Our society places a great deal of celebratory value on the passing of the old year. We look back on the old year and hope the new year is better. With as bad as 2011 was, 2012 has to be better, right?
The new year did not start out as nicely as hoped. Because there was a slight increase in Lucy’s CA125 level, Dr. Boente wanted labs done a couple days in advance. A CA125 test takes about two days to complete. The labs indicated her hemoglobin had dropped to 6.8. Lucy needed a transfusion on January 4th. Her next scheduled Taxol/Avastin treatment was scheduled for January 5th. This would have been the first treatment of the fourth cycle.
After Lucy’s CA125 level dropped dramatically during the second treatment cycle, it had been steadily increasing since. She was also having leg pain and stomach problems. Lucy’s cancer had become Taxol-resistant and platinum-resistant. The Taxol/Avastin treatments were cancelled and she was to start Alimta instead. Alimta is given once every three weeks in a very short infusion. Her first Alimta treatment was scheduled for January 12th.
While Dr. Boente was examining Lucy, he checked her legs to determine why they were painful. He did a Homans’ test on both legs. This involved Lucy sitting at the edge of the exam table with both legs dangling over the edge. He then supported her ankle with one hand and started pushing her foot back towards her shin. The left leg was painful while the right leg was not.
Because Homans’ test not a good indicator of a deep vein thrombosis (DVT, a blood clot in a vein deep under the skin), Lucy was scheduled for an ultrasound on her left leg. Fortunately, Suburban Imaging is one floor down from Minnesota Oncology. She had an appointment for that afternoon. The ultrasound determined there was a clot in her left calf. We went back upstairs so Lucy could get a Lovenox shot. Lovenox is an anti-coagulant drug. It is not designed to dissolve an existing clot. She received a prescription for Coumadin, another anti-coagulant. The Coumadin would start after a series of four daily Lovenox shots.
Coumadin is a fickle drug to properly dose. It requires frequent blood testing. The test is known as PT/INR, and is more commonly called an INR test. It’s short for Prothrombin Time/International Normalized Ratio. The desired result should be between 1.0 and 2.0. Lucy’s was at 8.9 after two days on Coumadin. Her Coumadin was reduced from 5 mg to 2.5 mg until she was retested in two days. It was also noted that her hemoglobin dropped below 7.0. Instead of getting her Alimta treatment on January 12th, she had a blood transfusion on January 13th. The Alimta treatment was rescheduled for January 18th, and the next INR test was January 16th.
The January 16th INR test reading was better at 3.9. The Coumadin dose was cut again, now down to 2 mg. Lucy was told to get an ultrasound on her right leg after its examination.
The ultrasound showed there was a clot in her right thigh. Her Coumadin was immediately discontinued and she received a Lovenox shot. The Lovenox shots will continue daily for a week. On January 25th she will see a hematologist. The hematologist meeting will decide her Coumadin therapy and try to find the cause of her chronic anemia.
DVTs are incredibly painful. Lucy’s right leg has ballooned up to twice its normal size but is slowly returning to normal. Walking is still very difficult.
There is some good news despite all the speed bumps she encountered. Lucy did receive her Alimta treatment on the 18th. Unlike her previous rounds of chemo, Alimta is a quick one hour infusion given once every three weeks. Her previous round of treatments took between two and three hours each week except for her “off” week. She is not experiencing any side effects from it. Having to make fewer trips for chemo will be a big plus.
It’s been a frustrating start to the new year. We’re both trying to stay positive. We may not say it enough, but thank you for your concern, prayers, support, and the love you have for Lucy.