Hopefully with this next type of chemo!
Yes, as you all know, Teresa really wanted to have surgery next.
And Dr. Abu-Rustum refused, saying she was too high risk.
He decided that over the phone. He hasn’t laid eyes on her since September 2017.
Of course, as we said before, if he thinks she’s too high risk, we don’t want him doing the surgery. But it’s still infuriating.
A number of people in a LMS support group I’m in recommended Dr. Samuel Singer (also at MSKCC). But Teresa is no longer a new patient at that hospital, so I cannot just ask for an appointment this time. It has to be a referral, likely through Abu-Rustum.
Dr. Musgrave is going to try to get her in, but even if it goes down fast, it could still take 1-2 weeks to get everything arranged, and get up there — if no more snow comes which would make travel difficult at best.
T was scheduled to start chemo next week, but after reviewing the ultrasound from yesterday, Dr. Musgrave said she cannot wait. The tumor has grown significantly since early December.
So she’s starting chemo tomorrow, Thursday, January 18. She could have done it today, but today was already scheduled as chemo education day, so we went with tomorrow. So she had a blood transfusion today.
Her hemoglobin dropped — still over 8 (8.3) but this unit of blood will help mitigate the effects of tomorrow’s chemo.
It is a 21-day cycle, just like last time.
The chemo I mentioned a few posts ago is definitely what she will be on:
She will receive the Lartruvo on days 1 and 8, and the Adriamycin on Day 1.
Doxorubicin is an anti-cancer (antineoplastic or cytotoxic) chemo drug. It is classified as an anthracycline antibiotic.
This chemo is more likely to bring on nausea/vomiting. She has the same anti-nausea meds as last time — zofran and compazine. She’s also taking the steroid dexamethasone again, but this time, it’s because it boosts the effects of the nausea meds. (Last time it was to help minimize the side effects of the taxotere.)
Doxorubicin is also likely to drop her WBC count, possibly severely. This time, she will not be given neulasta unless she “proves she needs it”. This is an insurance thing. 😒
This means she may be at much more risk of infection. We won’t know until next week at the earliest if it will drop her WBC count. It may also have a cumulative effect.
This drug is one of the chemos more likely to cause heart damage — which can even show up years after stopping it. Therefore, there is a lifetime limit on how much a person can take. This is why Teresa had an echo yesterday, and why Dr. Musgrave will carefully monitor her heart throughout this chemo regimen.
We did get some really good news from yesterday’s echo: There is NO SIGN of the pericardial effusion!!!!
A new medicine this time around is called allopurinol. If you’ve ever known anyone with gout, you may have heard of it. It stops the body from making any, or as much, uric acid.
When doxorubicin works, it can result in tumor lysis syndrome. In basic terms, as it kills off the cancer, the kidneys help flush out the dead cells. But if it works really fast and/or there’s a lot of tumor, it can overload the kidneys, and they can fail.
Teresa has a lot of tumor.
The allopurinol will help mitigate that side effect. They will also give her extra fluids during chemo on Day 1. And she must increase her water/fluid intake to help flush out her system.
If tumor lysis syndrome happens, it usually occurs within 24-48 hours of therapy.
“Lartruvo is a prescription medicine used with doxorubicin to treat adult patients with soft tissue sarcoma (STS) for whom doxorubicin is appropriate and who cannot be cured with radiation or surgery*.”
Radiation is generally used on STS larger than 2″, but since her tumor is so large, Dr. Musgrave said the side effects that radiation causes would outweigh the benefit.
*Teresa may still be able to have surgery. But at this time, we do not have surgeon for Teresa, and Dr. Musgrave is having good results with this chemo combo with another patient in the same situation as Teresa (including where gem/tax didn’t work). So she is hopeful T will respond as well. She said if Dr. Singer is willing to see her and says he can operate, they can do “sandwich therapy”: Chemo/Surgery/Chemo.
Doxorubicin is pushed with a syringe in about 10 minutes. Olaratumab is delivered through a drip over about an hour. Pre-medications can take about an hour.
Many of you have asked how you can help. There are 2 immediate answers we can give at this time.
1. Call. We’ve stressed before how having visitors helps Teresa feel normal, and how it keeps her spirits up. But we don’t know how safe visiting will be with this new chemo. Once we have a better idea of her body responds to it, we will feel safer in having visitors again. Right now, we’d like to ask that if you work with the public or children (or both) or have children, particularly young children who are more likely to catch everything going around at school, that you refrain from visiting at this time.
If you work with the public and are able to take appropriate precautions, that may be different. Please send me an email if this is you and you’re wanting to come by.
2. We feel a little weird asking for financial help, but it’s come down to that point, unfortunately. If Teresa gets through all 3 cycles of Dox/Olara, with no break in between for surgery, she will be having chemo through March 8. Her short term disability through work ends on February 23. She can take 2 90-day periods after that, but it will be unpaid. She can keep her insurance if she can pay the full cost, up front, out of pocket. And then there are all the other bills like rent, utilities, medical bills insurance doesn’t cover, and so forth.
I have a site now at http://teresa.grableronline.com. For those of you with PayPal accounts, you can donate directly through PayPal too. It is explained on my page called Help Me. I have some good resources on that site that aren’t on here. Right now, I don’t know how often I will make personal posts. Amanda will still be updating CaringBridge after each of my appointments. My personal site is not going to be a replacement for CaringBridge.
Amanda and I understand that not everyone can help financially. We ask that if helping that way isn’t in your budget, that you please share my fundraiser within your community to get the word out to as many people as possible.