Chemo Changes

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Cigna has now denied the second request and appeal from my neurosurgeon for a brain MRI to assess for new growth given my daily nausea. That means we won’t be getting a look inside my noggin until early July, the three month post-surgical mark, when they say they will cover it. I could open a patient appeal with Cigna, and/or go to the state board that regulates health insurers and file a complaint, but by the time I spend the mental and physical energy on that and it winds its way through institutional bureaucracy, it will most definitely be well past July and a moot point. I’m saving my sanity and strength, and accepting their decision for now. Life is literally too short.

But we aren’t ignoring the problem. My oncologist Dr. K has suggested a change in chemo to attack any cancer growth in the brain in a non-surgical manner. As I’ve mentioned in the past, most chemotherapies and immunotherapies aren’t helpful in treating cancer spread to the brain because they do not cross the blood brain barrier, the protective three-part layer that surrounds the brain. But some clinical studies have found that the drug combination of Xeloda and Tykerb, two oral chemotherapies, is able to cross that barrier and shrink brain metastases in some women with my type of cancer (HER2+). So I will be making the change as soon as the new drugs arrive from the specialty pharmacy.

I’m a little nervous about saying goodbye to Herceptin and Perjeta, since they’ve worked so well from the neck down for 18 months. But over the past 14 months we’ve treated 25 brain metastases with gamma knife and one of those again with laser ablation, so it feels like this change in strategy is smart. If Xeloda and Tykerb can work some magic up there, at least for a little while, we’ll be in good shape.

ronaldMCDandmeThere are a few cons to the treatment switch. First of all, it isn’t as gentle on the system as my current immunotherapy. I may experience some hair thinning or loss again (just when I was creeping past the Ronald McDonald phase of hair regrowth…sigh). And there’s the usual long laundry list of possible side effects that most chemos have – gastrointestinal chaos, hand/foot syndrome, white cell depletion, etc. But there are medications to combat those side effects and it’s worth it if it works to stop cancer in my brain. It will also be nice to be able to take treatment in pill form instead of getting infusions every three weeks.

Whole brain radiation remains another option for me if my July MRI shows new metastases. But for reasons I’ve talked about previously, I’d like to save that as a last resort.

I’ll keep everyone posted on how the new routine goes. We are getting really excited to go on our trip to Chicago next month – the first in several summer bucket list adventures – so I’m hoping it’s a smooth road!

10 thoughts on “Chemo Changes

  1. Most importantly, you look NOTHING like Ronald McDonald! With that said, I am annoyed with Cigna and sorry that you’ll be starting chemo again. I hope that once they do the MRI, they learn that it is not completely necessary so the course is short. Fingers crossed that you handle the new meds well. As always, sending happy thoughts, positive energy and lots of love! Hang in there, Girl!! xoxo

    Liked by 1 person

  2. Everyone who knows me knows my weakness for redheads (if course, in my prior life)……for the record, RONALD McDONALD was NEVER on that list. I know Ronald McDonald, Ronald McDonald is a friend of mine and (MOST THANKFULLY) you are no Ronald McDonald>
    Love and prayers to you, Tim, and the family always.
    XOXO—DiabetesDad (wonder where I got that name?) 🙂

    Liked by 1 person

  3. Cigna puts another roadblock in your way and your doctors come up with plan B. And now there are ‘Specialty Pharmacies’?!?!? Unbelievable!! You sure do deserve a vacation. Have a relaxing and enjoyable trip to Chicago!

    Liked by 1 person

  4. You are so incredibly strong, beautiful and resourceful. Excited for your trip to Chicago and beyond!
    Adore your sense of humor…. dancing to Hamilton tunes just like Elaine from Seinfeld:))))
    Love you

    Liked by 1 person

  5. God Bless you Paula. You seem so calm and rational — particularly about the insurance company and waste if energy in fighting them because it would push past when they approved it.

    Chicago can be great. Feel better and send me nod if I can help in anyway. My grandfather (R.I.P) was a big supporter of Memorial and happy to put u in touch with people there if helpful?

    Liked by 1 person

  6. Screw the insurance company. I hope the new chemo cocktail and the side effects control drugs do what they need to. And you have a great trip to see Hamilton in Chicago.

    Liked by 1 person

  7. You are one amazing lady! This we all know. Only you..with all you have going on..are looking to take a trip for pleasure. You surely deserve it as I think you deserve the MRI. Wise on your part-by the time you fight it and perhaps get a reversal on the decision, it will be the time they have one approved already. Our love and prayers for you are with you.

    Liked by 1 person

  8. Even though the insurance companies rule the world, they won’t ruin yours! Your positivity shines through. You are always so smart – brilliant insights about the energy bank and deciding where to spend it. And btw Ronnie is scary – the antithesis of you! Thank you for including us in your inner most journey. It is a privilege to be by your side in a virtual, mind space kind of way. I think of you daily. Lots of love! Here’s to Chicago!

    Liked by 1 person

  9. You’re putting that immense reserve of humor and strength to it’s truest test. we can only sit back with admiration, love and support from a distance. F-CIGNA!!!

    Liked by 1 person

  10. Paula have a wonderful trip! Let the windy city blow away Cigna from your thoughts while you have a wonderful and much deserved vacation. Sending waves of love and healing your way.

    Liked by 1 person

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