Teresa started Cycle 3 of Dox/Olara today.
Her numbers, overall, were very good! Her hemoglobin was *normal* for the first time since before any of this happened. Even after surgery, before she started chemo, it never went up into the normal range. And this happened without any transfusions (she hasn’t had any in weeks).
The range used is 11.7 – 15.0 g/dL. Hers is 11.8! Her WBC is 6.1 (3.5 – 11.0 K/uL), her RBC is 3.96 (3.79 – 5.11 M/uL). Her platelets are a little high again (they weren’t on 2/27 but were on 2/15) but Dr. Musgrave didn’t seemed concerned. Her neutrophils and absolute neutrophils were in good range to receive chemo.
Her CMP (metabolic) was good too. The only thing out of range was her total protein at 6.5, but the range is 6.6 – 8.7 g/dL, so she’s only *just* under normal.
Creatine, bilirubin, BUN, eGFR, liver panel, all great!
Dr. Musgrave is submitting a request to T’s insurance to get her approved for the heart protectant Zinecard. If approved, she’ll receive it on Day 1 of Cycle 4 (it’s only administered right before the doxorubicin).
As of now, her hair is still (slowly) coming back in.
When her numbers are great like this, it means it’s a good time for (healthy) visitors!
The CT:
As a reminder, this was done as a baseline CT, even though she’d already had 2 cycles of this chemo, because one had not been done in January (only an ultrasound; the last CT was early December). If you (re)read the previous journal entry, you’ll find where we explained that even if this CT showed growth in comparison to December, it doesn’t necessarily mean it isn’t working.
Overall, most of her other organs are good. Her heart is still showing as “normal size,” but we’ll need another echo (which should be scheduled after next week’s chemo) to see if her ejection fraction is still within normal limits.
Lungs: New, 4mm subpleural nodule along the right major fissure. Primarily atelectasis overlying the right-sided pleural effusion.
Pleura: Similar moderate right and decreased trace left pleural effusions.
Without a biopsy, there’s no way to tell if the nodule is a metastasis* or something benign. I’ve learned from other people with LMS that the general rule of thumb seems to be that if the nodule is 10mm or less, don’t touch it. Dr. Musgrave wasn’t concerned (I asked specifically about it).
* See end of post for an explanation of metastasis.
There are things that can cause benign nodules (ex: pneumonia and other disease which causes inflammation) scar tissue, etc. We’re going to get hold of this CT scan as soon as possible so we can see for ourselves exactly where it is located and see if it’s anywhere near where her right thoracentesis procedure was done. She did have quite a bit of pain during the healing time period, and said it felt like the muscles were torn and pulled a bit.
The nodule was not there before the thoracentesis, and no CT was done after them until this one on March 1. Hopefully it will turn out to be something like that, and not be a met.
She is still using her incentive spirometer, which in basic terms, checks how well your lungs function. The highest number on it is 2500. She can repeatedly hit numbers from 2000 and up. This is better than what I can do on the spirometer.
Musculoskeletal: Degenerative changes of spine (Dr. Musgrave said some of this is just going to be from aging). No aggressive osseous lytic or blastic process. Probable Tarlov cysts. (Tarlov cysts are fluid-filled sacs that affect the nerve roots of the spine, especially near the base of the spine (sacral region). The fluid is cerebrospinal fluid – ie fluid that leaked out of the spine. This is the clear fluid found in the brain and spine.) If it is this for sure, and they progress, in addition to pain, they can cause neurological problems. Right now she only has a little back pain but it is not limiting her activities.
That’s all we know for now. She’s due for her next chemo (Day 8, olaratumab only) on Tuesday, March 20.
We are resting in Abingdon through Friday, and then will get to visit with family we haven’t seen in awhile! If you’d like to call and talk to Teresa, you can reach her on the cell phone or on our home number.
Helpful Sites:
- What is Ejection Fraction – https://www.mayoclinic.org/ejection-fraction/expert-answers/faq-20058286
- Tarlov Cyst Foundation – Info https://www.tarlovcystfoundation.org/info/
- National Organization of Rare Diseases – Tarlov Cysts: https://rarediseases.org/rare-diseases/tarlov-cysts/
- What is Metastasis (often abbreviated as met or mets) – https://www.cancer.net/navigating-cancer-care/cancer-basics/what-metastasis
- CT or CAT Scan – https://www.radiologyinfo.org/en/info.cfm?pg=bodyct
- Thoracentesis – https://www.radiologyinfo.org/en/info.cfm?pg=thoracentesis
If you’re not sure about a word I’ve used, please ask! You can email me at if you’re not comfortable asking in a comment. Believe me, I look up a lot of the information myself before I post so that I can figure out the easiest way to explain everything. But I realize there may be things we understand that most people wouldn’t, but we forget that and don’t explain.