On Monday the ice was pulling away from the shore and the woods were busy with robins. I was feeling a little bit lightheaded, and it wasn’t spring fever. The previous evening, following a delicious Sunday meal, David and I were trying to watch The Tree of Life. It is a fairly trippy film; visually stunning yet contextually perplexing. Soon after the movie started, I developed an intense headache followed by chills and nausea and after an hour had to bail.
I popped an anti-emetic, which is supposed to quell nausea (but in fact generally produces the opposite effect for me) and got into bed with a large mixing bowl at my side. Within minutes I vomited. A torrent; more than I thought humanly possible. In fact (confirmed in the a.m. by measuring the capacity of the bowl) , 64 fluid ounces. My husband David (trained as a chemist) offered the mass to volume ratio: five pounds.
Gastrointestinal issues are a rather common side effect of treatment and can pose a significant challenge for cancer patients. Obviously, dehydration and depletion of electrolytes can happen rapidly under such circumstances as can loss of calories. Shedding five pounds in a matter of seconds is not optimal.
I am a tall person at five feet ten inches and the past few years my fighting weight has been about 145. Every Monday I am weighed, and currently (even prior to the ‘incident’) I tip the scale at about 132. Not too thin, but it doesn’t leave me with much of a ‘cushion’ either.
Dosing with an oral targeted therapy is a bit of a blunt instrument, blunter still in the dose escalation phase of a clinical trial, where 700 mg of an experimental agent may be administered to both a small woman and a large man.
When I was given infusion chemotherapy (cisplatin/taxotere), the appropriate dose was individually determined by body mass. Such fine tuning is more difficult when the medium is a tablet or capsule rather than a liquid. So, once dose escalation has determined what is safe as well as therapeutic, it is invariably a standardized unit; one size fits all. If patients of disparate size take the same dose, it only follows that potency and the potential for negative side effects might be greater in the smaller individual.
On Monday afternoon I had my blood drawn locally and upon returning from a yoga class on Tuesday, found a telephone message from Dr. Shaw. My liver enzymes are no longer elevated; amazing. Although there is yet an audible wheeze when I recline, I feel that I am breathing easier. For the moment my hopes of putting GI issues behind me at a lower dose of LDK 378 (400 mg) have been dashed. Perhaps my body will adjust and episodes will be sporadic. If not, I will deal with it. This is a comparatively easy treatment and so far, effective as well.
I finished watching The Tree of Life on Tuesday. My personal review? It reminded me of a meal where the chef has tried too hard; the primary ingredients are fresh and delicious but have been obscured by an excess of culinary flourishes. Less would have been more. And yet I felt the movie concluded on a perfect note; the song of a wood thrush.