Post Marriage Update

Friends,

Isn’t there an old saying: no news is good news? In my case that rings true. I got married on the Big Island and went on a honeymoon on Lanai (both in Hawaii), all while continuing chemotherapy. This of course, is terrific news to me! Since my last blog I’ve been fortunate enough to see many of you. That has truly been a blessing and could not have made me happier.

For the past couple months, my chemotherapy regimen has consisted of an infusion of Adriamycin. Even though this drug creates a lot of side effects for most people, my only side effects were nausea/vomiting and fatigue, so I consider myself lucky. I was able to control the nausea and vomiting with prescription medication.

I had a CT scan this past week to see how the Adriamycin was working on my cancer (the little bastards). The good news is this drug controlled the cancer. There were no signs on new tumor development, the main liver tumor did not grow at all, and most of the lung tumors did not change in size. There are 2 lung tumors that grew a millimeter or two, but that’s tiny! The other great news is that some of the enlarged lymph nodes around my liver also showed slight shrinkage. The flip side to this good fortune penny is that Adriamycin can be toxic to the heart muscles over prolonged infusion, and my echocardiogram showed that my heart wasn’t as strong in pumping blood through it compared to 5 months ago. It is still in the middle of the “normal” range so I have nothing to worry about, but the decrease concerned my oncologist to the point that we collectively decided to stop this drug and move onto something else.

So….what next? Well, we are going to try a combination of chemotherapies that are commonly used. The two drugs are called Cisplatin and Gemcitabine. I will keep the same schedule where I get an infusion on Monday for two straight weeks and then take a week off. Since there are two drugs, my treatment days will become day-long affairs at the clinic, where on Adriamycin I was only there for about 3-4 hours.

Cisplatin essentially works by damaging the DNA of cancer cells and not allowing the cell to repair. It has shown to be effective in many difficult to treat cancers including lung cancer and ovarian cancer. As with all chemotherapies, cisplatin has a number of side effects. Nausea and vomiting are common with Cisplatin, but I already have a good combo of drugs to blunt that side effect. Cisplatin can also be very tough on the kidneys at a high, prolonged dose. Therefore, I will need to drink a bunch of water while I’m getting this drug, and will receive at least 1.5 liters of IV fluids after I get the infusion of the drug. The addition of the IV fluids over 2 hours helps to make my treatment day so long. For the last couple hours that I’m there, I’ll basically be drugged up and running back and forth with my IV pole to the bathroom to pee. Take that as fair warning, there will be a delirious peeing man running around the Seattle Cancer Care Alliance on Monday afternoons. Hopefully I won’t have to wear one of those hospital gowns where my ass hangs out because that will be just too much! The uncommon side effect for this drug is neurotoxicity (damage to the small nerves in your body) at a prolonged, high dose. The smallest nerves are in the tips of your fingers and toes, so I may start to experience tingling and numbness in those areas. There are also small nerves in your ears so it can lead to hearing loss, but this is very uncommon and usually reversible after the drug is stopped. Notice how for most of the side effects, they occur with a high dose? I am getting what doctors would consider a low to moderate does since I’m combining it with another chemo. A little factoid about this drug – Cisplatin was a cornerstone drug of Lance Armstrong’s testicular cancer treatment.

The other drug, Gemcitabine (also known as Gemzar), is also used to treat a variety of cancers. It has been given and documented in combination with Cisplatin many times, and there are no known weird interactions between the two drugs. Gemcitabine also interferes with growth of cancer cells, eventually causing the cells to die. However, it can also interfere with the growth of healthy cells that I want to keep so the main side effect of this drug is decreased blood counts (red cells, white cells, & platelets). This side effect can be regulated with a drug, called Neulasta, which I was injected with a couple times while on Adriamycin. Neulasta stimulates blood cell development in the bone marrow. Hopefully I won’t have to turn to this injection too many times because you don’t want to keep depressing the cell count then stimulating them over a long period of time. Nausea/vomiting and diarrhea can occur with this drug too. Wow, what a shocker!

After explaining this all to me, kind of as an afterthought, my oncologist looks up at me and quizzically asks: “Want to try something experimental”. I immediately blurted out “Sure”. Apparently my subconscious is braver than my rational mind because I cringed and had a “WTF!” moment after I said it. Turns out, it isn’t so bad. There has been recent literature showing that diabetics who receive treatment have a lower rate of cancer and cancer related deaths. People have hypothesized this is due to the drug diabetics take, Metformin. Metformin causes the cancer cells to be unable to metabolize simple sugar and therefore makes the cancer cells turn to different means to grow/live. This causes the cancer cells to become weak and susceptible to our body’s immune system. My oncologist believes this kind of targeted cell treatment is the way we’ll be attacking cancer in the next few years. Metformin is basically just a horse pill (500mg for all you medical people out there) I have to take once a night. It can cause upset stomach and diarrhea but the body adjusts to it over time. Also, since this drug is common for diabetics, it’s very cheap. Nothing ventured, nothing gained. It can’t hurt, so any upside is gravy. That’s the way I look at this.

Weight watch – I have kept my weight steady over the past few weeks thanks to the fattening diet while I was in Hawaii. Woo hoo, that spam did the trick……..

I have another scan scheduled for mid-December to see how the two drugs are doing. So barring any complications I’ll likely be off the blogs til then. Happy Turkey Day!

Stay Well,
Rhone