Mets Day 939: Apparently I'm allegic to Lovenox

For the past month I've been injecting myself twice daily with enoxaparin (Lovenox) - mornings on the left side of my abdomen, evenings on the right. I've built up an impressive collection of track marks and bruises from the injections. About a week ago, I noticed a small rash on the left side of my abdomen. I assumed that it would go away, but it gradually has increased in size. Today I sent an email to Dr. Apolo describing the rash, and enclosing a picture. Less than an hour later, one of the physician's assistants from NIH called me and asked me to come in immediately. Alrighty then.

The NIH oncology clinic was empty when I arrived -- all the patients had already gone home, and the staff was wrapping up for the week. I sat down with the PA and a pharmacist, who puzzled through the various possible causes of my rash. After ruling out poison ivy, or a new laundry detergent, or an insect bite, or whatever else they could think of, they concluded that my rash probably was being caused by the Lovenox. According to the pharmacist, a delayed reaction to enoxaparin is "not unknown in the literature," although she'd never personally seen one. Lucky me: another one off case.

We discussed alternative blood thinners, including wayfarin and Xaralto. The pharmacist said that wayfarin had too many downsides. She also said that NIH did not think that Xaralto had been sufficiently tested in patients with metastatic cancer, although she allowed that it soon might be. She decided to change my blood thinner to fondaparinux (Arixtra), and I was provided with two weeks worth of syringes. One upside of fondaparinux is that I only have to inject it once a day.

I'm supposed to closely monitor my rash to see if it goes away. I have my next scan scheduled for November 18, and I'll see Dr. Apolo the same day, so we'll revisit what blood thinner I should stay on at that time. Oh, and we'll also find out whether or not my cancer is growing. No big deal (hopefully).