Tag Archives: Alimta and carboplatin

Still standing

turning to ice

turning to ice

A storm two days ago dropped ten inches of snow and it finally looks a proper winter around here. Today I trudged down to the pond; it was better than good to be out of doors.

I almost feel myself again after what can only be described as a rough go; the first cycle of carboplatin and alimta was significantly more difficult than I had anticipated. Of the attendant side effects it is the neuropathy that I continue to find concerning (or unnerving, as I said to Dr. Shaw–in an apt yet unintentional pun).

According to a National Institute of Health webpage: “Peripheral neuropathy describes damage to the peripheral nervous system, the vast communications network that transmits information from the brain and spinal cord (the central nervous system) to every other part of the body.”

Unfortunately, this damage can be both catastrophic and irreversible and it is not always easy to predict the extent of injury. In my case, by day five some of the symptoms had begun to subside; a positive indicator. However, a week and a half after infusion, both my internal tremor and a noticeable lack of sensation (primarily in my feet and hands) has lingered. The question is, will I experience an even greater degree of neuropathy during the second infusion?

The next ten days will be telling. Should my nervous system show signs of healing, I will be somewhat reassured. However, if significant neuropathy remains, I may be reticent to risk further injury.

Back to the present with a jolt

Showing a little bit of attitude

Showing a little bit of attitude

I plan to return to Marfa and points beyond as well, but first a quick update:

Tuesday, the day before infusion, I started taking dexamethasone, a steroid designed to stave off an allergic reaction to the chemotherapy agents, and with some additional anti-nausea effects as well. When I went to bed that night, my lungs sounded better than they had in months, and I coughed up very little fluid. It would follow that a good part of bronchorrhea is related to inflammation; it’s a shame steroids come with so many negative side effects. To wit–that night, I had a splitting headache and didn’t sleep a wink. I’m just glad we had agreed that David would drive me into Boston the next morning.

That was yesterday, Wednesday. Having taken the advice of members of my support group, prior to chemo I requested thermal packs to warm up my veins and I drank lots of water as well. After being dosed with zofran and more dexamethasone, infusion began. Alimta was only 10 minutes, and then another 50 for the carboplatin. Of course, that 60 minutes can stretch into many hours, what with waiting for lab results and the pharmacy to mix my personal cocktail.

L1020614I should add that I dressed for the occasion. First, the ironic but somehow very appropriate t-shirt shown above. My diamond earrings, to go with the platinum that would be coursing through my veins (my idea of a funny). And a lucky charm; some years back Jemesii  cast an actual piece of Lucky Charms cereal in silver, and it has become a cheeky and cherished amulet.

Heavy metal time

Heavy metal time

We left the hospital around 3 pm and I was feeling a little bit loopy but still pretty chipper. I took a couple of ambien prior to bed and logged at least six hours of good sleep. This morning I had two more steroids as well as some zofran and sent out an email to my family and a few friends to say that aside from a somewhat leaden (make that platinum) feeling in my limbs, I seemed to be tolerating the treatment. However, I believe I crossed my t’s and dotted my i’s a bit too soon.

An hour after lunch, I got hit with my first wave of nausea. I popped a compazine to little effect. After an hour I took two more zofran. Fortunately I never vomited, but was caught off guard—I’d not expected to be so nauseated on my first course (the side effects of chemo tend to be cumulative). The headache returned and I gravitated between chills and sweats; fortunately no correlating fever. My tongue felt swollen and I became cognizant of peripheral neuropathy (tingling and numbness–in addition to the relatively mild neuropathy which has been a lingering side effect of cisplatin/taxotere) in both my hands and feet. This ride was becoming bumpy.

However, I am happy to report that I feel somewhat better tonight. Also, I am greatly cheered by the phone call I received from Dr. Shaw:  the gene sequencing is a go.

Onward. Let’s just hope that the cancer’s butt is being kicked too.

Me again

I would like to thank all my friends from INSPIRE for sharing your individual stories. I believe by speaking out you are empowering not just yourselves, but others who have been impacted by this devastating disease, lung cancer.

Now it’s time to update my own status.

I met with various members of my team last Wednesday. Due for a scan in two weeks, they bumped it up to that day after I described my growing anxiety over steadily worsening symptoms; cough, fatigue, and bronchorrhea.

Bronchorrhea is an uncommon symptom associated with the variant of lung cancer I have, mucinous bronchioalveolar carcinoma, and it is making bedtime miserable. The moment I lay down, my lungs start to crackle. For the next 30-40 minutes, I cough, hack and spit as I clear 2-3 ounces of frothy mucus from my windpipe. It is exhausting and at times frightening as well. There is no antidote for this sort of bronchorrhea, other than treating the underlying cause, the cancer itself.

Although some of my cancer is yet responding to treatment, it is likely that a new clone or mutation has been selected out for; one that is resistant to LDK378. This scenario is suggested by the appearance of my scans, as my cancer is returning in a very different pattern than it has previously. Rather than a gradual consolidation of diffuse nodules, much of what we are now seeing resembles billowing smoke, and is likely responsible for the bronchorrhea. However, the only way to confirm this hypothesis is to retrieve some cancerous tissue.

Fortunately, a biopsy is now considered doable and a core sample shall be removed from my left lung on 12/12/12. In addition, I will take my last dose of LDK378 on 12/11 and one week after the biospy, I will start chemotherapy; four rounds of Alimta/carboplatin followed by continuous maintenance with the Alimta alone.

When I underwent chemotherapy in 2005, I had a port installed. As it is a foreign body, there is a risk for infection and there are now a limited number of antibiotics that I can tolerate, so at least initially, I shall forgo the port. Should infusion through an IV prove too difficult, we will reconsider.

So that’s the scoop, from the medical perspective.