I did convince Dr. B to let me try Ibandronate rather than the 'gold standard' Zometa. Ibandronate has been around for a while in Europe, but has only been recently approved here for osteoporosis (as Boniva), and is not yet widely used for bone metastases in the U.S. However, it turned out that a partner of his in a different office was using it with one of her patients, so he allowed himself to be convinced.
The reason I wanted the Ibandronate is because in the studies done in Europe, Ibandronate has fewer initial side effects and much less renal toxicity than the other bisphosphonates, but performed similarly to Zometa. It has less of a long-term track record, so although it seems as though it may lead to less jaw necrosis than some of the others, there is no way to know this for certain as of yet.
But between my rather dicey kidneys and my tendency towards getting the nastier side effects, it seemed to me that Ibandronate would be a reasonable choice over the Zometa.
Unfortunately Dr. B did not leave instructions for the infusion center, and both he and his assistant were out on the day I was scheduled for the treatment. The other doctor available, unfamiliar with the drug, would only allow me to have the 'standard dose' - the one given for osteoporosis. No amount of argument would convince them otherwise. I spent the next day trying to get hold of either Dr. B or his assistant... and then had to come back in the next day for the other half of the dose.
Unfortunately, the drug was sent in the form given to osteoporosis patients, which was in an 'IV Push' rather than an IV Drip. Which means the drug was undiluted when the nurse pushed it into what she thought was a vein. But she actually pushed it into the tissue of my forearm.
So the next day I woke up with inflamed skin and a hard, painful egg-sized lump in my arm. The inflammation and swelling continued to grow, and the pain continued to increase, so I ended up in the ER on Sunday night, fearful that I might have an infection. After a few hours, during which many people came in to look at my arm but nobody had a clue what to do about it, they sent me home with orders to take Benadryl (which did nothing) and ibuprofen alternately with acetaminophen (which did very little).
I went in to see Dr. B the next day. They were more familiar with the problem (basically it is as though they pushed salt into my tissue and caused a nasty sort of internal burn, which is exactly what it feels like), but unfortunately there still was nothing that can be done. I simply have to endure it until it goes down on its own. Because of the extent of the damage - what everyone at the clinic called 'impressive' - they are predicting that will be sometime in the next 7 weeks or so.
Next time it will be an IV Drip. And hopefully at the right dosage.
For those of you who might be lucky enough to have the rare oncologist who is more open to newer treatments than my own: another advantage of ibandronate over the other bisphosphonates, due to the lack of renal toxicity, is that there have been two studies in which patients were given 'loading doses' of ibandronate, in order to get their blood levels up to the effective levels within a week, instead of the usual 12 weeks. This meant that their bone pain was relieved within a few days, instead of a few months. If I had the chance, I would take this option. More information about these studies can be found here - print it up and take it to your doctor.