Chemotherapy - 12/2/10

Nineteen days from now, I will start chemotherapy. Recent scans have revealed numerous tumors in my liver and my left lung. Other than my headaches, which have been temporarily controlled by steroids, I feel pretty good. The steroids have an added benefit of minimizing the pain in my back and hips, which has allowed me to do a lot of walking and running lately. I am so grateful for that. I have an appointment with a neurologist on the 27th of this month, so hopefully, we'll find out what's going on inside my head. I've been rationing out the steroids (one pill every two days, which is usually when the headache gets intolerable and starts radiating down the back of my neck and across my back and chest). There will be no refills after this bottle is complete, unless the neurologist prescribes them. My non-medical background guess is that the tumor on the left side of my skull is causing the problem, even though the MRI showed no metastases to the brain.

I have been on Faslodex for only two months, which is really not enough time to determine if that treatment protocol was working or not. Some times with hormonals, it takes a while before any signs of improvement are noticeable. The good thing is that if there are toxicity problems with the chemotherapy, I can come back to the Faslodex. I may need the extra ammunition in the arsenal in the near future. Faslodex is also one of the reasons that I have to wait to start the chemotherapy. There needs to be a waiting period of at least a month between different treatment protocols.

I am approved for a clinical trial of three chemotherapy drugs: Taxol, Avastin, and Everolimus. Since it's a "blind" trial, I may or may not receive Everolimus. Everolimus is a daily chemotherapy pill. The "trial" is to see if the Everolimus enhances the benefits of the Taxol/Avastin treatment protocol. If I don't receive the Everolimus, I'll get a placebo as a substitute. About half of the patients in the clinical trial receive the Everolimus, and the other half receive the placebo. I've already been told that if I develop a rash (usually first appearing on the face - ugh!) that I'm getting the real drug. Taxol and Avastin will be given once a week for three weeks through my port in the treatment room of the cancer center that I attend. Sessions will take 2-3 hours. The fourth week is a rest week. I'll be scanned every 2 months to monitor the progress of the treatment. If there is stability or regression, we continue until the toxicity of the chemotherapy requires us to stop the treatments. If there is progression, we are back to the drawing board. The bad thing about chemotherapy is that even though it's the most aggressive treatment protocol, because of the toxicity, you can't stay on it forever. My options afterwards are very limited if this treatment protocol doesn't work. However, the rapid progression in the liver and lung worries my oncologist. At this point, I have no physical symptoms that there is anything wrong with my liver or lung. I see this as a good thing. Chemotherapy will most likely do nothing for the cancer in the bones, but it should help the vital organs. I need those, so they have become priority.

The well-known and most common side effects with Taxol include neuropathy (tingling and numbness in the fingers and toes due to nerve damage, with a possible loss of the nails), heart and blood pressure problems, and protein in the urine. Avastin is associated with excessive bleeding (especially through the nose). Other side effects that are typical with most chemotherapy drugs are hair loss, diarrhea or constipation, mouth sores, nausea, vomiting, low blood cell counts, dizziness, fever, chills, infections, and fatigue. I am all too familiar with the side effects of chemotherapy from my initial breast cancer diagnosis in 2003. The only two side effects that I did not experience then was the vomiting and diarrhea. For every side effect, the oncologist will try to prescribe a drug to counteract it, but most of the time, the counteracting drugs make the situation worse, because they also have their own side effects. It was an endless cycle of misery. When I was on chemotherapy before, I had to get injections for the anemia. My blood counts were so low that my oncologist did not understand how I could still function. I was on steroids the night before I went to chemotherapy, the morning of chemotherapy and the evening following chemotherapy to keep the chemotherapy drugs from "attacking" the vital organs (especially the heart). There is a delicate balance between killing off cells and killing a vital organ. Chemotherapy is no joking matter.

My oncologist said that this chemotherapy will not be as bad as the one that I had in 2003. One of the three chemotherapy drugs I was on then was called the Red Devil (Doxorubicin), and it was so toxic that it was injected with a needle by a nurse into the port instead of through an IV into the port. The nurse had to sit with me, injecting it slowly for 30 minutes as she watched me for allergic reactions to it. The Red Devil was the prettiest and brightest red that I have ever seen. It always mesmerized me as it went into the line to my port, disappearing into my body and proceeding to kill every cell it came into contact with. At the time, there were days that I was sure the side effects from the drugs would kill me long before the cancer. But I survived it, and I am prepared to survive this round of chemotherapy as well.

Yesterday, I was quite contemplative. I wasn't sad or angry. My oncologist and I had discussed this probability before, so I knew it was coming. Not only did the scans show progression, but my tumor markers (measured by blood tests) were steadily moving up, with the last test showing 30 points higher than before in less than a month. Because I had been feeling better, I had been making plans for more races in 2011 than I had this year. With more running/walking, I think I can get my marathon times back under 6 hours and my 50K times back under 10 hours. This will open up more races for me. I had necessarily stopped registering for some races this year because I knew I couldn't make the cut-offs. With January and February completely booked with races (registration fees and plane tickets paid), I'm wondering if I'll be able to go to my races. I wasn't able to race at all during the 6 months of chemotherapy in 2003. My training consisted of walking for a mile or two on the days that I felt okay. More mileage than that and I would get dizzy and had to end my workout for that day. On most days, it was a major accomplishment to just get out of bed and to take a shower without becoming totally exhausted. Working all day would leave me little energy for anything else. Because of the nausea and the lack of taste buds, I wasn't able to eat properly. I would have never guessed you could survive on tomato soup, crackers, Sprite, and an occasional ice cold piece of apple pie. Through trial and error, that type of food seemed to settle my stomach. I lost 25 pounds during chemotherapy. It was the best diet I had ever been on.

I do wonder what will happen this time around. My nails turned purple and black last time, but I didn't lose them. And I never had the tingling and numbness in my fingers and toes. I loss all of my body hair. I had mouth sores and bleeding from my gums, but I did not have nose bleeds. The anemia was bad. The dizziness, fatigue, nausea, breathing problems, chills, and fever were rough. Still, the possible side effects from this treatment protocol appear worse than those from 2003. Neuropathy, bleeding from the nose, a rash (if I get the trial drug), high blood pressure, and congestive heart failure? Hair and nails do grow back. Are those other side effects reversible? I've read that some times the neuropathy is permanent. If I have a good response to the chemotherapy, how long will I hold off the toxicity to stay on it? Six months, one year, or two years? Everything is speculation at this point.

After this week of news, I'm looking forward to the Run Like the Wind 24-Hour in Austin, TX this weekend. The plan is to go out and have fun on a 0.6 mile loop. Next weekend is the Bartram Forest 100K or 100 Miler in Milledgeville, GA. I really haven't decided which distance I will attempt. If I don't push it too much this weekend, I may try for the 100 miler at Bartram Forest. There is a 32 hour cut-off, and I've heard that the trail is pretty runnable. The HUFF 50K in Huntington, IN is next. It's been a couple of years since I've done this race, but it's one of my favorites. The weather is unpredictable, but that's part of the fun. And then I'll end the year on New Year's Eve with the Freedom Park 24-Hour in Morganton, NC. I really enjoyed this race last year, even though my sprained ankle was not completely healed at the time. I am looking forward to improving on the 69 miles that I ran last year. It will be my first race after my first two sessions of chemotherapy.

Nineteen days from now, I will start chemotherapy. It's not the beginning or the end. It's just part of my life's journey. I will end 2010 on a good note, and I will begin 2011 on a better note. I have work to do. It's a tough job ahead, and I'm up for the challenge. My mind, body, and spirit are in agreement. I am at peace. I still have my faith. Tiger knows how to run. More importantly, Tiger knows how to fight. ROAR!!!