It's been an exciting week...Zometa and pleural space catheters

So! It's been a week. Let's rehash....

Wednesday I had my first Zometa treatment. This is to help build back bone/reduce bone loss from metastasis. It's a bisphosphanate, which likely functions to inhibit the cells that break down bone (osteoclasts) and has also been shown to "increase disease free survival of patients with endocrine-responsive early breast cancer in a low estrogen environment" (1). That's me, a low estrogen environment lol Also....I like the words "disease free survival". 

Originally this bone drug was to be Xgeva, a shot with a lower incidence of kidney damage. However, insurance says nope, Zometa. Both are equally good treatment wise (at least that's the current thought), but Zometa is an infusion. Luckily it's not a long one, but it's an hour or so in the chemo corrale, luckily with amazing nurses. Love Christ Oncology nurses (Ft. Wright and now Montgomery!). If it doesn't work or I have kidney damage then I can switch to Xgeva. If you were worried about the government being involved in your health care, let me tell you that profit driven insurance companies are at least as bad if not worse compared to medicare, and they're intimately involved in mine, including the treatments I can get. Yes, this is a plug for socialized medicine and I am lucky to have good health insurance.

Zometa side effects were definitely doable if mildly annoying- pretty tired for 24-36 hours, and starting around 24 hours flushed and spiked a fever, which only lasted a few hours. This might be the only time I have these effects; we'll find out Dec. 28th, when I go in for the next round. Monthly deal this one.

Tuesday I saw the pulmonologists at UC, great group of docs there. It's fun going to a research hospital because they're into new treatments, and all the docs spoke with me like a human being who knew stuff. Nice and required. They recommended what others had, a Pleurx catheter, which is inserted into the pleural space to drain it.  My shortness of breath (SOB, that's still funny to me) is caused by a buildup of fluid there, and so with the catheter we can drain it at home instead of going in to the hospital and getting stuck with a large needle and drained there (thoracentesis, had two). The doc also recommended possibly a talc treatment after placement to scar the lining and stick it together, eliminating the pleural space (you can't fill with fluid that which doesn't exist). He gave me the paper on the research study, yeah!

So, in I went Friday for that. Placement and drainage go fine (thankful for sedatives and pain meds), but I have more pain than expected the night and day after. I was impressed with how easy it was to get ahold of the surgeon on Saturday, and he put in a script for me (tramadol, because you can't call in opiates anymore). Not a lot of love for tramadol, which worked pretty well on the pain, but nausea and lots of half sleeping occur and lingered for probably 12 hours after a dose. The real deal works just as well for me, with fewer side effects at lower doses, but lucky to have the pain meds, and I know of course there are issues with oxy. Ok, back to it. Why the pain? Turns out I have a "trapped lung", which means that the lower part will no longer fully expand leading to a nasty pressure differential when all the fluid is drained. Once a little fluid builds up the pressure evens out and the pain will go away. In my case this took about 36 hours based on pain. Now I can breathe better and have less pain! So, phew! And we can, and will, drain this thing at home regularly, just not all the way as evidenced by twinges and coughing when it gets as low as should. Key is going to be not overdoing it!  The down side of trapped long is no pleurodesis, the sealing of the pleural space with talc. So, that's out. However, the catheter itself can lead to scarring and treatment should reduce the effusion on its own. ...

Speaking of treatment, I'm currently on my off week for Ibrance, and that seems to have gone well side effects wise. If anything they're super minor. I'm also three weeks closer to having and feeling a response according to the doc, ie symptoms lessening, if it's going to happen (including effusion), so I'm crossing my fingers. Scans in probably eight weeks or so. 

So that's last week! I feel lucky to have had Thanksgiving to be with family (most of them socially distanced except the tiny pod of my sister's family and us). Zoomed in for "Black Friday shopping" - no getting up at 5am this year and way safer. I was also able to get a lot of work done, which was great since grading was about all I had time and energy for at the end of this past week. Monday morning the pod was unpacked, and it's looking a lot more cozy here! Soon, a tree. And we close on the MA house Thursday. Phew! This week department meetings mostly and thankfully no doctor's appointments (knock on wood). Looking forward to some walks, some yoga, some healthy and some not healthy eating, and socially distanced cookie baking this weekend! I think the phage and bacterial cookie cutters will make an appearance and here's hoping my coronavirus cookie cutter will also arrive by then :-)

Take care of yourselves, wear a mask, and stay away from places that don't require masks and have a lot of people (eg. indoor dining and gyms), if you can isolate as much as possible even with a mask. This surge is no joke, and the best way to thank healthcare workers is to practice the above. Vaccines are coming but dark days are immediately ahead...I hope we all find a little light through the coming days and are kind to ourselves and others.

1. Clézardin, P. (2013). Mechanisms of action of bisphosphonates in oncology: A scientific concept evolving from antiresorptive to anticancer activities. BoneKEy Reports, 2. https://doi.org/10.1038/bonekey.2013.1