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. So it was 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 was also given 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 fairly frequently blood testing. The test test is known as PT/INR, 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 note that her hemoglobin dropped below 7.0. So 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 was better, 3.9. The Coumadin dose was cut again, down to 2 mg. When her right leg was examined, she was told to get an ultrasound on the right leg.
The ultrasound determined there was a clot in her right thigh. Her Coumadin was discontinued immediately and she received a Lovenox shot. The Lovenex shots will continue daily for a week. On January 25th, she will see a hematologist. The hematologist meeting will determine her Coumadin therapy and try to determine the cause of her chronic anemia.
DVTs are incredibly painful. Lucy’s right leg 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 is going to 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.