Friday, October 21, 2011
Isn't that Special?
I saw my rheumatologist yesterday. I asked him...."So....is it pretty common to see patients have RA symptoms flare during chemotherapy?" Answer: "Uhh.....no....". According to both my oncologist and my rheumatologist, RA symptoms typically go into remission during chemotherapy. In fact, there are many cross-over drugs that are common to both cancer and auto-immune disorders. I tried a couple of them during my initial "guinea pig" stage of treating my RA 10 years ago: Prednisone, Methotrexate, to name a few. None of them worked very well to treat my RA until I started up on Enbrel injections.
Enbrel is different from the other DMARDs (Disease Modifying Anti Rheumatic Drugs) in that they are in a class called the Biologic Response Modifying Drugs. Herceptin, which I'll be starting next month, is also considered a BRM. In my highly technical understanding of them, they basically work by taking the trouble maker cells in your body and neutralizing them so that your body doesn't have a hissy fit and start attacking them (thus, auto-immune response), or, in the case of my cancer, they counter the HER2 receptor cells that talk nice normal breast cells into becoming irresponsible, whacked out, crazy cancers instead. And while I'm not a doctor OR scientist, I do find it interesting that I'm dealing with 2 separate diseases that seem to have some things in common. Or at least some treatments in common.
So, I appear to be, in the words of Dana Carvey's Church Lady: "Special". Auto-immune flare ups while they are actively poisoning my immune system. Just seems crazy to me.
The down side to this is that Enbrel, the one drug that I've successfully used to keep my RA in almost total remission for 8 years is not recommended during chemotherapy (according to my Oncologist). According to my Rheumatologist, it's not recommend to use in patients with active cancers. I pointed out to my Rheumy, that technically I don't have an active cancer. I know that the tumor in my breast was completely removed during my mastectomy. So...which is it? I know that I seem like the poster child for Big Pharma these days, and I'd really rather be part of those few, those happy few, those band of brothers, that experience remission of their symptons during chemo. But, unfortunately, I'm not. I'm hobbling around with softballs for kneecaps and a swollen ankle that makes me walk like Quasimodo or one of the living dead. So, I'm trying to talk my Rheumy into investigating if I can use a little bit of Enbrel while I'm doing chemo. The down side is that Enbrel is associated with a greater risk of developing certain types of cancers (not breast cancer). So it would seem that I'm damned if I do, damned if I don't. But when your choice is between, can I get out of bed and walk downstairs? vs. not; I'm sort of leaning toward the functional.
In the meanwhile, I have a few short term options to try and make my pain more manageable. I'm already on a daily dose of prednisone, 10 mg. This is helping but not completely. It basically makes the difference in whether I'm able to walk down the stairs like a 2 year old or like an 80 year old. My doc also had me up my dose of Celebrex to 2x a day instead of once. This is a type of NSAID...that is; a Non Steroidal Anti-Imflammatory Drug, which is easier on the Adrenals than full-on steroids and as a COX-2 inhibitor, gentler on the stomach than taking repeated doses of say Motrin 800 or something like that. Gentler on the stomach is a big win for me during Chemo!
My Rheumy said I can also come in for cortisone injections into my knees, which, as much pain as I'm in, are at the bottom of my list of fun things to do. The problem with the injections is not the injections but the fact that they stick a needle into the kneecap first and suck out all the inflammatory fluid that has accumulated around the knee. I had this done 3x when I was first diagnosed with RA, and my knees were about twice as bad as they are now. It's something that I'm really not jumping up and down to do (if I COULD jump), even though I know that it means less pain for a few weeks after. So....I'm going to try really hard not to remind my Rheumy that he came up with that option.
The third thing we are doing is....nothing. Well, actually, something, which is...wait and see. See if my next round of Chemo: Taxotere and Herceptin might actually help out some. I have to say that I'm not overly optimistic, but at the same time, what choice do I have?
In the meanwhile, today, I started on my twice a day dose of Celebrex, and I can tell that it is definitely making a difference. Going into my 3rd week of chemo recovery, it would be nice if I can avoid any more drama, no infections, melting eyeballs, fever, or ballooning joints. One more week and then I will have my last treatment of the A/C. I'm so excited to be almost to the halfway point of my chemo treatments!
And I guess, for now I will just have to be content with knowing that I really AM special.