It's been three weeks and two chemo treatments since I last posted. There's a lot to go over, and of course, almost none of it is good. As you recall, we were watching how the gemcitabine (Gemzar) was affecting Marye after her liver explosion in mid-November. The oncologist tells me that this chemo is so mild that most women don't need any anti-emetic at all while using it. But we've had no such luck. The treatment in late November and now the latest one (last Thursday) were both brutal. She started vomiting almost immediately and it lasted through the weekend. Still, I wasn't convinced that the chemo was causing it because she had some pretty serious nausea for the two weeks between treatments and it was unclear if her recent liver inflammation was to blame. Well, after last week, it's clear that the chemo is at least mostly responsible. The lab work shows her liver is back to functioning almost normally, but she gets really sick right after the treatment. Along with the nausea, she has a complete lack of energy and sleeps over 20 hours per day. On Sunday, she finally got up and took a shower. But it didn't end well as she fainted soon after. Fortunately, I was right there to catch her and bring her to the floor so she didn't fall. For about a minute I couldn't get her to respond to me, so I called 911. When the EMTs arrived, they checked her vital signs and Marye had begun to perk up a bit, so we didn't go to the hospital. I was ready, though, to take her downtown if that happened again.
By Monday, she started to feel a little better and was able to move around some, although her stomach was still pretty upset. I talked to the onc and let her know what was going on with the constant nausea and the passing out and stuff. Dr. Riley was fairly concerned about the whole thing and decided to set Marye up for an MRI on her brain to see if the cancer had spread there. Apparently, when there is uncontrolled nausea, that is a pretty good indicator of pressure on the brain caused by tumors. In the meantime, Marye was still vomiting all week, which was different than the last treatment, when she would feel sick, but not actually vomit. So I was pretty anxious about what the MRI would reveal. We decided to stop the chemo for a few weeks to give Marye a break and reevaluate after the MRI. Dr. Riley also wanted to give Marye some IV fluids and give her a bag of Zofran to help with the nausea. That was scheduled for Thursday.
We went down on Wednesday for the MRI, and Marye was feeling really lousy through the whole thing. On Thursday, I took her to the cancer clinic where they plugged her in and gave her the Zofran and IV solution. Although we weren't scheduled to see the oncologist, she appeared in the clinic around 5:30 pm, and she didn't look happy. Apparently, the MRI showed several punctates in Marye's brain that are concerning. They are very small (< 2.5 mm) and might be metastases, or nothing at all. If they are cancer, because the chemo drugs cannot penetrate the blood-brain barrier, the only way to fight it is with radiation. It's important to note that Dr. Riley wasn't convinced that this is cancer, and even if it is, the lesions are too small to be causing the nausea. Well, with Marye still feeling really bad, the doctor convinced me (and I, in turn, convinced Marye) that the best move was to just admit her into the hospital for a day or two to get a handle on the nausea. This would also allow the onc to keep a close eye on her liver, since it took a bit of a downturn since last week, based on Thursday's labs. Of course, this went over like a lead balloon with Marye. Laying in a hospital bed is not how she wants to spend the weekend before Christmas, or any weekend, for that matter. The same goes for me.
On Friday morning, Marye woke up and did actually feel a bit better. She at least put on a good show and we decided that anything that the hospital could do, we could get done outpatient. Of course, this isn't exactly true, since the clinic is now closed until after Christmas. But we figured that as long as she's not sick, she can stay home and stay hydrated. If she starts puking, I'll run her downtown to the ER. If she can hold out until next week, they can take labs and give her IV fluids and Zofran in the clinic, outpatient style. The only real good news from the past few weeks was that the tumor markers actually went down from last month. So, despite the horrible side-effects of the gemcitabine, it looks like it's actually effective on the cancer.
Moving forward, we need to make a decision right after the new year on what drug we want to use. If we stick with the gemcitabine, the side-effects are so horrible that her quality of life is complete crap. On the other hand, if we go to a different drug, there's no guarantee that the side-effects will be better or it will be effective. So, again, there's a balance to be struck between the efficacy and toxicity of the chemotherapy. As for the spots on the brain, the radiation oncologist recommends doing another MRI in two months to see if they grow. If they do, then we'll have to start with radiation, since no chemo can get to the brain. It sucks that the cancer can get through the blood-brain barrier, but the chemo cannot. It figures. In any event, unless something major happens, I don't anticipate another update until the first week of January. We are planning a quiet Christmas and New Year. I hope you all, too, have a nice holiday season.
-Chris
