Tuesday, October 1, 2013

Treatments, Tumor Markers, Herbs

Chemo #8 September 30, 2013
While travelling down I-40 to Chapel Hill does give me time to talk with my husband, I am finding I am feeling less than enthusiastic about it.  Yes, I want to “kill the cancer”, but the time away from home is troubling me.  Round trip amounts to 5 hours in the car if traffic is moving smoothly.  And with all the appointments and the waiting I will have to do today, I will be away from home and my daughter for a total of around 14 hours.  I plan to ask, today, about possibly being treated in Wilmington to make my treatment days shorter.

My oncologist has the flu, so I saw the Nurse Practitioner Ms. O. today.  She is wonderful!! 

I was given the flu shot today. 

Ms. O. and I began by talking about the redness of my skin along where the catheter extends from my port and travels to a vein in my heart.  She said it doesn’t appear to be an infection.  I told her about the hug my daughter had given me on Saturday where her shoulder compressed the port and had caused me pain.  The conclusion:  bruising from that hug.  After discussing my two nasty looking fingernails that will eventually fall off, I asked her what the benefit of being treated in Chapel Hill would be compared to Wilmington.  I said, “Surely they have access to the same information and drugs as you do.”

I explained further that my previous oncologist had said he wanted me to get the newest drugs available.  That is why he wanted me to be treated in Chapel Hill.  I had not asked him why Wilmington would not have the newest drugs.  His statement has been in my thoughts since he uttered those words.  Today I asked, “What is the difference in the two treatment centers?”

She gave me her reasoning of why Dr. A sent me to Chapel Hill.  It was quite different from my thinking, “Oh, my oncologist is dumping me” conclusion.  She explained that there were two possibilities:  First, he is a general oncologist and may not have felt he was up-to-date on the newest drugs specifically for my cancer and sending me to an oncologist who specializes in breast cancer would give me the best opportunity to get the best treatment and it would be backed-up with the best and most current knowledge available.  That made perfect sense. “OK”, I thought, Dr. A. may not have dumped me afterall”.  That makes me feel better.  Second, Chapel Hill has more clinical trials available.  This really put a different spin on the Dr. A. fiasco that I felt had occurred in April.  I wish he had given me a more thorough explanation of his motives, and I wish I had asked more questions.  He did not handle as I think he should have my transition to Chapel Hill and the ordering of the Her 2 neu test needed on my cancer to see if the subtype had changed from 2009. Perhaps his nurse was the root of the problem in that mess, or perhaps not.

As we talked, we came up with a possible plan for how and where treatments could occur in the future.  She said if I wanted to be treated in Wilmington, I could and still be a patient of theirs.  I could get chemo in Wilmington between scans.  When a new scan is needed, every 12-15 weeks, I would come to Chapel Hill for the results and discuss continuing treatment or moving on to a new treatment.  Then I could proceed with my treatments in Wilmington until the next scan.  I could also continue to have access to the clinical trials done in Chapel Hill.  If I became involved in one, the treatments would return to Chapel Hill.  This scenario means I could do away with going to Chapel Hill every 3 weeks.  With winter coming, I like that option.  But, I do have to look into where I might be treated in Wilmington because I am not sure I want to go back to Dr. A. 

We left this morning at 6:45 am.  I am hoping to be home before 8:30.  Yes indeed.  A long day it will be. 

Tumor Markers

Because I have been doing some reading about breast cancer and all the details of handling this chronic disease, I was interested to find out why I had never been tested for tumor markers.   She said that some doctors choose not to use them because they can be difficult to interpret.  It is a really a matter of preference by each individual doctor.  There is a doctor in Chapel Hill that she holds in high esteem and he does not use this method to determine cancer activity.  So, she feels comfortable with not testing for tumor markers.  

Furthermore, she explained to me that tumor markers are indicators for the amount of proteins that the cancer puts off in the blood.  Sometimes the test gives a false reading which adds to the difficulty of its use.  Even if tumor markers are high indicating cancer growth, they are not used alone to make assessments about whether treatments should be continued or discontinued.  A CAT scan or a PET scan is still done to see the activity of the cancer.  A tumor marker blood test does not always match these other diagnostic tools.  The mystery of why I have never had my tumor markers checked is now solved.

Because of my fear of the cancer metastasizing to my brain, I asked her how my largest tumor location between my lungs and of it wrapping itself around and infiltrating my artery might affect that outcome.  She said that it is not clear why some people get brain metastasis and others don’t.  While it does happen, the percentage is small.  And, brain metastasis can occur no matter where the cancer is.  A liver metastasis in a patient can have a brain metastasis later even though the position of the tumor is not near the brain. “Ok”, I thought, “I need to work on not worrying about this as much.”

Peoples’ writings on the breast cancer forums that I have been reading, specifically the Her 2 neu breast cancer forums, have left me with an impression that liver metastases seem to have longer survival times.  Sometimes I read of their scans eventually showing no evidence of disease (NOD).   I haven’t read this with lung metastasis.  This conclusion by me prompted me to ask this question: “Do people with stage IV breast cancer live longer with metastasis to the liver?”  Her answer was at least one that left me hopeful.  She is good at doing that for me, creating hope in what feels like such a hopeless situation. 

She said, “I know of a Her 2 neu patient that had a brain metastasis and metastasis to another organ. (I can’t remember exactly which organ right now.  It was not the lung.)  She had surgery to the brain and radiation and today is still being treated.  It has been 8 years.  It is so unpredictable how a cancer is going to respond to treatment.  It is different for everyone.” This doesn’t give me any idea how long I have, but it does give me hope that I could stay alive, with any luck, eight more years.  Someone has done it, maybe I can too. 

Vitamins, Minerals, Herbs
Last question of the day…”Can I take this (I gave her the bottle) multi-vitamin & minerals supplement given to me by a friend who is trying to help me”. 

“All the vitamins and minerals are fine, but some herbs can interfere with the metabolism of the chemo.  The liver metabolizes chemotherapy drugs and the herbs as well.  (That is why liver function is always checked on the day of each infusion.)  Certain herbs could make the chemo more toxic to your body”, she said.  “The liver may not be able to metabolize both at the same time”.  She researched on her computer the affects of Echinacea.  This is not an herb she would recommend I take because it can interfere with chemotherapy drugs.  (It pays to communicate with your health care professional.)   The next herb was dandelion.  No problems with that one.  Then she looked at Ginkgo.  It is another herb with the problem of causing toxicity.  She liked the fact that I had a friend who was trying to help me.  If I was not doing chemo now, I could use her gift of hope.  Thanks, Susan, for trying.

Next CAT scan
My CAT scan will occur before the November 11th appointment.  One more chemo treatment on Oct 21st then I will see if the drugs are working.

I had a Muga Scan today, too.  This scan checks to see if my heart is being affected by the drug Herceptin.  Results were not available at the time of this appointment.  I hope my heart is fine because Herceptin is dripping into my vein right now.

Overall, it was a good appointment.

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