Zometa and Zoladex Tomorrow

It's official - I will start Zometa tomorrow. I haven't had a chance to properly discuss this with my doctor as I don't see him for two weeks, but I have done enough on-line research to know that it's probably going to help. I had already scheduled my Zoladex appointment (that's the abdomen injection that shuts down my ovary production) for tomorrow, so I called my doctor's office and asked him if he also wanted to order the Zometa at the same time.

As I understand it, Zometa helps the bone-building process since caner that's metastasized to the bones either takes out or uses some parts of your bones (not sure exactly what the process), giving you less bone mass, or else, it adds extra bone to your bones. But in any case, both tend to weaken your bones and make you more prone to fracture. This helps makes your bones stronger.

There was apparently also some research that says that Zometa helped premenopausal breast cancer patients by making it somewhat less likely that cancer would metastasize to the bone. The reports say by 36%, but it had to do with a study of 1800 patients (I think), in which half got Zometa and half didn't (all were premenopausal, early stage breast cancerpatients). 6% of those on Zometa ended up with bone metastases versus 9% of those who didn't get it. 6% of 900 is 54 patients with Zometa, versus 81 patients without Zometa.

There are side effects (fever, nausea, dizziness, bone and joint pain), but the average percentage of folks who did were relatively low. So, it seems like a good thing to do.

This brings my total western medicine drugs up to four:
Xeloda - an oral chemotherapy
Tykerb - an anti-Her-2-neu targeted therapy
Zoladex - shuts down the ovary production
Zometa - builds bone

And, for acupuncture, I am on the following herbs:
5-mushroom blend - three of which have been scientifically shown to have anti-cancer properties
Paris 7 - a variety of herbs that fight toxic heat with one that may have anti-cancer properties
Gynnostemma - a variety of herbs that helps support your blood and help one of your energy systems

I also take turmeric in pill form (which has helped against melanoma) and also melatonin which helps sleep and which has also been shown to be affective against breast cancer cells in mice.

Take that, nasty cancer!

Getting to the Bottom of Sleep Problems

Monday afternoon, as I thought about my sleep issues, two things occurred to me:

1) I'd bought a different brand of melatonin. Everyone knows that each company prepares its herbal supplements and vitamins in different ways. So, I went and found the original brand I started using. When I picked up the bottle, there, up front and center, were the words, "timed release"! Ding ding ding ding ... lights went off . .. oh, yeah, that might make a difference!! My body probably metabolized the other brand fairly quickly and the amount of melatonin in my system probably disappeared after just a few hours and then I couldn't sleep. As the label says, "Time release melatonin is formulated to allow for a gradual release of the active ingredient during an approximate six hour period. This provides the body with a more even absorption of melatonin."

2) Several weeks ago, I switched to taking Tykerb after lunch instead of mid-morning. You need to take Tykerb an hour before eating and then you need to wait another hour to eat again. When I first started taking the meds, I'd have breakfast (with Xeloda) and then wait an hour and take the Tykerb, but sometimes because of meetings and appointments, it got to the point where I was taking it at about 11am instead of 10am and then having to wait until noon to eat lunch. Well, the joke in the department is that at 11:15am, I'm usually roaming the halls looking for someone to go to lunch with. My previous habit was to eat a couple of times in the morning (toast, then a mid-morning snack), but taking Tykerb and having to have a two-hour period where I didn't eat anything was getting really tough. So, then it occurred to me to wait to take Tykerb until after lunch because I am able to go several hours then without eating. But, one of the side effects of Tykerb is "trouble sleeping". Monday afternoon, I realized that I probably had a higher level of Tykerb in my system around 9-10pm then I did when I took Tykerb in the morning. So, yesterday, when I woke at 6am (which I usually do and then I doze until about 7am), I took Tykerb then. Worked out fine. No issues with the digestive system.

And, the end result? I slept better last night. Still not great, but better. I fell asleep by 11:30pm, woke up at 1:30am and then slept solidly until 4:45am and then until 6am. So, at least 6-6.5 hours of good sleep. Better than 3 or 4 that I'd been getting.

Whew! Man. It's always something! And, trying to figure out what things you need to tweak to in order to deal with side effects (low blood sugar from not eating versus not sleeping) ... hell, you need to be your own detective!

Treatment Updates

I still haven't started radiation treatments yet. I'm not all that eager to start, but I will do them because there are still a few hard nodules under the skin, which are presumably little tumors growing up from the lymph channels. I may, however, not do the full six weeks, depending on how my body responds to them. When I asked the rad onc about doing less to begin with, her reply was that it would be 3 months before she knew whether or not the radiation treatments worked - in other words, we could do less treatment, but since it takes awhile for everything to settle down, we wouldn't know whether or not there is still cancer there for 3 months. And, if it didn't work, then I'd have to do the radiation treatments again. Medical science just doesn't know or hasn't studied whether doing less would be just as effective as doing more. So, they stick to the standard treatments.

But my thinking is that the medications I'm on - Xeloda and Tykerb - have or are sensitizing the cancer and it will be easier to kill with radiation. I also take a five mushroom pill (3 of which have anticancer properties), melatonin (which has been shown to stop and/or reduce breast tumor growth in mice), and turmeric (shown to be effective for skin disorders and studies have shown it to stop tumor growth in melanoma). So, I guess I think doing a little bit of radiation will tip the balance in my favor - kill the suckers - and then the meds will be able to do their work.

The open skin wound continues to heal. I've recently started putting turmeric paste over a larger area than the original open wound - the skin over the implant was dark - and now the whole area is weeping more. I need to change the dressings twice a day. The way I see it is that my body is expelling the cancer through the fluid drainage.

I don't have as much lymphedema over the right ribs as before - I do some lymph massage everyday - and interestingly, the whole area is fading again. The area was getting redder AND more swollen after I painted my bathroom, so my guess is that a lot of redness is from the lymphedema, not the cancer. But as I said, there are a few little nodules that are little tumors, so I will submit to radiation, too.

Have a good Tuesday everyone!

Visit with My Oncologist

Yesterday afternoon, I had an appointment with my oncologist, who wants to check in with me while I'm on Xeloda and Tykerb. I had several questions for him, which were, in no particular order: 1) adjusting my dose while on Xeloda; 2) what to do with the skin mets; 3) using melatonin for sleep; 4) his thinking about radiation; and 5) insurance approval for Xeloda and Tykerb.

Regarding Xeloda, he gave me permission to adjust my dose of Xeloda. His preference was for me to take it Mon to Fri and then off on the week-end (something about biochemical processes), but I told him that I am really enjoying my week off of it. So, for now he was happy with me trying to take only 5 Xeloda each day while I'm on it, instead of 6. He was fine with me skipping the last dose because of the mouth inflammation. He also mentioned something interesting: apparently, women in Europe are able to tolerate 8 or 10 Xeloda each day, while in the U.S., women seem to only tolerate 6 each day. Researchers aren't sure why, but are looking at environmental factors, such as our diet, or maybe what's in our water or environmental contaminants.

Regarding the skin mets, there were 2 or 3 small areas (i.e., a few mm long) that started to bleed a bit. They were around areas that were pretty dry, so he said to use a small bit of aloe vera gel to moisten it up. By moistening it up, we can keep them from getting larger. He definitely saw improvement - he last saw me on Feb 22, so he saw the improvement over a 12-day period on these meds. So, my eyes weren't deceiving me!!!

He didn't know much about melatonin so I mentioned to him the studies I found related to it. I posted about it last Friday. The thing I forgot to mention is that there are some studies, I think so far just done on rats, that show that melatonin stops breast cancer tumor growth. He wasn't able to suggest a dose. I started with 2mg a night (about 6 or 7 times more than is usually used physiologically) and it didn't seem to help. I went up to 4mg on Tues night and I couldn't even get to sleep! I went back to 2mg last night and slept for 4 hours straight! Yippee. I think I got up to another 3 hours the rest of the night, but I woke up a couple of times and stayed awake. I found some articles on the internet that show that one can take as many as 75mg/night without ill effects, other than feeling sleepy and drowsy. Another article said that elder insomniacs had better sleep with about 0.3mg. One site suggested 40-50mg/day if you are a cancer patient. So, I will monkey around with the dose and see what works. Liz, over at www.lizkreger.com, told me that she uses 5mg/night and that works for her. My oncologist's nurse said that a 3mg dose works for her.

Regarding radiation, my oncologist thought that my reasoning was sound in terms of putting off radiation until I really need it. He said that if the meds seem to be working on the skin rash and the skin mets, then radiation (a one-shot, local deal) wouldn't be necessary. We also assume that if it's working on the skin, then it must be working throughout my body. Yippee! again! If we continue to see improvement, then once it's cleared up, I can go back to getting "pumped up"! Cool. It's kinda weird being half-filled.

He also said that insurance approved the Xeloda and Tykerb, without any extra say-so on his part. My thinking? That giving me Tykerb/Xeloda is cheaper than having it administered via IV, because not only do you have to pay for the meds, but also for the trained personnel giving the meds. Taking pills works for me! Better than having a port or having my arm/hand stuck with needles every so often!

So, yep, it was a good visit. I took my folks out to dinner to celebrate!

Melatonin and breast cancer

I think I may have mentioned that I get insomnia - have had it for years, ever since I started in a tenure-track job with the pressures associated with teaching, and the "publish or perish" attitude. Then, when my son was born in 2000, I just got used to operating on 6 or 7 hours of sleep and being tired all the time.

Then, in 2002, after undergoing chemo with AC, I developed hot flashes that would wake me up at night, too.

I continued to have insomnia, though, and I always attributed it to stress. My insomnia seems to be a little worse now under Xeloda and Tykerb, so I asked some other breast cancer folks what they use to get a good night's sleep. One person, Liz Kreger at www.lizkreger.com, mentioned that she uses melatonin.

I've been meaning to do some research related to melatonin and how that might help sleep. I just found one really interesting report on the web. The address is:

http://www.iht.com/articles/2005/10/05/news/snmel.php

Basically, according to this study based in Boston, the researchers found that women who have low melatonin levels were 70% more likely to develop breast cancer!!!!! The theory is that your immune system works at night, when you're sleeping. If you can't sleep, your immune system isn't able to work as well as it should.

Low melatonin is associated with lack of sleep. The article also states that your body's melatonin decreases when there's a lot of light at night.

Since my son was a baby, I have used night lights - in my room or an adjacent one, in the bathroom, and in Eddie's room. I know it stems from an incident one night when Eddie was less than 12 months old: he was in our bed and I got up at night to use the restroom and as soon as I got up, he rolled off the bed onto the floor. It had been really dark in our room, so I didn't realize how close to the edge I was. I'm also blind as a bat - really really near-sighted - and I find I like the light so I can see better.

A lot of stuff about insomnia says to make sure your room is dark, but I kinda pooh-poohed that idea because I didn't understand the rationale. I'm also so used to the night light now, especially when I wake up and have to use the restroom. But, you know what? I'm gonna take the damn thing out - maybe that'll help me sleep. Then, after a few nights, if I don't sleep any better, I'm gonna try melatonin.

Interesting, huh?