Loose Strife

We had a very nice christmas this year without incident. (Well, let’s not dwell on the unfortunate flair up when I lost my cool after Lily turned her nose up at my christmas dinner.) The day was very easy going and the kids were adorable. I’ll post some pics and video later.
Laura had her fifth chemotherapy infusion today. She’s still just slightly anemic. No cause for alarm. So the chemo went ahead as scheduled.
In many ways, Laura is doing much better than two weeks ago when she was in the hospital. As I’ve mentioned, the chemo/cancer nausea is gone and we’re hoping it will not return after today’s chemo. She’s eating almost normally. (Proof: she wants to go get some mexican food!) She has no significant bone pain and is on no pain killers at all. The lack of narcotics and the anti-depressants perhaps kicking in seem to be reducing her fatigue. She still doesn’t have much stamina, but she looks great.
The main issues now are low blood pressure and continued migraines. The low blood pressure can be a bit scary and is probably related to her fainting episodes that I mentioned last week. It can be surprising: she’ll be sitting around talking and looking normal, then when she stands up she’ll lose her footing and become disoriented. This happened again this evening when she stood up to leave after visiting at a friend’s house. As I was walking her slowly out to the car Laura hollered back to our friend that she needs an old lady walker with tennis balls on the feet.
Low blood pressure is often associated with heart problems. Laura did have a pericardial window (surgery to poke a hole in the fluid sack around her heart) and cancer was found there, but there’s no current signs that her heart’s not working right upon physical examination. None of her drugs are associated with such a side effect, either.
I wondered whether it was related to her migraines. The oncologist said that high blood pressure is sometimes related to headaches, but not low. But we’ll discuss it with the neurologist next week.
The migraines, as I’ve previously mentioned, are less severe, but it still seems unacceptable to be experiencing such pain a dozen times per day. At this point, we don’t know whether the drug that she’s taking to control them is actually working and the migraines would otherwise be much worse and making her sick, as in the past, or maybe it’s just coincidental. We expect that the neurologist will order some additional tests. Hopefully more avenues for treatment will become available as a result.
Today we received a better sense of future plans from her oncologist. Laura’s scheduled for another set of CT scans in 2 1/2 weeks. If the result is about the same as before or modestly better, then the oncologist said she would likely recommend that Laura take a “chemo break” and experiment with a different hormone therapy than the one used before (that didn’t work). Slightly counterintuitive at first, the onc also said that if there was a big improvement then she would want to continue with chemotherapy further. If Laura is still getting significant benefit, then it’s best to continue.
Surprisingly, the oncologist is not eager to have Laura’s ovaries removed even though she has tumors on them and her cancer is hormone receptive. The doctor said that the tumors on her ovaries are “peripheral” and “negligible” with respect to her metastases. The laparoscopic surgery, although not dangerous, is invasive and has its risks. And ovarian function can be chemically turned off (using a drug called Lupron, which Laura took earlier in the year). The final argument was that since studies have shown that Tamoxifen, the hormone drug that Laura took before chemo, is about as equally effective as ovary suppression and since Tamoxifen apparently didn’t work for Laura, then there probably isn’t much to gain by disabling the ovaries.
I’m not sure I buy it. Certainly the last argument is bad logic at best. Maybe I misunderstood, but we might want a second opinion. I now know of many young metastatic BC women who have had their ovaries removed and they didn’t even have tumors present. Lupron is not always effective. And it would seem like an obvious one-time procedure to eliminate estrogen that could be feeding the cancer. (Chemotherapy also typically shuts down the ovaries, so it’s at least conceivable that this effect is contributing to Laura’s cancer regression now.)
That’s it for now.