Well, would you look at that!

I'm in the middle of my 6th Xeloda cycle now and yesterday I got the results for the tumor markers from my latest oncology appointment.  Take a look:

See that steep downward drop at the end?  Pretty, right?  That's the additional 40% dive they took from 127 to 76 over the past month on Xeloda--very good news!

My liver numbers are back in the normal range, my tumor markers are dropping noticeably, and the Xeloda side effects aren't as bad as I'd feared.  Win, win, and win!

Normal for this type of tumor marker is below 40--I've been close to that on Faslodex, but never quite got there as a stage IV patient)--but if things can just keep on this way, I'm beginning to think it may be possible.  Wouldn't that be cool?

But whatever the future holds, thank God right now I'm responding well to this drug. 

A few Xeloda bits and pieces

Illustration by Joanne Negro from Wonder

Books' Let's Give a Party

I've obviously been thinking a lot about Xeloda these past few weeks.  "Thinking about" mostly means incessant Googling, worrying, wondering, and guessing.  But it also means talking with my oncology team and doing what they say.  So, and this is mostly for those of you who find yourself on Xeloda, but it's sort of a progress report, too, I have a few Xeloda related thoughts I'd like to share.

30% - Assuming I'm reading things right, Xeloda works in only about 30% of women with metastatic breast cancers.  That sounds terrible in real world stuff ("here, take this pill, it has unpleasant side effects and less than 1 out of 3 people found it either helped or at least kept things from getting worse"), but that's how these things go when your dealing with cancer.  I know I'm not going to convince anyone I'm made out of luck since I have this cancer thing plus I never, ever win raffles, but I feel like blessings are raining down on me that the first preliminary indications are that I'm one of that lucky 30%.  And the side effects haven't been so bad all things considered.

Fatigue - That's one side effect I've been feeling but I'm actually finding that in addition to early bedtimes and resting when I can, surprisingly a little moderately paced walk helps.  Well, that and sometimes coffee.  I'm finding that I'm having more trouble sleeping during my 7 days on weeks, so that might play into it, too, hard to say.

Nausea - This was hard the first week.  It wasn't the terrible all consuming nausea like I had the first day or two in 2012 before we got the right mix of antiemetic drugs during my stage III chemo, but it was happing a lot and it was unpleasant.  But I think I posted about my oncology nurse practitioner's advice to try taking a daily Prilosec (or 2 a day if it sort of helps but not all the way).  I thought it sounded a little unlikely to help since I wasn't having reflux or acid-type symptoms, but given that she's a) smart, b) experienced, and c) trained in oncology, I gave it a shot.  Besides, as she told me (and as I remember from 2012), traditional antiemetics tend to have more unpleasant side effects (sleepy, jittery, foggy, twitchy--tons of fun!) and if the Prilosec doesn't help those are still on the table.

And, I'm happy to report, I'm glad she's on my team because the nausea was much, much better the 2nd and 3rd cycle where I was also taking Prilosec.  I had a few waves of it during the week, but not so bad that I wanted to reach for my Compazine and not enough to impact my life.  I'm calling this a win!

Hand and Foot Syndrome - This side effect has been tricky.  I've been moisturizing all the time and had even taken to gooing up my hands and feet with Aquaphor ointment at night and walking around in white cotton gloves (think Mickey Mouse or a butler) to protect them, but was still finding my hands hurt and I was developing some raw spots on my hands and hard callus-like patches on the balls of my feet.  They seemed to be getting slowly better on my off weeks of the 7-days-off-7-days-on Xeloda cycles but starting up again quickly just a few days later when I was back on the on week.  It wasn't, so far, bad enough that I would need to cut back on the Xeloda but since the H/F thing is cumulative, it was a worry for me.

But, talking with my oncologist this week, she suggested trying 20% urea cream.  She mentioned Udderly Smooth Extra Care 20 as a good one, but the 20% urea was the important part rather than the magic of udder cream in and of itself.  As it turns out, my older brother (who, to the best of my knowledge can't predict future oncology recommendations, but I may need to rethink that one) gave me a tub of that at Christmas, so it was easy to give it a shot. 

One of my sisters-in-law always says to make sure you have the smart people on your team, and I'm glad I do because at least for me the 20% urea cream made a big difference.  The feet are better and the hands are a lot better in how they look and feel.  Everything isn't perfectly normal, but much easier to live with. 

I couldn't find the 20% urea Udderly Smooth in my local drugstore, but I did pick up some Excipial brand 20% urea cream to keep in my purse and desk because, like the Prilosec, things that are working without much downside are worth keeping on with.

Moving Forward - Well, first and most constant prayer is that the tumor markers continue to drop and future scans show things getting better or at least not getting worse, and that those things will repeat over and over again for a long, long time (or forever, because forever would suit me just fine). 

The fact that Xeloda seems to be working for me so far is a big win and the fact that the side effects are so far very manageable is also a win. As is the fact that, so far, there's no reason to need to drop down the dose or take and unscheduled break from it as has been my recent experience with the last few cancer drugs.

And honestly, for me, with the right steps, the side effects have been really manageable.  I'm able to work and cook, clean and take care of my home and family, do normal things without a whole lot of changes.

It seems from breast cancer forums I read that a lot of women are starting Xeloda recently.  It may be just that I wasn't paying attention before, or maybe it's that a lot of women started Ibrance when it was first approved and if you gave that the required 3-4 months and then a different antihormonal like Faslodex or Afinitor another 3-4 months, that brings us to now and Xeloda as a good first line chemo to try. 

If you're one of those women trying to find out what to expect with Xeloda, hopefully this will give you at least one snapshot of what at least the first 5-6 weeks of Xeloda can be like.  Not as good as not having cancer or not being on chemo, but not that bad, either.

And now I'm off to do the breakfast dishes (yes, it is after 12:00 noon now) and then I'll take down my Christmas tree and pick up some groceries.  Because I'm feeling well enough to do that sort of thing.  And that, to me, is exactly what winning is made of.

To exhale

Caspar David Friedrich's Wander Above the Sea of Fog 

I feel like I can finally stop holding my breath for the first time in 5 weeks.  Or maybe the first time in 9 months.  Whichever.

This evening I got a note from my oncologist with results of my latest tumor marker test and my tumor markers are actually down.  From 157 to 127 in  the past 5 weeks, just like that.

Finally another drug that's started out by working, thank God.

It's been a while. 

Except for a 1-time dip in June, I'm pretty sure this is the first time the tumor markers have been meaningfully down since July of 2014.  Even for most of my time on Faslodex, they were mainly holding steady.  And then, as regular readers will know, 2015 was a year of multiple failed drugs, ever increasing tumor markers, and scan after scan showing things going in the wrong direction.

It's a great relief to have some good news for a change.

I promise I really do understand that the expectation is still for the cancer to work it's way around Xeloda sooner or later, at which point we'll move on.  But at least Xeloda isn't another total failure (yes, Ibrance and Letrozole, Afinitor and Aromasin, I am looking at you). And even if Xeloda does punk out sooner rather than later, I figure we'll still be dealing with growth from a better point then we've recently been at.  At least that's something.  And you never know, maybe Xeloda will just keep on doing this beautiful thing for a while and exceed expectations.  It could happen just that way.

For me, for today, I will celebrate this little victory. Tomorrow will bring what tomorrow will bring whether or not I dance and cheer tonight.  And especially after 2015, where this cancer is concerned I'm glad to finally have something to cheer. 

And I can finally stop holding my breath, stop waiting and wondering whether Xeloda is going to do anything at all.

Nice start, Xeloda, thank you.

And away we go...

James and the Giant Peach cover by
Nancy Ekholm Burkert. I love these
illustrations.

When I was in 3rd grade, my teacher read James and the Giant Peach out loud to our class.  As I recall, it was an exciting beginning and a great adventure for most of the book. But I don't remember how it ended. In my memory, there was something about the peach rotting and things going badly and a desperate crash landing and James' animal friends going away forever and James ending up alone.  In my mind, it was not a happy ending at all.  In my memory, it was a sad and brutal finish to a story that had started out so full of joyous promise.

But today, looking at Wikipedia's entry for the book, trying to remind myself exactly what happened in the ending, the Wikipedia summary describes a story that ends happily, not at all sad and lonely the way I remember it.  Now I don't know what to think.

When I was in 3rd grade, life was a different kind of stressful, unpredictable, out of control, and too often lonely and sad.  It's entirely possible that what was a whimsical funny ending for many 8 year olds just hit all the wrong chords for me at the time.  Maybe what was supposed to be a fun and goofy ending just didn't work that way for me and the life I was living at the time. It's entirely possible.

I never re-read that book, never wanted to. I've read 100's of my old favorite books to my daughter and some to my step-kids, too, and I've delighted in the stories we've shared.  But James was purposely not one of them. I never wanted to revisit James and the Giant Peach and the terribly disappointing ending.  But maybe I should have or still should, at least so I could see if the ending is good or bad.  Maybe with experience I'd finally be able to see why someone I remember fondly as a very kind and caring 3rd grade teacher would think it was a great book to read to her class.  Because in my memory, I still don't understand the choice.

....

Do you want to know something surprising? My Xeloda didn't take 3 weeks to arrive.  It actually took 3 days (well, 3 business days, anyway) to show up on my doorstep.  After all the trouble with previous drugs, how's that for a surprise?

Maybe Xeloda has less paperwork and insurance approvals, or maybe it's just that with the Ibrance and Afinitor approvals, any questions for Xeloda were already answered in the system?  Whatever happened, it was pretty nice to have the pills so fast and without a single phone call to see what the heck was going on.

I got them so fast, in fact, that I actually had to message my oncologist and see if I needed to wait the 2 weeks it was expected to take after stopping the Afinitor and Aromasin or if I should start it sooner since I had the drug.  She told me a week would be plenty, so I took my first 3 pills last night.

I'll be taking 6 pills a day--3 in the morning and 3 in the evening--for the next week, followed by 7 days off.  Why didn't I start it yesterday morning to make a full first day like a normal person would?

Oh, come now, if you've read more than a couple of my posts, you know me and my story enough to already know the answer to that one! The reason is because I had taken my Aromasin in the morning before seeing my oncologist/nurse practitioner in the day so it wouldn't have been a full 7 days off of the prior drugs if I took it in the morning.

So, again, only if you're new here, your next question is probably, "Do you really think those extra few hours make any difference at all?  Really?!?"

Well, no, not really, but still it seemed like the thing to do, and when I'm anxious or afraid I find keeping things as predictable and well controlled as possible is sort of comforting.  There's so much with cancer that I have absolutely no control over whatsoever, I try to take advantage of the things I do.

So there you have it, and as of this morning, I'm 2 doses and 6 pills into my new stint on Xeloda.

It's really too early to tell how the side effects are going, much less whether it's going to do a good job reducing the tumors.  I felt a little nauseous this morning, but better after breakfast.  Also, my hands and feet felt kind of ichy/tingly yesterday evening and I didn't sleep well.  Does any of that mean anything after only just barely starting the pills?  Probably not.  I expect what it really means is that I have Xeloda on my mind and am hyper-aware of (read: madly, obsessively focused on) every little thing that could possibly ever be related to it in any universe, known or unknown.  Hopefully I'll be more relaxed about it in time.

I've read blogs and posts from a number of people who have had really great rides on Xeloda.  I've also read about people who didn't have so much success on it, but for now, because there's not much to be done about it anyway, I'm trying really hard to focus on success stories and the good potential this has for me with relatively few side effects as far as chemos go.

....

As far as entertainment goes, on the other hand, whenever I read fiction books these days or pick out movies to watch, I always cheat and find out the endings before I begin.

You might think it's James and the Giant Peach related madness, a crazy obsession focused on avoiding the same kind of disappointment, but I can't really blame it on that.  In my teen and young adult years, I used to love tearjerkers and loved all kinds of books with deep, sad, bittersweet endings.  For many, many years my favorite book ever was The Unbearable Lightness of Being, I loved the story, I loved the philosophy, I felt deeply for the characters and the tragedy of the situation, and I found the sad ending of inevitable destruction so beautifully perfect given the poetically tragic set-up that brought our characters to that final resolution.

But these days, after cancer, I can't stand to spend my time on sadness like that.

If I do ever re-read James and the Giant Peach and find out for sure if it's a crazy fun ride that leads to a whimsical, joy-filled resolution, or a crazy fun ride that leads to inevitable sadness, loneliness, and loss, I know myself well enough to know that it will be a re-reading that begins last-chapter-first and will not go any further if I don't like how that first look at the last chapter goes.

I know that sounds crazy, I understand it's a little nuts. But, I'm ok with that.

These days, I just can't take spending my time getting to know a story, getting to know and love characters, just to watch them end in sadness and despair.  Even beautifully tragic sadness and despair, I'm just not interested.

Really, in these post-cancer days, I can't even take spending my time getting into a story not knowing the ending and just having to worry that it will all end up in tragic sadness and despair.  Even if the ending turns out to be happy after all, I'm just not willing to put that kind of stress on myself.  If I'm going to put my heart and soul into a story for fun, I need to know it will come out well before I even start or I'm not willing to put my time into it.

Yep, I'm sure that makes me certifiable.  And I don't care.

But I do find it kind of ironic, as I sit here in real life typing this, less than 24 hours after starting yet another new cancer drug.

On the move again

Good news is the mouth sores stayed better.  I had a couple in the last few weeks, but one at a time and they didn't take weeks to get better, so that was good.

The bad news is that while Afinitor was working great on creating canker sores, it wasn't working as well on my cancer.  I had an ultrasound last week and found out yesterday that there's more growth in my liver, so moving on.

It really isn't overly surprising, I guess.  So far since my stage IV diagnosis in February of 2014, we've been working through the arsenal of anti-hormonal drugs.  But of the Tamoxifen, Faslodex, Ibrance and Letrozole, Afinitor and Aromasin, only the Faslodex (my 1st stage IV treatment) had any real success.  After my cancer evolved around that, it seems to have been able to outsmart that type of treatment no matter what the form.  But I really had hoped for better.

The cancer in my liver didn't increase by that much, but my oncologist doesn't want to keep throwing time at the Afinitor given my history, so I stopped taking Afinitor and Aromasin yesterday and will begin a chemo drug called Xeloda as soon as my insurance and specialty pharmacies can get it together and send it to me, probably in a couple of weeks (but, obviously, given my history with insurance and specialty pharmacies, I don't recommend holding your breath, unfortunately).

Xeloda is supposed to be an easy chemo (as far as chemo goes, I guess), not like the dose dense adriamycin-cytoxan-taxol I was on at stage III.  It's not an infusion, it's a pill (well, 6 pills a day for 7 days, then 7 off, then on again, actually) and it doesn't typically cause hair loss so I'm not back to the wig just yet.

It can cause nausea, vomiting, other GI issues, and fatigue, but less often than what people think of with chemo.  It can also cause mouth sores, but I guess at least if it does, I'm good at working through those by now, right?

The big side effect, most common and most impactful, is something called Hand Foot Syndrome (not to be confused with Hand Foot Mouth Disease, which isn't a side effect of any chemo drug).  Hand Foot Syndrome is a painful burning, swelling, redness, chafing, blisters and peeling on the palms of the hands and soles of the feet.  Lovely.

But not everyone gets it and even if it does happen, the severity seems to vary a lot and really bad cases aren't common, so that's good.

My nurse practitioner has me taking really good care of the skin to get it in as good shape as possible when I start.  And the 7-on-7-off schedule is supposed to help prevent worse side effects as opposed to the older 14-on-7-off regime.  So I guess we'll see. I know I tolerated chemo pretty well the last time in 2012, so who knows?  I may dodge the worst ones this time around, too.  

And, to be honest, if I have to walk around limpingly for the next decade with flayed palms and soles frightening children with my blistery hands and who knows what other kinds of side effects of various unpleasantness, it will be ok.  If it works for a while against the cancer, I can live with the rest.

Doesn't mean I won't whine about it constantly, because you know I'll do that!  But where there's whining, there's life, right?  (just try and remember that when I'm at my most obnoxious, ok?).

For those of you who find big words as amusing as I do: by now my cancer has beaten an anthracycline antitumor antibiotic, alkylating agent, tubulin-targeting therapy, an estrogen receptor blocker, estrogen receptor downregulator, cyclin-dependent kinase 4/6 inhibitor, 2 different aromatase inhibitors, and a mammalian target of rapamycin inhibitor.  But it has never seen the likes of Xeloda's thymidylate synthase inhibitor action before.  

And for those of you who have the sense of humor of a 12 year old the way I apparently do: Xeloda can be taken as a pill and not an infusion because it is synthesized in the liver into a compound called 5-FU which is the thing that does the thymidvlate synthesis inhibiting.  For my 5th treatment regime since my last clear scan in 2012, maybe sending the cancer a little gift of FU will be an auspicious sign.

We shall see...

A little better, a little motivation

Just a quick post this morning (getting ready for work and all) to say that with the weekend off, the sores are getting better and certainly more tolerable.  Thank goodness.

My diet has expanded beyond eggs and porridge and the pain is now situational rather than constant.  Such a relief!

I started back on the Afinitor Monday night (she said to do that when they were getting better rather than when they were gone).  So far still healing.  Fingers crossed that this continues!

Yesterday I also got back the results of my Ca27-29 tumor markers from my 2-weeks-on-Afinitor appointment and--surprise!--they were a nice steady 120!  That's basically the same as they were a little over a month ago when I stopped the Ibrance, had the 3 1/2 weeks off, and just 2 weeks of Afinitor under my belt.  I had expected them to go up with all of that and steady is always good, so I'm happy.  It may even make the mouth sores all worthwhile.

Hope it's the beginning of some good work from Afinitor!

Happy Wednesday, everyone!

A Rough Start

And for my next trick...

And the Lord said to Moses and Aaron, “Take handfuls of soot from the kiln, and let Moses throw them in the air in the sight of Pharaoh.  It shall become fine dust over all the land of Egypt, and become boils breaking out in sores on man and beast throughout all the land of Egypt.”

I've been taking Afinitor for 2 weeks now.  Math- and calendar-minded readers will notice that that was about a week and a half later than scheduled.

"Why?"  you might ask. Like Ibrance, Afinitor has to come from the specialty pharmacy and, as seems to be the way, there were delays getting the insurance to sign off on it.  You'd think I'd be used to that by now, but apparently my learning curve is a little slow.

But I did get it, finally, and started it as soon as it arrived.

Side effects:


Afinitor has some unpleasant potential side-effects, so I was hoping to dodge them all but not really expecting that would happen.

It didn't happen.

One of the potential side-effects of Afinitor is headaches (seen in 21% of trial participants). I started out with that one on the second day.

It wasn't the worst headache ever possible, but it hurt.  And it was persistent.  Very very persistent. This damn headache withstood Advil. It withstood Tylenol.  It withstood Advil and Tylenol.  For three long days it was there in when I woke up in the morning.  It was there when I went to bed at night.  And it was there every moment in-between.  But finally, on the fourth day, it broke and I've been headache free ever since.  Hooray for victories!

Another common side-effect is an itchy red rash (39% of trial participants).  On the third or fourth day, my upper arm started to feel like sandpaper.  I coated myself in heavy duty lotion to try and ward off anything worse, and that actually seems to have worked!  It's still a little rough and there are now some tiny red spots on my lower legs that I noticed yesterday, but so far so good.  I'll take it!

Also among the common side-effects is nausea (29% of trial participants).  That one came in waves on and off in the first week, but not so very nauseous, just a little.  And that one seems to have run it's course, too.  Hooray!

In that first week, I also had a little on-and-off fatigue (36% of trial participants) which resolved and some lingering dry-mouth (11% of trial participants), but nothing too terrible.

So after the first week, I was feeling pretty good.  "No big deal," I thought to myself, "this isn't so bad!"

Oh, foolish pride.

Because on the tenth day, I discovered the most common side effect (67% of trial participants): mouth sores.

Mouth sores:

Of course, I knew this was a possibility (ok, at 67% some might say likelihood), so I was taking precautions.

I was wrapping the pill in a thin piece of marshmallow before swallowing it (The internet recommended that to avoid contact with the mouth and throat.  I don't take something unauthorized or in high doses just because the internet said so, but it's a tiny bit of marshmallow we're talking about here.  And I am authorized to eat food, even health-free, smooshy food. So there isn't much harm in trying).

Swallowing gobs of mallow whole became my new party trick.

I also was swishing my mouth out regularly with baking soda/salt water rinse as a precaution to ward off sores.  I was even bringing a water bottle full of the stuff to work so I could continue my swish-fest during weekdays.

I don't really want to know what my co-workers may be thinking about my new found habit of bringing my water bottle into the public restroom with me.  Especially when we have a lovely kitchen with nice filtered water right there.  But my fear of looking stupid paled in comparison to my fear of mouth sores.  Turns out that was a good call. The only thing I missed was thinking it would prevent them.

Because on that tenth day, the couple sore spots in my mouth opened up and into painful sores on my tongue and the insides of my lip. And they've only gotten worse since then.

I could really use that mallow swallowing party trick, because I'm going to need something good to counteract this party-killer of having a mouth covered in sores.  It's not a very fun trick.


They hurt when I'm eating.  They hurt when I'm drinking.  They hurt when I talk.  They hurt when I'm doing nothing, to the point where they wake me up at night. And, of course, they're on the left side and on the right, so there's no avoiding them.

Here's the list of things that hurt to eat:

• acidic foods
• sugary foods
• minty foods
• hard foods
• hot (temp) foods
• hot (spicy) foods
• firm foods
• salty foods
• gritty foods
• crunchy foods

half the time even water hurts.

Things that didn't work:

I raided my local drugstore.  Twice.  Here's the list of things that didn't help:

• Biotene mouthwash
• ACT dry mouth lozenges
• Canker Cover
• Baking soda paste

Orajel Mouth Sore gel and the baking soda/salt water swishes each helped for a little bit, but not for very long.  And since Orajel can only be used 5 times a day, "not for long" was less helpful than you would think.

I also bought a new toothbrush featuring Thomas the Tank Engine (soft, small, and very rounded) and new toothpaste featuring Disney Princesses (gentle and bubble gum flavored, not mint).  Keeping your mouth very clean is supposed to help, but where there are so many painful areas to jab and strong mint hurts, too, it was getting kind of hard to do.
 

I went ahead and emailed my oncologist on Wednesday.  I needed to know how much was too much with these sores.  She said to keep swishing and phoned in a prescription for something called "Magic Mouthwash."

Magic Mouthwash is a mix of the active ingredients in Maalox and Benadryl with liquid Lidocaine.  It can be taken every 4 hours and makes your entire mouth completely numb (look, another cool party trick!) but only for the first half hour and then sort of numb for another half hour more.  It doesn't work for the full 4 hours until you can take it again, but at least that first hour is pretty good.  Which is something to try and focus on during the painful remaining 3 hours.

To the oncologist's office:

Yesterday I went in for my 2 weeks on Afinitor follow-up with one of the oncology nurse practitioners.  I was feeling kind of defeated.  Mostly because in the war against those damn mouth sores, I was being soundly defeated.

We talked about all the possible side effects I wasn't having or had gotten through.  And we talked about the mouth sores.  I told her how hard it was to eat or talk.  I told her how besides the sores I felt really good, but when it hurts to even talk, that's hard to live with.  I had read that a lot of people find the side effects get better after the first month and I told her I was willing to put up with anything for a time, but I didn't know how I was going to do this if it was going to keep on like this indefinitely.

She looked at my mouth and tongue, said "ohh, yeah," and went to talk with my oncologist.

Things I hope will work:

My oncologist told me to take a break from Afinitor.

Not for long, just until the sores are more healed and aren't as bad.

She told me to keep using the Magic Mouthwash (which feels a bit silly to call it because, quite frankly, "Magic" is overstating it a bit).  She told me to keep swishing with baking soda and salt water.

And when my mouth is better, I'll go back on the same 10 mg dose I had been on.

Where this stands:

So right now, I've only skipped one dose of the Afinitor.  The sores on my tongue feel a little better.  And the newer sores on the inside of my lip haven't opened up, so that's good. But right now, the biggest sore on the inside of my lip is still painful and throbbing, so we aren't all there yet.

But I get another swish of Magic Mouthwash in half an hour and more Advil, too, which should give me a break. 

And at least now there's new hope.  Because taking a break from Afinitor is something I hadn't tried yet and it sounds like it should help.  Plus my tongue feels a little better.  And that big sore is pretty big so it's not surprising that it could take a while (it's about half an inch in diameter.  Not a pretty look. But at least it's not on the outside. And the resultant fat-lip is a little Angelina Jolie-ish, so there is that.).

And I'm not dropping down to a lower dose, at least not yet.  After tanking on Ibrance because I couldn't keep on the higher doses, that's something I'm wary of, so that's a relief.

I really want to stay on this drug, and stay on it at a good dose.  Because, as unpleasant as this is, if Afinitor doesn't help, the next stop is chemo.  And it's not like chemo is going to be more fun.

Plus, Afinitor has some unpleasant potential side effects (trust me on this one), but cancer's side effect is death.  So that's worse.

And besides, if the internet is right, the sores could get a lot better after the first month.  Which is good, because I could use some different party tricks.