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#1 pammartin

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Posted 14 November 2011 - 06:44 PM

Because the Hydrea 2000mg and the Sprycel 140mg worked so well, today's blood work showed platelets at 66,000.  White count is holding at 4,200 and hemoglobin is down to 9.

First, no one told me to stop taking the aspirin, but common sense tells me that would be a ridiculous choice to continue.  Second, I am due for a Sprycel 140 mg, that I am almost afraid to take.  I am to re do blood work in the morning, but fearful of platelets dropping to even more dangerous levels.  I do have a medium case of petechiae, on lower legs, ankles, and upper thighs.  Then, just in the past few hours, my ankles have nearly doubled in size, so far the swelling is reserved for the ankles and lower legs.

No aspirin I can work that one out, but I am quietly thinking the 140 Sprycel is not the best idea for this evening and should I be heading for the ER because of the swelling.  I hate to be a hypochondriac, under different circumstances, I would poo poo this entire mess off, but unfortunately as we all know, we do not live under regular circumstances.  Any advice/comments I would appreciate.

Thanks



#2 jjg

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Posted 14 November 2011 - 07:00 PM

Hi Pam,

I'm always afraid to give medical advice so I'm not going to other than I agree with you about the aspirin. I'd contact your doc tmr about the platelets but 66 isn't super low although it may well head lower. It's not good to miss a dose but it's not uncommon for breaks to be required early on.

I recently had a sudden fluid increase but I'm 8 months ahead of you and most of the silly stuff happens in the first few months. Anyway in my case it was mainly face and ankles and it went away by itself over the next 10 days. Fluid can accumulate in places that are annoying rather than dangerous but can also be dangerous. If you are having trouble breathing then definitely go to the ER. It would be a good idea to weigh yourself at the same time every day to keep track of the fluid gains.

What ever you decide try not to worry too much.

Josie


Dx Dec 2010 @37

2x IVF egg collection

Glivec 600 & 800mg

PCRU March 2012

Unsuccessful pregnancy attempt - relapsed, 3 months interferon (intron A), bad side effects from interferon

Nilotinib 600mg Oct 2012

PCRU April 2013, 2 years MR4.5 mostly PCRU with a few blips

April 2015 stopped again for pregnancy attempt (donor egg), pregnant first transfer, 0.110 at 10wks, 2.1 at 14wks, 4.2 at 16wks, started interferon, slow dose increase to 25MIU per wk, at full dose PCR< 1 for remainder of pregnancy

Healthy baby girl Jan 2016, breastfed one month

Nilotinib 600mg Feb 2016

MMR May 2016

PCRU Feb 2017


#3 Fas

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Posted 14 November 2011 - 07:17 PM

Pam,

I do not have any experience with Sprycel and certainly are not qualified to give medical advice as to whether to take the next dose.  You certainly are not being a hypochondriac and please do what you feel is best for your wellbeing and if that is calling your doctor to discuss this or going to the ER ,then go.  Just the fact that you are so attentive to what is going on with you body is a good thing.  Wish I could offer more.

Take good care, God Bless,

Fran 



#4 Trey

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Posted 14 November 2011 - 08:18 PM

Not sure how the ER would help you.  If it were me, I wouldn't take anything tonight. 



#5 pammartin

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Posted 14 November 2011 - 08:33 PM

Thank you, I have calmed since posting.  Swelling isn't anything new, just tonight it came on quick, if there tomorrow I will take water pill.  You are right, ER would only freak at my low numbers, like they did with high platelets and stick me in-patient.  I would rather worry at home.  I did break down and take the Sprycel, although I know if I were doing this longer I would not have.  The fear of CML raging it's ugly head is stronger than the platelet fear so early in diagnosis.  I figured from Thursday morning till this morning is four days.  Platelets were at 210,000 on Thursday.  Today at 66,000.  So on average I lost 36,000 per day.  Tomorrow I would be at 30,000 if the drop follows this routine.  I will say if they are that low, I am not taking any more Sprycel for a bit, hopefully hematologist will agree.  Once again, Thanks Trey, the calming effect your posts have, you may never know.



#6 CallMeLucky

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Posted 14 November 2011 - 09:38 PM

its not uncommon for counts to drop drastically and then stay low for a while while the body recuperates and then starts to produce healthy cells again.  Given the fact your counts are dropping so much, I would think the 140 Sprycel should be reevaluated.


Date  -  Lab  -  Scale  -  Drug  -  Dosage MG  - PCR
2010/Jul -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 1.2%
2010/Oct -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.25%
2010/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.367%
2011/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.0081%
2011/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2011/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.00084%
2011/Dec -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Mar -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0.004%
2012/Jun -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Sep -  MSKCC  -  Non-IS  -  Gleevec  - 400 - 0%
2012/Dec -  MSKCC  -  Non-IS  -  Sprycel  - 100 - 0%
2013/Jan -  Quest  -  IS  -  Sprycel  -  50-60-70  - 0%
2013/Mar -  Quest  -  IS  -  Sprycel  -  60-70  - 0%
2013/Apr -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.036%
2013/May -  CUMC  -  Non-IS  -  Sprycel  - 50 - 0.046%
2013/Jun -  Genoptix  -  IS  -  Sprycel  - 50 - 0.0239%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0192%
2013/Jul -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0034%
2013/Oct -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0054%
2014/Jan -  Genoptix  -  IS  -  Sprycel  - 70 - 0.0093%
2014/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.013%
2014/Apr -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0048%
2014/Jul -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2014/Nov -  Genoptix  -  IS  -  Sprycel  - 100 - 0.047%
2014/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2015/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0.0228%
2016/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2016/Dec -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Mar -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Jun -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Sep -  Genoptix  -  IS  -  Sprycel  - 100 - 0%
2017/Dec - Genoptix  -  IS  -  Sprycel  -  100 - 0%
 

 


#7 pammartin

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Posted 15 November 2011 - 06:32 AM

Thanks everyone for helping me get through another CML night.  I am hoping platelet drop slowed to minimum.  I know I have said thank you, but it just doesn't seem like enough.  I was going crazy till I found this site, and I would still be going if I didn't have the support of everyone here.  All I have is written words, Thank You, hope everyone knows how much I appreciate your presence.



#8 Lizzybee

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Posted 15 November 2011 - 04:32 PM

Does your onc take phone calls outside of office hours?  At my very first onc appt, they gave me a phone number that a nurse answers during office hours and the answering service answers outside of dr hours.  When we called on a holiday weekend because I was spiking fevers, my onc called back in less than 15 minutes. This board is a blessing, but I weren't sure whether to go to the ER or take my medicine, I'd call my onc before posting here. You are right about ER personnel freaking out! But they would contact your onc and he would make the decision on whether or not to admit you.



#9 pammartin

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Posted 15 November 2011 - 08:46 PM

Thanks for the advice, if I could just learn to calm down a bit before I loose my control, I would do much better.  My oncologist does not have answering service beyond ER and he goes off to Florida every other month.  Great for him, not so great for me.  I have been investigating new doctors for the past few weeks, unfortunately although the health insurance it good, coverage is limited, so to date I have not made a change.  I am annoyed I did not do what I thought I should, cut down on the one med way before the platelets dropped to the current level.  I am also annoyed the doctors did not consider this as a possibility and reduce the meds before I bottomed out.  Our ER capabilities are small, some hospitals have closed this option, but a call to the oncologist this month will get no one, he is basking in the FLA sunshine till the first week of December.



#10 tiouki

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Posted 17 November 2011 - 04:12 AM

hello pammartin,

I have just read your story, I didn't really understand if you are taking hydrea AND sprycel at the same time. Normally it's hydrea first to lower white cells count then switch to sprycel for the deep response.

In any case, if you stop hydrea all your blood cell counts will increase, hydrea acts as a spring that reduces cell production so if you release it your counts will increase.

About sprycel in the first months it is quite normal that your blood counts get under normal values (platelets, white and red cells). They should then get back to normal. As it has been said, if your platelet drop under 50,000 you should stop all meds.

But my main question is why did your oncologist put you on 140mg sprycel? The standard dose for front line treatment is 100mg. 140mg now used only for patients in accelerated or blastic phase. Maybe you should want to reduce your dosage (I am on 100mg and this drug is very efficient). This could reduce your sides effects including cytopenia.


Good luck !
Pierre



#11 pammartin

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Posted 17 November 2011 - 07:46 AM

My initial response was much like Trey's, all my blood work read in normal range except for the high platelets.  Until the BMB results came in, the doctors were convinced I had Thrombocytosis, Trey provided a link for this above in his post.  Even on the Hydrea my platelets continued to rise, at highest they were very close to 2 million.  I began the 100 mg Sprycel and 2000mg of Hydrea because the next step was going to have platelets removed, Trey explained the procedure to me, but I forget the name.  My platelets began dropping within two days of taking both meds, so it worked, but because they upped the Sprycel to 140 mg and added the Hydrea 2000 mg, I was hit with a chemical bomb (Lucky's term and appropriate)  Had I more experience in all this, I would have probably stopped at least 1000 mg of the Hydrea on my own, and yes against doctors orders.  I believe this could have been regulated with more care and better results had the drugs been reduced after serious response was noted, but now this is a mute point.  I am off the Hydrea since last week, they took the Sprycel away yesterday and I go for blood work every other day.  Until my platelets rise above 50,000 I will not be permitted to take the Sprycel.  I will try to enjoy the break, and not think of the side effects if they are as severe as they were when starting Sprycel, when I start again.  Hopefully it won't be too long and my body will not respond as it did to the initial Sprycel beginning with all the side effects.



#12 Lizzybee

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Posted 18 November 2011 - 02:52 PM

I hope you find a doctor soon who knows CML and is more available to answer questions and handle emergencies!



#13 Buzzm1

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Posted 18 November 2011 - 11:17 PM

does anyone, who has experienced stomach problems with Gleevec,

know of food types that lessen the effects, or that seem to work better than others.

been taking Gleevec for close to two years, and this is the first time, I've had this problem.

thinking I was a little too overconfident in my stomach's ability to handle it.

became way to lax about having food with it. 

now it's becoming an uphill battle to overcome the apparent stomach inflammation,

and beyond......

damn, I think this was the last side-effect I hadn't yet experienced. 

thanks in advance for any helpful advice,

Buzz


For the benefit of yourself and others please add your CML history into your Signature

 

02/2010 Gleevec 400mg

2011 Two weakly positives, PCRU, weakly positive

2012 PCRU, PCRU, PCRU, PCRU

2013 PCRU, PCRU, PCRU, weakly positive

2014 PCRU, PCRU, PCRU, PCRU (12/07 began dose reduction w/each continuing PCRU)

2015 300, 250, 200, 150

2016 100, 50/100, 100, 10/17 TFR

2017 01/17 TFR, 04/18 TFR, 07/18 TFR 0.0012, 08/29 TFR 0.001, 10/17 TFR 0.000

2018 01/16 TFR 0.0004 ... next quarterly PCR 04/17

 

At the earliest opportunity, and whenever possible, lower your TKI dosage; TKIs are toxic drugs and the less we take longterm the better off we are going to be ... this is especially true for older adults.  

 

In hindsight I should have started my dosage reduction two years earlier; it might have helped minimize some of the longterm cumulative toxic effects of TKIs that I am beset with.  

 

longterm side-effects Peripheral Artery Disease - legs (it's a bitch); continuing shoulder problems, right elbow inflammation.   GFR and creatinine vastly improved after stopping Gleevec.

 

Cumulative Gleevec dosage estimated at 830 grams

 

Taking Gleevec 400mg an hour after my largest meal of the day helped eliminate the nausea that Gleevec is notorious for.  

 

Trey's CML BlogStopping - The OddsStop Studies - Discussion Forum Cessation Study

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#14 Judy2

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Posted 18 November 2011 - 11:26 PM

When my step-father was on chemo (different type of chemo) rice and apple sauce were two foods that were recommended for diarrhea.

Judy



#15 Buzzm1

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Posted 18 November 2011 - 11:47 PM

thanks Judy2

the feeling in my stomach is reminiscent of when, years ago, I had to take a strong anti-inflammatory

and after a time, it got the better of me.  The last anti-inflammatory pill I took, I no sooner took it,

than a bomb went off in my stomach. 


For the benefit of yourself and others please add your CML history into your Signature

 

02/2010 Gleevec 400mg

2011 Two weakly positives, PCRU, weakly positive

2012 PCRU, PCRU, PCRU, PCRU

2013 PCRU, PCRU, PCRU, weakly positive

2014 PCRU, PCRU, PCRU, PCRU (12/07 began dose reduction w/each continuing PCRU)

2015 300, 250, 200, 150

2016 100, 50/100, 100, 10/17 TFR

2017 01/17 TFR, 04/18 TFR, 07/18 TFR 0.0012, 08/29 TFR 0.001, 10/17 TFR 0.000

2018 01/16 TFR 0.0004 ... next quarterly PCR 04/17

 

At the earliest opportunity, and whenever possible, lower your TKI dosage; TKIs are toxic drugs and the less we take longterm the better off we are going to be ... this is especially true for older adults.  

 

In hindsight I should have started my dosage reduction two years earlier; it might have helped minimize some of the longterm cumulative toxic effects of TKIs that I am beset with.  

 

longterm side-effects Peripheral Artery Disease - legs (it's a bitch); continuing shoulder problems, right elbow inflammation.   GFR and creatinine vastly improved after stopping Gleevec.

 

Cumulative Gleevec dosage estimated at 830 grams

 

Taking Gleevec 400mg an hour after my largest meal of the day helped eliminate the nausea that Gleevec is notorious for.  

 

Trey's CML BlogStopping - The OddsStop Studies - Discussion Forum Cessation Study

Big PhRMA - Medicare Status - Social Security Status - Deficit/Debt


#16 Fas

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Posted 19 November 2011 - 12:36 AM

Hi Buzz,

So sorry to hear you are going through these stomach issues.  Hoping they pass soon. 

I have been taking Gleevec for almost 10 years and have had more than my share of stomach issues related to this drug.  After a few years on the drug I began getting real bad stomach issues.  I was scoped and they found my stomach lining irritated and also told me that my stomach seemed to be empting at a slower than normal rate.  Both they related to the Gleevec.  Don't know how true that info was, but based on the findings I made some changes in my diet that have helped and I have not had as much difficulty since.  First, I drink at least a few liters of water a day and think staying hydrated help move things along.  I always eat with Gleevec and I find it is not how much I eat, but what I eat.  Eating some sort of grain with my meals works really well for me - Kamut pasta, quinoa and quinoa pasta, brown rice, barley, steel cut oatmeal and buckwheat pasta are some of my favorites and seem to sit well in my stomach.  So, I might have oatmeal with soy butter for breakfast, vegetable soup with brown rice for lunch, etc.  Whole grains work much better for me than regular white pasta and rice.  I think the additional fiber helps to process things through my system more effectively.   Sweet potatoes, butternut squash mashed or as a soup have a coating and calming effect on my stomach.  I avoid cow's milk, butter, cream and use Almond or Soy milk instead as the aforementioned forms of dairy tend to really upset my stomach and cause bloating since starting Gleevec.  I also think I read somewhere that milk should not be drunk within several hours of taking Gleevec, but not positive on this info or why.  I just know my stomach no long like it very much.  Daily products that calm my stomach really well are Greek yogurt and kefir.  Maybe it has something to do with the active cultures and the probiotic aspect.  I use both every day and they seem to aid in my digestion and settle my stomach.  I also tend to eat smaller meals more frequently throughout the day and this change has helped as well.   I have moved to more of a plant based diet over the years with occasional fish and poultry, which I think helps minimize inflammation in the body, and frankly I just feel better eating this way.

Hope you feel better soon,

Fran 



#17 Fas

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Posted 19 November 2011 - 12:55 AM

Buzz,

Sorry I forgot to ask if you were taking the 400mg tablet or the 100mg tablets.  Just wanted to share my experience with both options.  When the 400 mg tablet became available I switched over.  How great to just have to take one pill.  What a mistake that was for me and that was when my stomach problems, which were not too bad at all really kicked into gear.  My stomach just could not handle that 400 mg pill, so back on the 4 (100mg) I went.  One other thing I do that helps is that I take 200 mg as I am eating dinner and then about a half hour later after dinner I take the other 200 mg.  Just that slight splitting of the dose has helped my stomach tolerate the med better.

Fran



#18 Buzzm1

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Posted 19 November 2011 - 09:44 AM

Hi Fran,

Thank you for taking the time to respond, with so much really good information.

I take the 400 mg Gleevec. 

my diet can stand improvement...i spend inordinate amounts of time on my computer

and keep most of my food groups next to me, dried fruits, nuts, etc.

eating lots of smaller meals, rather than the 3 squares a day.

like you, am eating less and less, poultry, and beef, and switched from dairy to soy.

lots of yogurt.

Buzz


For the benefit of yourself and others please add your CML history into your Signature

 

02/2010 Gleevec 400mg

2011 Two weakly positives, PCRU, weakly positive

2012 PCRU, PCRU, PCRU, PCRU

2013 PCRU, PCRU, PCRU, weakly positive

2014 PCRU, PCRU, PCRU, PCRU (12/07 began dose reduction w/each continuing PCRU)

2015 300, 250, 200, 150

2016 100, 50/100, 100, 10/17 TFR

2017 01/17 TFR, 04/18 TFR, 07/18 TFR 0.0012, 08/29 TFR 0.001, 10/17 TFR 0.000

2018 01/16 TFR 0.0004 ... next quarterly PCR 04/17

 

At the earliest opportunity, and whenever possible, lower your TKI dosage; TKIs are toxic drugs and the less we take longterm the better off we are going to be ... this is especially true for older adults.  

 

In hindsight I should have started my dosage reduction two years earlier; it might have helped minimize some of the longterm cumulative toxic effects of TKIs that I am beset with.  

 

longterm side-effects Peripheral Artery Disease - legs (it's a bitch); continuing shoulder problems, right elbow inflammation.   GFR and creatinine vastly improved after stopping Gleevec.

 

Cumulative Gleevec dosage estimated at 830 grams

 

Taking Gleevec 400mg an hour after my largest meal of the day helped eliminate the nausea that Gleevec is notorious for.  

 

Trey's CML BlogStopping - The OddsStop Studies - Discussion Forum Cessation Study

Big PhRMA - Medicare Status - Social Security Status - Deficit/Debt


#19 pamsouth

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Posted 19 November 2011 - 03:13 PM

I drink about 16 oz of water when I get up.  I never take Gleevec on an empty stomach.  I know I am suppose to eat several small meals, but I am more of a 3 square meals.  I think with Gleevec I could probably eat a small meal as long as it had some solid substance, not just soup or jello, but some real food. I probably drink to much milk, I think I would do better to switch to soy, hard for me to do, we were brought up on cow's milk and my husband drinks a lot of milk. You might trying splitting your 400 mg in 1/2 or getting some 100mg gram and splitting the dose throughout the day. I would rather work with my Gleevec then switch to another drug.  When I read the post from people taking one of the other drugs I see they have serious side effects, too.  So if I have issues I don't like to complain to my doctor.  Seems like there is a big push to the newer drugs.  They all have different chemicals and I don't want to test the waters, been on Gleevec for 6 years, and don't care to try and adjust to new chemicals especially at 63 years old. Doctor said it would be a piece of cake.  So I went to the leading Cancer Center of Indiana and got another opinion, plus been reading your post.  I find the patients are the ones that are taking the pills, not the docs, and I'm not sure the docs alway report their finding correctly.  When I got some of my reports to take with me to MD Anderson I read thru them and they were stretched a bit.  Been a few year ago.  Sometimes I wondered if they were talking about another patient or wrote their notes on the wrong patient file.  Just saying... like to hear it straight from the horses mouth, after all we are the ones that deal with the side effects, easy for them to say.  I still am a bit upset over the billions of dollars poured into research and NO CURE!  So far the DONOR TRANSPLANT is the only cure, of course the older you get the more dangerous, but I often wonder why they haven't spent more of the money on transplant instead of medicine, for at least the next generation.  I understand you may be on med's the rest of your life from a transplant & perhaps suffer serious side effect (permanently)  but at the same time it is a chance for a cure.  Maybe I am to old at 63. My 61 year old brother is a perfect match, His health is declining, quad by heart by-pass, stint this year, aneurysm 3 defib's and heart shocked about 3 times this year.  I keep asking the doctor at the seminars every year about the donor transplants and get  the same answer, my age!  Diagnosed at 57 now almost 64.  Big Risk, bad survival for my age!!!  However I keep wondering why are they spending more money and research on the cure.  Why have they not found a way to make transplant safer.  Are they truly working on it.  Could it be they make more drug money if everyone is on expensive patents for the rest of their life?  I don't know?  Just makes one wonder and I hear that a lot from others.  Could it be greed.  I know they a promised a cure for HIV for year, but that bug moves and hides.  OK I will get off my soapbox what do I know?  I guess I keep thinking when I was diagnosed in 2005 the word from the doctors on will have your cure in a few years, sure they will, its 6 years later and we are no closer??  


PamSouth


#20 Buzzm1

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Posted 19 November 2011 - 04:01 PM

thanks for sharing pamsouth,

Gleevec provides enough problems, no desire to switch to another drug,

as long as Gleevec is doing the job intended, which in my case, it is.

not at all happy about the cost of Gleevec, nor the extended 12 year patent protection

the back-room, closed-door agreements, between Big Pharma, and the White House,

are something that all Americans should be upset about. 

Default Big Pharma http://bit.ly/msN6D4


For the benefit of yourself and others please add your CML history into your Signature

 

02/2010 Gleevec 400mg

2011 Two weakly positives, PCRU, weakly positive

2012 PCRU, PCRU, PCRU, PCRU

2013 PCRU, PCRU, PCRU, weakly positive

2014 PCRU, PCRU, PCRU, PCRU (12/07 began dose reduction w/each continuing PCRU)

2015 300, 250, 200, 150

2016 100, 50/100, 100, 10/17 TFR

2017 01/17 TFR, 04/18 TFR, 07/18 TFR 0.0012, 08/29 TFR 0.001, 10/17 TFR 0.000

2018 01/16 TFR 0.0004 ... next quarterly PCR 04/17

 

At the earliest opportunity, and whenever possible, lower your TKI dosage; TKIs are toxic drugs and the less we take longterm the better off we are going to be ... this is especially true for older adults.  

 

In hindsight I should have started my dosage reduction two years earlier; it might have helped minimize some of the longterm cumulative toxic effects of TKIs that I am beset with.  

 

longterm side-effects Peripheral Artery Disease - legs (it's a bitch); continuing shoulder problems, right elbow inflammation.   GFR and creatinine vastly improved after stopping Gleevec.

 

Cumulative Gleevec dosage estimated at 830 grams

 

Taking Gleevec 400mg an hour after my largest meal of the day helped eliminate the nausea that Gleevec is notorious for.  

 

Trey's CML BlogStopping - The OddsStop Studies - Discussion Forum Cessation Study

Big PhRMA - Medicare Status - Social Security Status - Deficit/Debt





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