All is Unfair in Cancer and Hurricanes

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As featured on curetoday.com

Peptide Receptor Radionuclide Therapy (PRRT) is an exciting treatment for Neuroendocrine Tumors (NETs). While considered investigational because of its pending status at the FDA, Europe has performed this therapy with an 80% success rate for over a decade.

When a May Gallium-68 scan found microscopic tumors, my specialist recommended I pursue this treatment.  It took a lot of coordinating, but I was able to access this therapy at a facility in Houston under Texas’s Right to Try law, a preferred option compared to traveling to Europe.

My first treatment went great, leaving me virtually symptom free and slashing my blood tumor marker a whopping 75%. Investigational therapies are not always covered by insurance, so it was also pretty exciting when I found my insurance company paid for the treatment.

Life was looking like sunshine and kittens, so my husband and I decided the next trip to Houston should not be completely about cancer. So, we booked a romantic beach weekend in Galveston before my next therapy, scheduled for August 31st.

Cancer has already taught me to quickly develop back-up plans, so when the Houston clinic called to explain there could be a delay due to the approaching hurricane, I jumped into action, developing a Plan B and Plan C. Little did I know after all the events transpired, I’d end up on Plan F.

Plan A – Fly from Nashville to Houston to enjoy a weekend on the beach in Galveston before returning to Houston for treatment.

Plan B – Take the scheduled flight to Houston, drive to Dallas for the weekend. Return to Houston when the storm passes.

Plan C – Drive from Nashville, stopping to visit Memphis, Little Rock and Dallas, where we would wait for the green light.

Plan D – Reschedule therapy until September 12th, the one week my husband had an important commitment.

Plan E – Get my older brother lined up to take my husband’s place by booking him a flight out of Tampa September 10th. Enter Hurricane Irma.

Plan F – Break my husband’s commitment so he can come with me to Houston and spend the next few days calling airlines, hotels, etc. to reschedule…yet again.

While all of this was unfolding, I could rationalize that it would have been pointless for me to try to enter Houston during the chaos or for my brother to leave his family in the midst of a disaster, but still, it was stressful. Cancer already creates feelings of powerlessness, fear and uncertainty. Piling on more seems unfair. Before I spun into a ball of anxiety, I stopped and gave myself an attitude and perspective adjustment. I am lucky my situation is not critical because there were/are others impacted by cancer who had/will have urgent situations in the midst of these disasters. Rescheduling is a minor inconvenience when a hurricane is barreling toward your home.

As I rationalized and calm myself, I realized the similarities between hurricanes and cancer. Both are natural disasters, with human contributing factors. Both are completely unfair. Both can be devastating by taking everything you have. Both have the potential to create resilience. Both can bring out the best in people. Both create perspective because when we or our loved ones are in danger, the stresses of daily life don’t seem so stressful. And both are reminders that there is so much we can not control.

“If plan A doesn’t work, the alphabet has 25 more letters – 204 if you’re in Japan.” – Claire Cook

Read my others articles with Cure. 

 

My Double Life

The Mount LeConte Lodge in the Smokie Mountains is a special place only accessible by foot and booked a couple years in advance.  I had never heard of it, but when my Camino group was lucky enough to secure a reservation for July 7th, I jumped at the chance. Little did I know the hike would be on the heel of a new chapter in the cancer saga.

In May I had my first Gallium-68 scan (read about that here), which revealed disease not detected in my previous MRIs. I knew something was going on due to my blood tumor marker results and onset of facial flushing, a common symptom of Neuroendocrine and Carcinoid Tumors. My specialist, Dr. Edward Wolin, recommended Peptide Receptor Radionuclide Therapy (PRRT).  While PRRT has been done with much success for 20+ years in Europe, it is pending FDA approval in the United States. Fortunately, there is a clinic in Houston (Excel Diagnostics) who has been granted permission to perform this treatment. With Dr. Wolin’s help, I was able to get scheduled this week (July 10-14) after the 6-week waiting period from my last Lanreotide injection expired. Because the treatment is not approved, we are not sure if it will be covered by insurance and guess what?  It ain’t cheap. So, please stop here and join me in saying a prayer that insurance will do it’s job.

With the Mount LeConte adventure scheduled two days before the Houston departure, I contemplated if the hike was a smart idea and (quickly) concluded that as long as I felt good, I was not going to let cancer ruin yet another life plan.

At 6,593 ft (2,010 m) Mount LeConte is the highest peak in Tennessee and one of the highest in the Appalachian Mountains. I decided I should do a little training so I spent some time at Radnor Lake climbing up and down the ridges. During those hikes I felt awesome and ready for Mount LeConte, but on Independence Day, I was pooped after only 750 feet of elevation giving me reason to doubt myself. Backing down doesn’t compute in my brain so I told doubt to get lost as I packed my backpack full of gear and short acting Octreotide injections which I take three times a day now that my Lanreotide has run out.

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8:20 and ready to climb

There are a few trails to Mount LeConte and my husband and my(reluctant)self picked Alum Cave, which happens to be the shortest, but most difficult of the routes. Our group of four departed the trailhead at 8:20 a.m. It rained the night before and most of the hike was a walk upstream. Alum Cave is described as scenic but I couldn’t see anything due to fog. I was grateful for ignorance during the often stretches of metal cable on my right and an invisible drop on the left. It was hard. I was sweaty and tired, but 11:30 a.m. we strolled into the Lodge to find ourselves the first arrivals of the day. Put that in your pipe and smoke it, cancer.

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The Lodge was an experience! We were told to bring our own towel, which I incorrectly associated to a shower. When the receptionist bragged about a hot water spigot and flush toilets, I knew wi-fi was out of the question. It turned out to be a welcomed change of pace. Once the fog cleared, the vistas and quiet were appreciated. With sunrise came blue skies and a leisurely, but fast, descent from the top of Tennessee. At the bottom of the mountain, we packed up, stopped for lunch and headed home to our wonderful indoor utilities with enough time to re-pack for today’s (July 9th) departure for Houston.

I am so grateful to have spent some time disconnected in nature which provided me with the opportunity for noise-free reflection. This trip had me thinking about how I am full of contradictions and extremes. One day I am climbing mountains and the next day I am off for a cancer treatment. I am stronger and in better shape than most, but not healthy. I climbed up the mountain in the fog and down in the sun. I have no in-between. No average. No middle-of-the road. No even keel. I love this. I hate this. Who wants to be average? Me. I would love to be normal, but then again, I probably wouldn’t.

As always, prayers, thoughts and good vibes for the treatment to be successful are appreciated.  An offering to the insurance Gods would be welcomed too.

Upward and forward.

NET Friends – Stay tuned for blogs on my PRRT experience at Excel Diagnostics in Houston.

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Nerding Out on NETs in NYC

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Me with the Godfather

My six month check-up with my Neuroendocrine Tumor (NET) specialist, Dr. Wolin, in New York City happened to coincide with Big Apple NETs support group Luncheon with the Experts.

As always, it was wonderful to connect with other NET survivors and hear their stories. However, being able to ask questions of some of our communities champions, was pretty incredible. The most notable of the panelists was Dr. Richard Warner, who I’m calling the Godfather of NETs. He was accompanied by two knowledgeable colleagues, Dr. Lynn Ratnor and Dr. Jerome Zacks. During lunch patients were allowed to ask general questions regarding treatments, surgery and lifestyle. Some of the major topics included:

Familial links – This was an especially timely topic for me as I just had an email conversation with a NET survivor, whose sibling also had a NET. Everything I’ve ever read indicates it is not a hereditary disease and Dr. Warner’s opinion is that there are links. He thinks this will be a hot topic in coming years as the incident rates rise for NETs. Then this week, the Healing NET released some information on a clinical trial looking for enrollees on this topic.

Diet and Alternative Treatments – The general consensus of the panelists was that these methods should not be used alone, but in conjunction with treatments. And that patients should be cautious to not negatively impact any proven treatments. Dr. Warner did share some of his opinions regarding foods (and other things) that impact carcinoid syndrome:

  • Nasal spray
  • Dental shots with epinephrine
  • Alcohol (Specifically port wine was mentioned)
  • Fermented foods such as ripe cheeses, herring, etc.

Note: I’m sure this list should be longer, but these are the items he mentioned.

There was also discussion about products such as CBD oil, alkaline water, plant based diets and excluding sugar. Being the scientists that they are, they would not stand behind anything that hasn’t been studied and proven.

Gallium-68 – There was some discussion and explaination about this newly approved scan and it’s ability to detect small tumors often undetectable by CTs and MRIs. The Carcinoid Cancer Foundation has put together a nice page of information and locations where this is available.

Xermelo – A newly approved drug to be used in conjunction with Lanreotide or Sandostatin for uncontrolled carcinoid syndrome. Read the FDA approval here.

It was a really nice few hours and I did learn some new things.

Then Monday, I had my very first Gallium-68 scan at Albert Einstein-Montefiore Cancer Center and wanted to chronicle the process for others.

Setting up the scan wasn’t too complicated. The most unnerving part was when I was told I’d have to pay upfront for the test and they would reimburse when/if my insurance covered the scan. Fortunately, my insurance came through at the last minute and I did not have to cough up $3,400. Can we all just pause for a moment and say, Thank You to the Insurance Gods.

I received several calls ahead of time cautioning me this is an extreme fast for four hours. Normally, I fast for six, so four is a walk in the park. After my Uber dropped me off at the wrong address, in the Bronx, in the rain, I eventually figured it out and made it just in time to my appointment.

I was called back right away for them to start an IV, which is always a fun process for me since I’m hard stick. Normally, the average number of sticks is four and they did it in three, so that’s pretty good.

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Just a little metal tube of radiation, NBD. 

As soon as I was hooked up, two gloved doctors appeared with a thick metal tube full of radioactive liquid they injected into my veins. It wasn’t long, but it felt like fire going through my veins. They told me that’s unusual, which is becoming the story of my life. I was cautioned sometimes people can become nauseated after the injection. Fortunately, that did not happen to me.

After they emptied the tube, everyone quickly left the room and I relaxed and read as radioactivity flowed through my veins.

An hour later, someone showed up to escort me into the scan room.

As far as the actual scan, it was a piece of cake, compared to an MRI. There was plenty of room between my body and the machine.  The hardest part was lying still with my arms above my head for 45 minutes. I had them shut the lights off so I could take a little nap.

Then it was over and I was instructed to drink a lot of water to flush my system. I was pretty wiped out the rest of the day, which I’m not sure was due to the scan, the rain, the coldness, the lack of sleep, the excessive amount of walking NYC demands and/or the emotional/mental drain. Probably all those things, so we ordered in and finally emerged Tuesday and Wednesday evening for a bit of fun in the city.

If you’re interested in learning more about Gallium-68 scans, I recommend the Carcinoid Cancer Foundation website.