16 October 2023
It’s been a rough day. I crawled out of bed around 6:30 am, had coffee, cereal and read news online and went back to bed and slept 3 hours. The pain in the joints of my hands and knees and ankles kept me awake last night. So much so I texted Dr. Velez and asked if I could take Tramadol or Gabapentin for pain relief. He recommended Tramadol as the better choice and I’ll definitely take a dose tonight. I can take it once every 8 hours.
I later called Joel and asked if he could take me in tomorrow for my last Taxol treatment. He said he was free which means he’s adjusted his schedule to take me in. I’m just not sure I could drive safely.
That’s also why I called my endocrinologist, Dr. Jellinger, and asked if we could do a conference on the phone or computer. The secretary at the front desk checked and agreed. My appointment was for 2:30 pm and he finally called me on the phone at 3:30. I really didn’t mind. What I like about him is he talks to his patients and is in no hurry to leave them. I usually spend at least an hour with him in his office. He forgot his laptop at home so we did the consultation on speaker phone. He, as always, gives me a lot of information, mostly technical because he knows I understand most of what he’s saying.
He was very concerned my A1c had shot up to 8.6. On June 19th it was 7.8. After explaining they were giving me 4 mg of Dexamethasone (a sterol) the night before and probably the same amount IV during chemotherapy, he agreed that was the problem but alerted me to the possibility of adrenal withdrawal symptoms if they stopped the dexamethasone after the last Taxol treatment. He wants them to taper me off the drug and not go cold turkey. He suggested 1-2 weeks of prednisone to wean me off dexamethasone. Dexamethasone hangs around for long periods of time.
Dr. Jellinger also warned me my glucose levels might not ever go down at all once I successfully come off dexamethasone. He said not to worry because I’m on the most basic of treatments for high glucose (Metformin) and there are many, many other treatments that can compensate for that.
He’s also concerned about the Herceptin treatment every three weeks until I complete one year (I started it on June 5th). I told him my MUGA (Multigated Acquisition Scan – similar to an echocardiogram) reading was 62% and he said that was good but there are problems with any reading. One problem is HFPEF (heart failure preserved ejection factor) which means my reading could drop to 50%, still be in the normal range, and yet lead to heart failure. He mentioned that my low hemoglobin levels could cause a drop in efficiency but it could also be a serious heart issue. At least 62% is good for now.
Then there is HFEF (heart failure ejection factor) which the efficiency drops to 40% or less. That’s even more serious but also why they will continue to do echocardiograms and MUGA’s.
He would like me to go on Jardiance or Farxiga if my MUGA efficiency drops below 60%. I’m to talk with my cardiologist, Dr. Tepper, on Thursday and tactfully bring up the recommendations of Dr. Jellinger. Dr. Tepper is more of a minimalist and Dr. Jellinger is more proactive on issues. They agree to disagree sometimes. Another possible drug is Invokana. All three: Jardiance, Farxiga, and Invokana have the added benefit of lowering A1c.
Dr. Jellinger mentioned some signs of problems with the heart are shortness of breath and lack of endurance, both of which I currently have. I’ll also mention that to Dr. Tepper on Thursday.
I’ve noticed my eyesight seems to be changing. Jim recommended Elena Roth with Bascomb-Palmer in Plantation. I tried to get an appointment and when I finally reached a person on the number they said call, she transferred me and the call dropped.
I then called my primary, Dr. Dunhill, and he recommended someone from Holy Cross. I have an appointment with Zuzana Hrdlicka on Monday, October 23rd for a general exam. What I’ve noticed is lights seem dimmer and it’s almost like those old movies where they put vaseline around the lens of movie cameras to get a softened effect. From the general exam I can at least get an idea if I need cataract surgery. Chemo has a myriad of effects on the body.
Toes and fingers are still numb. Nose bleeds every morning along with runny nose. Absolutely no energy for anything. Back to little or no appetite. Itching is back. Joint pain, shortness of breath and I alternate between diarrhea and constipation. Vertigo continues to be a challenge along with bloating and wacky taste buds. A really weird thing is some mornings my fingers feel “fat” and bloated and other mornings my fingers feel slender and normal. My question is which of all the symptoms will eventually go away and return to normal and which I will have the rest of my life?
Stay tuned!
No experience with Tramadol, but my surgeon has prescribed Gabapentin to me, which has no discernible effect. I long for the good old days, when Demerol and Secanol brought joy after my wisdom teeth were extracted. Glad I was able to live better through chemistry. Tight lines.