25 Apr 2012

First do no harm...

"First do no harm" is the foundation of the Hippocratic oath.  It is no doubt what springs to mind when my medical professionals see me coming armed with the latest research and endless questions on drugs and treatments outside of conventional ovarian cancer regimes.

To back-track, I completed 7 rounds of topotecan at the end of the first week of April.  The first six rounds were the best chemo experiences I've had to date...no side effects to mention and a life!  The 7th round was the straw that broke the camel's back . The dosage was increased throughout the period and the last infusion seemingly saved up all that was possible. The result was toxic.  I've been asked by two doctors and several nurses to explain what happened and the best I could come up with was "like being in a black hole with no ability mentally or physically to surface".  A friend described a similar circumstance as the feeling of having her soul leave her body and being left with the shell.  So, this was not a near-death experience with all the welcoming lights and tunnels - just a death experience.  Perhaps hell.

This description, coupled with the word toxic, caused my oncologist to take me off chemo for the time being in order to give my body a chance to rebuild and recover.
The mind is so fickle however, it has no ability to remember actual discomfort or pain - only the knowledge that it happened.  So, not being daunted by a mere  black hole, I am now pursuing other treatments that could be helpful during this break.  Two drugs come to mind - metformin and tamoxifen.
Metformin is a drug which is typically used in the treatment and regulation of type II diabetes.  Several papers have been published recently about it's potential use in ovarian cancer progression, survival and chemosensitivity.  An article in the Journal of Diabetes - published in February 2011 by Donghui Li, states that "...there is increasing evidence from epidemiological investigations, laboratory studies and translational research that metformin may have a broad activity against cancer."  Armed with this and several more recent papers, I prevailed upon my medical oncologist, my general practitioner and my brother-in-law (who is a neuphrologist) to see if it isn't worth trying.  The theory is that glucose - which is what the body produces as fuel to live - is also the primary fuel of cancer.  If that fuel can be limited and modified the cancer cells will starve or eat each other.  Metformin has been recommended for use alone or in combination with cisplatin http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084625/ by the Mayo Clinic.  The possible side effects include weight loss and diarrhoea.  The three-way verdict is that there is no compelling reason NOT to use metformin.

Secondly, even though my tumour assays have shown that I am not BRCA1 or 2 positive nor HER positive, there is a body of evidence that shows that the hormone suppressing drug tamoxifen can be effective as a maintenance drug in between chemo cycles.  The female body continues to produce estrogen even after a total hysterectomy, in the liver, adrenal glands, breasts and fat cells.  The possible side effects of tamoxifen include hot flashes, muscle pain and constipation - to name a few.  Again, the doctors have agreed to the "no reason why not" theory.

My GP told me an interesting story about how the medical world was ultimately able to respond to HIV/AIDS - turning it into a very treatable, maintainable disease - she said that "they threw everything at it - not just one drug at a time".  I too see no reason "why not" - I'm going for it.

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