Good morning Sam. If you saw my other comment, I'm not a fan of the CA27-29. I personally haven't found it very trustworthy. That being said, your wife showed obvious response to the verzenio combo when her numbers took such a huge dip. Sometimes the minor blips 90-105-121 are nothing. Oh, and each person is different. I think "where" the mets are makes a difference as I've seen women with liver mets that numbers go into the thousands. My numbers are on a similar trajectory right now (90-104) and I am also on Faslodex but with Ibrance instead of Verzenio. I have had some progression in my femur met that we are radiating to see if that knocks it down, stops the pain and makes a difference in the numbers (without changing my meds).
Is her pain of the all-over aching-joint type? Being on Zometa tells me she is pre-menopausal? If that's the case it seems to me anyway that being hormone+ is harder because younger women get smacked with the stoppage of hormones. Even for us older gals (I'm 61) my joints hurt all over when I started the estrogen blockers and I had not nearly the amount to "block".
After about 7 months I adjusted. Also, the fatigue is the meds for the most part, and her pain could be adding to it.
So much comes down to where is the pain (spine, other bones?), is it somewhere where it may be pressing on a nerve? I'd press the doctor for a closer look if the pain is up there to see if there isn't something they can do to alleviate it. Sometimes radiating small spots can give pain relief.
Feel free to respond if you'd like and maybe we can figure it out.
Peggie

Hi Sam. Sorry you and your wife are having to deal with a stage 4 MBC. I received that same diagnosis 1 1/2 yrs ago, a recurrence from 2006. I’m mets to the bones (everywhere, mostly pelvis, legs, spine) and liver. My onco said that I lite up like a Christmas tree on my first PET scan. At that time my 27/29 was in the 2000’s. We got it down to the 600’s pretty quick with Ibrance/Faslodex, and when they stopped working with Afinitor/can’t recall the combo (post menopausal meds). The 27/29 never went below 300’s. We use the 27/29 as an indicator only and rely on a scan of some sort for a diagnoses. I’m curious that your onco is using CT scans whereas mine relies on PETs and your wife and I have the same diagnosis? If you think the CT is possibly missing something you could ask for a PET.
Fatigue is a constant (extreme) and I agree with another reply that it comes from a combo of the meds, pain/extreme discomfort, and in my case the inability to walk well let alone exercise. I don’t think there’s much that can be done to improve fatigue. It was suggested to me that I might be depressed which wasn’t the case but I can certainly see how it’s possible. All the best to you both.
Adana