Hip – Page 2 – Life As I Know It

A summer of good news

I’m happy to share that my cancer seems to be quiet and stable. I’ll take this.

I had scans 2 days ago and appointments today with my oncologist and for treatment. The CT scan identified something on my sternum but it can’t distinguish if it is healed bone or new cancer. Imaging is imperfect.

I have been getting CT scans (with contrast) and a bone scan roughly every 3 months since my diagnosis. I have bone-only disease and it’s hard to get good information from these images.

My oncologist wants to switch me over to PET scans, and he wants to do the next scan in October, two months away. I think he is suspicious of the CT results. Insurance companies don’t like to pay for PET scans but the oncologist is pretty confident he can make a good argument. I’ve only had one PET scan and that was how I was diagnosed with bone metastasis.

My immune system is not great right now – my blood work came back with low neutrophils. So, I have to wait a week to restart my Ibrance. I’ll have more lab work next Wednesday and if it looks better I can restart it. If it comes back the same then he will probably lower the dosage of the medication.

I have been having nerve pain all summer. I had a kypoplasty on June 1; the pain largely continued. I had an epidural steroid injection 2 weeks ago; the pain continues. Since nothing showed up on the CT scan, we can assume it’s not new cancer so I’ll head back to the other doctor to see what we can do.

The nerve pain is from the L4/L5 and extends all the way down my leg which makes walking difficult. I’m trying to get exercise in the warm water pool of the YMCA. It’s been a frustrating summer from a physical standpoint.

In other news, Evelyn is home from Europe and Maddy finished a 2 week, 12-hour per day dance workshop at the University of Colorado. It’s nice to have them both home. Ev will move into her apartment in ~1.5 weeks. Maddy starts her junior year next week. Glen is working a lot and will take time off later this month for an annual fly fishing trip.

However you choose to finish out the summer, I hope it is exactly what you need it to be.

Summer update – status quo

Hello friends and family. Checking in with you all to share I have no big news. That is good!

I had my monthly oncology appointment and things are “fine”. I’m taking my Ibrance (CKD 4/6 inhibitor), I got my shots today (Lupron & Fulvestrant) and I’ll go back in 4 weeks. Such is the life of an MBC patient .

I’m grateful for this. So many friends and acquaintances with MBC are not in a relatively easy place. I acknowledge that life is good right now.

Life is good but not pain free. I had my back procedure on June 1 and I am still having hip and leg pain from the nerve compression by my spine. My physical therapist and acupuncturist pointed out that it will take 4-6 weeks after surgery to feel normal. So, I wait and hope that it all resolves.

My blood work – specifically tumor markers – have been rather erratic, bouncing high and low. Because of this my oncologist said he is going to focus on results from scans and take any blood work information “with a large grain of salt”. I will have scans again in August.

Scan, assess, repeat.

Late last month we were in Galveston, TX for Maddy’s national dance competition. She did amazing and we are super proud. We spent a few days in Steamboat Springs after the Fourth of July and it was very relaxing. I’m grateful for both opportunities.

I hope your summer is shaping up exactly how you’d like it to be. If you get some wanderlust, come on out to Colorado. We have space for you and lots of fun things to do in summer.

~~~

Current meds: Ibrance (oral meds), Fulvestrant (injection), Lupron (injection), Zometa (infusion)

Status quo & pain management

“We do not need to change treatment plans at this time.” Music from oncologist Dr. Andorsky’s mouth to my ears this morning! What does this mean? My CT scan showed no progression of cancer, things are stable.

So, we carry on!

The one thing that did show up on my CT scan was the hot mess that my L4 vertebrae is, including a new compression fracture. I’ve not been feeling well since my fall in April and my oncologist was a bit worried this might have been due to progression. It appears that the pain is all related to my fall.

This of course is fantastic news and quite a relief. Is a CT scan absolutely definitive? No, it is not. It is a bit of an art to monitor terminal cancer. This being said, we have as much data as possible and so I’m confident we are on the right path.

My oncologist was very happy with how things are going and I think he was a bit relieved to see me in better spirits.

The reason for my better spirits – besides a stable scan – is that I’ve been able to keep my pain under control and I feel like I’m getting stronger. I can walk unassisted (no cane). I can walk more confidently both up and down stairs. I have not resumed longer walks or walks outside. I’m staying on the treadmill and trying to increase my length and endurance.

We have a plan to hopefully eliminate the pain!

On Thursday, June 1, I am scheduled to undergo an outpatient procedure to fix the compression fracture on my L4 (a kyphoplasty). Basically, they will go in, guided by imaging, and place a little balloon where the fracture is, lift up the vertebrae and inject some cement so that the vertebrae is not compressed.

The pain I currently have is mostly nerve-related pain in my leg. It’s decreased with my medication, but is definitely still there. I am very optimistic that this procedure will help and I’ll be back walking on the trails by mid-June! Cross your fingers with me!

And also please celebrate with me. Living with Metastatic Breast Cancer is stressful and my family and I live in 3 month increments. This provides just a tiny bit of breathing room and will make for a fantastic summer.

I always have a plan for when I get my CT scan results. Today’s treat was a fancy iced coffee.

Graduation tears

This morning was my last radiation treatment. The purpose of the radiation is to knock down any cancer that might be lingering in my hip and pelvis. The radiation does not cure my cancer.

Overall the radiation experience has been pretty straightforward. I only had 10 sessions and I haven’t really noticed any side effects. Fortunately, the treatments are quick and I live pretty close to the cancer center so the impact to my daily routine was minimal.

Radiation is done one person at a time and so you don’t interact much with other patients. I did get to know my 2 technicians relatively well. Interestingly, both of them were here on assignment (one from Tennessee and one from the Caribbean). The cancer center does not have enough full time local employees and so they contract health care workers from other parts of the country. This is not a new phenomenon, it’s been happening a lot since COVID not just here but across the country.

Did the radiation help? It’s too early to know. There won’t be a clear, obvious signal. If my cancer become stable again then, yes, it probably helped.

So I’m “done” with radiation. When I arrived, the technicians greeted me with “happy graduation day.” When I finished, the nurse I met with to ‘discharge’ me handed me a certificate of sorts congratulating me on finishing radiation, signed by all the staff. It was a lovely gesture. After I met with her, I cried.

I shed tears not because of the kindness of the radiation staff or for finishing radiation. I cried because I know this is just one small blip on my road of trying to keep this disease under control. I’m not “done” with cancer. I haven’t really graduated to anything. I don’t feel like this venture into radiation is anything more than documenting and checking off a procedure.

I know it’s ok to cry about this. I feel sad knowing the reality of my situation. I let tears fall until I got to my car. I composed myself and drove home. I have things to do today and I’ll tuck this into the back of my mind and get back to living.

Hope you have plans to live big today too.

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See my day-to-day living with MBC on Instagram: @nottodaymbc
Sciency-cancer stuff on Twitter: @dcharlevo

1 ☢️ down, 9 to go

After a short delay, radiation treatment is on.

I got a call late Monday (yesterday) saying my insurance approved the treatment plan, so in I went today for my first dose.

As my kids would say when they were younger “easy peasy lemon squeezy”. At least this one was. 15 minutes from when I walked in the door to when I left.

Two things stuck out to me.

The first is that it sounded exactly like when you get x-rays of your teeth at the dentist. Except, it lasted for like 20 or 30 seconds. Not gonna lie – that was a little unnerving.

The second was that they radiated the “front” of me and then the machine spun around the table and the radiated the “back”. This tripped me out a little because that radiation was traveling through the table into me. That hit differently. This is some powerful stuff.

Of course I knew this. At the same time, I go through most days with stage 4 cancer compartmentalized, ideally in the back of my mind. This made it come screaming front and center.

Tomorrow my appointment is at 8:45 am. They’ve already closed schools across the front range area due to a winter storm so there is a good chance I won’t make it. Not to worry, I have more appointments in the afternoon for regular oncology check ins and it sounds like they can squeeze me in for radiation in the afternoon. All the appointments are in the same building.

I’ll leave you with this wintery scene. We are expecting anywhere from 4-12” inches by tomorrow mid-morning.

Radiation and tattoos!

Well, I’m entering a new chapter of cancerland: radiation. I have avoided the radiation dance up to this point.

Alas, here we are.

One of the ways they monitor my metastatic breast cancer is through blood work and what they call “tumor markers”. If the tumor marker value is below a certain threshold, no active cancer. If it is above that threshold, “probably” active cancer. My tumor markers have been slowly rising above the threshold for a long time and then rose rapidly recently. My scans did not show any progression so the interpretation of the oncologist was that the cancer was stable.

Maybe not.

My hip/pelvis stabilization surgery last month showed significant “space” in my hip where basically the cancer had eaten away at the bone. That sort of thing does not show up well on imaging. So, the surgery was to shore up the bone, which it did.

The surgeon recommended a round of radiation to my hip to kill off any cancer cells that might be hanging out. For weeks now I’ve been preparing for the radiation therapy. This includes a consultation with a radiation oncologist, a preparatory appointment with a PET scan of the hip and then a simulation appointment where they line up everything in the radiation machine.

I’ve completed all of that.

I’ve learned that there is an entire team of medical professionals that work on my case. The radiation oncologist leads the team. Radiation therapists are experts in operating the machines. Radiation oncology nurses help patients manage side effects and also communicate with the family. The medical physicists work with the radiation oncologist and others to make sure each treatment is tailored properly for each patient. The dosimetrists work with the radiation oncologist and medical physicist to develop the precise treatment plan for each patient including calculating the correct dose of radiation.

No wonder it’s so expensive!

At my first preparation appointment I got a few tattoos! Not as exciting as it might seem.

I have 3 small black dots across my hips that will be used to align the radiation machine using lasers. It’s very common to get these small tattoos when getting radiation. The radiation technician joked that he has done more small black dot tattoos than any tattoo artist in Boulder!

The radiation machine looks like a very large Kitchen Aid mixer! The white draped surface to the right is where the patient lays, the table slides back toward the machine and the round element on the underside of the top is where the radiation comes out.

Now that everything is set up, I’ll have 10 doses of radiation over two weeks. I show up at the same time every day. It’s 15 minutes from when I walk in the building to when I leave. Fortunately the cancer center is only a 10 minute drive from my house.

The only hiccup is one that is not shocking. Insurance.

Cigna called to say that my radiation therapy is still not approved. The first request was for a procedure that did not conform to NCCN (National Comprehensive Cancer Network) guidelines. The radiation oncologist submitted a revised request. This one is still pending. It was pending as of 3:30 pm Friday afternoon. I can’t risk going to my 8:45 am appointment on Monday and not having it covered.

So, we wait.

Likely this will just be a short delay. It probably won’t have an overall impact on my situation. It is worrisome though because if I were in a more urgent situation, it would be frustrating and potentially harmful to delay.

In the meantime I’ll be spending the weekend doing some treadmill walking, playing with the cat, and reading some scientific papers on lobular breast cancer. Wishing you a weekend that is exactly how you want to spend your time.

Stay tuned for the next episode of Cancerland!

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Current medication: (2nd line of treatment) Fulvestrant, Ibrance, Zometa, Lupron

Holy Shit – My Pain was Legit

Happy 2023 everyone! I hope your holiday season has been exactly what you needed it to be. We stayed home and enjoyed each other’s company and brought home this little guy from the Humane Society to live with us.

Meet Toulouse – he’s 4 and the sweetest guy! He’s made himself right at home and we are all head over heels for him.

My hip stabilization procedure was December 12, just over 3 weeks ago. This morning I had a post-op appointment. Everything looks fine. I’m healing as expected.

It’s a bit frustrating to not heal faster. The surgeon commented that right now I’m in a period of time where the recovery slows a bit but our expectations do not. He thought that I was handling it better than most patients so that was nice. I’m trying to give myself a little grace, but it’s hard. I want to get out and move!

It was rather shocking to see the imaging taken just after the procedure.

The cancer is basically eating away the bone. For the surgery, they went in and filled in any cavernous areas of my hip with cement. They also added 2 screws that act like rebar in cement to hold it in place. The surgeon said they were surprised to see so much cavernous area and they put in a lot more cement than they were anticipating.

View of my right hip from behind. The dark area is cement. Within the cement two reinforcing screws are visible.

So, I told him that my pain was legit! He found that humorous and agreed that it was legit.

The image is of my right hip, looking from behind. The dark area is all cement. You can see the screws as well. Insane. It’s a bit sad too because it means that the medication was not really stopping the cancer from progressing. I’m hopeful that the combination of the new meds I started last summer and radiation I will be having next week will knock down any active cancer.

Tomorrow I have an appointment to get palliative radiation set up. They will plan everything out and then I’ll go in for 10 doses of ☢️, daily starting January 9. The actual radiation treatments should be quick.

So, the new year is bringing with it new treatments. Here’s to hoping they get everything stable. I’m also hopeful that 2023 will bring more advances in science that will provide more options for future treatment.

Onward!

Surgery plan – December 3, 2022

Many people have asked, I finally have a confirmed surgery date of Monday, December 12.

The plan is to have a procedure that should help stabilize my hip and pelvis. It will be done in Denver as out patient surgery and should only take 1-2 hours. I should be home that afternoon. One of my sisters is coming to help me.

I don’t need anything at this point. I don’t know how long the recovery will be; I’ve been told I should be up and about very quickly.

Later next week I have a consultant with a radiation oncologist. I will have some radiation to the hip later in the month just to kill off any pesky cancer cells that might be hanging out.

I appreciate all who have reached out. I hope to catch up with many of you who are local for coffee or a meal.

Thanks everyone!

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Cancer life on instagram @nottodaymbc

My monthly oncology appointment last week was fine. We just keep rolling along. Medications all the same.

Fulvestrant (a SERD that inhibits estrogen from feeding the cancer, 2 shots a month)
Ibrance (A CDK4/6 inhibitor that attacks cancer cells
Lupron (A monthly shot that puts me into menopause)
Zometa (A quarterly infusion that strengthens my bones)

My Cranky Hip – November 12, 2022

I mentioned briefly that my hip has been bothering me, so much so that I purchased a cane to help me walk.

Woman holding up a black cane. — This is my “fancy” cane. Lovely fleur-de-lis in white on black. It’s collapsible and comes with a bag so I can fold it up and carry it in my handbag.

I can’t walk unassisted, basically. I don’t want to continue to live like this because my quality of life (QOL) is not great.

So, I went to see an orthopedic oncologist in Denver.

I learned that the cancer has compromised my pelvis right exactly where my femur touches it. So, it’s painful whenever there is pressure or force exerted on it.

Dr. Lerman is in Denver and developed a novel approach to helping stabilize the pelvis of people with cancer. Rather than do a full hip replacement, he and Dr. Brown developed a surgical approach that will relieve my pain, take only a couple of hours of surgery, and have minimal recovery time.

It looks like I could have the procedure done after the Thanksgiving holiday. I don’t have any more details at this point, other than to share a short video of Dr. Lerman talking about what they do for the surgery.

I’m very glad that this looks to be an option. At the same time, I’m reminded that while my mind wants to move forward with life and do all the things….my body is riddled with cancer that is dictating everything.

I’m grateful for the access to care that I have. It’s also a struggle mentally and physically.

Thank you all for your support and checking in on me. I post about cancer stuff on this instagram account: @nottodaymbc