Neurosurgical Consult
(all the doctors, treatments and drugs are hyperlinked)
On Monday 12/5/16, we had an appointment with Dr Ramakrishna . Ultimately the goal to line me up with him is that 1. He will be following me bimonthly with MRIs to track my brain and 2. He specializes in Radio-Neuoseurgery and works with my new Radiation Oncologist team on the SRS Radiation like the type of SRS (there are many) I will get. He agreed that 5 cyber knife sessions to my scar line every other day and also that the mm spots will be zapped that same day 2 spots each session with True Beam SRS Radiation.
Side Effects: Fatigue
Small hair loss from the spots that get radiation, but its thinning & will grow back (I already was planning on cutting my hair into a bob before the wedding, but now I get some extensions to fill it in)
Possible need for steroids (trying to avoid them) if brain begins to get swollen from radiation.
Easy appointment, doctor sounds good in person and online.
Chemotherapy
On Tuesday I started chemotherapy, Gemzar and Carboplatin. First IV chemo in years, I was nervous and scared to death and was afraid of more steroids after how they make me so manic. So we meet my APN review side effects & with my MD and pharmacist approval tried to go without the steroids as a pre-med.
Pre Meds: Aloxi, Emend, Pepcid AC and we did not use the Steroids, but had to (see below)... well enjoy a chatty Cathy again and some hypomania and ADHD after chemo days.
Chemotherapy: Gemzar over 30min and Carboplatin over 1hour (1x every week for 2 weeks with one week off)
Side Effects: Flu-Like Symptoms (muscle aches, possible fever, tiredness) the night after chemotherapy
Mild-Nausea
Indigestion
Diaherra
Risk of lowered White and Red Blood Cells & Platelets
Started the pre-meds and got an allergic reaction to the Emend (as it can do that). Throat closed up, wheezing and redness. We had to put the steroids in. So fear and anxiety came back, I felt like crap. After that chemo went easy and no problems.
Today is the next day, I feel tired that's all no nausea a little stomach ache. Last night I had achy muscles like the flu, which I was told would happen.
We were told yesterday that SRS Radiation starts on 12/5 at 5pm. All radiations may be that late, but we are waiting on the next four appointments. My next chemo is 12/6. Kyle is my transport to those. We are working with out family regard rides to four radiations & also anyone to come spend a day with me on 12/10 and 12/17, because Kyle needs to go to work and I am not cleared to be alone all day yet. I asked some family first, but then may need a friend those days.
Kyle goes back to work on the 7th. Mostly will need people to come for company on: 12/8, 12/10, 12/13, 12/15, 12/17, and 12/19 for now. We are waiting on my neurosurgeon to tell me when I can take the subway for doctors. We are assuming by 12/19 and if I can be alone before 12/19.
If you feel inclined to help us financially there are a few ways:
1. share my GoFundMe
2. if you can a small donation would help, but I do not want to beg you, share if that's all you can do
3. share my Poshmark site with friends on Facebook or if you are on Poshmark - selling the used clothes helps
4. I am not doing Younique for now, but will be back. So doing parties and sharing my home business would help. I am planning on being back selling by mid January. For now my team is handling any holiday sales so I can get better.
Thanks all!
Wednesday, November 30, 2016
Tuesday, November 22, 2016
Brief Update Regarding My Page, Care and Treatment
First, I updated my treatment page. It may be helpful to review if you want to share what I am on and each chemotherapy drug and supplement and surgery and radiation treatment have been hyperlinked to what it is and explained why I am on it.
Next is that we are moving towards a solid plan.
Turns out having Brain Metastasis is better than the tumor that has been living in my lung lining for 3.5yrs. The Brain Tumor I had was larger than any cancer I have had (even from 2010). It was 5cm in diameter and has 10 under 1mm tumors in the parietal and temporal lobe. I have started to recollect a lack of emotional connection, loss of memory, acting on auto pilot, and not having good decision making for about two weeks. I was purely functioning on muscle memory, working out and doing bare minimal mental work.
How did I learn this? I re-read emails the week before the hospital with my doctor talking of a HEADACHE and also making plans to start chemotherapy at Cornell and coordinate with Sloan on November 14 and 23 to collect my t-cells for an immunotherapy. I have no recollection of that conversation or making plans. I also wrote nothing down on a calendar nor told Kyle that I was doing this. Me not writing and then talking about the same crap to Kyle (sorry dude) like 20x in a row is unlike me. I am pretty verbal and he even said I was quiet, withdrawn and mooping around a lot. I knew my markers were up and I needed to go on chemo, so the emotional part made sense given what we were dealing with. I also was driving and exercising with this and thats dangerous. I am super glad my temporal and parietal lobe are back. Those areas do things we honestly don't focus on. I am just glad my brain bounced back. I am pretty lucky.
Going forward my doctor is sticking with the same Chemotherapy we have been discussing for two months. She is suspecting the brain tumor is a new beast and is possibly like a BRCA1/2 gene. I am getting thrown on Carboplatin and Gemzar, which is a drug a lot of women with these cancers respond to. Carboplatin increases fatigue and lowers red cells and platelets. Gemzar lowers red cells and platelets and also I cannot drink alcohol on it as it goes right through my liver. I don't drink anyways, so I honestly do not care for that anyway. I NEED my liver before a beer. Just get me a cake people no wine, I will drive you all.
Next new piece is a quiet large neurosurgical, radiological and psychology team because well now my brain is in the piece. My new radiologist is awesome. I do love my old external beam doctor, Dr Butzbach - who is so kind, warm funny and honest, but I need more focused care with a radiologist who also specializes in breast cancer and brain tumors and new clinical trials. Turns out my new doctor's team trained my old radiologist for my bones, which explains why my medical oncologist in NYC kept me with her in NJ for easier care.
So yesterday we meet the radiology team - Dr. Sylvia Formenti at Cornell. I fell in love with them. Honestly, we left feeling great. I was nervous during the CT and she like held my hand during my brain CT. Clearly an awesome, smart, determined funny kind and super involved woman in ways to cure breast cancer with radiation, chemo and immunotherapies. Her and my medical oncologist - Dr Linda Vahdat at Cornell - are really close. I can totally see why as they are both smart, kind funny and have a true desire to find a cure for this. Not many people can say that about doctors (it is sad but horribly true - you can see in my blog, I have been there many a times). She works at Cornell but also is involved nationally for this type of care, worked on the medications for AIDS and then switched to oncology clearly after the AIDS medication came out in the 90s.
Dr Formenti and I reviewed many types of brain radiation and a few studies at Sloan Kettering she has been involved in regarding immunotherapy and brain mets. She is very determined to not let this close doors to any types of trials for me. She thinks ahead. I need that. She decided on 5 sessions of cyber knife therapy. Cyber Knife therapy is a radiation that uses small beams of radiation to the exact tumor. I would be doing this treatment while I start chemo on the 29th as they work well together to get the chemotherapy into the blood brain barrier.
We do not have a date of start yet, but I am assuming it will be the 28 to start cyber knife every other day and add chemotherapy on the 29th. At this time I honestly cannot be alone given both therapies tank your red cells, white and platelets. Kyle and I will be asking for people to walk me in NYC to care and also hang out with me at home. My doctors also ordered this to keep me safe. I can walk etc, but no driving or being alone for 4 more weeks. If you want to come by a day, shoot me a text. If you want to be my treatment buddy, come along for a day. All are welcome.
We also will need help with food. We are good until this Friday, but even take out brought or a small meal would help. I am still working up to my old energy and lately anything more than 30min of standing has been exhausting. If you want to send food ask me, Kyle or one of my parents. I would appreciate the help so Kyle can go back to work and I can focus on healing and getting my butt back to driving, working out and being my old self again.
Next steps are clearer, but not settled.
11/28/16 - Meet new Neurosurgeon, Dr. Ramnikrisna, who also does neurosurgery , gamma knife therapies and invasive types of surgical radiation to my head. We are setting me up with him for the future and have him also follow me every two months with an MRI of my brain. He also will be working with my medical and radiation oncologist as a wholistic part of my care.
Sloan Kettering - TCELL TRIAL - We are still moving forward with collecting my t-cells for future tcell therapy when this current crisis settles. T-Cells need to be collected at the most opportune time for obvious reasons - THEY NEED TO BE STRONG! I am calling Sloan today to discuss when I should come in and to help my team at Cornell to work with them... both my doctors want me in this trial. The window for the T-Cell collection has to be 1mo post surgery, 14days post radiation, 7days off of any steroid drugs, and 7 days off of chemo. With how this looks, I probably will be getting the collection in January. I am still on steroids, I cannot delay radiation and I need to heal from brain surgery and start chemotherapy ASAP. To do this trial, its one week off of chemo with a brain MRI that has been stable 4 weeks. I may get the transfusion in late winter if my brain behaves. The t-cell therapy is specific to my lung tumor, since that thing is the most stubborn beast, this trial is a great option for me. So pray my brain responds to radiation & I respond well to the new chemotherapy.
There is also another brain and breast doctor at Sloan - Dr Beal they wanted to connect me with that uses immunotherapy via radiation (shoot the immunotherapy into my head) for recurrent brain metastasis.
Genetics and Pathology - Not back yet. Pathology comes next week. We are also doing another Genetic Panel. My team has done one on every cancer excised from me to create a big map of every DNA problem my cancer has and to keep my cancer open for new trials in immunotherapy.
What I was worried about the most:
Last but not least... why I am not doing whole brain radiation. I know this cancer can get bad and a lot of women die from something called Lepo Mets - fluid in our brain and spine. Lepo mets is not a death sentence, as I have a girlfriend who had it for YEARS and never did whole brain until recently - I think its been 8yrs actually. It is a very rare and can happen once someone has brain metastasis. If its not treated right, clinical trials do close and we are left without a paddle. Thats sad, but its so serious you do need more intense care. WBR and intrathelial chemotherapy ports are used to target our whole brain and spine lining & are highly affective. Regardless all I knew was that whole brain is highly affective on that type of disease and I knew I would want to keep that in play just in case I needed it... you can only do whole brain once, so I would rather save the big if things ever get so big.
My team reviewed all radiations including whole brain and why it is good and bad. Then we discussed with my team my desire to hold off until its needed and we are on board. The FDA still says whole brain is the best, but my team feels cyber knife is better given my goals and how young I am & also my genuine concern of needing it for lepo mets ever (see i am just planning ahead).
I have seen 3 women I love more than the world die from Lepo and Brain Mets...There is not one day I do not miss my grandmothers humor and strength, not one day I do not miss calling my aunt kerry to talk about TV and cancer and jokes, and my friend Sheryl who was so smart and funny & a fellow social worker. Brain mets seriously has been a big part of my cancer journey and it does impact my grief, sadness and just depression that cancer is evil and it killed 3 women I admired and considered my best friends. I am seriously sad still and traumatized. I am allowed to miss them. I am lucky I have my family, my uncle, and Sheryl's parents for support. They are part of my home team.
Luckily, my team took that emotional in play and did explain why its done and how it does work in some patients. They did explain that they also are working now with my local psychiatric team to help feel OK with having brain mets and losing so many to cancer. My radiation oncologist called my psychiatrist right in front of me too coordinate care with the new anxiety and recurrent PTSD from the cancer in my life and family.
Thanks all and love you bunches.
Saturday, November 19, 2016
Well my Lazy Breast Cancer Ran a Marathon in 30days
As we know for almost 15mo this blog has been full of dying cancer, dropping markers, normalcy and paying down my medical debt. Pretty low key and I was just not a cool cancer kid. Normal cancer kid working full time, exercising 7x/week, running around, dancing partying and being me that usual sarcastic, funny, quick witted self. I felt I had cancer under its nose.
That changed 1 week ago out of left field. I had my 3mo CT Scans, which showed my cancer was slowly growing back in my lung space and lesions actually formed 3 small ones on my liver and my markers rose again. I had a plan come November 14 to start chemotherapy again and enroll myself in a TCell therapy trial based on using my body to help chemo work stronger. It was a good plan, made sense and physically I was ok.
See - plan, easy boring, kill cancer... usual 7yrs of my life.
Last Friday I woke up sick like I had the flu. Called my doctor and was told if it lasts 24hours go to the ER. This ibrance drug lowers our white cells which make us sick gals susceptible to viruses and infections. I was 100% convinced my two pukes and nausea was the flu.
The flu did not go away Saturday, so by the afternoon my on call doctor ordered me into the ER for fluids and anti-nausea. The symptoms lifted. I was awake, hydrated not sick, and went home. No headaches nothing, better, so I was sent home.
Then 12 hours pass. I wake up worse. Now I have a headache and I can't let go of my toilet. Me and the toilet got pretty close. I started to have cold sweats and was barely verbal. What is wrong I asked myself? Kyle had to get the ER, our families together and I thought this slow cancer now wants to kill me 5mo before I am married. I know then I thought crap I have to get into NYC and see a doctor my cancer is not being a nice friend to me anymore. I couldn't tell anyone that but get me to an ER now.
A second long ER visit happened. I was ordered for a Brain Scan. [Please note I have had 7 Brain MRIs since 25, 7 and 7yrs with cancer, so I never not did one. I get Brain MRIs annually and was planning on the 14th at chemo asking for one since the drugs weren't working. I was being proactive, my usual proactive self and figured eh I will get chemo and then a quick MRI when I am at my doctors no biggie].
The local ER found a tumor in a CT Machineon my left frontal lobe and immediately sent me to my savors at Cornell NYC. It took hours to wait. I could have died. My brain swelled bad. I could have lost speech, memories, words, thoughts and my life. I actually was at a risk of letting this stupid cancer get me with NO WARNING and it wasn't fair.
I got into Cornell early Monday AM and was already scheduled for a MRI and surgery that same day. Starting Monday the 14th I was at my home NY Presbryterian Cornell getting prepped to have my head popped open to kill cancer. MRI was done and then we discovered the 9mm buddy also grew 10 small buddies under 1mm a piece in my chrome dome. I now needed more radiation. Thanks big head for hiding cancer. I mean I have a nice smart head, but hiding cancer so not cool.
Moments were bleak. I have had a pretty east metastatic journey, no huge physical changes, quick small procedures, always have a response to therapy, but it pulled tricks this time. My big brain said no I wanna be smarter than dumb lung and bones and grew some hiding cells.. My big brain is not cool with me now. I am quite upset at how hungry it was for cancer.
Somehow my family, my friends, social media and I heard a voice (no joke I heard a deceased friend of mine from my cancer world saying do not give up you go) and you all know I am not super religious. I can't even imagine how it felt for them. I know I was scared but had to do anything the doctors said.
With the support of my family & my medical at Cornell (no joke somehow two doctors saved my life in less than 12hours), we had a plan. I was getting surgery with the top neurosurgeon in the world (see he is a famous man with a wikipedia page
https://en.wikipedia.org/wiki/Theodore_H._Schwartz) At the same time my oncologist, Dr Vahdat was pulling her strings in NYC to kill these bad brain babies with the best colleagues she works with. She was already creating another Vahdat plan of sheer magic. Lining me up with (I tell you not) two doctors who probably know more than Stephen Hawking when it comes to brains, radiation and breast cancer. I understand nothing on what they do except they both worked to help create immunotherapy and vaccines to cure brain cancers etc... so smart cookies. So a magic plan was in place and somehow this was stuff I do, like coordinate and life was coordinating itself.
In the last week I went through fear, sadness, anger, shock and hope in moments. I thought brain cancer was death in days and I would not make it. I never thought that about myself. I am pretty fucking hopeful despite the cards I was dealt.
Somehow I had a giant tumor removed from my frontal lobe and proved that I can have brain surgery that removed a giant tumor from my head and bounced back with no verbal, physical, emotional or usual pre-frontal cortex dangers. I was slow from recovery, but needed no therapy to bounce back. I have a barely visible scar and the tumor vanished on my surgical follow up. Is this luck? Hope? God? Someone was there...
I had my surgical MRI and the big tumor is gone and on a follow up scan isn't there. So I was sent home with flying colors! Honor roll cancer patient this week! I got out of the hospital two days early. Look I love overachievement but my body was like nope I have a plan fuck brain tumor. So we are home.
I have a few appointments coming already I start radiation planning on Monday the 21st and get my head staples removed only 1 week post surgery. Then on the 29th of November I have chemo and t-cell shit to do. Look I am becoming a non boring cancer patient! I am a serious cancer patient now who gets to live on the Upper east side for 2016 Christmas Season. I guess I got that wish (kidding). I always saw those people with serious cancer plans like hmm breast cancer must be easy, because labs every month and scans every 3months is not bad.
Now I got a plan, lots of trips into NYC and will need people to help me and my family anyway so I can kick its ass again. I have chemotherapy, radiation and imunotherapies lined up in orders that haven't been laid out yet. I will know more when we see the doctors.
If you want some good reading, hang on this cancer patient is going to shock the heck out of you in a few months. I have become one of them. The serious ones with strange plans of killing cancer.
As lame as this is, I have become the female lance armstrong - one strong lung, screwed up hormones from a sexual cancer and now a big angry brain. You know Lance is still alive right? He almost died 20yrs ago at my age from the same shit with his testes. So see you guys in my 50s...because I got many years to go here. When I am cleared to run again and swim and hike and rock climb, you know my head will be there.
Remember also we have the go fund me. I am not working at all now and the family could need help to get me around anyway with food, support or monetary assistance. This is not going to be a blip for a bit.
https://www.gofundme.com/2cxdds6s
That changed 1 week ago out of left field. I had my 3mo CT Scans, which showed my cancer was slowly growing back in my lung space and lesions actually formed 3 small ones on my liver and my markers rose again. I had a plan come November 14 to start chemotherapy again and enroll myself in a TCell therapy trial based on using my body to help chemo work stronger. It was a good plan, made sense and physically I was ok.
See - plan, easy boring, kill cancer... usual 7yrs of my life.
Last Friday I woke up sick like I had the flu. Called my doctor and was told if it lasts 24hours go to the ER. This ibrance drug lowers our white cells which make us sick gals susceptible to viruses and infections. I was 100% convinced my two pukes and nausea was the flu.
The flu did not go away Saturday, so by the afternoon my on call doctor ordered me into the ER for fluids and anti-nausea. The symptoms lifted. I was awake, hydrated not sick, and went home. No headaches nothing, better, so I was sent home.
Then 12 hours pass. I wake up worse. Now I have a headache and I can't let go of my toilet. Me and the toilet got pretty close. I started to have cold sweats and was barely verbal. What is wrong I asked myself? Kyle had to get the ER, our families together and I thought this slow cancer now wants to kill me 5mo before I am married. I know then I thought crap I have to get into NYC and see a doctor my cancer is not being a nice friend to me anymore. I couldn't tell anyone that but get me to an ER now.
A second long ER visit happened. I was ordered for a Brain Scan. [Please note I have had 7 Brain MRIs since 25, 7 and 7yrs with cancer, so I never not did one. I get Brain MRIs annually and was planning on the 14th at chemo asking for one since the drugs weren't working. I was being proactive, my usual proactive self and figured eh I will get chemo and then a quick MRI when I am at my doctors no biggie].
The local ER found a tumor in a CT Machineon my left frontal lobe and immediately sent me to my savors at Cornell NYC. It took hours to wait. I could have died. My brain swelled bad. I could have lost speech, memories, words, thoughts and my life. I actually was at a risk of letting this stupid cancer get me with NO WARNING and it wasn't fair.
I got into Cornell early Monday AM and was already scheduled for a MRI and surgery that same day. Starting Monday the 14th I was at my home NY Presbryterian Cornell getting prepped to have my head popped open to kill cancer. MRI was done and then we discovered the 9mm buddy also grew 10 small buddies under 1mm a piece in my chrome dome. I now needed more radiation. Thanks big head for hiding cancer. I mean I have a nice smart head, but hiding cancer so not cool.
Moments were bleak. I have had a pretty east metastatic journey, no huge physical changes, quick small procedures, always have a response to therapy, but it pulled tricks this time. My big brain said no I wanna be smarter than dumb lung and bones and grew some hiding cells.. My big brain is not cool with me now. I am quite upset at how hungry it was for cancer.
Somehow my family, my friends, social media and I heard a voice (no joke I heard a deceased friend of mine from my cancer world saying do not give up you go) and you all know I am not super religious. I can't even imagine how it felt for them. I know I was scared but had to do anything the doctors said.
With the support of my family & my medical at Cornell (no joke somehow two doctors saved my life in less than 12hours), we had a plan. I was getting surgery with the top neurosurgeon in the world (see he is a famous man with a wikipedia page
https://en.wikipedia.org/wiki/Theodore_H._Schwartz) At the same time my oncologist, Dr Vahdat was pulling her strings in NYC to kill these bad brain babies with the best colleagues she works with. She was already creating another Vahdat plan of sheer magic. Lining me up with (I tell you not) two doctors who probably know more than Stephen Hawking when it comes to brains, radiation and breast cancer. I understand nothing on what they do except they both worked to help create immunotherapy and vaccines to cure brain cancers etc... so smart cookies. So a magic plan was in place and somehow this was stuff I do, like coordinate and life was coordinating itself.
In the last week I went through fear, sadness, anger, shock and hope in moments. I thought brain cancer was death in days and I would not make it. I never thought that about myself. I am pretty fucking hopeful despite the cards I was dealt.
Somehow I had a giant tumor removed from my frontal lobe and proved that I can have brain surgery that removed a giant tumor from my head and bounced back with no verbal, physical, emotional or usual pre-frontal cortex dangers. I was slow from recovery, but needed no therapy to bounce back. I have a barely visible scar and the tumor vanished on my surgical follow up. Is this luck? Hope? God? Someone was there...
I had my surgical MRI and the big tumor is gone and on a follow up scan isn't there. So I was sent home with flying colors! Honor roll cancer patient this week! I got out of the hospital two days early. Look I love overachievement but my body was like nope I have a plan fuck brain tumor. So we are home.
I have a few appointments coming already I start radiation planning on Monday the 21st and get my head staples removed only 1 week post surgery. Then on the 29th of November I have chemo and t-cell shit to do. Look I am becoming a non boring cancer patient! I am a serious cancer patient now who gets to live on the Upper east side for 2016 Christmas Season. I guess I got that wish (kidding). I always saw those people with serious cancer plans like hmm breast cancer must be easy, because labs every month and scans every 3months is not bad.
Now I got a plan, lots of trips into NYC and will need people to help me and my family anyway so I can kick its ass again. I have chemotherapy, radiation and imunotherapies lined up in orders that haven't been laid out yet. I will know more when we see the doctors.
If you want some good reading, hang on this cancer patient is going to shock the heck out of you in a few months. I have become one of them. The serious ones with strange plans of killing cancer.
As lame as this is, I have become the female lance armstrong - one strong lung, screwed up hormones from a sexual cancer and now a big angry brain. You know Lance is still alive right? He almost died 20yrs ago at my age from the same shit with his testes. So see you guys in my 50s...because I got many years to go here. When I am cleared to run again and swim and hike and rock climb, you know my head will be there.
Remember also we have the go fund me. I am not working at all now and the family could need help to get me around anyway with food, support or monetary assistance. This is not going to be a blip for a bit.
https://www.gofundme.com/2cxdds6s
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