My CO-1686 Cramps in Hands, Legs, and Feet

I get a kick out of warning anyone who is younger than me to never ever get old because getting old is not for amateurs.  Of course all I get is the same look that I used to give a 25-year-old girl friend of mine when I was 18 years old and at the peak of self-perceived youthful pulchritude: the puppy-dog eyes that said, You wretched old maid!

For one week last month, I experienced something that I had never experienced in my youth: Leg cramps or Charley Horses.  They woke me up in the middle of every night. Those twisters hurt!  Fortunately, getting out of bed and pacing took care of the cramps.  Night after night, one leg or the other cramped. Then one morning as I was chopping onions for a breakfast omelet, my fingers locked in position.

Something is wrong with me! I announced to my husband Octo.  His eyes peeked above the LA Times front page and said with an inflection, Well? He probably wanted to add, So what else is new?

One day the cramping reached a crescendo.  Entered the mother of all Charley Horses. Both my legs cramped simultaneously, sending me writhing in pain in a spread-eagle position on top of the bed! I screamed and cried real tears.  The live drama affected Octo profoundly.  He had been used to the roar of laughter, not cries of anguish. Let us try massage, he offered. He got a jar of what smelled like Ben-Gay and applied the stuff on my calves and feet with his limp fingers. Give it more pressure, I groaned. He continued with the limp strokes then asked, Does that feel better?   Poor Octo! He meant so well that I did not have the heart to scream, THAT IS NOT MASSAGING; THAT IS FONDLING! Seeing no relief on my face, he quit and gave me two Ibuprofens, which I took enthusiastically.  I would have swallowed anything to alleviate the pain. I would have opened my mouth as wide as a sinkhole and let him pour my leftover MMJ (medical marijuana) appetite drops down my throat. In about 30 minutes, my ten toes pointed in the proper direction and my whole body relaxed.

As soon as I could stand, I rushed to Google University (GU) and did some serious research on this Charley Horse thing.

To gain wide-range knowledge, I went general: “Cramps.” Bam! Out came all sorts of information on cramps during menstrual periods.  It cracked me up. I gave up periods several decades ago.

I fine-tuned the search: “Cramps without periods.” Wham! Things got worse.  Titles on cramps during pregnancy scrolled down one after another.

I was batting zip!  GU and I were in Miscommunication City big time. However, the results gave me a rude awakening that shocked me totally.  I could not believe other women also suffer from cramps. How could that be possible? It happens when the blogger thinks the sun only rises for her.

I went straight to the point: “Cramps in legs, hands, and feet.”  Bingo!  The site listed causes of and treatments for the malady.

According to GU, exercising, lack of potassium and magnesium, dehydration, can cause  cramps in the legs, feet, and hands especially of older people because they lose muscles  and the remaining muscles get overstressed easily.

Right off the bat  I eliminated rociletinib as the cause. After almost 2-1/2 years on the CO-1686 now-non-clinical trial with no such side effect, why now?  Of course, anything is possible. Next, I eliminated lack of magnesium and potassium because Dr Brevity always assures me, The labs are good.  Exercising did not factor in because I was quietly minding my own business snoring when each one-leg cramp happened. I was sitting on the edge of the bed planning on painting my toenails acid green when the spread-eagle Charley Horse occurred.

Dehydration emerged as the clear perp.  Facts supported it.  The morning before the Mother of all Charley Horses attacked, I had taken an hour leisurely walk along the leafy creek. To protect me from the sun, I used the Royal Umbrella, the one Octo had bought as a souvenir at the Buckingham Palace during our 2009 trip. Never a souvenir enthusiast, I remember musing at that time, Oh for stiff-upper-lip’s sakes, an umbrella souvenir from England!  I’d buy a souvenir reminiscent of the British Empire history like a miniature replica of the guillotine that chopped off Anne Boleyn’s head.

I recall that after returning home from the walk, I perspired profusely.  I probably just drank enough water to quench my thirst when I should have chug-a-lugged a quart more to replace the fluids lost from my remaining muscles.  Plus, during the week of the nightly one-leg cramp, my body had already been talking to me about needing hydration. The root of the Charley Horse problem: I had stopped practicing what I preach, Hydrate, Hydrate, Hydrate! It happens when the senior babe reverts to denial mode that she’s been turning into a prune for quite some time.

It’s been a month since I resumed conscious hydration.  Neither Mrs Charley Horse nor any of her nasty kids has come to visit.

GU came through again! And incidentally the latest scans and labs are Stable and Unremarkable respectively. The CO-1686 non-trial keeps on truckin’.


A footnote on Octo:

In the time span between the draft and the publication of this post, Octo signed on to hospice.  He had been diagnosed with Acute Myeloid Leukemia in March. My once-super-healthy 82-year-old caregiver and I have traded places unwittingly. He had been in the front-row seat of my cancer journey and now I have a ring-side view of his hospice care. Devotions take turns as the world turns.





My CO-1686: Elevated Liver Enzymes

The liver enzyme elevation was just another episode in Feisty Heifer’s continuing saga in the CO-1686 clinical trial boat as it sails toward the sunset.  I want to share the story because (a) it has useful information for anyone who cares to know, and (b) I get my jollies out of fantasizing that some people actually read my blog.

Two weeks before the ODAC speech trip in April, I had my regularly scheduled blood analysis and consultation with the Good Doctor. The drill has become second-nature to the registration clerk who asks me every time if anything has changed in my insurance, to the phlebotomist who draws my blood with a smile and a small personal story that I draw from her, to the trial coordinator who collects my now-inconsequential dosing diary, and to Dr Brevity who zooms in and out of my life in a fraction of an hour. Usually he tells me, The labs are good, and proceeds to the stethoscope motions that signal the end of me in his busy schedule. But that day was fateful.  Your liver enzymes are elevated, he muttered.  How elevated ? I asked, perturbed, but with the unmistakeable air of authority of a blogger who trawls Google University (GU), I added, Are you talking about ALT and AST?  Yes, he answered, and gave me the numbers: ALT 125 (normal range 7-52) and  AST 88 (normal range 13-39) then asked, What have you been eating? Seafood?

OMG! My liver enzymes were more than twice the normal upper range.  Suddenly visions of my liver oozing toxic crud into my bloodstream flashed in my head. I thought for a moment, then light dawned.  I remembered lately I had been eating a lot of deep-fried oysters and loading up on sushi for no celebratory reason. I am simply an environmental eater kinda old chick.  Place a heaping platter of jalapeno-topped nachos in front of me while we chat and next thing we know they’ve evaporated. That’s assuming the bar maid is plying us with ice-cold cerveza.  For my conversation with Dr Brevity, I limited the verbiage to oysters. You have to be careful with those things, he warned. I disagreed and tried to dazzle him with scientific data:  I fry the oysters in 375-degree Fahrenheit hot oil for 6 minutes, enough to kill the pathogens. Unimpressed, he strode out of the examination room and moved on with his life.

As soon as I got home, I rushed to GU and audited some courses. At this point, I must recite the mother of all disclosures. I am not a physician. My academic attainment closest to a medical degree is that the Big Kahuna of Lung Cansah Research refers to me as “the diva.” I’m not dispensing medical advice; I just have this crying need to showcase the diva’s Inner Healer.

First, GU gives definitions of ALT and AST. Translated simply, they are stuff that may indicate liver damage. According to GU, 2 to 3 times the normal value of ALT and AST is considered mild. The mild elevations might be caused by food, alcohol, or certain drugs. Maybe the numbers are something to worry about, maybe not.  I zeroed in on the worry angle. Worrying in moderation is good. It starts the brain to focus on a problem and find solutions.

I eliminated CO-1686 as the cause of my liver enzyme elevation because why now after having been on the trial for nearly 2-1/2 years? Of course, anything is possible.  I assumed for one second that oysters were the culprit, then thought, Nah! I had been eating those things raw since time immemorial with no consequences except serious allergic reaction early on, which I fought and beat resulting in immunity to oysters. Of course, my self-styled immunotherapy at age 8 could have killed me. I’d even dare say those oysters were contaminated because growing up in the Manila slum where hunger trumped hygiene, contaminants were a staple in the diet. It was a place where sanitary food, when ingested, induced withdrawal symptoms. So I searched for other causes of elevated liver enzymes that might match my circumstances.

I read that overexercising can aggravate muscles and cause them to release ALT and AST that adversely affect liver enzyme tests.  Now, we’re cookin’! In the week preceeding the blood test, my husband Octo had fallen ill and was confined in a hospital just outside our gated community.  Being the perfect wife that I fancy myself as, I visited him daily.  I also figured it was a great opportunity to get my exercise out of the way.  Talk about exercise! My daily visit involved an hour round trip uphill, downhill brisk walk.  Call that my cardio.  My arms got their workout as I waved them vigorously at the gate guards.  The big smile that I flashed to anybody who made eye contact exercised my facial muscles. The spring in my steps massaged my calves.  It happens when one wears Z-Coil shoes.

I remember at the end of that week, I felt like I had been trampled by stampeding bulls.  Every muscle of my body ached.  It admonished me that all I need at my age is a leisurely 20-minute walk along a leafy creek – not the Bataan Death March kind of trek.

I listened to my body like I have always done.  I chilled in the physical exercise department in the three weeks leading to the next blood test.

The day of reckoning came.

Labs are good, muttered Dr Brevity. How about the elevated liver enzymes? I asked. What liver enzymes? he countered. He had already forgotten about them and nothing about them in the report grabbed his face. The one-off problem had resolved.

Fresh oysters tossed in my homemade gumbo sounds pretty yummy right now.