Shadow in chest is recurrence
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Dear dear Liz
Belated Happy happy Birthday!!!!🙂🎂🎂🎂🎂, ok maybe only half the sugar, some fruit and...🍒🍒🍒
The sea bass - yummmm, love it!!! So glad you got out - and I am sure you are looking forward to some adult time with your husband - the teenagers will be fine.
(I have had a crazy 48 hours - some work issues - but will post again soon.)
You are never far from my thoughts
Hugs to All,
Ioana ✨✨✨🍷😌
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and SadiesS,
Here is the link
https://www.pfizer.com/files/news/IBRANCE_Backgrou...
Go to page 3 - haematological abnormalities.
...have followed the Ibrance thread for a while now - around Dec last year - maybe Jan, Zarovka was having trouble with her WCC and was borderline for dropping her dose - she twisted her supplements - I think Coriolus ( but you need to check with exactly what, by whom, and why..,!!) and her WCC bounced solid above 1 - worth a PM to her, there were several posts about it. And yes I have that sort of memory ....🙄
She subsequently did go down to 100 mg but according to the posts it was a strategic decision not a WCC driven one.
And yes anaemia can cause shortness of breath particular when the drop is acute - ie not over months where you adjust by modifying other physiological parameters.
That menu sounds divine - I can eat caviar by the spoonful - ohhh wicked and wonderful indeed!
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Long day today. Lots of hurry up and wait but did have the tap so we will see if this reveals the nature of this bug, assuming I do have an infection. Apparently I have a lot of small loculations - respirologist likened it to Swiss cheese where the catheter had been placed. While it looked okay on CT, the ultrasound indicated my body's response to the drainage irritation was to develop adhesions like septa. I've been put on some heavy duty (2) antibiotics for the next week until I hear back from the respirologist. In the meantime he had four views of a chest x-ray taken and plans to consult with my MO and surgeon to decide what to do next. He appears to be leaning towards a thoroscopy- I need to reasearch what this entails and what the outcome will be as I understand there could be complications given my cancer diagnosis.
As to the blood, my WCC is fine, rebounding every time after my initial dose reduction to 100 mg. What I don't understand is the steadily declining RBC count and associated drop in hemoglobin. It never recovers during my off week of Ibrance and, in fact, has continued to decline even with 2 1/2 weeks off. Claire has indicated she had a dramatic drop in hemoglobin her second round of Ibrance but not this steady decline. A transfusion helped in her case. Perhaps my blood is waving the white flag and I need some new stuff? Another mystery to discuss with my oncologist. Good thing he's patient.
Bad news is I am definitely tea total for the next little while. Alcohol and one of the antibiotics do not mix! So much for a caipirinha in this hot weather...
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Hi SadiesS,
I will tell you what I know - but it will be full of generalities - not specific to your case.
A thoracoscop involves looking inside the chest ie thorax, with a videoscope.
There are many reasons for such a procedure, but you GOT IT, not to be lightly taken.
Among the most common ones related to above adhesions ( loculated may also be used to describe it)
- tissue for diagnosis
- to surgically get the two layers of pleura (visceral and parietal ) to close - this is called a pleurodesis.
You can also perform lung surgery with the aid of a videoscope - and it would then be VATS ( video assisted thoracic surgery)
It involves a general anaesthetic, a double lumen tube ( not small - for ventilation) and hemodynamic monitoring - intra-arterial line. You need good post operative pain management and physiotherapy for optimal lung recovery.
PM me if you have any specific questions?
As to the RBC - ie your dropping hemoglobin, they have a longer life span - thus slower turn over then white cells.
Unless there is a nondrug related reason for your anaemia - you could ask your patient MO - whether it would be worth doing serum iron studies, and also looking at the full blood count - is this a microcytic or macrocyclic anaemia you are battling? ( ohh ...he will love you for that!) 😊🌷
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Hi Liz,
I am assuming you are trying to recover from the onslaught of all the drugs.
Always thinking of you!!
( I am often slow - superblooming slow in some thinking processes - but you know I am wondering what colour was that blazer??)
Hugs galore,
Ioana 😊🌷🌷
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Hi Ioana
I hope this post finds you well. I continue on a positive path to recovery. I still have moments when I experience fatigue and some residual GI issues now and again. However I am feeling stronger everyday.
My last Taxotere tx was 29 June. I have my second HP in a week's time. I am now on monthly Falsodex injections and yesterday started Letrozole, after an incompetent 10 day delay on the part of my local med centre!
I did look st the SE's for the AI but then I've adopted the wait and see approach. I could begin to stress over what could happen, but for now I will deal with it as each SE occurs ( and if they occur)
I could use some advice though about supplements to minimise bone loss. Should I be taking cod liver oil etc? The flashes are increasing now but I take a deep breath! Occasionally my sleep is affected though....😡
This is me with some make up on and my best wig. Last night was yet another belated birthday meal with good friends. This is the best I have looked and felt in months.
The blazer is mighty fine. Navy blue with a fancy lining. Will send a photo shortly.
Pat: will PM you this eve.
Hi Claire, how's things? I haven't jumped on Ibtance thread so occasionally out of synch with updates.
Happy weekend guys x
L x
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hi liz lookin good dear heart big huggs for birthday
I had bone density scan after one year of letrozole no change
Have been taking calcium with vitamin d so bloods are excellent in normal range
Seems that some people strart out with osteophenia or even osteoporis and letr I zole can have a very damaging effect so that have to have extra therapy for this
All best bright
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Hi Bright
Thank you for your kind words.
Think I will look into supplements at my local health store this weekend. I appreciate your thoughts on this as I start the hormone therapy.
Liz
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Liz - Sorry I have been tied up with new onc and appointments after returning from Paris. Here is a pic of Monet's beloved gardens at Giverny where he lived for 43 years. Amazing. I think you look great in your wig and love your twinkling eyes. If you ever have problems with bone density; Xgeva (given in a shot) is a much better choice than Zometa (given IV), and less bad SE's like osteonecrosis or ONJ. I will be on IV chemo for 3 mos (no port), onc will scan after 12 weeks to see how I am doing. I plan to work from home for 3 months or so, then hoping to move to an oral chemo like Xeloda, and return to the office part time. I am still in your pocket, albeit smaller as I have lost another 7 pounds. I loved my first class air to Heathrow on BA - worth the splurge. My sister came up and had champagne with me along with part of my dinner and breakfast - as my suite was easily big enough to serve 2! Ioana - always lovely to hear from you my Aussie sister, ditto Pat my sweet CN friend. We are such a good support team for each other. Liz - you rallied us and we are not leaving. Much love on this sunny, hot, humid CA day.
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Looking good Liz! As to supplements, I currently take calcium but probably need to do a better job of proactively ensuring that my bones stay healthy. It is one area where I appear to be lucky. I was heavy for many years and as a result have very strong bones. But now that I will likely be on an AI for an indefinite period I need to take more care.
So glad to hear that you are feeling stronger.
Claire, lovely to have you back on the Forum although I am sure you would prefer to still be in Paris! I've really appreciated the information/advice you have provided while I sort through my latest lung/blood issues. Not happy to hear that you are losing weight. Is your oncologist concerned? I have always found it interesting how different we all are. So many struggle with weight gain and yet, you and I seem to be more inclined to lose. I lost more than 10 pounds in about 2 months between first symptoms and diagnosis and, while I seem to have stabilized, need to force myself to eat to keep the pounds on. Probably not enough wind consumption..
As always Ioana, thank you for sharing your knowledge. I'm trying not to jump the gun as we are still waiting for the tests to come back but must admit that I am not overly thrilled with the notion of that procedure. Bit too invasive given the limited benefit. Seems to me forging ahead with my current treatment in the hopes that it dries up the remaining loculated fluid makes more sense. But we shall see...
Hope all of you have a lovely weekend in all our various time zones. It's a holiday in Canada on Monday so I have an extra day to recover before the onslaught begins again.
Cheers. Pat
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Hello Liz,
You look great - nothing like a good meal shared with friends!!
This is a link to a great post by bestbird
https://community.breastcancer.org/forum/8/topics/...
I am not suggesting you should take all of them - but it is an informed glimpse into the wonderful world of integrative oncology. I have not seen someone yet - I wanted to wait until all the poisons were truly out of my system but it's the next step in my plan of staying well.
Claire has already mentioned the big guns of bone preservation.
There is some work showing that denumosab ( Prolia) maybe be protective, even in the absence of documented bone mets.
For the simple things
- bone density scan - so you know where you start
- Vit D support ( I use 5000units daily and get it from an American site called iherb)
- calcium supp ( you can either go daily or a higher dose ten days a month and a break)
- weight bearing exercises - walking and a set of simple 1.5kg weights for a set of upper arm repetitions can fit into any schedule, plus Z posted yoga poses
- if you walk regularly worth going to a physio/sport centre and getting your running shoes fitted to your gait - eg flat feet need arch support etc - our guys are called 'active feet' - go figure!!
😊🌷
Claire - a little while back you mentioned silk blankets - I looked them up as it sounded divine - any particular brand ?? Did you order it online? I have to say the US does much better on product choice.
On that loss of weight - I am sure you got this... protein drinks ...I say that partially because a visit to a nutritionist is my to do list.
Thank you for the photos - the gardens are astounding - you can almost see the man at his art!!
I have this little motto when I think of you 'when only the best will do!'😊
Ioana 🌷
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Hi Ioana
Thanks for that nutritional information. I am going to discuss with York on Thur. I doubt they will be much help though as I've never been given any dietary advice.
Not sleeping well since I started Letrozole. I miss having days ( and nights) when I realise I haven't thought about bc.
Saw my nephew and his girlfriend today. Young couple just starting out. My treatment wasn't really discussed but few people realise that I'll always be in treatment. Hmmm .......
L x
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Claire,
Wonderful photo and wow what a holiday!
The BA flight too- jealous. I'm planning something special for my 50th. You guys can help me with the itinerary.
I'm with you as you embark on this next treatment. Claire.The plan to work from home sounds wise.
X
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Hi Ioana,
I need to seek your advice yet again as it appears that I have traded one problem for another. My condition is much improved thanks to the antibiotics. While I am not 100%, still coughing and SOB going up hills, I am able to function again, walking Sadie at almost my usual pace. At least I was able to function again. I now have severe nausea, I believe from the Metronidazole. I feel horrific with gut pain and nausea to the point that vomiting would be a relief. (Not there yet.)
I am taking the pills with food, drinking plenty of fluid (possibly too much as I keep hoping it will settle my stomach - it doesn't), taking a probiotic and eating natural yogurt when I can (recognizing that dairy interacts with the Cipro). I don't know what more to do. Any suggestions?
The respirologist prescribed one week with a three week repeat if necessary. I assume this will depend on the results of the culture but the thought of another three weeks of this gut is pretty daunting. If it's not one thing it's something else! Sigh...
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Will pm you - although I am not sure I have much wisdom to add.
😊
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hi Liz,
The following study relates to an older post of ours referring to nonsupportive relationships - hey les call them destructive.
https://academic.oup.com/aje/article/157/5/415/766...@fimnet.fi
It basically states that the risk of breast cancer is twice ( the hazard ratio is double) in women who have had a divorce (in fact hubby dying is less of a risk then the breakdown). It is a prospective cohort study of 10,000 women published in the American Journal of Epidemiology. It might have to do with ones capacity to resolve/end death whereas the other being a continuous cause of stress but that is my simple speculation... still data is data. So 'let it go' on a number of fronts (relationships included but more importantly for me present little stuff) is my new motto.
SadiesS - Absolutely GO to the September champagne! WOW wow wow
Are you really back at work? Should you be? Can you offload some responsibility for much needed head space??
I ask because unless I am very lazy and very disorganised I have to tell you these days I need ( or just am aware of that need) a lot more time for myself.
I am undergoing some self imposed puppy training. The puppy is me. I used to make a quick list of to do for the day while having my coffee. It is now green tea and that is ok. I split the list into urgent/ and important ( the urgent being the stuff that makes the world run/ the important being the stuff I need to do for me) and I refuse to focus on the urgent until much about the important gets sorted. Like lots of women I have a job, a child, two parents and a house. - not to mention the chooks - wish me luck.
To both of you Hope that today brings answers.
Lalady1 never far from my thoughts. Hopefully Abraxane treats you gently. 😊🌷
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Sooo.... that jerk I went out with for awhile is responsible? Good to know. 😉
Yes I am back at work and no, probably shouldn't be. It's a bit of conundrum. I want to work but my job is stupidly stressful. Quitting to take a more reasonable job would be committing economic suicide. I would lose a high salary, gold-plated extended health, disability benefits and it will impact my pension. Yet I don't feel I am ready to go on full time LTD (and would also feel pretty uncomfortable as I can work, at least for the present). So, for the present, I keep working when I can (thankfully not a physical job) but figuring out how to create that healing space is never far from my mind. Still deliberating...
Hope the next round of HP is kind to you Liz. And Claire, also thinking of you, hoping all is well.
Pat
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SadiesS how are you traveling? DiV will still chuckle at that one - but this is a few pages back in the thread.
Fever? Shortness of breath? Walks?
I know Liz is away - enjoy.😊🍷
I have a new hen and found a good home for my roosters.
I have a day off on Monday - I will walk and read to my heart's content.
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this is something I have looked into as part of handling work stress - it is the only thing that I know that is able to change physiological parameters such as blood pressure and heart rate in reponse to stress.
http://www.med.navy.mil/sites/nmcphc/Documents/hea...
So what I am trying to say that in response to stress your heart rate and blood pressure go up, pupils dilate, you get sweaty, tremor and so on - the higher the stress the greater the response. Although we experience less 'high stress' in daily life, it is continuous in nature. Deep breathing such as described above is the only thing that allows you to consciously control that physiology.
The army uses it all the time but instead of calling Yoga ( which I expect it's where it's started conceptually) yep too touchy feelyso the boys, they call it combat or tactical breathing.
Here is a link with an overview of the physiology
http://goflightmedicine.com/on-combat/
🙂🍷( ahhh breath, long sip of a great Pinot, breath again - well you all get the idea!
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Hi Ioana,
Things improved with the antibiotics so walkies with Sadie are better. No fevers at this point.
I spoke to the respirologist yesterday and he reiterated that I'm a bit of a challenge. Nothing grew from the culture but then he only took a sample from the largest pool of liquid in my lung. Interestingly no malignant cells either. But the thing is, my pleural cavity is a mess now. Lots of adhesions and small pockets of loculated fluid 10-30 mL in size. Which one had the infection? Hard to know. Apparently he consulted with my surgeon and in his words "he groaned". Not a good sign - he doesn't want to have to go in to clean it up. So, I think I am stuck with some SOB due to the adhesions and fluid (hopefully this will continue to dry up). I also believe I am still dealing with the hemoglobin issue. Next blood work scheduled for next week so will know better. My MO is away until the 21st so if it is seriously low I will need to connect with someone else at the Cancer Agency.
I studied mindfulness meditation at one point but found it hard to make space for it in my busy life. It's a high priority now among other changes I need to make. I'm reading Radical Remission at the moment, trying to wrap my head around the proposed dietary changes. I do eat a lot of veg but the prospect ofno meat, no dairy, no sugar (aka. no wine)? This is a tall order.
Glad to know the chickens got sorted. Enjoy your day off!
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😊
GREAT news on finding no malignant cells in that specimen!!!!
And sounds like you found a wise surgeon - love them when they don't jump in, when all symptoms are improving. A wait and see approach is supersensible. You may still need a pleurodesis at some distant point but it will be a lot easier if Mother Nature cleaned up a lot first or it may resolve actually enough for good function.
SadiesS there is another explanation but without films ( ie knowing how big was the effusion and associated loculations ) I am speculating. Now that you are stable you can ask - I am assuming the effusion was considerable in size.
Sometimes these catheter irritate the pleura and the pleura bleeds - forms a hematoma - fancy word for a large bruise/clot - risk higher in the face of impaired platelet function you would have on Ibrance. When this clot/bruise reabsorbs - it can form adhesions and the process of reabsorption can give you fevers - plus sometimes the clot itself can get infected. Depending on the size of it - it can explain your anaemia - the lab picture of the anaemia will be microcytic ( blood loss or iron depletion) or in chronic illness - mixed ( sometimes chronic illness patients have a Vit B deficiency as well). It will be interesting to see how your blood picture behaves now this is improving.
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Liz and SadiesS
I put that inspire counting to four, hold for four and exhale for four up because it is the only technique we know off that actually improves physiology - in the face of stress.
The army and the rescue medical forces use it not to combat "stress" per se - the problem when you are stressed past a heart rate of 120 ( there are lab studies on this) you start getting a tremor and as your pupils dilate your vision is impaired - and you can see skills sets such how shooting or intubating someone on a field would be impaired. So they do the "tactical breathing" to control heart rate ( noradrenaline , cortisol etc) and thus not have the hand tremor, improve vision.
(PS above 160-170bpm the boys get really wired and loss of bowel and bladder function happens😨)
Radical Remission is the next book on my list.
I was just talking to Liz about this - I am reading Anitcancer: a new way of life David SS - and it has some good concepts.
For my part I can not give up/ wish to give up cheese, yoghurt, wine and the occasional red meat but I can certainly work a lot more organic vegetables and green tea in my life, add some turmeric and shallots to my salad dressings - heck take the time to make the salad dressing like I used to in Paris.
Roosters found a home - came back from that farm with one hen!😊🌷
We are trying to plant corn, carrots, potatoes and kale - they should not be too hard to harvest - famous last words!
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Hi. Interestingly thoughts. The respirologist also mentioned that the immune response to the adhesions could be causing fevers. My effusion was quite large (almost three litres) and, while there was no sign of blood for most of the draining, the last few drains were quite sangiuneous (totally did not get the spelling right on this).
I also can't imagine being that rigorous but there are a few things I can easily improve, particularly staying away from sugar and processed foods (although I don't eat much in the way of processed good). I also want to experiment more with smoothies and can try to eat more raw veg rather than steamed. Green tea is not an option either Ibrance... go figure.
Smiling about the vegetable patch. Nothing ever goes as planned. Here, the darn deer would get the crop before I did. Last year rats managed to decimate my tomatoes and this year they ate the only two Cox's Orange Pippins on my trees. (Cold winter led to poor pollination.)
That book is on my list as well. Let me know what you think.
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Hi all
Have returned from a week's holiday. It has been great fun: lots of lovely restaurants, interesting places to visit, long walks, one on a Welsh beach and family time.
So now I am home and working towards preparing for the start of term.
I have given work some thought and have decided to build some days off into my return. I like Autumn and want to have some time to walk, meet a friend and unwind. If my family are lucky I might even make them a stew!
How is everyone? Missed you guys.
L
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Welcome back Liz.
It's been very quiet on your thread... just Ioana and I talking to each other! It sounds like you had a lovely time. And I'm glad that you are thinking about a phased return. I vacillate back and forth on what to do about work. In an ideal world, I would go down to 3 or 4 days per week. I just don't move as quickly as I used to and as a result I feel I am always spinning.
I think that you and Claire are having an influence on me. I'm also starting to turn my mind to travel now that the catheter is gone from my life. I'm feeling so much better now with the infection gone. The two places that are top of mind for me at the moment are Costa Rica (would need to be February or March) - the biologist in me loves the idea of all that wildlife and diversity - or more immediately, perhaps a trip to New York. A few Broadway plays... a stroll in Central Park.. and a few museums... All dreams at the moment but seriously starting to look into something.
Glad you are back. Look forward to more updates.
Pat
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hello Liz,
Welcome back - hope you all enjoyed your break.
I don't know about you ladies but you are clearly stronger - I work three days (granted long days) and I struggle with time for myself. You see while on chemo and radiation although I was sick physically I had a lot of "me" head space - it gave me an excuse to slow down and strangely it was good for me. I am probably not explaining right but you get the drift - it was horrid in many many ways but it forced me to stop. I need time to properly care for myself - I think we all do.
I spoke about this before - I am slowly trying to make small cut backs on both time and budget. I have moved to comfortable sneakers for work - I sneak into the hospital at 0600 am so I am unlikely to be on parade. I have kept my hair short - this way I don't have to die the whites - it spikes and takes next to no time.
I have made a budget - wow - the first ever - because I always assumed I would just work more. It doesn't quite balance but it's a start.
Probably the hardest thing for me - is letting things go - part of my obsessive personality is essential for work and that needs to stay but there are a lot of small things that I am teaching myself to ignore. Learning how to pick the good stuff and let the rest go - not be so sensitive, not vibrate every time someone expresses a need, an opinion etc etc etc.What seems to work best for me is offering myself a reward - no matter how small - cup of tea, walk, as a distraction - and then ...I smile.
Liz - I know your scan is coming on the 29th but will leave that to that day. Definitely thinking about you.
Pat - so good to hear that you are better - how is your Hb -?? are you going back to Ibrance.
I love both New York and Costa Rica as destinations - have not been to either. Yes travel be it close or far is important.
On the threads - good things about Abemaciclib. It may be quite different - following.
I am also following the two started by Z on cfDNA and immunotherapy. Clever and very exciting - lots to say about it - please have a pick if you haven't already.
To wrap up -downing my home made yoghurt everyday - I use an Australian culture but Genesis on Amazon have a good brand. And trying to get my exercises in - lots of walking, some yoga and some weights. Pushing myself to get back to my swimming.
I have followed Claire from afar. Gentlest of hugs!!
😊🌷
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Ioana,
I understand completely. I often described my first experience with BC as a curse and a blessing rolled into one. I was fortunate not to be extremely sick while going through aggressive chemo and radiation (with the exception of a couple of blood infections) and continued to work full time throughout. My job was very flexible and there was no requirement to interact with the public so it provided a necessary distraction. Having said that, for the first time in my life I cut myself some slack. My expectations of myself were significantly lower, I listened to my body, resting when I needed to and didn't drive myself as hard as I typically do. When I was tired, I napped. I also walked a great deal. That gave me the "me time" that you spoke of.
Unfortunately, as the years went by I slipped more and more into the old habits. I did maintain some things, my haircut being one of them. I used to joke about the MacPherson buzz cut (after my oncologist). I have very fine hair which I used to perm. Each day was spent with the blow dryer, curling iron and tons of hairspray to hold it all in place. I would never have had the guts to go super short but when it came back in after chemo I quite liked it. Since that time I have kept it short and easy - wash and a bit of gel to get me through the day. (Well, now I'm back to fuzzy duckling hair but it is coming back.)
I really hope you stick to your guns and maintain that space for yourself. It's easy to forget "me time" in our busy lives and with all the demands placed on us. Now I'm in a different place, and to be honest, I'm finding it difficult to carve out that space. One challenge is my 86 year old mother who is doing great for the most part but tends to be the "Queen of Can't" in many ways. I feel the pressure of trying to meet her needs while trying to take care of myself. And then there is work... But slowly I am also trying to cut extraneous things from my life and looking for ways to offload responsibilities where I can (i.e. doggy daycare, hiring a gardener, etc.).
As to the Hb, it was still very low last week when I had my blood work. Increased from 81 to 82 over a two week period but that was after a month off Ibrance. I'm on day 9 of my fourth cycle of Ibrance so suspect that it will start dropping again. My MO just returned from two weeks away and indicated he would get back to me once he reviewed my blood work, etc. He may decide the toxicity of the Ibrance is a problem but I may suggest we play with the protocol a bit, perhaps two weeks on and two weeks off. I firmly believe that there is much to learn still with this drug.
I'm also following the discussions on Abemaciclib, immunotherapy and cfDNA. Lots of interesting information. I'm particularly interested in the Abemaciclib. I think it may prove to be a much better option. The question I have, if I need to switch to Fulvestrant down the road, would Abemaciclib be an option now that I have been on Ibrance? Interesting regardless.
Wishing you all a stress free week. Cheers. Pat
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Hi Pat and Ioana
Thanks for keeping the thread going ladies. I have had time away and time to think.
Above all I am trying to make my life easier. I am therefore working on that principle whilst being realistic about how much I can change things.
Trying to be calmer, care less, stress less, engage in argument less etc. There were times on holiday when I really yearned to just please myself. However my family situation won't change for a couple of years until the boys go to university.
However on work free days I can: enjoy Autumn walks, coffee shops, shopping trips and lazy sofa days. So I do hope to achieve a better life balance. Of course I pray that I am well enough to choose my path for a while. The end of August scan looms. I wonder what I can expect? It seems so cruel that I feel relatively fit when this horrible cancer is lurking...
Claire- how is tx going? Di- what is new in your life? Erin- how is life on HP for you?
Hugs to all
Liz x
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Pat,
I will write more soon but just wanted to remind you of this.
https://clinicaltrials.gov/ct2/show/NCT03007979
It was mentioned on the Ibrance thread once.
I often wondered if the three weeks on/one week off simply mirrored chemotherapy regimens and whether Pfizer pushed that dosage through trying to get ahead of Ribociclib.
I am tempted to say the Hb is not all Ibrance - some of it may be chest and sepsis and you just did not have the resources to make it up. If it was all drug and nothing else I would guess you would have hovered at 10 after being off drugfor a month.
(as to Abemaciclib - if one has fair stability and some time, my answer would have to be YES - it's a different drug - the side effect profile is significantly different so it's mechanism of action MUST be different - and we know that it is)
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