So experiencing progression for the first time is as awful as you might think. It's stressful. It's scary. It all around just sucks. I had my quarterly scans on 2/7. Brain MRI came back with the all clear and then some. Only two of the three treated spots are visible on scans and both of those are down 1 mm in size from the November scan, making them 2 mm and 1 mm. Great freaking news. For the PET however - things are not as great. If you recall, in November there was some indeterminate activity going on in my liver and it required an MRI to confirm. The SUV on the scans was mildly over the background activity level (so not really "hot"), but 3 masses were seen. Also in November, the masses in my lung were pretty "hot" on the scan and the lymph nodes in my chest were luke-warm. So all around you could characterize my November PET as showing things starting to activate. Well this February scan confirmed that activity without question. Everything has increased in size and SUV - lung masses, lymph node masses and liver masses. The existing lung mets increased in size minimally (fractions of a centimeter), but are showing at about a 9 to 10 SUV on the scan "hotness" meter. The lymph nodes are behaving similarly. My liver however - the 2 masses in there increased 1 cm each in 3 months and also went from low SUV uptake of about 2 or so in November to a 9 in uptake for this scan. They seem to be acting differently than the other known sites. Somewhat parallel in behavior is also a new lung met about 2 cm in size but showing in the low 2's right now. My guess is it's behaving like the liver mets did in November - letting itself be known, but not fully activated yet.
So what does all of this mean? It means it's clear that I've experienced what's known as "progression" on my current therapy. The disease has progressed, as they would say clinically, and is no longer responsive to my current treatment. What does it mean for me? It means a lot of things. Overall, am I in a worst spot than I was last year? You could argue no - that this is definitely better than a lesion threatening to collapse my vertebrae and take out my spinal cord, block my airway or break my hip. Yeah, I'm better off than that, right now. It also means that I need to now change therapy though.
Having gone through my first line of treatment (as it's called) in such a way that I have extremely minimal side effects, it is very, very easy to get lulled into "normal." I feel like me, I look like me, I'm behaving for the most part -- like me. It's very easy to forget that I'm "in treatment" and will be for the foreseeable future, when I feel like I do right now. There were hours, at the very least, some days these past few months where I actually didn't think about being in treatment. Hence, it was very hard to hear my oncologist tell me she thinks I need to switch to chemotherapy as my second line of treatment. And not just any chemotherapy, but Taxol specifically, for 4-6 months. It's IV chemo - it's what people automatically think about when they hear "chemo" - it's losing my hair, having a port placed in my chest (that will more than likely stay in my chest since I'm in treatment for the foreseeable future) and going in once a week for a few hours to be infused with treatment.
My doc gave me an alternative option for chemo called Xeloda. It's an oral chemo, but still chemo, but it doesn't cause hair loss. It causes it's own issues ranging from nothing, to hand-foot syndrome (different from hand-foot-mouth), tummy troubles, nausea, etc ... It's hard to know how you'll tolerate it until you're on the medication. Xeloda also crosses the blood-brain barrier, which is a positive for me as well.
The way she sees it - she is trying to protect my liver as quickly and effectively as possible. If my liver is compromised, it narrows my treatment options tremendously because the majority of medications are processed through the liver. If my liver can't handle it - then I'm in serious trouble. She wants to "wipe out" what's going on in there, and then once things show they're clear, she'll switch me to a maintenance therapy, like a different anti-hormone therapy perhaps.
The way I see it - it's certainly appealing to think that I could attain the highly sought-after "NED" - no evidence of disease. It's what every single person with cancer is seeking. The holy grail - if even for a couple months between scans. No evidence of disease in your body as detectable by scans. It's the closest anyone will get to cured. It's the highest hope.
But what if it doesn't wipe it out? What if it doesn't work? What if I have progression on chemo? Then what? It means my whole life is about to shift even more dramatically - that's what. It means their "most effective chemo" isn't effective for me.
And that's not a door I'm ready to open. A possibility I'm just not ready to acknowledge. Especially not when I feel like I do right now.
So needless to say - it's been a week and a half of research and worry and denial and stress and lengthy conversations with my doctor and Mike and my mom and my cousins and my friends and making deals with myself like - if I have to do taxol, then I'm not getting a port. I'm going to do it with an IV in my arm, that way, if it works like she hopes it will, then I'll have another year or two or more at least of life without a port. Deals like that - where I'm trying to have some bit of control over the situation in any way possible. I tell myself they can always put a port in later if my veins can't handle it or if it becomes an issue. What I tuck away is the likelihood that the vein in my left arm will probably blow more than once and be quite painful - not to mention the possibility for irritation from the pre-meds and the chemo they're infusing. And I can't really alternate arms because I've had lymph nodes removed from my right side and they try not to poke or prod the right side for fear of causing lymphedema. I tuck away the thought of indefinite chemo - if 4-6 months isn't enough to clear it all out - if it just causes stability - then I'm on chemo for a long time - years potentially. And granted stable is amazing. I can live a long life with things as they are right now if the disease stays stable. I can see my boys grow up and even see grandchildren - if the disease stays stable ... and of course I don't get hit by a bus or something. But it's a big pill to swallow. Once a week for three weeks, one week off, and bald - indefinitely ... or until my body can't handle the toxicity any longer.
The lack of control in this situation is maddening. I'm grasping at whatever I can, to do what I can, to hold on to as much normalcy as possible for me - for Mike - for my boys.
I also don't know if I'm ready to give up the anti-hormone therapy tries just yet either. Biopsies say they're still receptive, but activity in my liver and lung suggest otherwise. There's just so much to process - I don't know which way to go, which path to take, which cliff to step off of ... because yes ... every decision in this process feels like a cliff ... leap of faith ... after leap of faith ... after leap of faith.
We head to MD Anderson on Thursday for a second opinion from my oncologist there. After that, I should be able to come to a decision on which way I want to go. On the table right now - options that I think I can come to grips with mentally and emotionally - are 1) Xeloda, 2) a clinical trial if there's one that makes sense and believe it or not 3) taxol ... and yes, even the port.
Camden just turned 4 on 2/15. We celebrated with an amazing dinosaur cake, cookies and piñata with his classmates. We went to a family and friend dinner as well. He's growing so much, so fast and it's amazing to watch. He is bold and curious and so, so friendly. He's so happy and fearless and optimistic all the time. And he never stops talking lol. Nicholas is turning into a little boy right before our eyes - mimicking our gestures and getting out little jumbles of words and phrases. He's saying "Haley, no!" quite distinctly on a daily basis as well. He's also so happy all the time. I would do anything to see them grow up ... to see them become amazing, good-hearted people ... to see them grow into their beautiful spirits. And if that means chemo indefinitely ... so be it. It's a small price to pay.