Tuesday, October 22, 2013

Chemo #9/next CAT scan, chest pain

Chemo #9 

I made it through Chemo #9!  And, I am feeling pretty good this morning.  Now if I could only stay this way…

Yesterday, I had expected to have an appointment with my doctor, but instead I saw a Physician’s Assistant, Ms. P.  My doctor was in with another patient and then needed to eat lunch, so I suppose they felt like I had been waiting long enough to see someone, which I had, so Ms. P. jumped in to help.  At the end of the appointment Doctor R. came in to see me, so I was able to ask her one question that I have asked before but can’t seem to let go.

After the introduction, Ms. P. looked over the sheet that I am asked to fill out at every appointment.  It is yellow and has questions about my health.  The instructions ask that I rate each question from 0 (none) to 4 (worst).  The questions ask such things as, Do you have any pain?, If so, where?, Do you have diarrhea or constipation?, Any vomiting?, Chills?, Fever?, Hair loss?, Difficulty breathing?, Numbness/Tingling?, Urinary Pain?, etc.  Sometimes the person seeing me looks at it, and sometimes they don’t.  Today, Ms. P reviewed each question.  She stopped on the one that caught her attention.

“Tell me about your chest pain,” she said.

Chest Pain
On October 13th, I awoke with soreness in my back on the right side along my back ribs.  Every time I would breathe deeply, I would have chest pain.  Initially, I thought I must have slept in such a way that caused my muscle to remain tense and wouldn’t relax.  The next day, the back pain was gone, but I still had the pain when I breathed deeply.  The pain would radiate out from the center of my chest and I could not determine whether it was coming from my stomach or my lungs.  It did give me a bit of a scare because my brain was giving me images of my chest tumor between my lungs enlarging.  I kept thinking please don’t be that, it is way too soon for me to have to face what comes next with that devil.  I was pretty confident it was not a heart issue.  But, because it was lasting for so many days, I was beginning to think I needed to have someone listen to my lungs to make sure there wasn’t any fluid accumulating from further lung metastasis.

I explained to Ms. R. that I called the Nurse Navigator on Thursday.  She felt like my chest pain was due to my stopping my inhaler.  I hate using my inhaler because it causes me to be so hoarse that it makes it difficult to read aloud to my 10 year old.  I have always loved to read to my children.  But a paralyzed vocal cord from my cancer pressing on the vocal nerve, breathing issues and the need for an inhaler and sinus drainage from the allergies makes my speaking voice weak and makes reading and indeed talking difficult.  The extreme hoarseness is not consistent, I am so thankful, but lately it has been troublesome.  So I stopped using the inhaler in hopes of having a stronger voice.  Well, because of that, it seems I may have brought myself some unnecessary pain.  As bad as I want to, I can't seem to do without the inhaler.  Again, I started using it.

A few days later, and I had relief!

Ms. P, the physician’s assistant, and I discussed the chest pain and she agreed that I need to have continued use of my inhaler. My allergies must be really bad right now because when I talk it sounds as if I have to take a deep breath at the end of every sentence.  My sister noticed it when I spoke to her on the phone the other night as did Ms. P. noticed it on this day. This has happened before I knew I had cancer.

Ms. P. also felt that my stomach could have caused some of the pain since I have been complaining of that for the last couple of visits.  She suggested I take some Pepcid or some other over-the-counter medicine. The steroids and the chemo are hard on the stomach.

Before she listened to my lungs, we talk about the rest of my list of questions.  I am always prepared with a list of questions or plans to be made.  During the weeks between appointments, items pop into my head and I write them down. 
Next CAT scan
We needed to plan for my next CAT scan.  This will look at my neck and chest to hopefully see reduction or stable cancer which is good too.  The abdomen was looked at last time and was clear so this time it won’t be looked at.  I will have the results at my next appointment which is November 11.

Testing for Herceptin resistance
My next question stemmed from the research I have been doing on the internet.  I have found information about a study that was looking at the affects of curcumin which is found in the herb turmeric.  The study broke down the different cancer subtypes and noted the response of each to this treatment.  (The initial results had some good responses but more research is needed.) One line was an SK-BR-3-hr which was an ER- Her 2 neu + (My type is ER- Her2 neu+ but I have no idea if it is the same breast cancer line. ).  This type is Herceptin resistant.  I wanted to find out if my cancer could be tested to see if it was Herceptin resistant since this targeted therapy is part of my treatment.  Ms. P said that this testing was not available for commercial use.  So I guess I won’t know about the resistance unless it is seen on the CAT scan.  It seems like this would be very beneficial information to have, but only clinical trials make that available for patients apparently.

Siemens Serum Blood Test
Also, in my research I discovered the Siemens Serum Blood test.  Christine Druther, founder of the Her2neu support group www.her2neusupport.com website highly recommends this test to check her serum levels, of her now in remission, HER 2 neu cancer.  If the serum levels are higher, it would appear her cancer was growing or had returned.   This is the second time I have asked this question.  The two medical professionals I have asked did not know about this blood test or perhaps the name is what they were unfamiliar with.  As I was talking to Ms. P I realized that this could in fact be a tumor marker test.  She said it could be.  This morning, I checked my thinking on the internet, and I found out that is what it is.  Question answered.  I won’t be getting this test because this group of doctors in Chapel Hill see flaws in this testing and rely solely on imaging to see cancer treatment responses.

MUGA Heart Test
The MUGA scan that I was given at my last appointment to see if Herceptin is damaging my heart was at 61%.  This is an acceptable range but is down from the 66% heart function of three months ago.  This troubles me because it is down, but it may go up a little at the next MUGA scan in 3 months.  As long as it is between this 66 and 61%, things are good.

I have been thinking about eating grapefruit lately, but I am aware of its negative interactions with many drugs.  So my next question dealt with whether or not I could have some.  I love grapefruit. The answer to my question was just as I had expected.  It figures that the Taxotere and some of the other drugs I take on an as needed basis metabolize through the same pathway in the liver as grapefruit.  So it will be best if I avoid it. Darn.

Next, Ms. P. listened to my lungs and felt for enlarged lymph nodes.  She heard no unusual sounds in my lungs and said they sounded clear!  The chest pain I have been experiencing is not from fluid in my lungs.  That is a relief.  And, she couldn’t feel any enlarged lymph nodes in my clavicle area. That is another piece of good news.

My Esophagus
As the appointment came to a close, Ms. P. said she would go find Doctor R. and see if she could see me for a few minutes.  She left and returned with Doctor R.  Doctor R. sat down while Ms. P. stood. I decided to ask her the question that has been simmering in my brain especially when I have any kind of chest pain.  The mass in my chest brings horrific visions of what could happen to me if it enlarges.  It could constrict my esophagus, compress the vein farther that it is next to plus begin to compress and the artery as well.  Again, my research on the internet may not always be the best thing for my mental health, but it helps me prepare for what I could face in the future.

I asked if she knew of any cases where the cancer was removed from this area. (Cut out like cancers are cut out of intestines and then put back together.)  I was thinking that if it started to cause problems that removal seemed like it would alleviate these problems more permanently than other treatments.  Doctor R. said that my tumor’s position in the mediastinal area butting up to my esophagus is not very common and she cannot predict if it will stay the way it is or grow.  Surgery is not an option as this has not been shown to extend life.  The esophagus is not flexible like the intestines and it is secured to the structures that surround that area making it extremely difficult to reattach.  Patients, especially those with esophageal cancers have to have all nutrients taken in through the stomach after such a procedure is done. She did say that we may not have to deal with that issue for two years. (What? She said 2 years, never has a number been given to me, so seems I may live for 2 more years! ) But wait a minute, I thought no predictions could be made.  See, I know she has in her mind what she expects to happen based on her experiences. Of course she went over what things would be done if it ever did cause problems such as swallowing difficulty.  Radiation would be done if no chemo was shrinking it rapidly enough or at all.  And, stents can be placed to stop narrowing of the esophagus, vein, or artery.  Or the esophagus could be stretched to allow for easier swallowing.  (Probably not stretched too far since it doesn’t stretch easily.) I read these procedures can have complications.  Yikes.  She told me to try not to worry about that area because the cancer may not grow.  It may metastasize to another area that could be more life threatening. Oh, that was comforting although true.

Side notes:  I have noticed that I have not recovered as easily from the last two chemos as I did the previous seven treatments.  By the third week, I was pretty close to feeling like my old self, but these last two I am not quite there.  Chemo, what fun.  

My hair, interestingly, is thickening as it grows. Now it is not the thick head of hair that I have always had, but hey, if it keeps this up I may be able to walk around without my hat or bandanna.  The hair in the front top of my head doesn’t look quite as nice as the sides and back.  There is hair in that area but the color is grayer than the rest of my head so it looks balder but really isn’t.   

Bye Bye Chemo #9.  I hope my scan looks good so Chemo #10 can KILL more cancer!   

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