I went in today for a consultation with the oral surgeon on having my tooth pulled and an implant put in.  It was a really weird visit because somehow he was under the impression that we were going to pull the tooth today.  He came back to talk to me for a minute and then said something like, "Okay, let's go back and get you numbed up."  I stopped him and asked what he was talking about and he said, "Isn't that what you are here for."  I said that I thought I was coming in just for a consultation because I have had some recent health problems that may affect my treatment.  So I told him about the cancer and the Avastin that I have been on and he did express some concern with the Avastin but said that the only thing they can do is to keep an eye on the jaw and treat any infections that come with antibiotics and oral rinses.  He also feels that it would be good to pull the tooth first and give the jaw a chance to heal and then if that heals well we can look into putting in an implant at a later date.  The tooth is far enough back in my mouth that I don't think anyone will even notice unless I show it to them.

I still want to wait a few more weeks if I can before I have the tooth pulled so I went ahead and scheduled an appointment for March 11.  DH isn't too crazy about just having the tooth pulled but at this point I think it is the best option for me and I think that if I can get it done in between any kind of cancer treatments then it is probably the best time frame for me as well.

M&M had late start for school this morning because the juniors were taking the ACT test today.  It ended up working out nicely because I was scheduled to go in and have my port flushed so she was able to stay home and watch MJ for me.  I was originally planning on just taking MJ with me since it was going to be a really quick visit.  (I'm not sure if they would have liked that or not though.)

I was only gone for about 30 minutes which was really nice.  I checked in and they called me back after a couple of minutes and I was in and out of the infusion room in about 5 minutes.

After talking with the study coordinator and nurse at Huntsman, we have decided to pull me from the Avastin study.  I would most likely be pulled from it anyways after just one more infusion and I think I need to get my tooth taken care of while I am not on it anymore.  I have been kind of expecting it but it seems kind of weird.  I have been on the Avastin for over 2 years now.  Since I won't be going in in 3 weeks for my regular infusion I had them setup a time for me to go to the clinic in Daybreak to have my port flushed.  It needs to be flushed about every 4 weeks to keep it functioning properly.

My infection has cleared up and I take the last of the antibiotics today.  Now I just hope the infection stays away!

I called the dentist's office today to ask if I could get a prescription for an antibiotic.  They called one in to the pharmacy today and I picked it up and started taking it.  Hopefully it will clear up the infection quickly.  I also called the oral surgeon's office and set up a consultation for an extraction and implant.  And of course the way that the specialists work is that the earliest they can get me in is February 27 - which will be at about my 3 week mark from my last infusion.  And they won't even do anything most likely for another couple of weeks after that.

I unfortunately think I am coming down with an infection in my tooth now...  It has been causing me some pain today and general achiness in that area of my mouth...  I think I will need to call the dentist in the morning to see about getting on an antibiotic and discussing which treatment option I think I will go with.  Then I will probably need to call my oral surgeon to try and get in for a consultation.  The fun just never seems to end for me!

I'm wondering if there is a correlation at all between my tooth problem and my rising CA-125 number.

One of the nurses from Huntsman called me today to talk some more about the Avastin with my dental work.  She said that she had talked with my doctor and since the Avastin has a pretty long half-life, she recommends that I try and put off any major dental work for 3-4 weeks if I can since I just had an infusion on Wednesday.  I will be taken off of the study and will keep my CT scan and lab work appointment in six weeks as well as meeting with the doctor.  We will discuss then what our next step will be once we have results from the scan and labs.

I asked about getting my port flushed if I am not keeping my infusion appointment in 3 weeks.  It is a good idea to have it flushed at least every 4-5 weeks and I will not be going back in now for another 6 weeks.  We decided to set an appointment for the clinic near me for 3 weeks from now just to have it flushed.  That should be a nice, quick visit.

Some not so great news today.  I had a dentist appointment this morning just for a rountine cleaning and mentioned that I had been having some tooth/jaw pain off and on in the right lower side of my mouth.  This is the same section of my mouth that I have an implant already and then a year after the implant had to have an apicoectomy/root canal procedure on the tooth right behind the implant.  After the hygienist did the cleaning, they took another x-ray of my lower right jaw and the dentist came in and looked at the x-rays and apparently I have some tooth decay on that tooth once again.  The dentist drew me some pictures of what is going on with the tooth and told me what my possible options would be.  My concern with hearing all of these options is that the Avastin that I am on has some warnings with it if there has to be any major dental work done.  The Avastin interferes with the blood stream and clotting and healing.  I expressed some concern to my dentist and he told me which of the 3 options would be the least invasive.  I don't think that that options is the one that I would prefer to do though.

Then later on in the day I talked with the study coordinator at Huntsman and she said that my CA-125 number has now jumped up to 70.  That is the upper limit for the study so she said that I can stay on the study through my next infusion in 3 weeks but once they get results from my next lab work in 6 weeks, I will probably have to be pulled from the study - assuming that my number stays the same or continues to go up.  She said that the decision was up to me if I want to stay with the study through the next treatment or not.  I then told the coordinator about my dentist appointment this morning and she said that she would look into the specific requirements and recommendations regarding dental work while on the Avastin.  She said that she would discuss it with my doctor and let me know, but at this point I will most likely be pulling myself from the study to get this dental work done.

Met with my Huntsman doctor today.  The nurse that drew my labs was looking at my info and asked how long I have been coming in for treatments.  I said it has been a little of 2 years now.  She was saying that she noticed my age and thought that I was awfully young to be going through all of this.  She then asked how they found the cancer.  It's hard to believe that it's been over two years since my diagnosis and even my surgery now.

So far all my labs look good but it takes a day or so to get the results for the CA-125 number.  They said that that test they run in batches so they run it at a certain time during the day and do all of the CA-125 draws at the same time.  I asked what the course of action would be if my number is above 70.  They said that there are a couple of different options that we can go down.  One would be to put me on an oral maintenance drug called Tamoxifen.  This is one that is used quite often with breast cancer patients and the thinking is the same with ovarian cancer patients.  With BRCA-1 patients it is thought that the female hormones can contribute to the cancer and the Tamoxifen helps to inhibit to production of those hormones.  Another possible option is another study drug which is called a PARP inhibitor.  There is a study that is apparently looking specifically at BRCA-1 patients and if the drug helps inhibit the growth of tumors.  That is also an oral drug that I think they said is taken once or twice a day.

All of this of course is assuming that my next scan still comes up clear and that I feel fine with no other symptoms exhibiting themselves.  If my next CT scan is not clear then we would look into another possible surgery and/or chemotherapy treatment.  The hope though is that even if the cancer comes back, we will hopefully be catching it at such an early stage that it will be more easily treated than the first time around.

My blood pressure was normal when I went for my infusion so that part went relatively easy.