Cycle 4, Day 1

This was yesterday (April 5).

It was a long day. It started by being at the hospital at 9:45am for her echo. The cardio tech had a student/intern with her. He did a lot of practice scans, and then the tech came back and she did the actual exam. Longest. Echo. Ever. (Over an hour.) But they were both VERY nice. 

And best news – we got the echo results today. NORMAL. Her ejection fraction is still 55%. (Simply put, EF tells you how much oxygenated blood your heart can pump through your left ventricle each time. Normal range is 55% – 70%.) Doxorubicin hasn’t changed anything. Yesterday Teresa also started receiving Zinecard, which is a chemoprotectant for the heart for those receiving doxorubicin. T will be at her cumulative dose after Cycle 5. I’ve learned recently that apparently a number of patients, especially with LMS, surpass the lifetime dose by using Zinecard

We went back home after the echo. I wanted a nap, but with only an hour before we had to head down to the Cancer Center, I didn’t dare. I had lunch. T did not. She always makes sure she has fasted 8 hours before labs so that she can monitor her glucose levels. (So she takes something with her so she can eat as soon as the blood is drawn.)

Teresa’s numbers? Much awesome!

White Blood Cells: 7.6
Red Blood Cells: 3.80
Hemoglobin 11.9!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! (So, she’s always tired 1-2 days post-chemo, but in general her energy level has been improving, and this is a big reason! 11.9 is the best it has been since before she started getting sick last summer. 11.9 is NOT ANEMIC!!) Happy tears? Yes, I have these.

(The highest her hemoglobin ever got before was 11.1 on October 4, 2017, but that was prior to starting any chemo, and probably before the tumor regrew very much. Standard range: 11.7 – 15.0.)

A big part of her anemia last year was because the tumor was taking so much blood for itself. So this change is highly encouraging.

Platelets are a little high, but they fluctuate between normal and high, fairly regularly, and Dr. Musgrave doesn’t seem concerned. We asked one of the chemo nurses, and she said it’s likely just chemo-reactive (as opposed to something being actually wrong).

Everything but her total protein on her Complete Metabolic Panel (CMP) is in range, and that is only off (low) by .1.

We had a great office visit with Dr. Musgrave, who answered several questions for me. She also felt T’s abdomen, and said that she feels “squishier”. 🙂  (Her abdomen used to feel hard and rigid. You can still feel some of the hardness when T is standing up, but it is likely just the tumor shifting – now that there’s probably more room in there for it to move around. Although we won’t know for sure until the next CT, it sounds like the chemo may truly be shrinking the tumor. Fingers crossed!)

I asked about the lung nodule, and Dr. Musgrave confirmed what I had been told in the Leiomyosarcoma Direct Research Foundation (LMSDR) group: it could have been a minor infection, it could be scar tissue from the thoracentesis. It is very tiny, and unless it shows up larger in the next CT, right now it is not a concern. Her lungs still sound good. She can still do (consistently) way better than I can on the incentive spirometer.

Teresa suspects she may be starting to have peripheal neuropahy (toes, fingers), and a friend recommended Alpha Lipoic Acid. I asked about it. Dr. Musgrave is not familiar with it. I told her I would look it up and bring information back for her, and she said that sounded good. We’re also going to see about T trying powdered Lion’s Mane mushroom in some meals (i.e. obviously not in cereal!) as it is also supposed to help with nerve regeneration – and is also good for memory.

I asked if Dr. Musgrave could check T’s vitamin B12 levels. They’d been super high last fall. A deficiency in B12 can make you more likely to develop neuropathy. T’s levels are still high but coming back down into normal range. 

This cycle, Teresa will receive the Neulasta patch on Day 8 instead of Day1. Day 8 has less chemo, and is also obviously when T’s numbers are lower to start off, and our understanding is that with less chemo to fight back against, the Neulasta may work again. (Out of all the chemo weeks, it was only there last cycle where it didn’t seem to do anything.)

Her next CT should happen after Cycle 5. It will be at the hospital and she will be pre-medicated. Hopefully she will not have another contrast dye reaction. Dr. Musgrave said it is unlikely that T will have to deal with seafood allergies because of this, but we will make sure to test this cautiously just to be safe. 

After the next CT is also when Dr. Musgrave would decide if Teresa needs to be restaged. (Original staging was 2b.)

Dr. Musgrave is going to check in with Foundation Medicine as she still hasn’t heard anything yet (genetic testing/gene mutations of tumor). 

T will get Aloxi+Emend on Day 8 now too (so she won’t get nauseated on olaratumab-only weeks).

I also had 2 very detailed questions for Dr. Musgrave about metastasis and having T’s tumor tested and re-tested for a few things. But those I gave a printout to her for, since I also provided links to a number of medical/scientific journals to back up my questions and research. I gave her my email address too, because they were questions that would take time and consideration, and I knew we probably weren’t her last patients that day.

She said she’d definitely look through all of it and get back to me. If you’re interested, you can see what I shared with her here: http://teresa.grableronline.com/research/

Next Thursday (April 12), is Cycle 4, Day 8.

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I will do a brief post here whenever Teresa is able to write about our recent (and amazing) short trip to Dallas. (We drove. My Mom went with us.) I’ll also be sharing the photos on and off Facebook, since I know not all of you do Facebook. I’ll share the photo link here too, to make sure you all get a chance to see it. I probably will not be able to process the photos until we’re back in Roanoke (next weekend). The laptop I use in Abingdon, and our internet, are simply too slow.

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More on Ejection Fraction: https://www.mayoclinic.org/ejection-fraction/expert-answers/faq-20058286
More on chemoprotectant drugs: http://chemoth.com/chemoprotective

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