Three weeks is one week too many

It's certainly been a week of ups and downs. Linda started her third week off Sutent by walking the length of our street (300 ft uphill) and staying outside for a while to talk to some of the neighbors. She was clearly getting her strength back, but it would only be temporary. By Wednesday, she was starting to lose her appetite again. On the other hand, the mysterious pain in her chest had gone away, so we could eliminate the painkillers from the daily medications. Thursday was the day we saw the cardiologist at Christ Hospital, and he had good news-- Linda's heart is fine. In fact he emphatically said that there was no heart damage, and that should not be a reason for her to stop using Sutent. We also had our weekly blood draw, so it was off to Bethesda North for that. (We've certainly seen a lot of the city lately, at least the parts of it that are near hospitals.) But as the day wore on, it was clear something was wrong---Linda was getting more and more tired. That afternoon we got a call from B-North. The blood test indicated very low Hemoglobin levels again (anemia), and Dr. Bhandari ordered another 4 hr blood transfusion after our appointment the next day (Friday.) Linda slept most of the rest of the day and couldn't eat at all.

So when Friday morning came around, she was so weakened from the low hemoglobin and lack of food that she lost her balance and fell. She was fortunate not to break anything, but she's got a nasty gash on her left temple. The weather was pretty bad Friday morning, but nothing was going to keep us from this blood transfusion now! Our office visit with Bhandari came first, and as always was very interesting. He said he finally spoke to Dr. Atkins in Boston. Atkins told him that he remembered Linda and her unusual case (we had to stop the IL-2 treatment because her cancer was growing so rapidly.) He also indicated that he had seen cases of low albumin and low protein levels that were caused not by Sutent, but by the cancer itself. He also noted that even as aggressive as Linda's cancer is, the pathway it uses to reproduce is clearly the one that Sutent is blocking, given her very positive response of tumor shrinkage. So he strongly urged Bhandari to continue Sutent, at a reduced dosage.

Bhandari also pointed out that Linda's anemia was probably cancer-induced as well, so it was imperative that we begin treatment right away. Apparently three weeks of R&R had also given the cancer time to regroup. However, there was good news. Linda's thyroid levels were back in the normal range, her platelet count was up, and while still low, her blood protein levels are higher than they'd been in a month. So it's back in to the battle once again. Linda is still weak, but it is amazing how much better she looked after the transfusion. But until she gets some strength back, I follow her around whenever she's walking or standing-- she doesn't like that one bit, but she's tolerating me for now.

Jim