Doctor, Doctor Give Me The News

 Robert Palmer - Bad Case of Loving You (Doctor, Doctor)

I am extremely happy to report that I received one of the best scans I've seen in a while! Everything dropped but one lymph node in my neck; it is bigger, but barely. Here is a comparison of the last two PET scans:

Description/Location	8/28/2020 PET	6/29/2020 - CT/PET
Left supraclavicular bulky adenopathy	1.8 x 2.4 Max SUV  9.3	1.8 x 2.5 suv max 8.1
Liver #1	1.6 x 1.6 Max SUV 12.4	1.4 x 2.5 cm max suv 15.4
Liver #2 (lateral left hepatic lobe)	0.9 x 1.1 Max SUV  5.7	1.1 x 1.2 max suv 7.5
New porta hepatis node right upper abdomen	1.1 x 1.9 cm, max suv 20.2	1.5 x 2x2. max suv 29.8
Right Axillary node (Abdomen and Pelvis)
Right subpectoral		0.7 x 1.1 cm, max suv 10.2
Preval node right upper abdomen		mas suv 14.0
New bilateral metabolically active axillary and internal mammary lymph nodes
New metabolically active cardiophrenic lymph node
Anterior mediastinal lymph node	0.7 x 0.8 cm, max suv 3.4	1.4 x 0.9 cm, max suv 5.3
Aortopulmonary window lymph node	0.6 x 1.2 cm, max suv 3.5	1.1 x 1.3 cm, max suv 4.9

 PET/CT IMPRESSION: 1. All but one area of lymph node metastases show improvement. The one exception is left supraclavicular metastasis, which shows focal progression. 2. Treatment response in hepatic metastases. 3. Partially groundglass opacity in the left lung shows improvement compared to the prior exam. This may represent a pulmonary metastasis with treatment response.  NOTE: All previous pet results are in older posts.

Now, before you ask too many questions, let me just say that every radiologist reports findings a different way, using different names. Is it confusing? Hello? It's Crazy!! Even Dr. Kocs says that there are times it is difficult to determine what they are saying. So the items that are showing as blank? They were reported in previous scans using the descriptions noted, but could they be something reported before with a different description? Very possible. So I did the best I could to match up tumors by previous measurements. What is clearly obvious is I have a lot of tumors. For those new to the blog, I had bad news in February, then again in May when we started really watching the tumor markers, and then again in June when the treatment quit working. Note: A May PET showed some shrinkage. But couple that test with tumor markers and something is up. Tumor markers tipped us off this last time. So to see everything shrinking is great! To top it off, my tumor markers are going down too:   

	Range	28-Aug	24-Jul	19-Jun	5-Jun	22-May	8-May	10-Apr
CA 15-3	0 - 32.4	26.1	37.8	42.5		29.7	25.5	20.7
CA 27-29	0 - 38.6	47.4	75.2	90.3	69.3	61.8	62.8	46.2

It's been a great week!

I met with Dr. Kocs to discuss test results before beginning cycle 4. He walks in:

Dr. Kocs: You!

Me: Me!

Dr. Kocs: I'm smiling under my mask!

Me: I've very happy!

Dr. Kocs: You deserve this ...

Dr. Kocs told me he used me as an example today, not by name, of course. Another patient was having similar luck and he recommended Erubilin, then gave her the reader's digest version on my former treatment success (not), but with the new chemo, we are seeing the best results we've seen in a long time. 

So now what? We stay the course. I finish two more cycles, then another PET on 10/9. 

Chemo was uneventful. The nurse took my labs from my port (save the veins!). I danced while waiting for the lab results before they would release the chemo, then got more wiggles in during steroids. I'd say 30 to 40 minutes today. I didn't really let loose too much cuz there was a very ill woman near me; I don't know if she could handle the pep in my step or my flailing arms, so I toned it down. I considered not dancing at all ... but only for a second. Of course I have to dance! It's chemo day!!

To make my day even better, my neighbor friend brings me my surprise pumpkin scentsy gift. I get a new plugin, a great new scent, and some Halloween goodies as a bonus! If you are a scentsy fan and need some, I'll hook you up with my friend.

Life is good! I am a happy girl! The only thing that could make it better is extended time with my family. For now, quick hugs, telephone calls, texts, video chats, and virtual cooking will have to do. 

Have a blessed weekend, everyone! Be kind! Try to put a smile on someone's face every day, even if that someone is you 😊

What's in a Title?

Hi Everyone!! 

 I thought I was being clever by using song titles for my recent posts that helped describe the topic. I include a link to the song that inspired the title, along with the name of the artist. However, I recently found out that most of my readers didn't catch on. I guess I am not so clever after all! And I thought I was "all that"; it's always good to knock me off my pedestal for a bit. It keeps me humble.

 Now that you know, maybe you want to take a listen to the songs I reference.

 I bring this up because in my latest post I included a short six minute film called "Behind the Mask" instead of a song. I felt it was very fitting for the post and a thought provoking and inspiring film. I loved it and had hoped others will enjoy it as much as I did. But most didn't even know it was there. Sorry for not being more forth coming. Never assume, right? 

 I want to continue this trend to not only give you a look as to what is going on in my fight against cancer, but also start it off with a little "treat". Going forward, it may be a song, a comedy sketch, a short film, an inspirational poster. Just a little something extra. I hope you enjoy my little treats going forward. Here is a sample of what I am referring to: 

Jeanne Robertson: Don't Flash the Bellman

Jeanne Robertson: The Toothpick Man

Bring Me to Life and Don't Give Up On Me

 Evanescence - Bring Me to Life  August 14

This is the song I play when I feel like flipping off certain people or the world in general. I picked this as my chemo song for Friday ... cuz I really want to flip off cancer!!

So the last word on the cancer battle is I was on antibiotics because my white blood cell count was elevated, along with ANC, typically indicative of an infection. Well, labs came back negative. I stopped the antibiotics after two days.

I meet with Rachel again. My ankles are still a bit swollen. We drop the steroids down to 2 or 2.5. Rachel talked about a possible diuretic for three days to help the swelling. I suggested that we wait until after we drop the steroids and do the PET on the 28th, then reassess. She agreed.

My throat started hurting right before going to my appointment. They take this stuff very seriously. I had to wait in the lobby until I was cleared to go up. Rachel checked my throat and saw stuff consistent with sinus drainage from allergies causing the sore throat. I am to gargle with salt water to help. I take Tylenol when I get home and it goes away. 

Blood results are not posted still, but Rachel did tell me my white blood cells were down to 5, still in normal range. Red blood cells improving. I am not anemic. Liver enzymes are great. Off to do steroids and chemo. 

Another session down. I feel fine. Onward!

Cathy came in for a visit! Don't worry - she self quarantined for two weeks before heading my way. Cathy helped me hang family pictures in my office. Actually, I watched Cathy hang family pictures in my office. My job was to find suitable pictures and frames. It looks great! We play cards, read, and just overall relax. Mike was stellar in the kitchen with enchiladas and pulled pork. Heaven! Cathy treated us to dinner Monday night before heading home on Tuesday (no, we didn't go out ... pick picked up). All in all a great visit! I also go a homemade cobbler out of the deal.

Andy Grammer - Don't Give Up on Me  August 21

I am finishing up cycle three today. Yeah! I made it! I see Josh today (aka Duggie Houser). My weight is down by a couple of pounds. Also, no swelling in the ankles. Lowering the steroids is already helping. I am noticing that I am more nauseous, but still not requiring medication. I told him let's still with the 2 to 2.5 for now. Maybe we will go off them completely soon. 

Josh told me to be sure to let them know if I make any major diet changes or something. He knows I want to lose about 15 pounds. They get concerned when you start dropping weight. I told him my plan was to go for 2 to 3 pounds a month at the most. Change my diet, exercise program to something sustainable; don't try to lose it all too fast, only to gain it back ... and more ... later.

We go over the bloodwork. White blood cell counts are up to 7.5, still normal. Red blood cells in normal range. Liver enzymes are good. Calcium is low but nothing to worry about. All in all, chemo queen continues to handle this stuff like a boss!!

I go to ARC early Thursday morning for thyroid labs (they have been trending low; we adjusted the dose; checking to see if we need to up it again - cancer plays havoc on how your body handles thyroid hormones). We do a PET on Friday at 8 AM, then head to Texas Oncology for labs to check tumor markers. I should have results Monday or Tuesday. I will ask if I can do a telemed visit with Dr. Kocs on results instead of having to wait a week.

I think this stuff is working, but I don't know how much. The one tumor I can feel is going down but it seems to have regained some ground during my off week. I am feeling my liver more these days, which typically means it is swollen and angry. Well, I'm angry too because of the two spots on the liver. Those are the suckers that we are most worried about these days and we have to get a handle on it. Hoping we don't have new tumors sneaking in again. I hate cancer!!

Send positive thoughts my way on August 28!!

Don't Stop

Don't Stop - Fleetwood Mac

Chemo song for this week is Don't Stop by Fleetwood Mac. I think it is quite fitting for the battle I'm fighting. One day at a time; one step at a time. Looking ahead to tomorrow.

 I am feeling empowered these days. I'm not sure why ... maybe it's the good blood work results? Maybe it's the way I am continuing to sail through this chemo with minimal side effects?

Regardless, I went trolling for some inspirational saying to reflect how I feel and the mindset I need to keep to win this battle. I hope some of these inspire you as well.

Now onto some news you can use! I met with Dr. Kocs last week before my blood work. I mention this only to relate that we did not discuss the results. Here is a glimpse of our relationship:

Dr. Kocs, entering the exam room:  Bishop!

Me: Kocs!

Dr. Kocs: Staying out of trouble?

Me: No!

Dr. Kocs: Typical. My plan is to finish the third cycle then do a PET on August 28th. Don't spoil my plan!

Me: Wouldn't think of it.

We chat about the treatment, how I am handling chemo. I told him I am getting fat, weigh more now than ever and my clothes don't fit, without the benefit of ice cream and cookies! He lowered the steroids from 10 ml to 4! Hope it helps!

For the first time in forever, I did not stress lab results. I didn't even bother the nurses to load them to the patient portal, knowing that we tested for tumor markers. I was calm, cool, collected all week. For those of you that know me and results, this is a definite departure. I typically stress until I see them, especially when checking tumor markers to see how this treatment is doing. Results were finally posted on Thursday. Ready for the results? Here goes:

Tumor Markers compared to early June:

CA 15-3        37.8 from 42.5 

CA 27-29     75.2 from 90.3 

CEA             1.6 from 1.4 (normal range)

Blood cell counts:

WBC                   5 from 4.3 (within normal; it's been 7 months)  

RBC                    3.6 from 3.42 (low)

Neutrophil           2.5 from 2.2 (normal)

Liver enzymes are all within normal ranges. Needless to say, I was happy with the results. I wish tumor markers were down more, but the good news is they ARE going down. I suspect we will test tumor markers again when I go in on August 14 (next week is my off week - no chemo).

Blood results from yesterday have not been posted yet but I did go over them with the PA, Rachel. A couple of things to note:

WBC count is up again, to 9.5. Yay! Not so fast. This is an alarming jump in just a week. Also Neutrophil was high (ANC). This is typically indicative of an infection. Definitely something we need to check out. Rachel ordered a urine test and it came back with bacteria and white blood cells. They are doing a culture over the next few days to get more information. Meanwhile, I am on a twice a day antibiotic until we know more. 

Rachel listened to my heart and lungs. All sound great! I did mention that my feet and ankles feel a bit swollen. She agreed. It could be that I am retaining water, again caused by the steroids. She isn't too alarmed as my left and right seemed to mirror one another. She would be more concerned if one foot/ankle were swollen and the other was not. Regardless, something we are going to watch. One of the things Rachel suggested and will add to the notes is that we may want to drop steroids down to 2 on the 14th if I continue to handle the chemo without nausea and vomiting. Possibly eliminate the steroids altogether, as with this chemo it is mainly to ward off nausea. Note: I do have some nausea almost daily, but not the point where I am getting sick and not to the point where I am taking any of the medication I have for nausea. I do carry around the dissolve on your tongue nausea meds in my purse, just in case. Nothing is being taken for granted.

After I get home from chemo yesterday, I get a call from my BCBS nurse, Esther. I love Esther! I told her how I was doing and that we have a PET slated for the end of August. She will call me next week or the week after to see if they have submitted the order for approval. I suspect they won't do that until next week at the earliest because the approvals are only good for 30 days. Regardless, Esther will be on the case and make sure we get approvals quickly. I thank God for bringing me Esther, as it is always nice to have another tool in my belt, another person in my corner.

I must say, I am feeling very well taken care of by my medical team. And to add that I have an advocate from my insurance company? Who would have thought I would have an advocate from the insurance company?!  I am very, very blessed. God is good!

Stronger (What Doesn't Kill You)

Stronger (What Doesn't Kill You) - Kelly Clarkson

I have been posting "happy" songs on my Facebook timeline every day for a while now. I call it the Pandemic Happiness challenge. It helps. I also started posting what I call cancer "fight songs" on chemo days. So far, I've posted the Rocky theme song and Eye of the Tiger. My next cancer fight song is going to be the one referenced above. I think it's an appropriate "kick cancer to the curb" song. Hope you take a listen and keep cancer patients in mind.

So, what is going on, cancer wise? This is my off week. My next session is Friday, July 24. Is it working? Who knows. Here is what I do know:

• I feel "weird" the first two or three days post chemo. It's almost like a painkiller hangover .... a bit loopy, a little out of sorts. Weird.
• I am taking hot baths almost daily now
• My "go-to" when I am feeling out of sorts
• The one tumor I can feel seems a bit smaller, but that could be wishful thinking
• I can still "feel" my liver, just not as much; I think that's a good thing

From a bloodwork perspective, my white blood cell counts are at 4.3 (4.8 is normal), the highest they have been since February. Oh, yeah! Red blood cell counts are low, so we need to keep on eye on those. Liver enzymes are holding steady in normal ranges. All in all, positive results.

I keep gaining weight. I am the heaviest I've ever been, including when I was about to pop out a baby! I feel bloated, fat, and overall disgusting. My clothes don't fit. Thank goodness I am working from home because my work clothes are either too small or I feel miserable in them. Definitely something to talk to Dr. Kocs about on Friday.

I am thinking about asking Dr, Kocs for a nutritionist and/or a holistic oncologist to compliment the chemo we are doing. I heard when the liver isn't functioning normally, then it can cause weight gain. Considering our main concern right now are the tumors in my liver, I can't help but wonder if they are playing a part into my new found obesity. I know my thyroid has been out of whack and we recently upped those meds. I go back in four weeks for another blood test to see if more tweaks are in order. It could be thyroid related. Regardless, I HATE IT!! The worst part? I am not even eating ice cream or homemade cookies .... and I continue to gain weight!!

I am finishing up a one week vacation. I didn't go anywhere, obviously. But I did try to get out in the mornings, walk, and take pictures. I had a great day today, photography subject wise. Here are a few I like:

 Paloma Lake path

My advise? Find whatever feeds your soul. Feed it often!

 Brushy Creek

A funky shot of the bottom of a bridge. I always look for funky.

 Brushy Creek

I gravitate toward water shots of any kind. I love waterfalls, even man-made ones.

Brushy Creek

Love shots where you get a mirror image in the reflection. This is one of my favorites. I might even print and hang this one.

PET Readout

Results

PET/CT scan

BISHOP, VICKI Exam Date: 06/29/2020 

PET - TUMOR IMAGING W/ CONCURRENT CT, SKULL BASE - MID THIGH: 6/29/2020 SKULL BASE TO MID THIGH PET/CT - CLINICAL HISTORY: Left breast carcinoma subsequent treatment strategy 

COMPARISON: PET/CT 05/01/2020, PET/CT 02/13/2020 FINDINGS: NECK: Visualized portions of the brain show normal metabolic activity. Brain parenchyma is normal in appearance. The orbits, intra and extraocular structures are normal. Visualized sinuses are well aerated, with no air fluid levels or abnormal activity. The salivary glands are symmetric, and have physiologic uptake. Oral cavity and pharynx are normal in appearance. Lymphoid tissues around the pharynges show normal uptake. Larynx is normal, and has physiologic uptake. The thyroid has normal parenchyma and normal physiologic uptake. CHEST: Scarring in the upper lobes bilaterally is stable. Ill-defined airspace opacity in the left upper lobe/lingula is again identified measuring 1.5 x 2.5 cm, previously 0.9 x 1.4 cm. Maximum SUV is 4.3, previously 1.5. No new pulmonary lesions. No pleural effusion, pleural mass, or pneumothorax is noted. No abnormal FDG activity is seen in the pleura. Esophagus is normal, and has physiologic uptake. The heart has normal metabolic activity. No evidence of pericardial effusion. Reference background activity (mediastinal blood pool): mean SUV is 2.0. ABDOMEN AND PELVIS: Previously measured hepatic lobe lesion 2.4 x 2.5 cm, previously 2.0 x 1.9 cm. Maximum SUV 15.4, previously 10.9. Lateral left hepatic lobe segment lesion, new maximum SUV 7.5. The pancreas is normal in appearance and has physiologic uptake, without mass or inflammatory change. The spleen demonstrates physiologic activity without splenomegaly or mass. The adrenals are normal, and have physiologic uptake. Physiologic FDG excretion is seen in the kidneys. No contour deforming masses, calculi, or hydronephrosis. Normal physiologic activity is seen in the bowel. No evidence of bowel obstruction. The reproductive organs are normal in appearance and activity. The bladder is normal. Reference background activity (liver): mean SUV is 2.8. LYMPH NODES: New lymphadenopathy * Anterior mediastinal lymph node 1.4 x 0.9 cm, maximum SUV 5.3 * Aortopulmonary window lymph node 1.1 x 1.3 cm, maximum SUV 4.9 * Right subpectoral lymph node 0.7 x 1.1 cm, maximum SUV 10.6 Prior lymphadenopathy * Left submandibular lymph node maximum SUV 10.2, previously 8.0 * Left supraclavicular lymphadenopathy maximum SUV 8.1, previously 6.6 * Porta hepatis node maximum SUV 29.8, previously 9.9 * Precaval lymph node maximum SUV 14.0, previously 4.5 BONES AND SURROUNDING SOFT TISSUES: Physiologic FDG uptake is seen in the bone marrow. There are no sclerotic or lytic lesions. PET/CT IMPRESSION: 1. Disease progression with new lymphadenopathy. 2. Previously characterized lymphadenopathy has progressed as well. 3. Progression of intrahepatic disease with enlarging lesion and new disease in the left hepatic lobe. 4. Ill-defined pulmonary opacity in the left upper lobe has enlarged and is more metabolically active. Findings are suspicious for neoplastic involvement in this clinical setting.

So .... what does this all mean? 😕

Yellow = Chest (new)

Blue = Liver

Green = Lymph Nodes

Pink = Overall Findings

Basically, what I've said in the previous post. Liver is growing; a second lesion on the liver, approximately one centimeter. Possible lung involvement in the chest (note: we've seen this; comes and goes. Could mean infection - I am on a ZPack now). New lymph node involvement.

In a word? Okay, a couple of words …. Cancer Sucks!! Not good results but could be worse. Let's hope the new chemo kicks some booty!!

You Should Be Dancing

You Should Be Dancing - Bee Gees

Those that have been following this blog, know that dancing makes me happy, keeps me sane during the crazy called cancer, and provides a form of exercise and personal entertainment during chemo. Check out the following video! Sent to me by a childhood friend via Facebook. Couldn't be more fitting!

Me During Chemo

Speaking of chemo, I started my new treatment on Thursday. Whee!! I am now on Eribulin in three week cycles: infusion on Friday for two weeks, then a week off. Rinse and repeat. 

I had no idea what to expect so I bring my chemo bag: socks for hands/feet in case we ice them, blanket cuz it is cold in there, charged phone so I can play games or listen to music, lip balm, hand lotion, hand sanitizer (Covid), my mask (Covid), water, wallet, and keys. I found I can probably leave most of it at home next time. Good! That sucker was a bit on the heavy side.

Chemo was uneventful. The ladies and gents still know who I am …. by name. I AM the chemo dancing queen, after all! I got a nurse I've had many times. She saw me and says "You're with me, Ms. Bishop" without me saying a word. First up, labs. Then I am off to see Hannah, my favorite PA.

Hannah brought in a new PA who was shadowing her. She introduced me as the chemo queen. That's right! I have continued to amaze the docs with blood levels, lack of side effects, etc. I did learn something new, but longtime suspected. Metastatic Lobular Carcinoma is difficult to treat. It is sneaky, resilient, and likes to have it's way with you. Mine is doing a pretty great job so far. Does that mean an automatic death sentence? Absolutely not! It just means we may have to go through several treatment options before we find something that works longer than 3 or 4 months. I am up to the challenge!

Back to infusion. I asked my nurse what is the process on this treatment. Twenty minutes of steroids, then anti-nausea push, then chemo push. The chemo push is about the size of a quarter inch in the syringe … small but provides a powerful punch; they push it slow, takes up to five minutes. I told my nurse I would not be dancing today because I wasn't sure about timing, what to expect, etc. Now I know …. I can get in 20 minutes! I also told my nurse that I post a cancer fight song for every chemo session, this week being the theme from Rocky:

The Theme From Rocky

I told her next week will be "Eye of the Tiger". So what does she do? Plays "Eye of the Tiger" for me while doing the chemo push! Made my day!!

After I am done with chemo, I am off to the Pharmacy for new anti-nausea meds. At first, I turned them down; I have a whole bottle that I've rarely used (twice in 9 months). My nurse encouraged me to get the new meds; they melt on your tongue and work quickly. The pharmacist told me I can take the new meds and if they aren't working, I can take my existing meds about 30 minutes later. OMG! Is this an omen of things to come? I told Dr. Kocs to give me something powerful …. without killing me. I asked for it!

Here is a list of the most common side effects from my new chemo:

• Risk of infection, includes fever and chills, painful urination, soar throat, cough or shortness of breath, stuffy or runny nose, swelling or redness of a wound, or changes in skin color
• Neuropathy or nerve problems, includes numbness in hands and feet, muscle cramps, loss of balance, less feeling of heat or cold in fingertips and toes, trouble hearing (hehe …. now I have an excuse!)
• Hair loss in about four weeks or so; I don't think I will dodge the hair loss bullet this time around
• Nausea or vomiting
• Constipation

One of the less common side effects is loss of appetite. Believe it or not, I am already having that, along with the metallic taste in my mouth. Possible mouth sores, too. I have my mouth rinse my friend Jen said I would need at some point. I think we are there. I was also feeling nauseous yesterday and again this morning. Not enough to take meds (yet), but enough to pay attention.

It's gonna get real, folks!!

My next appointment is Friday, July 10. I WILL be dancing during the steroid drip next week! Should have my new dancing shoes by then (my new keds). One of the pairs I ordered is called "Happy Stripes". It fits my happiness mission these days.  Here is a picture:

Aren't they cute? They are screaming my name! I get them Tuesday!

I will post PET results before the weekend is out. I need to update my bloodwork spreadsheet as well as my tumor tracking spreadsheet first. See what project management does to a cancer patient? Stay tuned!