I
had an exciting morning with our dear Dr. Priya Gor. Wow. Very bright
woman- her mind works a mile a minute. When I was checking out and
making arrangements for additional tests etc, I said "she is a
RIOT" and the staff person responded " that is one word for her".
Everyone knows that she knows that she is very bright. She tends to bark
orders without full information and expects the staff to kind of know
what she means--- like can't you read my mind- I followed her closely
and reinterpreted behind her for her staff. They actually were thrilled
with me- I walked in there with my FMLA papers completely filled out and
all they had to do was put a signed copy away. I said it looked like
they could use a social worker around there. "Oh we have one"- I said
where is she? They said she works part time in the administrative offices
2 days a week. She never goes to the chemo infusion sites. She talks to
people only on the phone- in my mind, she is not doing social work and I am sure she is not a MSW either. She is doing patient representative
work- to see if people need anything else. She can assess situation and
refer them to whatever they need. She is not having a relationship or
working as a patient advocate in the clinic setting. NOT social work to
me.
While
Dr. Gor and I were in the exam room, I had to say to her, as we are
discussing making big changes, that I wanted to summarize what I heard
her say as she spoke very fast and used language not
entirely familiar to me. She thanked me for trying to slow her down. She
almost listened to my summary while she entered information into the
computer, but I did not get confirmation that I had it right. But
I believe I do. So here it goes.
She very quickly assessed me and determined that I was allergic to the “T” in my TC cocktail
– I will affectionately refer to the "T" as GIN {see (1)}----I had
broken out in a rash, experienced flushing in my face almost immediately
after the infusion, and slight fever over the weekend- my skin has
been getting tighter from the allergic reaction and I was itchy like
MAD! Not so unlike my allergic reaction to Melons when I was a little
child....... AND If you read below- this is not usual but not common. Now I am taking a Prednisone pack
to reduce itchy rash etc………. She also felt that my joint bone pain was
due to the "GIN" in my cocktail and not the Neulasta. (2) She said the medicine to reduce infection usually attacks large bones like your Femur and Sternum. My pain was in my hips, my knees, my ankles and feet- She says the pain was likely caused by the "GIN". Time will tell as she
said that there is no way to put less medicine in the machine for next
time as it comes pre-measured. I will explore this and will call the
drug manufacture over weekend or next week. Nancy Patterson's healing
over the phone really worked cuz I now have such infrequent pain hit-
they do come from time to time but not intense at all.
My
side effects are: dry mouth, dry skin, diarrhea which has lead to
abdominal tenderness., some nauseaness early on, metallic taste in my
mouth, joint pain, headaches, and the insane itching from the allergic
reaction
Given
that I am allergic and my desire to get this done sooner rather than
later, we are trading cocktails. We am bringing in "A" to the team.
Which I will affectionately call "VODKA" . You know, thinking of this as
alcohol really isn't too bad of an analogy- both are toxic to the
body.
There is a slight trade off in the switch that is concluded in a head to head study- TC out performed AC - however I am making up for it by doing DDC (Dose Dense Chemotherapy) Read below (1a)
TC out performed AC--- Study
results at a median follow-up of 5.5 years reported in 2006 showed that
TC improved the disease-free survival rate by an absolute difference of
6% and overall survival by an absolute difference of 3% compared with
AC (Jones S et al: JCO 2006;24:5381–5387). At SABCS, Dr. Stephen Jones presented seven-year-follow-up data and reported outcomes in older patients—i.e.,
women age 65 and over. Dr. Jones said that higher doses of docetaxel
were used in the US Oncology Trial and that there may be more synergy
between docetaxel and cyclophosphamide. “This study is the test of time.
We now have a survival advantage for TC,” he said.}
NOW FOR ALL YOUR WORRY WARTS!
WHY I will be fine-
#1- I did have one round of the TC "GIN" cocktail
#2- I will be NOW having dose dense treatment (1a) - You can not do chemo dense treatment with TC
#3- I will no longer get chemo every 3 weeks but ever 2 weeks. My last treatment will be on February 19.
#4- Chemo dense therapy out performs traditional, every 21 days rounds of chemo (1a)
Unfortunately it
comes with potentially more adverse reactions so my heart will now be
closely monitored. In fact tomorrow I am having a MUGA test (2a) at
SJRA.
So
I will keep all of you posted. Too tired to write any more tonight.
Will be working with Selene tomorrow to get title for my blog. She is
leaning toward something simple with the word cancer- I am not feeling
that generous to cancer and I like the one I used tonight, "FUN LADY
WISDOM" So if you have read this to this point, please reply for your
vote. My dream is to continue to write on the blog even after this
experience with cancer is behind me and share my thoughts and hard
earned wisdom about my lessons in my life. HECK- maybe one day I will
get that book(s) written.
TITLE Options for BLOG Are: PLEASE reply for your vote.
- Fun Lady's Wisdom “Lessons from Cancer and other living things”.
- My view given from breast cancer
- Insights behind my cancer diagnosis
- Stepping into breast cancer
- Embracing my cancer lessons.
- Lessons in breast cancer
OH
Fudge- I forgot to mention that I need a port for my vodka- it cannot
be given the way Gin is given- so I am waiting to have my breast
surgeon, Dr. Gilliam give me a time for Tuesday the 19th to get that put
in. Next infusion: Friday January 22, 2016
(1a) Dose-Dense Chemotherapy (DDC) aims
to achieve maximum tumor kill by increasing the rate of chemotherapy
delivery, not by increasing dosage (which is the theory behind many stem cell transplant protocols).
By administering the same doses of chemotherapy previously given every 3
weeks on an every 2 week schedule instead, the chemotherapy interrupts
the rapid growth phase of the tumor cells. Thus, the therapeutic drugs
interfere with the Gompertzian curve, hitting the tumor cells at the
time when they are just beginning to grow rapidly again. In other words,
"hit them while they are down." This model was called the Norton-Simon
model, after the researchers who first described it.
You
may ask, why we haven't tried this before? The concern has always been
that giving chemotherapy more frequently would lead to low white blood counts and infection, a potentially deadly combination in a patient receiving chemotherapy. Through the use of growth factors (Neupogen, Neulasta, Leukine),
we are able to have faster recovery of white blood cells, decreasing
the chance of infection. Several DDC studies have shown a higher
incidence of anemia (low
red blood cell count) and bone pain (likely related to the use of a
growth factor) with these regimens, but the DDC regimens also mean a
decrease in the length of therapy by 4-6 weeks, which may be appealing
to some.
Studies in Breast Cancer
While
the theory seems logical, in practice the results have not been so
convincing. The first study was done in women with node-positive breast
cancer who were receiving chemotherapy with cytoxan, Adriamycin, and
taxol. The women who received DDC every two weeks had an overall
survival of 92% three years after treatment, versus 90% for the every 3
week regimen. The same result in favor of DDC was found whether
Adriamycin and cytoxan were given at the same time or sequentially (one
after the other). As for recurrence of their cancer, 82% of women
receiving DDC remained cancer-free, compared to 75% of the women on the
every three week regimen. Longer follow-up will give additional
information in the coming years.
ANTONIO, Texas — After 10 years, dose-dense dose-intensified
chemotherapy continues to offer significantly better disease-free and
overall survival than standard chemotherapy for women with breast cancer
with axillary node involvement, according to a new study. Ten-year
overall survival rates were higher in women treated with an intensive
dose-dense (IDD) regimen of epirubicin, paclitaxel, and cyclophosphamide
than in those treated with standard-dose epirubicin and
cyclophosphamide with sequential paclitaxel (69% vs 59%; P = .0007). High Risk for Adverse Events The
survival advantages came at a cost, however; 9 patients (1.3%) in the
IDD group developed myelodysplastic syndrome or acute myeloid leukemia,
compared with 2 (0.3%) in the standard-dose group. That had a couple of
clinicians who were not involved in the study worried.
(2a) MUGA Scan
A
multigated acquisition (MUGA) scan creates video images of the lower
chambers of the heart that hold blood (called “ventricles”) to check
whether they are pumping blood properly. It shows any abnormalities in
the size of the ventricles and in the movement of the blood through the
heart. Other names for this test include cardiac blood pooling imaging,
nuclear heart scan, nuclear ventriculography, and radionuclide
ventriculography.
Some
people may need a MUGA scan before chemotherapy to find a pre-existing
heart condition. Doctors also use MUGA scans as follow-up care to
identify potential long-term heart side effects called late effects.
Cancer survivors who may need follow-up MUGA scans include:
People who have had radiation therapy to the chest, spine, or upper abdomen
People who have had a bone marrow/stem cell transplant or certain types of chemotherapy.
For
these survivors, the test can identify heart-related late effects,
which may occur more than five years after treatment. Learn more about late effects of childhood cancer.
Effects on the heart from drugs used to treat cancer
Some types of chemotherapy,
such as anthracyclines, may damage the heart during cancer treatment.
Examples include daunorubicin (Cerubidine, Rubidomycin), doxorubicin
(Adriamycin), and epirubicin (Ellence). Other drugs used to treat
cancer, such as trastuzumab (Herceptin), can also cause heart problems.
Sometimes, heart damage from these drugs can cause congestive heart
failure (CHF). CHF occurs when the heart does not pump enough blood to
the rest of the body. People with CHF may experience swollen hands and
feet, shortness of breath, dizziness, and an irregular heartbeat. Most
often, however, the heart damage is mild and only seen on MUGA scans or other heart tests.
(1) Taxotere®(1) OLD "GIN" / "T" Ingredient.
Chemocare.com
uses generic drug names in all descriptions of drugs. Taxotere is the
trade name for docetaxel. In some cases, health care professionals may
use the trade name taxotere when referring to the generic drug name
docetaxel.
Infusion-related side effects (symptoms which may occur during the actual treatment) include:
Allergic
reactions (rash, flushing, fever, lowered blood pressure). Happens
rarely, usually occurs in the first or second infusion.
How this drug is given:
- Docetaxel is given through a vein (intravenously, IV)
- There is no pill form of docetaxel
-
Premedication with a corticosteroid pill starting a day prior to
docetaxel infusion for 3 days is given to reduce the severity of fluid
retention and allergic reactions. Your doctor will prescribe the exact
regimen.
-
The amount of docetaxel that you will receive depends on many factors,
including your height and weight, your general health or other health
problems, and the type of cancer or condition being treated. Your
doctor will determine your dose and schedule.
-
premedication with corticosteroid starting one day before infusion.
You will be monitored closely during the infusion for any signs of
allergic reaction.
(2) Neulasta®
(pegfilgrastim)
is a prescription medicine used to help reduce the chance of infection
due to a low white blood cell count, in people with certain types of
cancer (non-myeloid), who receive anti-cancer medicines (chemotherapy)
that can cause fever and low blood cell count.
(3) NEW "VODKA"/ "A" Ingredient - Doxorubicin, called adriamycin, is a chemotherapy drug used to treat many different types of cancer. Why is this medicine prescribed? Doxorubicin
is used in combination with other medications to treat certain types of
bladder, breast, lung, stomach, and ovarian cancer; Hodgkin's lymphoma
(Hodgkin's disease) and non-Hodgkin's lymphoma (cancer that begins in
the cells of the immune system); and certain types of leukemia (cancer
of the white blood cells), including acute lymphoblastic leukemia (ALL)
and acute myeloid leukemia (AML, ANLL). Doxorubicin is also used alone
and in combination with other medications to treat certain types of
thyroid cancer and certain types of soft tissue or bone sarcomas (cancer
that forms in muscles and bones). It is also used to treat
neuroblastoma (a cancer that begins in nerve cells and occurs mainly in
children) and Wilms' tumor (a type of kidney cancer that occurs in
children). Doxorubicin is in a class of medications called
anthracyclines. It works by slowing or stopping the growth of cancer
cells in your body How should this medicine be used? Doxorubicin
comes as a solution (liquid) or as a powder to be mixed with liquid to
be injected intravenously (into a vein) by a doctor or nurse in a
medical facility. It is usually given once every 21 to 28 days. The
length of treatment depends on the types of drugs you are taking, how
well your body responds to them, and the type of cancer you have. What special precautions should I follow? Do not take any grapefruit or it by products
Less common side effects of doxorubicin--Changes in the way your heart works- Doxorubicin
can affect the way the heart works but this is usually temporary. You
may have tests to see how well your heart is working before, during and
sometimes after treatment. If
you have pain or tightness in your chest, feel breathless or notice
changes to your heartbeat at any time during or after treatment, tell a
doctor straight away. These symptoms can be caused by other conditions
but it’s important to get them checked by a doctor. Second cancer Rarely doxorubicin can increase the risk of developing a second cancer, usually leukaemia, years later. But the benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this. How you have doxorubicin - You
have it through a thin, short tube (a cannula) put into a vein in your
arm each time you have treatment. Or you may have it through a central
line, a portacath, or a PICC line. These are long, plastic tubes that
give the drugs directly into a large vein in your chest. You have the
tube put in before or during your course of treatment and it stays in
place as long as you need it.
