Day 214, I Want a New Drug

I Want a New Drug
In my previous blog entry, which turned into a creative writing exercise, I hopefully painted a picture of rapid improvement in my condition mixed with some fear of the side effects of the next drug in my treatment.  I started that new drug just a few hours after that blog post.  It seems my fears of the side effects were not unfounded.

This is not any ordinary pharmaceutical.  It’s not something they keep on hand at the local CVS.  Instead, it’s handled by a specialty pharmacy (in this case, CVS specialty) which then ships the drug to a normal CVS for pickup.  It could be shipped directly to my home, but I’d worry about the local wildlife getting into the package while we’re away.

Before it would ship, I had to talk on the phone with the specialty pharmacy and answer a bunch of questions, then there was the mandatory consultation with a specialty pharmacist who admitted it’s hard to have any meaningful questions until I’ve actually taken the drug.  So we talked about the finer points of how to take pills on an empty stomach to fill some time and then my medication was sent on its way.

There was a bit more paperwork and a surprising number of handouts at the actual pickup.  The specialty prescriptions were waiting on the tippy top shelf in humble brown bags, versus the white bags used for normal drugs.  Inside the brown paper bag was a rather frightening plastic bag.

Looks like this ain’t yo momma’s aspirin!  I was somewhat surprised by the use of the term “chemotherapy drug”, because it’s not the cytotoxic, kill everything that grows type of drug normally associated with chemotherapy.  In this case, it seems to mean “prescribed by an oncologist”.

Safety precautions aren’t that severe.  The actual tablets shouldn’t be handled by children or pregnant mothers, because.. well I’m not sure actually, but it seems to make sense that you want to keep anything that mucks about with hormone levels far away from growing bodies.

And what this drug does do is muck with a specific enzyme that performs one of the steps in making testosterone, and who knows what other hormones are being suppressed as a result.  It does suppress some of the normal stress hormones such as cortisol, so I also have a prescription for a low dose of prednisone which acts like cortisol and serves to replace the suppressed hormone.

With all the hormonal mucking about, it’s not terribly surprising that in the days after starting this new drug I went from feeling strange to totally exhausted and depressed a few days later.  “Depressed” isn’t quite the right word, as it implies laying listlessly on a couch.  What actually happened was an emotional breakdown that consumed a rather surprising number of tissues.

My emotions are about as hormonal as it’s possible to get.  In a strange way that’s good news, as the drug is doing exactly what it was prescribed to do.  To make things even more fun, my occasional hot flashes have gotten more intense.  Now instead of being uncomfortably hot a number of times a day, I get uncomfortably hot and sweat profusely.  This is mostly just an annoyance until it starts waking me from my sleep.

The good news is I may have hit bottom over the weekend and have been improving since.  It’s hard to say for sure, because before any of this started I was already a bit cyclical in my moods.  Sort of like being manic depressive, but not to the extent that I’d be diagnosed as such.  So it’s really hard to say if my bad couple of days were caused by starting the drug or were just the usual two steps back after a very impressive three steps forward in the preceding weeks.  Most likely it’s a combination of starting the drug at the exact moment I was due for a crash anyway.

Time for a quick musical intermission:

During this low period, there’s been lots of angst and worry by me about whether I’d be able to stay on this drug or not.  After having had a decent run this morning (that’s a bit of understatement), I’m feeling much better and will just stay the current course until I meet with my oncologist a week and a half from now.  That would be an appropriate time to review how I’m responding to the drug (including blood tests to check liver function) and discuss whether a dosage adjustment to either the drug itself or the prednisone makes sense.

About that run: I’ve been making an effort to increase the length of my runs recently, and set another high water mark today of 6.8 miles in just over 90 minutes.  That kind of pace isn’t going to set my hair on fire but not that long ago I was struggling to do less than half that distance in more than half the time.  If it didn’t feel quite as great as some of my other recent runs, that probably has a lot to do with the slightly warmer and much more humid weather we’re having today.

So in summary, my new drug is currently playing head games with me, but in the objective world of time and distance, my running isn’t showing any noticeable effect.  I haven’t even been on it for a week yet so it’s time to chill a bit and see where things are at the end of the month.

P.S. It’s really awesome that this post was entirely about side effects and not a word about the cancer itself.  Many men end up on this drug because other drugs stop working.  In my case it’s hopefully going to deliver a knockout punch.

P.S. 2 “The drug” is Abiraterone, it’s just easier to type “the drug”.  It’s also fun watching the non-pharmacists working the counter at CVS try to read it off their computer screens.