel a great deal of comfort and support from the breast cancer blogging community. Plus, I want to use my blog to keep my loved ones up to date and to, I hope, be of comfort and support to others.

[My title was inspired by Jen at Learning to Live Lengendary and her post "Missing Mabel.")

Flashback to the Biopsy Table

"But my girl's only eight," I cried! The radiologist and technician stopped making their "no need to worry" noises as the image on their ultrasound screen became clear.

I knew, before the needle biopsy. The CT had already shown apparent metastacized tumours in my liver and bones. We could feel the breast tumour. It wasn't pea sized. It was huge. I knew what this meant.

"But my girl's only eight!"

Can you hear the terror in my voice? I can hear the paper on the biopsy table, under me and feel the cotton robe against my cold, frightened skin. I can see the dim light coming in from that north-facing window. And I can feel the terror. Not that I might lose my life, that's not the issue. That my daughter's health and happiness would forever be tainted by my diagnosis, by my prognosis.

I will need a miracle to survive this disease. But every morning that I can face my dear girl with a smile is a miracle for which I thank God.

"Patient at Risk for Pathologic Fracture"

There it is. The last sentence on the CT scan report. The sentence the doctor didn't mention. "A lesion in the right femoral neck places the patient at risk for pathologic fracture at this location."

Google explained to me that the femoral neck is the top of the thigh one, just before the ball (head) that fits into the pelvis at my hip. It is a pretty vulnerable spot, particularly in Ottawa during such a cold, icy winter.

I usually get up with my daughter and walk her to the school bus stop. The last few weeks I have become increasingly nervous about out our walk. The stop is only a few houses away. But there is so much ice on the road, and a bit on our front walk, to be honest. It is time to hand this job over to Geoff for a while. I hate to do that. He has taken on so much of the household tasks since I got sick. I like to let him sleep in a bit in the morning. But the risk is too great.

If I were to slip, the chance of the femoral neck snapping seems to be high. Surgery would be required to fix it, whether it is pinning the bone together or replacing it with a prosthesis (as in hip replacement surgery). I expect it would be more disabling than my previous pelvic fracture. Since reading the CT report, I've been feeling some pain deep in my hip. The Tamoxifen I'm on can cause bone pain. Or maybe it is in my head. Maybe I'm making a mountain out of a molehill.

On Thursday, I see an orthopedist, and then next week, my radiation oncologist. They will be able to tell me more. Maybe the risk isn't as great as I fear. Perhaps Dr. M could use radiation to strengthen my bone. Having been off chemo since November, my bone marrow should be able to withstand the radiation. We'll see what they say.

But in the meantime, I think I best stay off the road.

What the Future Holds

I may have mentioned in previous posts that I understood that if my tumours continued to shrink, I might get a break from chemo this fall, while I would continue with the drugs Herceptin and Pamidronate (the cancer-stopper and bone-builder, respectively). I knew that because I have advanced breast cancer that I'd be on and off chemotherapy for the rest of my life.  Apparently it will be more "on" than "on and off."

Last Friday, Geoff and I met with my wonderful oncologist to get the results of my latest CT scan.  We got good news. The tumours in my liver continue to shrink. They are still numerous, but under 1cm in size, except for one. That last large tumour has continued to shrink and is now about the size of the end of my pinkie finger. By the way, my blood tests for some time have shown that my liver is functioning well despite the tumours.  I figure that if my liver can live with cancer, so can I.  The tumours in my bones appear to be stable; no better, no worse.  Contrary to what I was expecting, there were no new fractures. I believe the CT looked at my breasts too. The results didn't give any measurement of the original breast tumour. I don't know if that means it's completely gone or if they just didn't measure it.  It doesn't really matter.

My oncologist reminded me that Stage IV breast cancer is a chronic disease. Like other chronic diseases, such as diabetes and even depression, medical treatment doesn't take a break. He also explained that the unfortunate reality of breast cancer is that, eventually, each chemo medicine stops working. He hopes to get as much benefit as possible from each chemo treatment.  So, I will continue to get Taxol every three weeks, "as long as it is working and it is well-tolerated."

I have to be honest, I was disappointed to get the news. Somehow, I'd dreamed up a chemo-free future where, for one thing, it might be easier to return to work. I have to rethink things. I have to accept that the chemo will continue. So every three weeks I will have a few days where I feel tired and nauseous, and have sore fingers and toes (my weird side-effect).  I don't know how well my hair will continue to grow.  My chemo-brain syndrome will continue to interfere with my speaking.

I get a tiny break though.  No chemo on September 28; I start again October 12.  That means I won't be recovering from chemo when I do the Run for the Cure on the 30th, that I can attend a retirement party on the 28th, and that my nephew's wedding won't be on a chemo weekend.  See?  All good.

Test Results from April

I finally met with my oncologist last week to get the results of the tests I did in April:  CT scan, echocardiogram and MRI of the axial skeleton.  Good news all 'round.

The CT scan showed further shrinkage of the liver metastases and no new ones in other areas of the abdomen.  The shrinkage wasn't as dramatic as between the October and January CT scans, but it's still shrinkage and the doctor was happy with that.  It seems there are only two tumours larger than 1cm.  That's a huge improvement.  I'm just looking forward to a day when the liver tumours are countable rather than "numerous."

The echocardiogram was great again.  My results were high enough that I can continue to be treated with Herceptin.

The MRI of the bones had a little good, a little bad news.  It showed a great deal of healing of the bones in my lower spine and pelvis, which was attributed to the radiation treatment I had in late November, early December.  Unfortunately there is a new compression fracture in my spine.  The surprise is that it was not due to a cancerous tumour but to osteoporosis.  I have a strong family history of osteoporosis, and given my history of non-exercise and only medium consumption of dairy, I figured I would get it eventually.  It looks like the chemo treatment has actually brought the disease on early.  Like the other fractures, it should heal over time. 

So, good news for all of us that have been waiting.  Thank you all for your concern and good wishes.  They mean a lot to me.  See my next post for treatment changes.

Oncology Update: April 12, 2012

Yesterday, I had an appointment with my oncologist.  I was hoping to get the results of last week's CT scan.  Unfortunately, given the Easter holiday, the results were not yet ready.  I have an appointment with my GP next week where I should be able to get my results.

In the meantime, oncology is sending me for an echocardiogram to make sure my heart is bearing the chemotherapy well, and a bone MRI to see the status of the bone tumours across my body.  We had an interesting chat with the doctor about the tests.  She said that in the fall, because I was so sick (see Geoff's blog on that), I got the Cadillac of Cadillac of tests.  Now, it's important to repeat those tests to be able to adequately compare the results.  She also explained that the CT scan is their best tool for assessing the tumours on my liver.  She's conscious of the risks involved in the CTs use of radiation.  Once my liver tumours are more stable, they may transition to using ultrasounds, which do not use radiation.  For the bone tumours, the CT isn't as effective and the doctor will use and MRI, which they will compare to the ones done in November.  MRIs do not use radiation, neither does the echocardiogram, which is essentially an ultrasound of the heart.

We also talked to the doctor about going back to work (actually she wouldn't talk about that) and vacations.  She was concerned about my hope to go to Ireland this summer.  She suggested we start with some shorter, closer vacations and reminded me of the potential stress of unfamiliar beds and uncomfortable restaurant chairs.  I think a trip to Montreal is long overdue.  We'll try to go once our lovely niece there finishes school for the year.  Perhaps we'll head to Oakville in June to see my brand new lovely niece, once she arrives.  After I told her I expected I shouldn't go on roller coasters or ride a bike at this point, she looked at Geoff and said something to the effect of, "I can see what you're going through."  I guess she thinks I'm pushing too hard to return to a normal life.  Geoff cracked up after we left when I complained about the two of them ganging up on me.  But really, if I want to get back to normal, I have to start doing normal things!  I don't want to spend the rest of life on the couch watching daytime television.  I've had enough of that.

Back to chemo on Friday.

Coming Up Next: CT Scan April 5, 10:30 am

Next week, I have my next CT scan of the chest and abdomen.

It will get a good look at the liver tumours as well as some of the bone metastases. After several more rounds of chemo (than between the previous two CT scans), I expect to see greater reduction in the size of my liver tumours. Unfortunately they are, to quote the last scan's report, "numerous." I am also hoping that this scan will show actual healing of some of the bone mets.

Postitive energy and prayers would be welcome on April 5th, the day of the scan.

Update: March 18, 2012

I never did give you an update on my March 9 chemo session.  Lena's March Break got in the way.  Short story anyway; it was fine.

I had an appointment with the oncologist on the 14th.  He was away, so one of the GPs saw and examined me.  She was very pleased with my progress since the last time she had seen me, several months back.  She even said I made her day.

We went over my prescriptions. She is in favour of weaning me off as many drugs as we can. We're starting with the blood pressure medication and one of the stomach medications. So far so good. I'll need to monitor my blood pressure. It had gotten to the point that it was even lower than me usual LOW blood pressure. Cutting the medication back by half should bring my blood pressure a little closer to normal -- and farther from "you better be careful standing up."

We also talked to her about when I could start driving again.  I feel pretty ready already, but figured I would spend some time in a parking lot practicing before hitting the road.  She disagreed.  In fact she was more conservative than Geoff.  She suggested a full month in the parking lot, including lots of practice getting in and out of the car.  She implied it could be a long time before I would be ready to drive the minivan.  I haven't driven it since we bought it, just a five minute test drive in October.  This doesn't make me happy.  I'm feeling stir crazy enough and look forward to more independence.

A CT scan has been scheduled for me for early April, so I expect I'll go over the results with the oncologist in a month's time.  I sure hope the scan will show further shrinkage in the liver tumours and stronger bones.  I'd appreciate your prayers and positive thoughts in advance of the CT. 

With Stage 4 breast cancer, I know the doctors can't cure me (yet).  So I'm looking for a miracle.  Your prayers and energy may make the difference for me.  Many thanks to you all.

Update: February 15, 2012

I'm overdue to update you on last Friday's chemo session.  Plus, I met with my oncologist this morning and got some unexpected news.

First, chemo.  It went pretty much the same way the last couple of sessions have gone.  The chemo itself is fine.  Afterwards, though, I end up tired and lose my appetite.  I haven't eaten much since Friday.  Even my favourite things, like Saint Hubert chicken and cream of wheat, I could only eat a bite or two of them.  My cousin Sam mailed me some of my grandmother's best cookies, genetti.  Even the genetti I have to eat slowly to get them down.  It's a shame.  Still, considering how difficult chemo is for so many patients, I know I'm getting off easy.  I can't really complain.  And that is why my appointment with my oncologist was somewhat surprising.

His focus is on maximizing my quality of life while controlling my disease.  He wanted to get my liver metastases under control and then reduce my chemotherapy.  The last CT scan showed that the liver mets have shrunk significantly, but it appeared that the bone mets had grown.  My oncologist pointed out that it takes months for bone mets to heal, and for the healing to be visible on a scan.  His interpretation of the CT results is that the bone mets may have grown while my chemo was interrupted in November/December, but they are probably responding as well as the liver mets are -- we just can't see it yet.  He's now going to reduce the amount of Taxol I'm getting by 20% to improve my quality of life (that is reduce the extent of tiredness and lost appetite I'm experiencing).  On another note, he will be reducing the amount of steroids I'm getting with the Taxol, which should reduce my swelling.

In a couple of months, he'll repeat the CT scan and if the results are good, he expects to cut my Taxol to once every three weeks, rather than twice.  Eventually, if my results remain good, after another couple of months, he'll cut the Taxol entirely and stick with the Herceptin for "maintenance."

He also mentioned that the liver is the most important organ in my treatment, the one he was most concerned with controlling.  This makes me feel much better, given the dramatic results I had on the liver mets.  I had been worried about the bone mets, but his comments this morning made me less concerned.  I just have to be more patient with the bone mets.  The fact that my pain levels are greatly reduced is probably a more accurate reading on my bone health than the CT scan was.  That's good.

Oncology Results: January 18, 2012

First, thank you for all of your good wishes and prayers since my last post.  I am sure they helped.  And I am sorry to keep you waiting with this post, but I have been terribly drowsy for the last several weeks, to the point that I couldn't stay awake reading the morning newspaper or wait for the doctor's appointment.  During that point in time, my Sweetie posted for me.  You can see his summary on the Geoff Takes On blog, here.  Despite today being a chemo day, and me having slept most of the day, I'm feeling more energy this evening.  So, without further ado, here's my take on the oncology results we got on Wednesday:

The previous week, I had had two tests, an echocardiogram and an CT scan of my chest, abdomen and pelvis.  I was worried that in the month or so when I didn't have chemo that my cancer might have spread.

First, the echocardiogram, nothing had changed since the one I had in the Spring for unrelated reasons.  My heart is good.  I have mild regurgitation in my mitral valve, but that doesn't seem enough to call it mitral valve prolapse.

And then there's the CT scan.  Geoff and I were holding our breath.  I don't know if I'd really given you a sense of the liver tumours I had.  This CT scan described them as "innumerable."  That's not great on its own, but the rest of the news is.  There were a couple of large tumours that had been measured last time.  One of them went from 4" by 3.6" down to 3" by 1".  That is a major change!  Another went from 1" down to 0.35".  In the words of the CT report, there is, "marked interval [since last test] improvement in hepatic [liver] metastases  consistent with partial response [to the chemo treatment]. No new metastatic disease is seen inter-abdominal [No mets in other abdominal organs]."

They also said that the fractured pubic bones are healing on both sides of the body.  And I had been told the break was only on one side.  I also learned there are fractured ribs; I can feel them, now that I know they are there.  That explains the shortness of breath.

I have to laugh at they way they write the report.  It's by body part or organ.  For example:

"Lungs:There is no interval development of bilateral subsegmental atelectasis [collapse of the lungs] with no consolidation or suspicious pulmonary nodules." In my own words: blah, blah, blah, no cancer in the lungs, yay!

"Heart: Grossly unremarkable. ..."  Hmm, I suspect some of you would disagree.  On the plus side, what it means is that there is no cancer in my heart, which is very good news.

I won't go into detail about the bone metastases, since the CT scan isn't the best test to measure them.  We know they're there and there are a lot of them.  'nuf said.

This is very good news for us.  Geoff was visibly relieved during the appointment, thank goodness.  Personally, I thank God for the good news.  I know the doctors did an awful lot: choosing the right chemo is important, as is radiating the right spots.  After that, prayer makes the difference in the end.  So thank you all for your prayers and good wishes.

My oncologist says there's good reason to be optimistic this disease can be managed for many, many years.  That's what we're looking for.  Many, many years.

p.s. Strangely, this CT didn't measure the breast lump.  Could it not see it?  We can't feel it.

Wish Me Luck: Oncology Appointment & Test Results

Tomorrow I'm meeting with my oncologist.  At least, I hope it's my oncologist; often it's one of the GPs that assists him.  They are very good, but I want to see the big guy.  Particularly this time.  Last week I had an echocardiogram and a CT scan and I will have blood tests done just before the oncology appointment.  I really want my oncologist to give me the results, particularly if it means he's going to change my treatment plan.  As his nurse suggested at my last appointment, I will call her and remind her that I'd like to see the big guy; she'll do her best.

The echocardiogram was to check my heart health, because herceptin treatment is tough on the heart.  I know that the chemo treatment caused me to have high blood pressure, which is being treated effectively with metoprolol.  The CT scan looked at my breasts, abdomen and pelvis.  It should tell me the size of the breast and liver tumours.  I hope the CT scan will also tell us how well my broken pelvis is healing.  It's feeling better every day, as far as I can tell.  But I'd like a second opinion.  The blood tests, together with the others will decide whether I have chemo on Friday or not.  I need to have sufficiently good results in a number of areas, such as my blood count and calcium levels.

Like I said, my pelvis seems much improved, and I've told you that the breast tumour has shrunk quite a bit.  But I am worried about the one-month break from chemo as a result of my hospitalization in November.  I know that radiation was working on killing cancers in my lower spine and pelvis at that time, but how much was cancer growing in other areas over that period of time.  What will the CT results tell us?  Do I have less cancer or more?  Are my tumours bigger or smaller?  Are there new ones or did some disappear?

How much has chemo and radiation helped?  How much has prayer helped.  We'll never know, but there's time enough for a little more prayer before the appointment Wednesday at 3:00 p.m. Eastern Time.  Wish me luck, pray for me, whatever you're comfortable with.  And I'll let you know how it went as soon as I wrap my mind around it!