Thursday, June 02, 2016

limbo and dreams (updated)

I am still in limbo. My head is healed and I feel more like myself, except for some odd symptoms (my jaw is still freezing shut intermittently for a minute or so. It's so annoying. And embarrassing. It's not really something I can hide and it happens at the most awkward times).

I had my surgery on May 9. Everything said to me leading up to that implied that moving ahead was urgent. And yet here we are. I have a lot of faith in my medical team but this time information is not forthcoming and it's making me crazy. I can't plan a thing and I would just like some kind of information. I know I haven't fallen through the cracks. I would just like someone to explain to me where things are at.

I like information. It makes me feel in control.

So don't ask me when I will be having treatment because I don't know.

On another note, I had some strange dreams last week.

I dreamed that the area in which I lived was being flooded and I had to rush back and get a few things before all was washed away. When I arrived at home, though, the rain stopped, the sun came out and there was a brilliant blue sky. I didn't have to leave after all.

In another dream, a small furry mammal was hit somehow and fell to the ground, dead. In my dream it was a "possum" but it looked more like a groundhog. The body lay in the same spot throughout the dream and I would check on it periodically to see if it was still there. The last time I looked before waking, the animal jumped to its feet and bolted up a tree. After several days of lying still, it wasn't dead at all.

Deconstruct that. No so hard.

Now let's get some news, so I can follow my dreams.

Update: I finally have dates. I don't start for a couple of weeks. I asked why and was told that my oncologist said that it's "not urgent". I asked if this was because of the decent MRI and the nurse said she thought so. After the first date in June, I will go in weekly for a few weeks and then I guess we will re-visit the schedule.

I feel mostly relieved because I can plan my life a little. I just wish I didn't have these annoying symptoms that remind me what's happening.

Tuesday, May 24, 2016

may you live in interesting times

It's been two weeks since my surgery and for some reason, I thought this would be the easy part. I don't really know why I thought that, except that both my surgeon a and my medical oncologist seemed to the think that putting the Ommaya in could have been like day surgery and I would be feeling like myself again in a week or so.

Not so much.

The nurses were much more cautious and they said to take it easy, be consistent in my activity and increase it very slowly. Ultimately, this is what makes sense. I just wish I weren't so damned impatient.

My surgery was on May 9th. I was in the recovery room for much longer than planned because there was no bed for me in the neurology ward. I ended up being moved in the middle of the night and sent home by noon the next day. And I was just kept in as long as that, so that I could get my three doses of IV antibiotics.

I had a good first couple of days at home (and it was such a relief to be there) but later in the week, after a fast taper on the Decadron (the steroid with which I have a hate-hate-like relationship), I started to notice that my eyes were getting swollen, as though the lids were filling with water. By Saturday afternoon, they were swollen to slits.


They got worse.
No one told me this could happen.

The next day, Sunday, my eyes were starting to improve but my head was hurting. In the beginning, all the pain had been around my incision. By the following weekend, the top and back of my head hurt and it felt just like my brain was swelling. Or a new tumour was cutting off the flow of liquid. It hurt and was very, very scary.

I debated going to Emergency (I hate the ER but the stuff I was reading online pretty much said it could either be a nuisance or kill me) but in the end, decided to take it very easy and call my surgeon the next morning (Monday).

My doctor's secretary made me an appointment and had me come in. My surgeon ended being called away to an emergency and we spent 5 hours at the hospital. It was worth the wait. A CT scan showed that there was no bleed and no obvious new tumour. My doctor put me back on the steroids (a drag but good for the swelling), shared a pretty decent MRI with me and a very hopeful story of a patient with leptomeningeal disease who he knows and has treated, who is still alive and active, two years after her diagnosis.

I told him that I'm collecting hopeful stories.

I went home in a much better mood but woke up in the night with a killer urinary tract infection, my second in a month and almost definitely contracted at the hospital. I have finished my course of antibiotics to treat that and am trying to consume as much probiotic as I can, to avoid a resistance to antibiotics. 

It's totally a case of two steps forward, one step back. On Saturday I felt pretty good and .possibly overdid it. Today, my head hurts again and I am tired from the steroid induced insomnia. I'm also feeling irritable and impatient. I am not supposed to bend down or lift anything. And I hate having to ask for each thing that I need to be done for me.

Today is my regular Herceptin treatment. I still don't have a date for IT Herceptin

At least I'm sitting in the sunshine as I type this. I just need to chose to be in better mood.

Or not.




p.s.: This totally reads like writing on speed. The steroids make my heart pound and my fingers fly!

Friday, May 20, 2016

beating the blood brain barrier

Ouch! My writing muscle hurts! I realized this week that I have not blogged since March 23. I have so much I want to say that I don't know where to start, so it feels a little overwhelming. 

About 10 days ago, I had an Ommaya Reservoir, installed in my brain. Compared to my other brain surgeries it was a walk in the park but I'm still dealing with all kinds of fallout from the anesthetic, pain and healing. I had my staples out yesterday, though, so the end of the tunnel must be in sight (although my head hurts as I type this).

You can see my incision and the staples here. It's in a semi-circle at the front, slightly to the right.

The good news is that we have decided to try something that is still pretty experimental: injecting Herceptin (also called trastuzumab, to which I have been a super responder. I have been on the drug for 9.5 years and since since going into remission, have no detectable cancer below the neck) directly into my brain, thus getting past the issue of the blood-brain barrierThis is known as Intrathecal (or IT) Herceptin. There is currently a trial happening in Montreal (and a resident who works on it was just in Ottawa, working with my oncologist) and there are stories of people going through the process in the Western US. I will be the first in Ottawa. I'm told that everyone in the hospital is very excited.



By artwork by Patrick J. Lynch, Kuebi = Armin K├╝belbeck - own work, the brain is taken from Image:Skull_and_brain_sagittal.svg made by Patrick L. Lynch. Made with InkScape., Public Domain,
https://commons.wikimedia.org/w/index.php?curid=6066950


IT trastuzumab was effective in targeting extramedullary (LM) metastases. This resulted in the prolonged survival of our patient for 46 months, compared to a median life expectancy of 3–4 months for breast cancer patients following the diagnosis of LM without treatment []. Given that IV trastuzumab does not cross the blood–brain barrier or blood CSF barrier, IT trastuzumab offers a direct approach to the leptomeninges. (from: "Intrathecal trastuzumab: immunotherapy improves the prognosis of leptomeningeal metastases in HER-2+ breast cancer patient", US National Library of Medicine)

The decision to go this route is the first time I have felt hopeful in a while. My oncologist is nervous about side effects and finding the right dose. I had a very intense reaction to Herceptin when I started and because this kind of treament is still experimental there are potentially some very serious side effects (even death). There is also little clarity as to what dose would be both safe and effective.

Anecdotally, and in trials in Montreal (and elsewhere) the response has been very positive, over all. I'm glad my oncologist has been convinced to give it a go. Additionally, my latest MRI has revealed that the three tumours in the brain lining are all stable, so we are feeling less urgency. This is also good news, although I am keen to get started.

The bubble wrap is called a "Bear Hugger" and it's warm and lovely.
The drugs probably helped with that feeling.

Wednesday, March 23, 2016

the latest

I wrote this in the form of a letter a few days ago. Doing so has been a huge relief to me. I know that it's not the same for everyone but expressing myself in this way has been both calming and freeing.

I have sent it already to family and to friends with whom I have been speaking. It helps a lot because we can start the discussion from here and I don't need to explain from the beginning each time. Or not talk about this stuff at all, in the knowledge that they know. 

It works for me.

You should also know that I learned all this on March 4th (and suspected before because of the symptoms I was having). The news was worse than I had hoped (of course) but I have had some time to absorb and, given that I have also turned the corner on the Cyber Knife am doing pretty well.

Most of the time.





March 20th, 2016

Dear family,

Hello all. I wanted to share an email with all of you, as I am unsure as to what information I have shared with whom and, as always, find it easier to do so in writing. 

I have just had my 5th tumour zapped. The first was in November 2012, the second in May 2015. Numbers 3 and 4 were in December of 2015 and are still there but stable. The most recent was on Tuesday, March 15. As you can tell from this, things have accelerated. I have been told by my radiation oncologist that I should not be surprised to see a new tumour every time I have an MRI (every 2-3 months) for the next while.

The tumours have also moved from the tissue in the brain to its lining and present as more of a "thickening". They're also closer together, which makes them harder to zap. Since tissue can only be radiated once, this means that we are running out of room for Cyber Knife.

There is unfortunately no drug that would address Her 2+ breast cancer in the brain that crosses the blood-brain barrier. There are some amazing breakthroughs on the horizon and we are hopeful that we can keep using CyberKnife for something to become a reality for me. We met with both oncologists on March 4, after what had already been a very hard day, so we still have many questions. I do feel like I am getting really good care and like both my oncologists a lot.

We saw my radiation oncologist again on March 15, right after my CyberKnife and he showed us the images of my brain and really took his time answering questions. My next appointment with my medical oncologist is May 4 but he has said that I am welcome to ask to come in and talk to him before then and I plan to do so.

The next step in the progression of my brain mets is something called "leptomeningeal metastasis" or "carcinomamatous meningitis" (they mean the same thing). This is when the cancer cells progress from brain tissue to the lining and then into the cerebral-spinal fluid. Please don't Google this. I did and found very dire info and didn't realize it was from 2005. Lots has changed since then for the better. It's not a good diagnosis but more hopeful than 15 years ago, for sure! I will include a fact sheet or two at the bottom of this message with more info. I already have some of the symptoms, including sporadic loss of sensation in my face (I call it "facial paralysis" as I feel increased pressure and then my jaw won't open. It can make talking a challenge, sometimes with funny results)

This is a pretty good fact sheet about brain metastasis: http://www.brainmetsbc.org/en/content/frequently-asked-questions-about-brain-metastasis

This one is addresses symptoms. I have the first 7 only: http://www.brainmetsbc.org/en/content/symptoms-and-diagnosis-0

On leptomeningeal metastasis:


We are still hoping that I can look back on all of this in two years and feel relief and happiness that I am still well but we are also being realistic. I need to live in in this hope but also accept that I need to do so in the body I have for the time that it is left to me. This emotional fallout has been very hard to deal with but I have had some time (a couple of weeks anyway) and am moving towards acceptance (with lots of hope, not forgetting the hope).

In happier news, Daniel will be 13 in a few weeks and Sacha will be 18 soon after that! We have told Daniel that he doesn't need to make his decision yet whether to have a party (for his non-Barmitzvah) or a trip. We'll keep you posted. Meanwhile, we are thinking of a family vacation out west in the summer.

We have concert tickets to see Courtney Barnett for late May in Montreal with Sacha. He has been informed that he has to buy his mother a legally purchased beer. 

Having things to look forward to is making us all much happier these days.

Please feel free to ask any questions once you have read this over and absorbed but don't feel like you have to do so. I just wanted us all to be on the same page and to spare myself the difficulty of having to repeat myself.

With much love as always,
Laurie and Tim


Monday, March 21, 2016

good things



Time for another one! What would yours be?

In random order, the things that make me happy these days:

Lynn Miles.

Billy Bragg.

Tea.

Thinking about Canadian travel.

Colours.

Massage and reflexology.

My friends and chosen family (and that includes lots of real family).



My sister (because that bears repeating).

Dark humour.




Dog faces.




Tim (for 25 years this month. Over half my life).




My brain (ironically, I know).

Spring.



Tuesday, March 15, 2016

Cyber Knife is radiation (and other news)

First of all, thanks to you all for giving me all this space. It has meant a lot to me.

I'm ready for questions now and to talk about it but first I have to have lunch and then go to Cyber Knife radiation.

The name is confusing but it's radiation that can be done differently than whole brain (which is generally only done once). Each new tumour can be targeted directly in one to a few days and you can keep going for quite a while. It's newish technology so no one is certain what that means.

My first brain tumour (in November 2012) was treated with conventional surgery, followed two months later with radiation. We did the same thing in May 2015. The two tumours zapped in December (4 days that time) are still there but stable. 

So this is number 5. Every person is different but I find that it takes me a week to recover (this was hard the first time, when I was told people generally have no side effects). As with Herceptin, I am chosing to believe that this is because it's working.

It's "tricky" as they say because it's not in the tissue of the brain but a thickening of the lining. They also have to avoid the other tumours and tumour scarring. I trust that my radiation oncologist is very good but we have all established that art and science are mixed in these proceedings.

Clear as mud? Not even going to proofread but will post. 

See you on the other side.

Monday, March 07, 2016

at least i know what to expect on the table

I have a new tumour.

I will be doing Cyber Knife some time soon. I don't have a date yet but I'm not worried about that. They are on it.


Both my oncologists (radiation and medical) are not just good and smart but they really care what happens to me.

I have had a few days to take this in but have had some other (non blog related and not my story to tell) things on my mind. I have been feeling bad that I haven't explained here but I am letting that go.

Know that I am doing OK. We are doing OK. I just need a few days to rest, sleep (which I have not been doing for more than a couple of hours a night) and take care of myself.

Please don't take it personally, if you don't hear back from me about this right away. I know I am loved and supported. 

If I don't want to talk about it right now, just follow my lead.

Going to knit tonight and watch the last Downton Abbey tomorrow. 

So no spoilers.