Friday, January 18, 2019

Sew Chaotically! ~ SCRAP (not stash) busting!!!

Lot's of sewists are wisely and ethically talking about and acting on "Stash Busting" ~ the process of using their current "stash" to make beautiful things rather than purchase more and more.  For the uninitiated, a "stash" may refer to fabric purchased and stashed for future use, but can also include patterns, ribbons, buttons, and other bits and bobs.  I used buttons I already had in MY stash (recycled from shirts that had gone the way of the dodo) in my recent makes for my boys.  I applaud those goals and work to keep my stash small and used as well.

But, this post is about what to do with the little scraps leftover from your making!  If you sew often, the quantity of these bits can really add up.  Sadly, I would end up throwing lots of these remnants away!  Or box them in a closet never to be seen or heard from again! As one who recycles and composts, this was not okay!!!  Obviously, I use pieces that are sufficiently large to make facings, line pockets, and even piece together garments.  Some patterns really lend themselves to that!  Here are a few I've used:

The Linden Sweatshirt by Grainline Studio is a great way to use remnants!  You can make it long or short and even piece the front and back as needed, based on the size of your scraps!

The Polly Top (a FREE download from By Hand London) is another great scrap buster.  This one was made using a gingham remnant and fabric from a knit top that was never worn!  The one below was created from a scarf Roo didn't use and a bit of left over yellow cotton gauze!  

I've lost count of the Sorbetto Tops (a FREE pattern from Colette!!) I've made!  The back can be cut on the fold (or not) and the length and utilization of the front pleat is up to you.

This little top (M7093) is also useful for scrap busting and lends itself to lots of different looks!       

V1440 creates a pretty top, which allows you to use bits of your stash in the contrast pieces.
I've made several workout tops using M7610!  A fun make and another great way to use up those random bits leftover from knit projects!!! 
 Another way I use my larger scraps is in making bias binding:

It's actually fun to make!
When you use it, the results are so cute and profesh!!!
But what about those smaller bits...that really can't be used for pattern pieces or binding????  SADLY,  I was tossing those!!  No more!  I have embarked on two new projects that will let me find a useful, pretty outcome for them as well!!!

Bonnie Hunter's Carolina Chain Quilt.  Deets here and here!!!

Now, before completing a project, I am cutting scraps into 2 inch wide strips.  Once I have enough in color groups I like, I will start piecing them!!!
For the bits that are too small for even that????  Got plans for those, too!!!  As filler for a POUF for B to rest his leggies on!!!  (There are lots of options out there, but Closet Case Patterns has a free pattern available.)

I've put together an AMAZING system for collecting these scraps!  
A shopping bag hanging near my sewing area makes gathering them easy!!!
Time will tell how these last two projects turn out.  So far, I think I'm set to collect the building blocks for both of them!!!  Here's to "stash" and "scrap" busting!!!  Sew Chaotically!!! - les

Thursday, January 17, 2019

MERDE! ~ Yes, again......

Oh my dear sweet Stevie.

I learned today that you are gone.  I believe you always knew how much you meant to me.  I certainly knew how much your lovely S and those kiddos meant to you!!!  You were such a trooper.  A loyal man, dedicated to your family.  You were so glad to be able to spend more time with them, often mentioning your walks and meals with S in particular, in these recent years.  I am glad you had that.  You were patient and brave.  Willing to play my silly musical games.  Willing to 'call BS' on my shenanigans as needed.  Ready to offer help to others when you could.  Thanks for putting up with my silliness and bossiness.  I am so glad I got to meet you and S in person.  I loved your smile.  I will miss you, my friend.  But, I will hold you and yours in my heart forever.  Rest in deserved peace.  May precious memories soon bring more smiles than pain to dear S and your children.

Much love, c

Wednesday, January 16, 2019

Rheumatic issues and arthralgias (joint pain) when utilizing anti-PD-1 (Opdivo and Keytruda) melanoma treatments

Unfortunately, joint pain while on immunotherapy is fairly common.  The degree to which the patient suffers is almost the only variable.  Some of us are managed fairly well with things like ibuprofen and stubbornness.  Others are debilitated to the point that treatments must be delayed and other medications like steroids and immune modulators like Remicaid are required.  If you search this blog under 'immunotherapy side effects', you will find zillions of articles on joint pain and immunotherapy. 

 Now, there's this:

Rheumatic immune-related adverse events secondary to anti-programmed death-1 antibodies and preliminary analysis on the impact of corticosteroids on anti-tumour response: A case series. Mitchell, Lau, Khoo, et al. Eur J Cancer. 2018 Nov 12

Rheumatic immune-related adverse events (irAEs) occur in approximately 10-20% of anti-programmed death 1 (anti-PD1)-treated cancer patients. There are limited data on the natural history, optimal treatment and long-term oncological outcomes of patients with rheumatic irAEs.

The objective of the study was to describe the spectrum and natural history of rheumatic irAEs and the potential impact of rheumatic irAEs and immunomodulators on anti-PD1 tumour efficacy.

Cancer patients with pre-existing rheumatic disease before anti-PD1 therapy or de novo rheumatic irAEs on anti-PD1 therapy were retrospectively reviewed across three sites. Patient demographics, treatment history, anti-PD1 irAEs, and anti-PD1 responses were evaluated. Relationships between the development or pre-existence of rheumatic irAE, use of immunomodulatory agents and outcomes were evaluated.

This multicenter case series describes 36 cancer patients who had rheumatic disease before anti-PD1 therapy (n = 12) or developed de novo rheumatic irAEs (n = 24). Thirty-four of the 36 patients sustained rheumatic irAEs (median time to rheumatic irAE: 14.5 weeks), including 24 de novo (18 inflammatory arthritis, three myositis, two polymyalgia rheumatica, one fasciitis) and 10 flares in 12 patients with pre-existing rheumatic disease. Corticosteroids were used in 30 of 36 patients (median duration: 10 months), and disease-modifying antirheumatic drugs were used in 14 of 36 patients (median duration: 5.5 months). The objective response rate to anti-PD1 therapy was 69% (n = 25/36) overall and 81% (n = 21/26) in the melanoma subgroup.

Rheumatic irAEs are often chronic and require prolonged immunomodulatory therapy. Prospective studies are required to define optimal management of rheumatic irAEs that maintain long-term anticancer outcomes.

So yes, there may be the need to continue treatment for joint pain and arthralgias after completing immunotherapy.  However, these response rates look pretty good!!!  Pros and cons - the life of a melanoma rattie.  Hang tough out there! - c

Tuesday, January 15, 2019

Chaotic Cookery! ~ French Daub, my version!!

 I've been cooking for years and years!  Literally:

Yep!  That's me at the age of 3, rolling out pie dough!!  I still love cooking.  I once wrote:  It is an artistic outlet with love and utilitarianism combined.  For me, cooking is fun, relaxing, and provides a delicious result!!  But, better than all those things, it allows me to share time and love with dear ones.  Brent and I worked hard to make sure that we sat down to dinner with the kids EVERY DAY!  It was a precious opportunity to share our day, laugh, and EAT!!!  We are all hardy and adventurous eaters which added to our cooking fun.  For us, our travels often began in the kitchen with a cookbook and culminated in bringing the tastes and smells discovered on our adventures back home, as we worked to recreate dishes we had enjoyed.  Which brings me to this....

As I clipped recipes and documented my own, I kept them in this black spiral notebook.  Eventually, the kids dubbed it the "Black Magic Cookbook" and made this cover!

If you want the best "Beef Stew" in the world, there's just no competition.  Simply turn to Julia Child's Boeuf Bourguignon!  You can't beat it.  For an easier, cheaper, yet still really delicious version there are lots of French Daubs.  Here's mine...
Do NOT get hung up on specific quantities or ingredients!  It's stew after all!  Add what you like.  Don't want to use wine, use extra broth or water.  Don't like carrots?  Leave them out.  Got some mushrooms wasting away in your fridge?  Toss them in!!!

Stew is not the most photogenic dish!

But on a cold day in January, it is a beautiful the thing. And if you aren't careful, your bowl will empty before you remember to take a pic!
Now, if only some birds would come to my feeder!!

Guess they heard me!!  HA!
May you enjoy a lovely winter day!!  And, if you're up to it - a little Chaotic Cookery!!! - love, les

Sunday, January 13, 2019

Baseline levels of IL-9 predicted response to Adoptive cell therapy (ACT) using TIL in melanoma and a complete response in TIL paired with nivo (a case study)

A little old, and I don't tend to post much on TIL - but still....  Here are two reports:

Prospective analysis of adoptive TIL therapy in patients with metastatic melanoma: response, impact of anti-CTLA4, and biomarkers to predict clinical outcome. Forget, Haymaker, Hess, et al. Clin Cancer Res. 2018 May 30.
Adoptive cell therapy (ACT) using tumor-infiltrating lymphocytes (TIL) has consistently demonstrated clinical efficacy in metastatic melanoma. Recent widespread use of checkpoint blockade has shifted the treatment landscape, raising questions regarding impact of these therapies on response to TIL and appropriate immunotherapy sequence.
Seventy-four metastatic melanoma patients were treated with autologous TIL and evaluated for clinical response according to irRC, overall survival and progression free survival. Immunologic factors associated with response were also evaluated.
Best overall response for the entire cohort was 42%; 47% in 43 checkpoint naïve patients, 38% when patients were exposed to anti-CTLA4 alone (21 patients) and 33% if also exposed to anti-PD1 (9 patients) prior to TIL ACT. Median overall survival was 17.3 months; 24.6 months in CTLA4 naïve patients and 8.6 months in patients with prior CTLA4 blockade. The latter patients were infused with fewer TIL and experienced a shorter duration of response. Infusion of higher numbers of TIL with CD8 predominance and expression of BTLA correlated with improved response in anti-CTLA-4 naive patients, but not in anti-CTLA-4 refractory patients. Baseline serum levels of IL-9 predicted response to TIL ACT, while TIL persistence, tumor recognition and mutation burden did not correlate with outcome.
This study demonstrates the deleterious effects of prior exposure to anti-CTLA-4 (though perhaps that result is only due to those patients being "infused with fewer TIL"??????!!!) on TIL ACT durability and perhaps more importantly shows that baseline IL-9 levels can potentially serve as a predictive tool for response and help guide treatment sequence and selection.

On the other hand:

Rapid complete remission of metastatic melanoma after first-line treatment with nivolumab plus tumor-infiltrating lymphocytes. Zhao, Yang, Li, et al. Immunotherapy. 2018 Sep 10.

Melanoma is the most common type of skin cancer in both men and women in the USA. The standard treatment modality for advanced melanoma is immunotherapy, either alone or in combination. As single-agent immunotherapy is usually inadequate, combined immunotherapy might be a good choice and combined treatment modalities appropriate for melanoma need to be explored. Herein, we report a case of metastatic melanoma successfully treated with combined therapy of tumor-infiltrating lymphocytes and nivolumab. Complete remission was achieved approximately 4 months after the initiation of treatment. The treatment was well tolerated and only grade 1 fatigue occurred. The patient was still on complete remission 1 year after stopping the treatment. Our result showed that this treatment modality might be an ideal option for patients with metastatic melanoma.

Wonder if that patient would have had that complete and durable response to nivo alone, as I know from personal experience (and that of others) that nivo alone CAN provide complete responses in contradiction to the statements made in this report.  Additionally, how did this patient attain this therapy?  Hmmm....

For what it's worth. - c

Friday, January 11, 2019

Sew Chaotically! ~ Three MEN's shirts! Three happy boys! M6044

Since October I have had a blast sewing for others.  This challenge was no exception.  Three men's shirts for three of my fave boys!  The challenge was that I had none of their actual measurements nor bods available for fittings.  But, there was a lot of love and a resident "Mannie" (aka B!!!) to use as a block for adjusting the garment smaller or larger in areas I felt appropriate for each recipient.  I chose this McCall's pattern as it had good reviews and the simple lines I wanted.  Poor Jamester's shirt was the guinea pig, in that I made his first.  For him, I made a straight medium with no adjustments.  It went together very well! Fabric choice by his girl, Miss Roo!!!

Rather lame pic, as MY "mannie" is way too small for this shirt....but still!

Much cuter on the Jamester himself!!!
Now - nice flannel versions for my Dear Double D's.  Pic from a celebration with Dan and Don a couple of years ago!

I had fun playing with the pockets!
The placket for the cuff was super easy because the sleeve was made in two pieces.  Leaving a portion open and hemmed formed the placket. I flat felled the seams using one of my favorite tricks - sliding a plastic clip board underneath the fabric so pinning is easy while the piece remains on my ironing board.
Ta dah!!!!!
And they're done!

I think they liked them!!  At any rate - I had fun!  Sew chaotically!!! - les

Tuesday, January 8, 2019

First follow-up appointment after CAPOX for ex-goblet cell adenocarcinoma of the appendix (GCC) and a RUN!!!

Yesterday was my first follow-up appointment with my oncologist after completing (in my own special way, full deets in prior posts) the 4 rounds of oxaliplatin and capecitibine in the past 3 months prescribed as adjuvant for my Stage II GCC.  Whew!  In so many ways!

It was pretty non-eventful as expected.  Here's my self report:  My feet still burn quite a lot.  Although I no longer feel like I am walking in over-sized clown shoes!  My fingers are still pretty numb at the tips but I can type, pick up pins and deal with other fine motor skills much better than previously.  The area of the IV infiltration to my right forearm is still red, weird and tender - but improving since B had the genius idea of putting a moderate strength steroid cream on it twice daily.  It is no longer waking me with pain when I accidentally smush it in my sleep!  I have been dealing with pretty significant joint pain, particularly to ankles, knees and hips since the very start of treatment and they are still hanging around with a vengeance!  The brown splotchy lesions I developed are gradually resolving.  Oddly, patches of vitiligo that I began to develop in my Opdivo trial are increasing.  So, weird.  BUT!  My abdominal pain is gone!!  I can eat pretty much what I want though I am taking that adventure slowly and still taking my pepcid.  Currently, salads, citrus fruit, and apples with peels are back on the menu! FYI (with a TMI warning!!) ~ After surviving 2 months of liquid poopage every 2 hours round the clock following surgery to remove my appendix and right 1/3 of my colon, succeeded by obstruction and a second surgery, and all sorts of crazy poopage problems while on CAPOX with at least 4-6 loose stools on the good days, things are much better!  Stooling is not "normal" with 2-3 loose stools per day combined with some urgency ~ when you gotta go - you gotta go!!!  Still, if you are facing this sort of colon removal, it is a manageable process!

Anyhow, the main point of my recheck was to determine a plan for long term follow-up.  B rechecked with the docs I consulted at Vanderbilt, not to mention all the papers and peeps knowledgeable about GCC.   We went over their points and her own perspective with my local oncologist.  In the end, we determined that I will have my first follow-up scan (a low dose CT without contrast of the chest and regular CT with and without contrast of the abdomen and pelvis) at the end of March.  Future scans are planned to be a CT without contrast of the chest combined with a CT of abd/pelvis WITH contrast only, in order to keep continued radiation exposure to a minimum.  The consensus is to have your first scans 6 months after diagnosis and then annually.  Additionally, I will be seeing the oncologist and having lab work, to include a "CEA" level, every 3 months.  What is "CEA"?  Carcinoembryonic antigen is a protein in your blood that is normally very high in a fetus, but is usually low in healthy adults. It can be elevated in those adults should there be a growing thyroid, lung, breast, ovarian, pancreatic, stomach, bladder, colon, or rectal cancer.  As you see from the list, GCC is NOT included.  We are rolling with this test due to its usefulness in colon cancer which may, or may not, match up with my cancer. In fact, when it was drawn in the hospital just after having said cancer, my levels were normal.  But, we'll try it.  B is also researching other tests we may add to the mix.  How long will this go on?  The end point was not conclusively determined, but will likely be somewhere between 3-5 years.  All peeps interviewed agreed that we are at the point in my melanoma ta-dah (16 years overall, 9 years Stage IV and over 8 NED) that I am no longer in need of scans in that department.  Obviously, additional studies would be ordered should I develop untoward symptoms or demonstrate adverse numbers in my lab values.

In the spirit of upward and onward, combined with a break in the cold rainy weather that has been a bit perpetual lately,  B and I have done some "structural" work on our garden (taking out some saplings and overhanging tree branches, pruning overgrown roses, crepe myrtles, fruit trees, and rhodies) as well as taking down some netting/fencing that prevented the intrusion of rabbits and deer not at all!  I have continued to increase my indoor work-outs moving from 10 minutes to 15 on the elliptical as well as upping the 'level' from 3 to 4!  I am doing more sit-ups, push-ups, planks and reps with my weights.  But, the coup de grace to call an end to my incarceration is this:  I completed my first run since August!  It was more of a slog.  Only a mile.  But, I did it!!! 

Pre run!
On my return!!!  None the worse for wear.  With photos from my ever watchful Medical Meerkat Photog!
It is not always easy, but in the words of wise dear Jeanne, "Life is good!" - love, les