Missing

I feel like I'm missing. Like the real me is lost. Like I disappeared on May 17th 2017. I keep trying to find the real Jo, the one who found joy in the simple every day things. To stop being selfish and only reflecting on myself and my symptoms. I miss her and I know other people do too. I want to be me again for myself, for Rob, for my family, for my friends, for my dogs but I feel stuck. 

I was talking to my Dad recently and he told me the phrase, "the light at the end of a tunnel is another train coming" and at the moment that's genuinely how I feel. Every appointment we have feels like another shit piece of news. 

I know I'm on "the best treatment in the world right now" for my cancer and that I should be bloody grateful as there are some many people out there who would love to have access to the drug but I'm just finding it really difficult to cope.

QT Check and update

Last Friday we went back to Guildford for my QT prolongation check-up. I had an ECG and had a sneak peak at the numbers, one was 310 and the other was 440. The last time the magic number was 481 so both of the numbers were under that. We waited for quite a while as TC's clinic was running an hour late. We were called in and then told that my QT rhythm was back to normal. Good stuff. TC then said that I had another week off the trial drug due to how the cycle works....

4-weekly cycle:

- 1 Letrozole tablet every day

- 1 Calceos (calcium carbonate and vitamin D3) tablet every day

- 3 Ribociclib tablets for 3 weeks, then 1 week off

At the moment I'm on week 4 of the cycle which means no Ribociclib. This Friday (1st September), I'll have my end of cycle check. This includes another ECG, bloods and vitals. As long as my ECG shows my QT rhythm is fine I'll be going back on 3 ribociclib pills. To be honest this does frighten me a bit as what if it negatively affects the QT rhythm again? I also had lots of side effects when I was on the ribociclib (in addition to the QT rhythm): nausea, constipation, diarrhoea, severe anxiety, insomnia and fatigue. I'm shit scared of getting them all back again.

Since coming off the ribociclib for the fortnight, the only symptoms I've had from the above list are anxiety (but much less so), insomnia and fatigue. Obviously I've still had other side effects (hot flushes, night sweats, bone pain in various areas, thinning hair, weight loss and emotional swings), but I'm not sure if they are attributable to the cancer, menopause or letrozole. I've also had a metallic taste in my mouth but I know that is because of the zopiclone. The zopiclone is helping me sleep by the way! I'm still waking a few times a night, but nowhere near what I was. I'm nervous about becoming dependent on it though. I'll be discussing with TC on Friday as it's important I'm able to sleep without relying on pills.

At the appointment last Friday, I mentioned to TC that I'd had some bone pain, he said it was more than likely the cancer dying. Let's go with that! Last time I blogged I said I was having zometa and was worried about the potential pain. Am pleased to report that although there was some pain the day after, it was very minimal compared to last time! Having said that, it actually has increased in the past few days, especially in my sternum and lower spine. This does make me nervous that it's the cancer spreading but I have to just hope that the systemic treatment is doing its job.

I went to the dentist today as I've had some pain in the upper left side of my mouth for about two weeks. It's not constant, but it is noticeable. The dentist thoroughly examined the area and gave me an x-ray but said he could not see anything obvious causing the pain. Rather than reassuring me, this makes me catastrophise that I have bone mets in my jaw and skull. Another thing to mention to TC on Friday....

In other news, and a bloody big achievement, yesterday and today I drove myself to the office. It may sound like nothing, but until a fortnight ago I hadn't driven for a few months as I was simply unable to due to pain. It's also a massive step because I hadn't physically been in the office since before my diagnosis. It felt weirdly normal to be there. Almost like I hadn't been away. I guess because I've been working from home when I've been able to, it's not like I'm out of the loop when it comes to the actual work. I'm really proud of myself for making the step and going in. It's a step forward towards some normality and gaining some form of control over this bastard disease.

Cycle 1 - Halfway check

So I've just had my two week check for my first cycle on my trial drug. Rob drove me to Guildford and we met with Avril (the research nurse), she sent me off for my blood tests. I had to wait for about an hour for my bloods to be taken and once they were done we met Avril again. I was feeling really anxious and shaky, we chatted about the side effects I've been having and I was then sent off for an ECG.

Common issues from my trial drug at this point are low blood counts, rarer are issues like heart problems.

We were waiting to meet TC when Avril came to see me and told me there is an issue with my heart rhythm. Fuck. The QT something or other was too high. I had to wait for an hour and then have another ECG.

We were waiting for ages to see TC, and when we were finally called in, my second ECG also showed that the QT rate was too high. The rate had reduced since the first one, but not enough for the trial parameters or to actually be safe. Therefore they've taken me off the trial drug for a week but I still continue with letrozole. 

TC said not to worry and that at the start they will always play around until they get the dose right. Easier said than done though. I guess it makes sense, as why would a dose for me be the same dose as say a 15 stone woman... I have to go back in a week for a repeat ECG and then they will look at what to do, probably reduce my ribociclib dose down. I've just got to hope this is what happens rather than getting taken off it all together.

I also told TC and Avril about my lack of sleep. Although when I take the diphenhydramine I manage to sleep fitfully (as in I still wake multiple times a night but I manage to fall asleep again after the night sweats), it still isn't good sleep. So he's prescribed me something called zopiclone which I will take tonight:

Zopiclone boosts the effectiveness of a chemical in the brain called gamma-aminobutyric acid (GABA). GABA blocks transmission across nerves in the brain and has a calming effect. By boosting the effectiveness of GABA, zopiclone improves sleep.

Then yet more waiting until I had my adamantium which was pretty much the same as last time, apart from the fact every chair was full of different people receiving treatment. When I last had it, I had the ward to myself. I've just got to hope I don't get the horrible pain tomorrow like what happened 6 weeks ago, please please!

Where are you Sandman?

Until this shituation arrived, I never realised how much I took for granted. Walking, driving, sleeping, working, thinking. All of these and more have been taken out of my hands since treatment started. I manage to walk now most days as mercifully my pain has reduced. However, I have my adamantium again this Friday, the day after the last time I had it, the pain was awful, I was crying out, I'm crossing everything this won't be the same again. Other people have said the first was the worst so I really hope this happens for me too.

Anyway, this post is about sleep, or lack thereof. For the past week, I have had really awful sleep. As in I haven't really had any. The other night I watched the clock tick by, hour after hour with no sleep coming. Then, the night sweats arrived. These are a hideous side effect of the menopause, which are exacerbated by my letrozole. One night I had 18 in a night, they keep you awake, or if you are asleep, they wake you up. You end up "sweating" the bed. Sometimes it's a minimal sweat, sometimes it's a full on drenching, Whichever it is, it's not pleasant.

Unfortunately, because of my oestrogen positive breast cancer, I can't take HRT, so alleviating the symptoms has to come another way. I called my trial team to discuss and they recommended a few drugs, we had to wait a few days to hear back from Novartis who are the trial owners, and unfortunately I cannot take them.... Bollocks. I also cannot take any natural sleep aids (though they wouldn't help with the sweats) like herbal Nytol, Kalms or anything else similar. 

My trial team also told me I could change my letrozole brand back. When I took letrozole for a week before I took my ribociclib, I was on a brand called Dr Reddy's. When I started the trial drug I was given a new brand called Manx Healthcare. Before the trial I had very minimal night sweats, since starting the trial drug, the sweats have started. It could just be coincidence (as I'm getting further away from my oophorectomy and therefore the side effects from that could be kicking in), but they've said I can switch back, so I've done that for the past 3 doses. It will take a while for my body to get rid of the other version and may make bugger all difference, but it's worth a try.

Rob has very kindly bought me something called a Chillow. It's basically a cool mat which you put in your fridge. It is full of a gel which becomes cool and then at night you put it in your pillowcase. When you lie on it it's supposed to keep you cool. I've tried it for two nights now, it does keep you cool for a few hours, but then heats up with the warmth of your head. You can turn it over, I'm not sure how effective it is to be honest, but it's something. We also have the free-standing fan going. 

So last night my sweats reduced, thank goodness. However, I didn't sleep. At all. It was awful. Again I watched the hours tick by (this time metaphorically as I try not to look at the time on my phone), watched the sky get lighter, twisting, turning, getting hot, shivering, it's just awful. I ended up moving beds in the end. I think I slept from 5:30-6:30, that's it. Today I am beyond exhausted. We are going to try sleeping under sheets rather than the duvet. We have been sleeping under a duvet and also tried a quilt but neither are ideal. Let's hope the sheet idea works even a little.

I took a call from my trial team earlier today, I'm allowed to take diphenhydramine! This is a sleep aid which is an antihistamine that works by reducing histamine which stimulates your mind. My mum has picked me a Nytol version up today, so I will try taking one tonight and hoping that it works.

So my magic (hopefully) combination will be: 

Fan + chillow + diphenhydramine + sheet + new-old letrozole = sleep....? 

Fingers crossed! 

Bone scan, new drug & a bit of a blow

Today I went to Guildford for my bone scan for the trial. First we had a chat with the trial nurse Avril who wanted to see how I was and also wanted to discuss my new hormone therapy drug letrozole. We spoke about my anxieties about eating and my nausea and also about my pain in my left hip and back.

Avril then revealed some sad news to me, the cancer is also in my spine. Fuck. It's in my lower lumbar region. I can't begin to explain how devastated this makes me. I know it won't change my treatment plan, but just knowing it's somewhere else is a complete hammer blow. To me, spine damage means more risk of paralysis so I am beyond terrified.

Then I had to go down to the nuclear medicine room for some bloods to be taken (again from my sore arm!) and have a radioactive injection for the bone scan. Both went without a hitch thank goodness and then we went back up to wait for my meeting with my trial oncologist TC.

We waited for about an hour and then had my meeting with TC. He again waxed lyrical about the wonderful ribociclib drug, gave me lots of advice on nutrition and spoke to me about my fears about the side effects. I also explained how devastated I was to receive the news about my back. He told me  that it really didn't make a difference to the plan and that I was just to control any pain with painkillers. It's hard because I'm so scared about it, but he seemed not to be concerned.

After the meeting, I went down to nuclear medicine for my bone scan. I lay on the bed and the camera came very close to my face. It took about 35 minutes. I could see some images on the screen near me. Now obviously I don't know how to interpret scans but I could see my skeleton and bits on it that were lit up. Last time I had a bone scan I saw loads of lit up areas all over my ribs, I couldn't see much at all there this time so hopefully that's a good sign and means the rads worked. I could still see the sternum shining and a bit in my shoulder area, but the new bit I couldn't see last time that I could this time was my hips and lower back. So with the news I'd just been given about my back, this makes sense. Last time I didn't know I had secondary cancer, this time I see the areas and it's just a case of being more informed.

After the scan I went back up to find Avril who gave me my prescription of letrozole. Earlier I had explained to TC how scared I was about the side effects of this drug. He said that yes I may get some SEs but that if I took the pill that afternoon, by bedtime, cancer cells would be being killed. Blimey.

We got home and I took the first pill. So a difficult and overwhelming day, but at least the systemic fight has started.