Tuesday, June 29, 2010

Update - June 29

Since my last update I have received my Avastin (yesterday Monday June 28) and had a follow up exam with my physician (a couple of weeks ago). the exam is still good with no evidence of recurrence, and the lab test CA-125 remains in the low normal range. All good.

When I went for Avastin yesterday my nurse had trouble getting blood return through my port. (the "port" is the thing that was inserted into a vein to give constant access to my blood and veins. "Blood return" means when the nurse injected a syringe of liquid into the vein through the port, but then pulled back to create a vaccume blood came into the syringe. Or in this case, blood did NOT come into the port). This means that little blood clots have developed on the inside of the port blocking blood access. This has happened only once before - when I went to the place in Atlanta for one of my blood transfusions.

In this case the problem is probably that blood is so infrequently collected through this port and medicine so infrequently injected. I only receive the Avastin every 3 weeks now, and I only have blood work done every 6 weeks.

the nurse was able to fix the problem by injecting an enzyme that digests the blood clots - but she had to do it twice. And wait 45 min - 1 hour after each injection to see the result. Since my medicine was not available when I arrived and we had to wait for that, only to learn that the port was not working, and then had to inject the streptokinase (the enqzyme that eats blood clots) twice and wait an hour after each injection, I was at the doctor's pretty much all day. Good thing I took work along. And good thing my colleague did not take me up on my offer to come into work that afternoon after I finished my chemo (anticiapted to be by noon, but not completed till nearly 4 pm).

Other news:

(1) My hair is coming back!!! I am so happy to have hair at all that I don't care if it is very short and sort of sparce and I still look like a marine at boot camp (a very old, very fat, very out of shape marine...)

(2) last week I took Thursday off and drove to Jackson, Mississippi to see neice Louisa M Chapman and her regional ballet troupe perform in the international ballet competition. It was well worth the trip, even if we could not find a very exciting place to have dinner after ward. I gather that Jackson, MS residents do not fancy night life outside of their living rooms.

(3) Tomorrow night I go to Cherokee NC to practice clinical medicine again in the Cherokee Indian Hospital clinic July 1 - 9. I think I am up to it, but I am a bit nervous about the ability to manage a day that is more physically stressful (have to stand and walk all day) and that requires constant attention and decision making. for obvious reasons, I am skipping the ED this year. dEfinitely not up to that yet.

(4) Main continuing problem is the neuropathy that developed from one of my chemotherapy agents. It has definitly improved since I finished the standard chemo. However, I still have trouble with my feet, am clumsy walking and occasionally have balance problems. I just have to hope it continues to improve. On the good news side, I no longer have to ask the vet to apply flea stuff to my dogs becasue i can again manage to open the containers myself. For a while there I could not. I stil have clumsy hands occasionally, but I think it is mainly normal clumsy rather than neuropathy clumsy. I am inclined, however, to attribute all my typos to neuropathy, rather than attribute them to sloppiness or my historic problems with spelling anything correctly.


Monday, June 7, 2010

Labs last Thursday, Avastin today

In the past couple of weeks I graduated to only getting labs tested every 6 weeks - which means my blood cell counts have come back to more or less normal after the standard chemo and remained stable for several weeks. That is good news.

My most recent lab tests were last Thursday, followed by Avastin today. Currently my energy seems to take me pretty well through 3-4 days a week, then I get worn out and take it very slowly for a couple of days and recover. This week I am stepping up to working 4 (rather than 3) days a week. We will see how it goes...

My hair has returned to a sort of peach fuzz state all over my head. I suppose if you have not seem me at the end of my chemo with essentially no hair it does not look like progress. But believe me, it is progress. These days I mostly go hatless except when I need protection from the sun, which is any time I am out.

Results of the clinical trial that tested women who got standard chemo against women who got standard chemo plus Avastin during and for 10 months after standard chemo have been released and document a "progression-free survival" (time you live with no evidence of the cancer coming back or growing larger) advantage of about 4 months for women who got Avastin over those who did not.

Since I am getting Avastin, this is good news for me.Combined with the Japanese trial that suggests that dose dense TAxol (the kind of standard chemo I got where I received carboplatin every 21 days but got Taxol every week) gives on average about a 2 year progression=free survival advantage over the standard method of dosing (carboplatin and taxol both only once every 21 days) and i am feeling that it was a very good thing for me to have entered this trial.

The remaining question, which the trial I am in is designed to answer, is whether there is a survival advantage to getting standard chemo directly into the belly (intraperitoneal or IP) rather than into a vein (Intravenous or IV). Guess we will have to wait for the outcome of this trial to learn that answer. STudies to date suggest that there may be some advantage to IP treatment over standard IV chemo, but that is the chemo where both drugs are given only once every 21 days. No way to know what would happen with the Dense dosing of Taxol which I received.

Meanwhile, I increased my work days from 3 per week to a planned 4 per week starting this week. I have no plans to "overdo it" as many have expressed concern that I might. But at the same time, I see no advantage in prolonging an convalesence any longer than necessary. Sitting watching TV is loosing its charm - but I need to build back a bit more strength and endurance before i am ready to venture out on vacation trips or other outings. So pushing myself a little bitter further physically and mentally every week seems the best way to maximize the efficiency with which I get from where I am to where I want to be.

Thanks for your support.