Scratch "Chemo" off the To-do list

My college roommate, Melinda, recommended I write "chemo" down somewhere and then put a check mark next to it. (Actually, she recommended I write "chemo 1", "chemo 2", etc.) I went in to work today, took down the Sweeney Todd newspaper ad that's been there for about a month (sorry Johnny Depp) and wrote "Chemo" in big letters. Then I drew a line threw it.

Very satisfying.

Later at my documentation team meeting, the writers gave me a fabulous box of gourmet chocolates (there are at least two serious chocolate snobs on my team and I am grateful to reap the benefits of their strong opinions). I had two of the chocolates after dinner and I feel quite sated (and loved).

Then! I went to get my final post-chemo Neulasta shot and the nurse gave me a congratulatory bouquet of flowers. This must be de rigeur there, because all the staff kept congratulating me on finishing chemo. It made me a teensy bit weepy, I confess.

So, yay. Now, on to radiation, which, truth be told, doesn't have me too concerned. I'm expecting the tedium of the routine to kick in at some point, but as someone pointed out to me several months ago, this is a marathon. And quite frankly, after four months of chemo, seven weeks of radiation doesn't seem like that big of a deal. Check back with me, though, around week four or five ;-).

Radioactive

I had my radiation consult yesterday and I have my last chemo treatment today: this really is a week of milestones. (Yay!)

I met my radiation oncologist, Dr. Lorraine Champion, and liked her very much. ABCCC puts out a very good breast cancer treatment video and she's the narrator. (You can see her explanation of the radiation treatment here.)

They did a CT scan on me to assess how much heart and lung involvement there could potentially be in my radiation treatment. Basically, because the lungs are under the breasts, they can't totally avoid zapping them a bit, and this causes scar tissue (about 5% to 6%), which is not life-threatening. Of course, they'd prefer to avoid this with the heart, so the CT scan lets them know if they need to perform "respiratory gating". In this case, the patient has to fill the lungs, to push out the chest wall. Then, hopefully, the heart can be marginally protected. Of course, this means that you have to maintain this position during radiation and, um, can you say "kind of a drag"? Luckily, my heart is out of scope for radiation and I don't have to worry about this.

I have a simulation appointment on Friday, January 18, and then I should be starting treatment on Tuesday, January 22. Then I have 35 treatments, Monday through Friday. The entire appointment should take only about 30 minutes, so I should be able to do this either before or after work. The first 28 treatments will be for the entire left breast and for the area where they removed the ancillary lymph nodes (left armpit). The final seven treatments will be for the tumor area only. They call this "boost radiation".

And there's your Radiation 101.

I can't tell you how happy I am to be at my final chemo treatment. All in all, I have been extremely fortunate and have not suffered as much as many people I see in the waiting room at the Cancer Center. I thank my parents, Ralph and Nancy, for some extremely hardy genes.

And thanks again to all my friends, family, and co-workers who have helped with chemo, by providing company, or food, or housecleaning, or flowers, or just not telling me when I looked less than my best. I feel so inordinately lucky.

Hemoglobin Be Damned....

....full steam ahead. :-)

My hemoglobin continues to hover in the 9's (9.4 yesterday, to be precise), so still no aranesp shot. But, all in all, that seems fine at this point.

Dr. Kuan says that a study was done that seems to link use of the shot with recurrence. She also feels that the study was one of those "let's give 900 mg of something to a rat and see what happens" experiments, rather than something that would actually indicate if something helped. (I love how rational she is.) Her point was that the insurance companies are using the questionable findings from the research to avoid giving the shot.

Furthermore, even if my hemoglobin drops below 9 (normal is 12 or above, btw) next week, it's my last infusion. So, while they might consider giving me a transfusion, it's doubtful because my system will start to recover within a few days of the infusion and we won't be throwing anymore toxins its way in the next few months, and my blood counts will start to recover all on their very own.

So, there it is. I'll be a good girl and try to get some iron into my system.

Meanwhile, the hot flashes are driving my tired soul crazy. Between anemia and menopause, I'm tired and cranky and a bit crazy. Please--if you see my family--be kind to them. They are having to exhibit major amounts of patience with me lately.

And honestly? The phrase "hot flashes" is a bit coy. I feel like I'm going to immolate several times a day. I'm so not kidding.

See? Even this entry sounds cranky. <sigh> I'm sorry.

In other news? We're starting on our "office" this week. It's Frank's and my Christmas present to each other. California Closets will be working its magic in the room just off the kitchen and everything should be done around mid-February.

Oh! and we booked hotel and flight for a week in NYC for our 25th anniversary this June. Something to look forward to, after all this nonsense is finished.

One to Go

It's been a fun and eventful holiday season. And as I've maintained, the busy holidays have made the chemo trudge zip by pretty quickly.

Maggie's holiday choir concert was lovely, a week ago Wednesday. That's her, singing her solo, just to the right of their wonderful choir director, Kathe Jordan. Poppy and Grandma were there with us, and Grandma swears she got more pictures, which is somehow better. Being the competitive family we are, there was some discussion later about quantity vs. quality. The photo here is representative of "quality".

Christmas Eve was at our house. Jackie, Yusuf, & Shiraz Cassim, and Rick, Becky, Jake, & Nina Price joined us for a crab feast. Dinner was lovely and we all enjoyed the homemade "Bouche de Noel" that Emily spent all day preparing. Shiraz had recently shaved his head in a trendy fashion move and so I had company in the hairless department on Christmas Eve. Here's a pic of we hairless "twins".

Christmas morning was pretty wonderful and relaxing. Poppy and Grandma drove down from their comfortable sleeping quarters (at John & Lynn Price's--they were in El Salvador for Christmas) and we all opened presents sometime around 8:30 or 9, and then had a leisurely breakfast. That night we all went to Rick and Becky's for a wonderful prime rib dinner, and enjoyed the food and most excellent company. Andy, Nancy, and Allen Price were there, along with dear friends Robert Allen and Dennis Vaux.

And yesterday, Boxing Day, was my penultimate chemo infusion. Yay, yay, and double yay! Em took me to the cancer center after 1, and they were running a bit behind (four nurses had called in sick), so Frank picked her up at 5:45 so she could get ready for her guests (she had some of her friends over for gift exchange and sleepover), and then he came back to relieve her. We got out of the cancer center a little after 7 p.m.

And now? I have one infusion left. I'm still just-this-close-to-anemic (inching down from 9.6 to 9.2--where below 9.0 gets me the much needed aranesp shot). And I continue to suffer minor GI effects. All in all, really, nothing to complain about.

My folks left Fairfield this morning and should be in Pasadena sometime this evening. They're going to have tons of fun doing Rose Bowl parade touristing, along with some other SoCal delights, before heading on back East. We had a lovely visit and look forward to seeing their photos from their trip down South. Here's a parting photo of the lovely couple, from Christmas Eve.

Glass More than Half Full

So we're 3/4 of the way there now. Yay!

I apologize for not posting in such a long time. The good news is that things have been pretty boring in cancer recovery land. The only ill side effect I suffered after the first Taxol (two weeks ago) was some muscle/bone achiness (it felt like I'd been working really hard in the garden the day before), which was easily remedied with some tylenol and advil.

In the meantime, we've been enjoying some holiday festivities with my folks, and getting some holiday shopping done, and writing Christmas cards, and working. Maggie had a nasty bug over the weekend (102.6 fever) and now is mostly better, but will have some trouble getting rid of the lingering effects, I think (coughs and sneezes). Basically, life goes on.

Mom accompanied me to my second Taxol infusion yesterday, and while things mostly went well, there were a couple bumps in the road. I was in the chemo room by 1:15, and the oncology nurse had my pre-meds all ready. She was having some trouble with the machine though, and so, while each of these three meds should have taken about 15 minutes, she had difficulty with the IV machine and there was a delay in getting each one going. It wasn't until my mom said, "maybe you should try another machine" that she seemed to consider this a viable option (there were at least two unused IVs in the room). Even taking these delays into account, I was ready for the Taxol no later than 2:30, and probably before. But my Taxol didn't get started until 3:10 p.m.

And then, about 15 or 20 minutes into the Taxol, I decided to throw some drama into the proceedings. The Benadryl (one of the three pre-meds) had pretty much knocked me out and so I was lying prone on the recliner. I was not necessarily sleeping, but I was dozing in an out and I was awakened by a tightening in my chest (felt like a classic asthma attack to me) and I could feel my cheeks flushing. I promptly knocked over my water bottle, reaching for my inhaler (poor Mom, trying to understand my mumbling and figure out what I wanted--sorry Mom!) while also trying to sit up and calling to the nurse, "I'm having a reaction to the Taxol..."

As soon as I was sitting up and had used my inhaler I was better. But the typical--and sensible--response to such a reaction is to stop the infusion. So, I got some O2 and felt better and the nurse took notes. A nurse and nurse's asst. ran breathlessly into the room, saying they'd been paged for a Taxol reaction and everyone told them all was okay. Good news--you don't have a crisis. Bad news--you ran down here for nothing. :-)

Since I was so clearly stabilized, they started the Taxol back up after about 15 minutes. Dr. Kuan dropped in to check on me, and to clarify what preceded my reaction, and we all think it would be better if I sat up during these infusions. Ah well. Only two to go.... :-)

Because I got started so late, I (and another patient) needed to be moved upstairs from the downstairs treatment room (where we were put because the main room upstairs was full when we started) around 5 p.m. Mom and I finally got to leave around 6:45 last night. I'm going to try to change my final two chemo appts to start earlier.

We got home, and Frank had made a nice roast chicken dinner for the five of us (Mom, Dad, Frank, me, and Maggie). And then my folks left for their RV up in Fairfield.

Oh! and this time, almost certainly because I did not do the steroids before going in, I got a full night's sleep last night. I feel great this morning and look forward to getting lots done. I'm sort of assuming I'll feel some aches and pains tomorrow, but again, I know it's easily remedied. It's not nearly as awful as the nausea, which required meds that knocked me out, and which has their own dopey residual effects. I prefer clarity, but that could just be me. :-)

In other news, Em has three finals this week, last one Friday at noon. So, we're hoping to see her bright shiny face by 8 or 9 on Friday night, when we'll be enjoying the company of John, Lynn, Kevin, and Sarah Price.

We're planning to get our Christmas tree on Saturday morning, and then Frank and I are going to my (always very fun) office holiday party at the Palace. We're spending the night there--carving out some romantic alone time in the middle of chemo and the holidays. All in all, it should be a lovely weekend. Hope your holidays are lovely and warm and (relatively) stress-free!

Happy Thanksgiving Week!

I am so very, very happy to say that I am done with Adriamycin and Cytoxan. Ick, ick, and ick again. I have reached that point in chemo where just the *thought* of chemotherapy makes me feel queasy, so I am especially pleased to be starting the next course of treatment next week.

Jackie was my chemo-buddy for the final AC. We got to find the other chemo room, downstairs, the existence of which I was completely unaware until we spent several hours there. Jackie was remarkably well-equipped with magazines, water bottles, and even a conversation topic game. She also brought her camera and so I am able to include this pic of me and Dr. Kuan.

I have my blood draw and check-up with Dr. Kuan tomorrow, at which point I'll schedule my Taxol infusions. If everything goes according to plan, we're most likely looking at one infusion next week, two in December, and one in early January, and then (dare I say it?) we're done with chemo. More importantly, the Taxol is supposed to be easier to take than the AC. A small percentage of folks have a bad reaction to the Taxol (such as my friend Karen C-O), and Dr. Kuan says we'll know right away if I'm in that minority (fingers firmly crossed).

Meanwhile? The holidays are starting! Yay! I'm a huge sucker for Thanksgiving and Christmas and already am listening to holiday music at work, and at home when I can get away with it (it scandalizes Frank, so, not too often at home). My parents are already in California after a mad dash across the continent (the story of their 2007 RV trials and tribulations are really fodder for a whole other blog) and should be at Travis Air Force Base in Fairfield early tomorrow.

Emily found a ride from UCSB and gets home sometime Wednesday evening.

We feel lucky to be spending Thanksgiving with John & Lynn and their table(s) of 27. I love big Thanksgivings, and we've been honored to be included in the Price family Thanksgiving for several years now. It will be lovely to relax and visit and just enjoy the holiday.

We wish you and yours the very best, happy, peaceful holiday. See you again after Turkey Day.

Just Hangin'

I was *supposed* to go shopping with my dear friend Jackie yesterday, but I was a weenie and I bailed. I felt somewhat guilty about it--she had, after all, made time for me during her weekend. It's not as if I was doing anything important yesterday. The most exciting thing I did was walk up Solano with Frank, to get some coffee at Peet's.

You might think (or at least, *I* would think) that during my "good" week, I'd be eager to get things done, to take advantage of not feeling nauseous or crampy or just generally icky. And Saturday morning, we ran quite a few errands and accomplished a lot. But I'm finding that during my so-called good days, I want nothing more than to laze around, enjoying the fact that I don't feel like crap. For example, I really had planned to get some laundry done yesterday. A modest ambition, right? Did any laundry get done? Absolutely none. Ah well. That's what the "is it clean or is it dirty" clothing pile is for, right? :-)

During our walk yesterday, Frank and I stopped at Five Star Video to get our week's worth of Columbo DVDs. We've always been big Columbo fans, and we have found these DVDs to be pretty wonderful for chemo recovery. We've seen almost all of them, but we can't always remember whodunit, and it's always fun to watch Columbo trip up the "smarter than thou" murderer. And the ones we haven't seen are interesting (and you can sort of see why they're not in constant rotation with the others).

Spielberg and Jonathan Demme both directed episodes. And Steven Bochco (Hill Street Blues, LA Law, and NYPD Blue) was an occasional writer. And the actors! It's so much fun to watch Roddy McDowall play an entitled nephew who rigs a cigar box to blow up in his uncle's limo (thus paving the way for him to run the family chemical empire).

And what can one say about Peter Falk? He's just brilliant, that's all. We're still in Season One, so we're enjoying watching the evolution of the idiosyncrasies that we have attached to his character over the years. In the first couple episodes, he drank bourbon. By the fifth episode, no more drinking. In the first season, his cigar is always lit, but we know that later, it never is. He talks about his wife, the famous-by-her-absence Mrs. Columbo, from the get-go. But the dog (named "Dog") doesn't show up till later.

If you've not seen Columbo in a while (or <gasp!> you've never seen it), rent some episodes from your local DVD shop the next time you're feeling under the weather. It's perfect sick-time viewing.

I Love My Oncologist

I had my check-up with Dr. Kuan on Monday, after a very rough weekend. My stomach still was causing me some distress on Monday and while I waited first for my blood to be drawn and then to see Dr. Kuan, I kept getting teary. I had to keep reminding myself to get a grip, that really I was doing fine, but I kept getting weepy.

So when she entered the examination room, and asked how I was, I just got weepy all over again. I apologized and explained that I am kind of spoiled by just how well my machine of a body typically works. And while there are lots of drugs for the nausea, the stomach cramps that I had been experiencing for three days were really just getting on my last nerve.

And what did my good doctor do? Well, she wrote me a prescription for something to reduce the acid in my stomach (still waiting for insurance to cover that, thank you). But first, she got up and gave me a hug. A really long one. Which made me cry again, of course, because I am nothing if not a one-woman answer to drought. Then she stepped back and said, "You need to do something for yourself this week. Pamper yourself. Get a massage."

Don't you love her? I'm getting a facial tomorrow (clean pores *and* a face, neck, and shoulder massage). Kisses to Dr. Kuan for the permission. If only insurance covered facials.....

Meanwhile, my numbers are still really good (like I said, I have a pretty good machine). So, on to the next and final AC infusion on Tuesday.

Chemo Stinks

I wanted to be a bit more rude in that headline, but decided to spare the feelings of some of my gentler readers. Suffice to say that I would happily donate to any cause that could find a way to cure cancer without chemotherapy. It is a serious drag.

We drove to Santa Barbara on Friday (about a five hour drive) to visit Em for Parents & Family Weekend at UCSB and I was feeling tired but mostly okay. Saturday I was wiped and losing energy fast and by later in the evening, I was accosted by the same cramps that had attacked me on the Saturday after my second infusion of AC. I was pretty miserable for most of Saturday evening/night and Sunday just kept nibbling at carbs to keep my stomach on a mostly even keel as we drove home.

Today, Monday, I feel mostly better but really am so ready to be over this. Ah well. One more infusion of the AC left (next Tuesday) and then we get to do a change-up to the Taxol. I figure, if nothing else, at least my body will be faked out by the change in meds and things should improve, even if just temporarily.

Meanwhile. It was wonderful to see our older daughter in her new milieu and thriving. She's a non-partier at a party school and so I think it's fair to say that she's not finding a surplus of new boon companions. But she's putting herself out there (interning for CALPIRG and working costume crew for the theater department's fall production of Woyzeck) and she seems to be loving some of her classes.

After a five+ hour drive, we arrived Friday evening and picked up Em and took her downtown to State Street for dinner. The next day, Saturday, I was partially mobile and after an aborted campus tour (We bailed after this pithy observation by one of our tour guides: "We have five nobel laureates here at Santa Barbara and they are professors. And they teach"), Em took us into the infamous Isla Vista where we had pizza for lunch. For the rest of the day, I hung out at the University Center while Frank and the girls walked the campus. Em and Maggie had some nice sister-time and went rock climbing at the Rec Center later in the afternoon (Emily: "I'm pretty sure Maggie is part spider monkey") while I got cozy on a sofa at the University Center and Frank checked out the bookstore.

The weather was mostly foggy and/or undecided, so we never did get to the beach or the pool, but that's okay. Emily was the main attraction and we got to see lots of her.

We're looking forward to having her home, if only for a few days, at Thanksgiving.

Wigs, etc.

Sorry for the delay in updating. I've been either working, socializing, or taking a much-needed break to veg.

First up! My co-worker Colleen went wig shopping with me on Thursday. It was quite the excursion.

When I googled for wig shops in San Francisco, the top-rated place that showed in the listings was a place called "Rosalie's". It's way out on Columbus Ave, at the edge of North Beach, almost to Fisherman's Wharf. Colleen and I managed to snag parking right outside the shop (virtually unheard of) and wandered in.

This place was amazing. First, the place was simply jam-packed with stuff. Wigs competed with dresses and accessories for space. There were dress racks suspended from the ceiling--you'd have needed a hook to get anything down. And second, the many styles of clothing and wigs available made me fairly certain that Rosalie's is frequented by our transgender friends. We saw the Liz Taylor wig, as well as the Jaclyn Smith, and even the Dodie Rosecrans--SF socialite--circa 1970.

Anyway. We made our way through the maze of wigs and clothing and started to feel that unless I wanted something truly outrageous, this might not be the shop for me. And then, we rounded the final corner and came across at least 4 wigs that would work perfectly.

The man working the store asked me to sit down in one of the barber chairs situated in front of a mirror, so he could try the wigs on me. (This man was teeny: I'd be shocked if he weighed 90 pounds, truly. And if he is under 70 years old, I'd be shocked. But his hair and moustache are both still jet black, so he's still working it.) He tried on two of the wigs Colleen and I picked out and as he prepared the third, he said that after we were done with these four wigs, he'd like to try one on me that he had picked out. We tried on the four wigs and got two "maybes" out of the bunch. And then he tried on the wig he picked out. Herewith, the "Bobbi" (though you have to imagine that "i" dotted with a heart). Bobbi definitely out-ranked the other wigs and the longer I looked at it, the more fun it was. I mean roots? On purpose? So, we purchased the wig for a *steal*. Quality wigs typically start at $250-$300. When I asked how much the wig was, he seemed to be somewhat embarrassed and whispered, "$65". Um, okay, we'll take it!

To see the other two fabulous wigs I've got, as well as a shot of me sans cheveux, you can go here: Karen's Hair Looks.

I've also got some new chapeaux to show off (including a fabulous hand-knitted cap that looks a bit like a fuzzy blonde fro), but that will need to be another blog entry.

The rest of the week was good. Work got done and then Maggie and I enjoyed The Magic Flute at the SF Opera, along with her friend Siobhan, and her mom (and my friend) Dierdre. We had brunch in the city (Absinthe, for those of you who know SF) and got to the opera for a 2 p.m. show. Nice end to a pretty weekend.

I had my third infusion yesterday and Maggie accompanied me. She missed a few classes at school, but I feel that right now, we have to have some perspective on our overall outlook. She learned, I think, what I'd hoped she'd learn--it's not scary and it's a bit boring. I gave her a brief tour of the cancer center and then we both did a lot of waiting, with the occassional bit of attention. We checked in at 1, and Frank picked us up at 4:45.

Today is Halloween and lucky Frank will be opening the door and handing out candy. I will be firmly esconced somewhere in a prone position, watching trashy DVDs. Or, hmmm, maybe Lord of the Rings.

Oh, and Frank has the best joke of the week. I was telling him that I can't sleep on my right side because that's where the port is. It's uncomfortable to put too much pressure on it, and I'd hate to dislodge anything. So Frank says, (are you ready? It's somewhat nautical in nature) "You can't sleep on your starboard because of your port!" Get it? No? Ah well, you can google it if you're really curious.

And Here We Are Again...

....on the other side. Mostly.

Day + 3 this time is much the way it was last time. My stomach is feeling a bit timid, but I'm drug-free and so feeling pretty good. I'm pounding the saltines and drinking the water, and even better--I'm not doped up on the sofa all day.

Tuesday evening, after the chemo, I was fatigued, but okay. Wednesday I was mostly okay, but fatigued. Thursday I slept and watched DVDs and ate some pretty bland food. Frank made pasta carbonara for dinner, which I enjoyed, but might have been a tad bit heavy for me. I didn't suffer too much, though, so, all in all, a good couple days.

We're lucky enough to be invited to several birthday parties this weekend, but I think we'll be seeing how I feel tomorrow before we make any social decisions for the weekend.

Meanwhile, my hair is mostly gone. I'd say I've lost a good 3/4 of it and it's so very sad looking. :-) I really wish it would just finish falling out so I could be done with it. I'm wearing lovely hats, including this very nice cap that Michael knitted for me (the pic is from before hair loss), and I'm sure the hats would be more comfortable without the pathetic itchy remnants of hair.

Two Down

Well, the chemo part is done, and now we just get the next couple days of fatigue, headache, hair loss, and (hopefully limited) nausea. So, I'll more sincerely feel like it's "two down" sometime around this weekend, I'm guessing.

Once again, the adriamycin gave me a minor allergic reaction, which triggered my asthma. No biggie, just interesting. And I'll probably add a benadryl or something to my mix of pre-chemo drugs next time.

I'll be working from home tomorrow, and Thursday (based on my experience last time with Day + 2) I'm planning to take the day off and wallow in DVDs (Jeeves & Wooster is pretty high up on the list). If the pattern follows last time, I should be mostly okay by Friday. Time for more finger crossing out there!

It's also time for a big thank you to all the friends and family out there who are taking care of us. The emails and cards, the groceries and baked goods, the carpools and flowers. Really. I'm not sure we always show the appreciation we feel. Please know how grateful we are and how loved we feel. Thank you.

Numbers Are Good

I had my bi-weekly checkup yesterday with Dr. Kuan. My white blood cell count and platelets are within normal range. My red blood cell count is a bit low, but still okay, she says. Given that yesterday was the 9th day, she said that if my white blood cell count was going to be low, that would have been the lowest day. Other than that, I'm healing just fine from the surgeries and, assuming my numbers are just as good next week (they test my blood before every chemo infusion), I'm good to go.

I told her that I'd heard that the side effects were "cumulative", inasmuch as your body grows weary of fighting this stuff and the side effects become worse with each infusion. She said that was definitely true of the "numbers" (white blood cell, etc.) but not necessarily true of the nausea. I'm wondering if she's just trying to help me maintain some cautious optimism, because then we started talking about the inherent suggestability of some words/sensations (like nausea).

I told her about the poor ill man at last week's chemo orientation, and she told me about a patient she had when she worked in Houston. He lived outside of Houston and so had to drive in for his treatments. It got to the point where all he had to do was see the sign for Houston as he entered town and he became nauseous. Another patient only had to hear her name and he became nauseous. So, there you go (and there you are). The wonderful world of chemo side effects. :-)

....And Back into the Light

Whew. That was certainly an interesting three or four days.

To recap: I had my first chemo treatment on Monday. All went well and I was fatigued Monday evening and experienced some insomnia that night.

Tuesday I felt okay. A little light-tummied and tired, but otherwise, okay.

Wednesday? Ick. Not so great. I was still using the Emend (the finest in anti-emetic medications) but the nausea would not be kept at bay. So, I supplemented with another medication that just wiped me out. So I felt nauseous and dopey. Perfect. By the end of Wednesday, I was starting to feel better and was actually able to eat some real food (as opposed to the saltines, almond butter toast, and yogurt I've been consuming since Monday afternoon).

Thursday morning I felt pretty much the same, but without meds, so I took that as a very good sign. I stayed on the saltine/toast/yogurt diet and got through the day just fine.

And today, Friday, I feel very hungry. Yay! Frank made me some very tasty bran muffins with flax seed for breakfast and I might get really crazy and have half a sandwich for lunch. No, don't try to stop me... :-)

In other news, Frank and I attended the Chemotheraphy Orientation at the ABCCC last night. It was interesting (intentionally and unintentionally). First the intentionally interesting part. Among other things, we learned that a) cancer cells rapidly divide, and b) the way chemo works is to attack rapidly dividing cells. Of course, your system has other cells that are rapidly dividing. These include cells in your GI track and your hair & nail follicles. Which explains many of the side effects of chemo. There was a lot of other information, too, and it was useful, overall.

The unintentionally interesting part was when the pharmacist kept talking about the N/V (nausea/vomiting) side effects of chemo. She was obviously knowledgeable and experienced and knew her field, but English was not her first language. And so everytime she said "nausea/vomiting", it sounded a bit harsh and abrupt. She described the various stages of "nauseavomiting" explaining that you could have Level 1 vomiting would would not be very much, or you could have Level 5, which would be pretty much all the time. The man sitting to my left had not, thus far, experienced any of these side effects, but confessed that with our friendly pharmacist constantly saying "nauseavomiting", he was beginning to experience some pschosomatic symptoms. This did not seem to impress the speaker as she continued to say over and over "nauseavomiting". Finally, the gentleman stood up and said he thought he needed some air. Before he could get to the door, he started to swoon, and luckily one of the nurses was there to catch him. The poor man was out like a light. When we went to bed last night, Frank and I kept cracking each other up, saying "nauseavomiting" repeatedly—remembering the absolute oblivion of the woman who tortured that poor man into fainting. (And have I made you a bit queasy with that charming story?)

Sleep patterns are weird, but that's a lot easier to handle than the ickiness of nausea. Typically, it's Frank who's up at 4 or 5 a.m. each day. Today, I was up, too. I was very hungry and so had a small bowl of cereal to tie me over until breakfast. But I got plenty of sleep, so I'm feeling fine.

So, while I wrote on Monday, "One Down....", today, I feel that a bit more sincerely. Here's to hoping the next infusion isn't any worse than this one was.

One Down—Nine to Go

Frank and I checked in at the Alta Bates Comprehensive Cancer Center (ABCCC hereafter) around 8:30 this morning. Around 9, they took me to the VAD Draw room where I was swabbed and then they put the totally cool little hooked needle/catheter into the port. They drew blood for testing and then sent me back out to the lobby. I took the first of the Emend 3-day anti-nausea treatment pills and prepared to wait.

Typically, we're told, it takes them about 20 minutes to do the blood testing and then they start to gather your chemo meds, but they had some issues this morning and I didn't go back to the treatment room until about 10. No biggie, really. As Frank reminded me, this is the beginning of a marathon--there's no need for sprinting right now (i.e., chill).

I neglected to take my camera with me this morning (maybe next time?) so I shall endeavour to describe the treatment room. Imagine a large room, maybe half the size of a basketball court. In the middle of the room is a nurse station/counter. Lots of carts, and monitoring equipment, etc. scattered about. (Probably not "scattered". Probably placed. But to my untrained eye--scattered. I don't judge. I merely observe and report.)

Around the perimeter of the large room is a succession of glass door cubicles. There must be 20 or so of these little cubicles. In each cubicle are two easy chairs, a TV, a visitor chair, a bathroom, and cabinetry with supplies, etc. Also, primarily, of course, the automated IV machines that let them administer multiple fluids simultaneously.

I was seated and they took my vitals (again. Three times today I had my vitals checked. They are nothing if not thorough.) Jessica, the nurse, explained that first, they'd give me some anti-nausea meds with the saline IV. When that was done, she had to "push" the nasty Adriamycin (also known as Doxorubicin) through a syringe into the IV. It was the color of Kool-Aid or Hawaiian punch and it triggered my asthma. Just a bit of a drag, and Frank retrieved my albuterol inhaler from the car, just in case, but my body sort of picked up the slack and the asthma started to dissipate on its own, so I was fine.

It took about 20 minutes to finish up the two fat syringes (looked like about 25 cc's each) into the IV, and then Jessica put the bag of Cytoxan on the IV rack.

While we were patiently waiting (me with my fabulous elasto-gel therapeutic cold gloves, to try to minimize the effect of chemo on my hands and fingernails), the pharmacist dropped in to see if I had any questions about the meds they'd prescribed for me (three anti-nausea meds, in addition to the Emend I take the first three days of the infusion, and an antibiotic for if/when I spike a fever) and to make a list of everything I'm taking (including my asthma control meds).

He was pretty young and cute and very earnest and he typed up the list and printed a copy for me, so when I see a different physician for any reason, I can just whip out my list of meds for them. Most excellent.

When he was done, the nutritionist stopped in to talk about my chemo diet. First week is to "dextox" and to make sure I'm not taxing my system but ensuring I get what I need. Second week is the building week--lots of legumes and other non-heavy proteins (sardines, wild salmon, cottage cheese, eggs). She also recommended Glutamine powder the first week (yum!) and ground flaxseed. Oh! and the good/interesting news: she'd prefer I drink green tea, but that it not be decaffeinated. She doesn't like to have the tea any more processed than it need be. So, there you go. I *can* have a cup of tea in the morning.

When the Cytoxan was done, about an hour after it started, the nurse "flushed" the catheter with saline and then shot me up with Heperin (anti-coagulant, to prevent clots). She removed the needle and catheter and Frank and I were on our way home by about 12:15. One treatment done. Yay!

With all the anti-nausea meds, I'm being cautiously optimistic, and thinking I'll be fine tomorrow. But, we've been told that, if it's coming, tomorrow is when the nausea will hit. So, keep your fingers crossed.

Ready, Set, Go!

What a busy couple of days we've had.

First: we got Emily happily esconced in her dorm room (Anacapa Hall) at UCSB over the weekend. We left home at about 10:30 a.m. on Saturday with a borrowed van (thanks again, Sarah & John!). We hit a bit of traffic around Watsonville, and some very icky rain a couple times, but got to Santa Barbara before 4:30. We managed to wrangle our way on to campus, stopped off at the bookstore (where we picked up Em's preordered books) and then left her bike locked up in front of her dorm. (Emily's room is one room away from this back door to the dorm. Not too shabby.)

After spending a lovely evening at the Ramada Limited and a quick morning visit to the Mission Santa Barbara, we got Emily moved in to her dorm, had lunch with her in the dining commons, and said "see you in five weeks" around 1 p.m. on Sunday. (I didn't get weepy until we were halfway down the hall.) Frank and I were back in Albany around 6:30 last night.

Second: On to today. I had a 10:30 appointment with my medical oncologist. All went well and she said that, as long as my surgeon is okay with it, I can start chemo next week. Finally! Don't get me wrong. I'm not exactly excited about chemo, but I do feel that the sooner I can get started, the sooner I can be on the other side of this, and I'm really ready to get started.

(It turns out I will not be doing the Taxol test. The treatment involved pills and self-injections and Dr. Kuan nixed the whole idea. It was kind of funny listening to her talk to the research department. "That's not a good test. No, you really should just scrap that test. What about this other one? <listening> No. That's not a good test. These are not really good tests." Anyway. We're doing the prescribed 4 cycles of AC and 6 cycles of Taxol, each two weeks apart.)

I scheduled a Monday morning first time infusion for the AC (I'll be there from about 9 till 1 p.m.) and a Tuesday follow-up for a shot of Neulasta (to get the white blood cell count going).

At 2:45, I met with my surgeon. He confirmed what Dr. Kuan told us--the margins were clean and there is no residual cancer in the breast or lymph node area. Yay! He said that, yes, I can start chemo whenever Dr. Kuan is ready. Then he brought up radiation. He talked about the "mammocite" proposal he had mentioned during our pre-surgery consult over a month ago. Mammociate radiation is when they put a balloon catheter into the tumor site and zap you with radiation from the inside as well as the outside, for five days. This greatly reduces the radiation time (from five/six weeks to five days), so that's a plus. On the other hand, there really aren't any long-term statistics for this form of radiation yet and so no one can offer assurances that it will be as effective, in the long run, as the good old six weeks of daily radiation.

If we pursued this form of radiation, we'd need to do it before chemo, and so we really needed to get Dr. Kuan's opinion. I called Dr. Kuan and after some phone tag, we spoke about the radiation. Given my high risk status, she doesn't recommend the mammocite radiation. So, there we are.

We'll start the AC on Monday and then do three more cycles over a period of eight weeks. When that's done, we'll get started on six cycles of Taxol over twelve weeks. Then we'll take a short break and get started on the radiation.

And, in the interest of fair and balanced reporting ;-), I have to say that I am in love with Blue Shield right now. They approved one of the more expensive anti-nausea meds (Emend) and so other than having a liter or so of toxic chemicals in my body next Monday, I should be feeling okay.

2B or not 2B?

Frank and I saw Dr. Kuan today, to go over the pathology report and to discuss chemotherapy. What a long appointment.

First, the details. The CT scan showed the breast lump and the rather large lymph node in my armpit, but that's it. So, yay, we get a zero on the M(etastisis) for the TNM staging for breast cancer. We told Dr. Kuan that Dr. Broderick had said I was staged at 3A (67% survival rate) and she looked confused. She said, no, a T(umor)2 and N(odes)1 meant a 2B. She looked through the pathology report and we talked about lymph nodes that are "matted," which can move a stage 2B to a 3A, but she said the pathology report showed no indication of this, so we're going to take that 2B with no further argument, thank you very much. All in all, given the TNM "score" combined with the fact that the tumor was "high grade" (i.e. aggressive), gives me a 75% survival rate. (But as my oncologist friend, Carla, reminds us, "these statistics refer to large numbers of people, not to individuals.")

After clarifying those details, Dr. Kuan let me know that the cancer center is doing a clinical test on Taxol infusions. If I sign up for the test, my chemotherapy would consist of 4 bi-weekly infusions of Doxorubicin (Adriamycin) and cyclophosphamide [abbreviated AC], and then either 12 weekly infusions or 6 bi-weekly infusions of paclitaxel (Taxol). The benefit of taking part in a clinical trial, of course, is that you have even more doctors watching your condition. So, despite the fact that weekly infusions would be a drag from the perspective of getting on with life, we are considering it.

We got to meet the nurse for Dr. Kuan's practice, Lisa Mune, who showed us how the "port" works for the chemo infusions. You can go here for an image of where the port goes. This port, which is surgically inserted under the skin, enables the nurses to give me my chemo meds and to draw blood without having to find a vein every other week. We're hoping that Dr. Broderick can put in the port when he's doing the recision to get more of the margins (still no word on when that will occur, yet).

But, if you look at the image, you'll note that meds go right into the vena cava, which leads right to the heart. So, to make sure my heart can handle all this (the Adriamycin, the "A" part of the AC, is hard on the heart) I'm having a heart scan (MUGA) on Thursday morning.

Whew. What a day.

On a positive note--I went camping this past weekend with the moms and daughters in Maggie's girl scout troop. There were four girls and four moms in Marin and it was lovely. I came home on Sunday utterly exhausted. But I'm figuring I won't be doing much of that kind of thing for at least the next six to nine months, and I wanted the Maggie time.