Third Line Therapy

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Mphotoemories of another angst-filled day of sitting in bed waiting for the side effects of my first round of chemo playing tug-of-war with what I know must happen, I ask John to bring me my pills.

“The new ones?” he asks.

“I guess,” I grudgingly respond. Really, this is me? Really?

The pills have been sitting on the counter for a few days now. The need for a pneumonia vaccine and Zach’s cold have served as noble excuses for my not starting the treatment. Fear of mouth sores, fatigue and vomiting are the true culprits. Perhaps even a wee dram of denial that it has come to this – a third line therapy – so quickly. How can I dread something that is my next and one of only a few remaining hopes? I’ve lived through the side effects before, at least the most common ones. I know that my hair isn’t going to fall out today, if it falls out at all; that mouth sores won’t appear upon taking it. My mind plays tricks on me, actualized in my gut. I’m not sure looking at the box of pills is a risk factor for nausea, but that seems to be its impact.

The pills don’t look evil. They don’t even look powerful. They have none of the foreboding of the bags of infusion meds that used to hang from my IV pole, or the bright red-orange serum that was once pushed into my veins. Exemestane – white and smaller than a baby aspirin, it reflects darkly in my soul and I wish again there were a different path. It will, we hope, diminish the cancer’s food source: estrogen. The Pez-shaped everolimus is a new-ish breast cancer drug in a new-ish class of targeted therapies. It’s target, the mTor pathway: part of a complex signaling pathway that promotes the growth of cancer cells. If you inhibit mTor, you inhibit cell growth. Assuming the pathway is activated in me. We don’t have a biomarker, a blood test, to determine I’m the right candidate for this one. It’s a crapshoot. Lucky 7s….

With nowhere left to hide, I want to find the “take no prisoners” me, but she left a few days ago. I marvel that despite all the experience and knowledge I’ve amassed, it still comes to this, that fear and anxiety remain my steady companion. Slowly I bring the pills to my mouth, one by one, with a prayer leaning to the side of fear over hope. Prayers once came easily but not longer do. My stomach heaves. I pop a borrowed Ativan for good measure and wait for what comes next. My throat doesn’t close; I don’t begin to immediately feel exhausted, and like I did just about a dozen years ago, I wonder if I’ll have the stomach for comfort food come afternoon.

P.S. Have you ever read the tightly-folded packet insert that comes with medications? I’m quite certain that somewhere in there I read that the meds should be taken with Haagen-Dazs Sea Salt Caramel ice cream, and so I must….

27 responses »

  1. *hugs* My doctor says not everyone gets the side effects, and 20% of patients on placebo do get them… It might be ok. Target those mTors! PS If HaagenDasz not helpful, try Ben&Jerry’s Cherry Garcia. Those fudge flakes are powerful.

      • Absolutely! Tell John I’ll bring him some lemon squares to give him something to do while we’re out :) let me know what My Zachary wants. I don’t feel horrible, just a little stuffy and sneezy. Think I made the right decision yesterday…even tho wasn’t what I wanted to do.

  2. Oh Lori you express so well the thought process that is going on as you take this new Afintor pill. I clicked like on this but I love your writing, not what you are having to go through. The trangst is real. The unknown will become known. I send you all the love and prayers for this to work and not bring about uncomfortable side effects. Hugs and xoxo – Susan

  3. Like Susan, I want to like your post for your writing, NOT for what you are going through. Sending hugs and warm thoughts…and while you are having your sea salt carmel, I’ll take some mint chocolate chip! :-) JoAnn

  4. Hi Lori. I remember how long it took for me take my first Tamoxifen, so that’s as close as I get to knowing what you are going through. I love you’re wit in the midst of trangst and I’m pulling for you here in the wilderness of Denver, CO.
    PS My first born is Zachary, he’s 30 now and one of my best support givers. My Zack and I hope for the best for you and your Zach.

    • Thank you so much! I’m on day two and fewer tears this morning, so that’s progress! Keeping my fingers crossed that my Zach and I can pay it forward when he’s 30!

  5. Lori- I am so very sorry for what you are going through. I must say that you are so articulate, warm and disarming in your descriptions that I am filled with admiration and awe. This can’t be easy for John and Zach either. Even without a shared history, my money is on you! Bob and I will bring the Haggen-Daz anytime! Much love, Joan

    • Thank you so much Joan. While you’re right, it isn’t easy, I couldn’t do it without my guys! They are a constant source of strength, encouragement and love.

  6. dear Lori,

    good for you – grabbing onto anything that can be of comfort, that can help see you through with feeling all is so surreal. I am so glad you have shared this part of your story, the first time taking the new medications and all the emotions that came with it, so we who love and care so deeply for you can do what we can to send you big hope and encouragement.

    much love and light, and loads of gentle, warm hugs,

    Karen xoxo

  7. Oh, Lori…huge sigh. Deep breaths. And ice cream.

    Several years ago, when a friend of mine was getting chemo infusions for stage IV Hodgkins disease, I reimagined the names of all the drugs in her cocktail as fearsome characters blasting her cancer cells to smithereens. Vinblastin, for example, became Vinny Blastini, a former made-man for the Mob who had reformed his life and now fought cancer full-time. We laughed our heads off, and she shared all our silliness with her onc, who wanted to share it with some of his other patients. Whatever it may have added to the process, it worked, and she has been stable and in remission for years now.

    I think the chemical name of Afinitor lends itself to such a purpose. Ever O’Limus could be a reformed rabble-rouser from the IRA, who now plots guerilla action against metastatic breast cancer. His favorite ice cream is Chunky Monkey, but he’s open to trying new flavors. And he’s a little salty himself.

    Much love to you, Kathi

  8. Must be something in the air… I just posted about how chocolate chip cookies are getting me through some unexpected side effects. I hope the ice cream does the trick and staves off all of yours! I hope this drug works wonders for you. Lots of love to you.

  9. Ativan is a big friend of mine, these days. I like the idea of taking ice cream with the pills. Sounds like a winner. I do hope this is the solution for you, Lori. You deserve the best. Thanks for your beautiful writing. It helps keep us Stage IVers going. XOX

  10. It is crazy the games we play with ourselves. We know better, but it doesn’t matter. I have been playing tag with my doctor–missing appointments, etc. No matter how old, not matter how mature when it comes to things like this we hold onto denial and play stupid games with ourselves hoping no one will notice. Keep on keeping on, my friend. We are all here to support you. xoxoxoxo

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