Round Two: Infusion Two Days 2 - 8

Let me first of all share the good news I received during my check up with Dr. Patel yesterday, Thursday June 25th. Upon examination of my abdomen Dr. Patel said that the liver size was reduced; my question to him was, "Are you sure?". He then proceeded to show Randy and I the facts about my tumor markers:

Test / Normal Range / April 30, 09 / May 26, 09 / June 18, 09

CA 15-3 / 0.0 - 38.4/ 197 / 305 / 126

CEA / 0.0 - 5.0 / 268 / 350 / 72.4

There you go, the chemo is working!


Liver function tests:

Test / Normal Range / April 30, 09 / May 26, 09 / June 18, 09

ALT / 10 - 60 / 86 / 59 / 20
AST / 10 - 42 / 100 / 92 / 29
Alkaline
Phos / 42 - 121 / 128 / 144 / 117
GGT / 7 - 64 / ? / 142 / 77

(I had this in a nice table format but publishing changes everything so I have tried to divide the information with the "/" marks. Bottom line, if it's too difficult to read or your not interested then you can just take my word for it ... CHEMO IS WORKING :). )

I have no idea what the liver function tests tell us but I can read the norm and see the difference as of June 18th; the liver function has improved.

At first I thought the results were after two chemo infusions but they are not because on June 18th I had the second infusion and this is the lab tests run prior to the start of the second infusion! Makes the results even more impressive doesn't it?

When I compare the chemo of 2006 to the chemo of 2009 there are some differences; some of the differences are good and some are not so good.

First of all the first infusion for each was difficult and the second infusion was easier. This certainly was true for the most recent infusion - I did not have the flu symptoms as intense as I had with the first infusion. Furthermore, with the drug I am receiving now, taxotere, the immediate side effects are easier; I have far less nausea and far less of a salty taste (again I am fortunate to have a salty taste rather than a metallic taste).

BUT, I am on a heavy dose of taxotere and it is very, very tough on my white cells. With the 2006 chemo my body followed the standard pattern and the cells did not start falling off until the 7th day. That meant that when the immediate side effects were over I would have a few days of feeling good and the ability to be around people before the cells would begin to fall and I needed to be in isolation. This is not true now, my cells start to fall immediately and they fall so low that the fatigue is tremendous.

One week ago today was the infusion:

The next day I had a Lukine injection (prompts the bone marrow to produce white cells);

Sunday was the day of flu symptoms and I did not have an injection;

By Monday I was so fatigued it was difficult to shower and dress in order to go in and receive another injection;

Tuesday was better but by the afternoon I was very tired;

Wednesday I was wiped out again and exhaused by the time I got in to receive the injection;

Thursday (yesterday) I had very little improvement in the fatigue level and lab tests indicated the neutrophils had fallen from a high of 3.8 on June 18th to .3 yesterday (norm is 2.0 - 7.8) and the total white blood count fell from 5.7 on June 18th to 1.8 (norm is 4.1 - 10.9).

I am glad that I had the three early injections - it is hard to know how much lower the cell count would have been. I started yesterday on a 7 day injection schedule; I've had two and five more to go.

As I have written before, the injection itself is given in fatty tissue and so they are not painful. I have been having them in the back of my right arm (cannot use the left arm because of the loss of lymph nodes in 2006). Today my arm had a few bruised and red patches so we switched to the hip - there is enough flab there for the injection to be painless HA!

I have experienced the most incredible pain as the result of the injections and then sometimes I will have very little pain. The heating pad, vicodin and ibuprofin help me to deal with it. This past Monday the pain was so intense I asked Randy to come into the bedroom and be with me; he quietly stroked my back and spoke comforting words, I actually thought he might start breathing with me like when he was my labor coach when I was having April HA! Let me tell you, my husband is the very best!!!!!

Here are some other details:

I weighed 124 on May 12th, yesterday I weighed 114. In between these dates I did get up to 119 so it appears that I gain during the "good week" (which is the third week of the cyle and the week I receive chemo) and then I have chemo and the weight drops again. Yesterday Dr. Patel told me to have a milkshake everyday.

The tips of my fingers look like raisins - they are shriveled and the skin around my cuticles is thin, dry and peeling, if I bump or scratch my fingers the skin peels.

I am bald with patches of hair growth. We will see what happens on the 14th day of this cycle - the patches of growth may decrease.

My eyes, nostrils, mouth, throat and esophgus burn - the quickest growing cells die first - I love the Magic Mouthwash.

Did I say how much I love the heating pad? It helps aches and pains and warms my feet when they are cold.

When I don't write for several days don't worry, it just means that I am too tired. If anything is seriously wrong I will have April or Randy write a post to inform you.

Here is one of the many verses that I think of during the tough times:

I can do everything through Him who gives me strength. Philippians 4:13

Everyday we have to start our day believing this and then we will live the day acting like this.

Thank you so much for your emails, cards, calls, encouragement and especially for your prayers - our prayers are being answered! You are a blessing to me and I really believe that you are part of the "strength" that He gives to me each and every day.

Round Two: Infusion #2 Day 1

Today's lab results were good giving evidence that my bone marrow continued to produce white blood cells after the injections were completed, overall the white blood cell count was 5.7 and the neutrophils were up to 3.8. I am very happy with the results.

The trial drug infusion went well today. First I was pre-medicated with Benadryl and steroids followed by a short waiting period and then the one hour infusion of the trial drug began. At about twenty minutes into the infusion I began to feel a warmth at the base of my throat and top of my chest, at the same time my heart began to beat faster. Randy got Kari's (my assigned oncology nurse for the day) attention and she immediately stopped the infusion and checked my blood pressure which was up to 148/83. The PA and another nurse consulted with Keri and it was determined to give me another 80 mil of the steroid which would bring me up to the same level I was given the first time I had the reaction. Following the additional steroid there was a short waiting period and then I was able to finish the infusion. Once the infusion was completed I waited the one hour observation period and left with a blood pressure of 117/78.

I also had a brief check-in with Susanna, Dr. Patel's PA. Together we decided that it would be best to begin the Leukine injections before my cells plummeted and I had no immune system. I like the idea of not having the extreme fatigue an additional bonus is that I will have the injections every other day versus everyday. Saturday will be the first injection followed by Monday and Wednesday then I will have labs and see Dr. Patel on Thursday.

Tomorrow I will receive the chemo drug and Herceptin following pre-medication of Benadryl, steroid and Ativan to prevent nausea.

It was a good day today and I expect it to be so tomorrow! Thank you for your prayers, encouragement, cards, and positive thoughts.

PS It must be the good health combined with the steroids ... I ate a large dinner followed by ice cream and cake and one hour later I'm starving! I'm going the protein, chicken, cheese and sundried tomatoe wheat thins ... then I'm going to have a root beer float.

Round Two: Infusion #1, Day 15 - 20

This past week has gone by quickly; I have enjoyed being with friends and family but have also made sure to rest each afternoon. Sometimes I have slept for less than thirty minutes but a couple of days the naps have been as long as two hours.

I was surprised Sunday afternoon to receive a call from Dr. Patel. He said that he was very encouraged that the chest x-ray one week following the first chemo indicated the lung fluid was almost gone, he went on to state that he felt the chemo was already working. I was not sure if the reduction of lung fluid was due to the massive steroids or chemo, it was good to hear that Dr. Patel feels it is due to chemo.

Then Dr. Patel and I discussed the Leukine injections; he said that I was receiving the maximum dose of chemo and that I should expect to receive Leukine injections each time. That makes me feel a little better; I had been worried that it was an indication of my body not being strong. On the other hand, needing the maximum dose does give an indication of just how serious Round Two really is.

Tomorrow is infusion number two of the trial drug and Friday I will receive chemo and Herceptin; although I dread what the next two weeks could be, I also look forward to giving some good punches to the cancer cells. Late Monday evening I felt tenderness in a new area of my abdomen and of course it leads me to believe that there is a new area of inflammation and/or new tumor growth. Randy thinks it does not seem different, I hope this time he is right and I am wrong!

My daily routine became easier this week; by Monday my hair was falling out everywhere and I decided to have it shaved before chemo at the end of the week. Fortunately Shelley, my hairdresser, was able to fit me in on Monday. There were no tears this time; I know that it will grow back and I know how much easier it will be for me when I am fatigued. Jack and Madison remember the first time I was bald but this is a new experience for Connor (the youngest grandchild). When Connor saw me yesterday he wanted to know why I was wearing a hat and his specific question was if I was going to a baseball game (this family loves baseball). When he did see my bald head he said it was "crazy"; it was obvious that his use of the word crazy was not in the sense of "crazy-good". I did get a compliment from him later when he saw the color of my toe nail polish (tangerine), he said he liked it and it was "cool".

Last night I attended a nutrition class at CBCC (Comprehensive Blood and Cancer Center); the information was good and I was able to visit with three friends so the time was well spent. I will write about nutrition in a future post.

I am reading a the book, Unstoppable by Cynthia Kersey; my friend from work, Richard, gave me the book along with a couple other books before I left on medical leave. I will end today's post with an Ethopian proverb written in the book:

"When spider webs unite, they can tie up a lion."

Thanks for your encouragement; kind and supportive words; and your prayers - we are going to tie up this lion!

Round Two: Infusion #1 Day 14 Update

White Cell count is up; overall count 5.1, neutrophils 2.9. I'm on track for infusion #2 one week from today.

Round Two: Infusion #1 Days 9 - 14

Yesterday was the seventh Leukine injection and today I have labs and a check up. I feel sure that the white cells are higher and I am hopeful, but not certain, that the count will high enough so that I will be released from isolation.

Today is day 14 and in the chemo cycle this should be the point where the white blood cells begin to climb on their own. By next Thursday, the 18Th, the cells need to be high enough in order for me to receive infusion #2.

The Leukine injection is given in the fatty area behind the upper arm; since my left arm cannot be used I have seven little bruises on the back of my right arm. The injection itself is painless; I wish I could say the same for the side effects. Advil, vicodin, a heating pad, and a warming blanket made the side effects easier. The side effects of the last three injections were more tolerable, the pain and aches were more focused in my hips and legs and there less pain radiating from the spine. After each injection I would have approximately one hour before the side effects would begin and then the discomfort would be with me for a few hours before it would subside. Later in the evening the side effects would return only to a much smaller degree.

During my chemo orientation I was told that if I required the injections I should be prepared to have the injections following each infusion thereafter because my body would become "lazy". I have talked with some people however who only needed one or two courses of the injections. I hope I only need this one course. By the way I have found the most delicious way to have the protein powder is in a milk shake, as the Barefoot Contessa would say, "How bad is that"?

For the most part my daily schedule for the last week has focused around the injection appointment followed by the rest of the day spent in bed dealing with the pain and aches. Needless to say the days sort of blended together. Most of the time I laid in bed watching the Food Network and looking forward to having the energy to cook some of the delicious food I have seen!

The thrush is gone and my mouth has returned to normal, I am so very thankful! I still continue with the routine of brushing and rinsing with salt water following each meal or snack and I am careful to not eat food that is spicy or acidic.

Today's check up includes a follow-up on my cough which thankfully is gone. If I did not mention it in the previous post, last week Dr. Seninning increased the dose strength of the antibiotic I was taking and that has worked.

This morning I noticed that my hair is beginning to fall out; it is time for me to get my hats ready. I have mixed feelings of course because on the one hand it will be so much easier but of course on the other hand it makes this so much more real. I do still have moments of not believing that this is happening again.

I have found that I have less fear the second time around and that is of course because I have some knowledge of what to expect. I have been tested before and I know that God will provide all the resources necessary for me to endure this time of testing. I may not be confident that my white cells are high enough yet, but I am absolutely certain that God will provide the resources I need to deal with whatever comes my way.

I will close today with some of my favorite verses, Philippians 4:11-13:

"Not that I speak from want; for I have learned to be content in whatever circumstances I am. I know how to get along with humble means, and I also know how to live in prosperity; in any and every circumstance I have learned the secret of being filled and going hungry, both of having abundance and suffering need. I can do all things through Him who strengthens me."

Thank you for your encouragement and prayers; I count each of you as a gift from God - a part of the many resources and blessings He has provided for me.

Round Two: Infusion #1 Days 7 and 8

Imagine a semi-automatic pointed at you shooting one challenge after another and you will know how my week has been.

Yesterday was my first check-up since the infusion and it included blood work. On 5/28 I had a total white blood cell count of 4.7, yesterday the count was 1.1.

The neutrophils count was 3.5 on 5/28 and yesterday it was 0.1. Neutrophils are the most abundant of the white blood cells and they are the first immune cells to arrive at the site of infection. Basically a count of 0.1 meant that I had almost no front line defenders.

Yesterday I began a seven-day series of Leukine injections to stimulate the bone marrow to produce white blood cells.

Today shortly after waking I experienced intense muscle spasms and bone pain; stimulating the bone marrow causes bone aches and can cause muscle spasms. It seems safe to assume that the first Leukine injection is already at work.

The injections are given in the fatty tissue of the arm and fortunately there is no pain - slight bruising but no pain. Seven days in a row includes Saturday and Sunday so tomorrow while most of you are sleeping in I will be receiving at injection at about 8:00 am because on the weekends everybody reports for injections at eight.

To wrap this up I'll say that it has been quite a week but I've got my pink boxing gloves on!

Round Two: Days 5 and 6 (Tues and Wed)

I went to bed Monday night feeling pretty good and believing that I would wake Tuesday feeling even better. Well, I woke Tuesday morning to bone aches and I felt ripped off. It was not fair, Monday was better than Sunday and Tuesday should have been better than Monday. An electric lap blanket and ibuprofen helped and really the bone aches were not as bad as they were when I had Taxol in 2006.

My mouth was more sore however even though I had faithfully brushed my teeth and rinsed with warm salt water. By yesterday afternoon my tongue looked like hamburger meat ... mothers who are reading this may have guessed ... I have Thrush. Two rounds of antibiotic and chemo proved to be too much and the yeast/fungal infection has run amok in my mouth and down my throat. I began taking a medication late yesterday afternoon and it is better.

Not only can I barely taste anything but anything I put in my mouth, including water, burns like crazy. G..R..E..A..T I am being challenged. If you were inclined to feel sorry for yourself before you read this I bet you are not so inclined right now are you?

So here I go;

I am writing this on a laptop using high speed Internet, how many people have a laptop let alone a computer?

I did get to see April and the kids yesterday evening for a couple of hours; it was a wonderful dose of sweet medicine for me.

As I write this my husband is defrosting the "frost-free" refrigerator/freezer before we give up and buy a new one. He can take care of me and my disabled brother; watch over/clean up after my elderly father; cook a great meal; laugh with me over our darling precocious grandchildren; hopefully fix the freezer; and much more this week alone without cracking ... yet. He gets my "Husband of the Year" vote.

Our daughter passed her final entrance exam with an almost perfect score. This past year, April has faced huge and unexpected challenges that have turned her life upside down but she has faced each challenge with determination and resolve. I am proud of her for not hiding and running away from the challenges.

Tomorrow I have lab work and see the PA for a check up and then I see another doctor in the practice for what I am not sure. I think he is one of the infectious disease doctors and he will be checking to see if my mouth and throat are healing. At CBCC I get wonderful care so where they say to report is where I go. My cost for this excellent care is only $25.00 each time I see a doctor - I am thankful I have insurance.

This morning I started the day by studying Galatians and was reminded of one of my favorite verses, "...the fruit of the Sprit is love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control ... "

My final thought for you today is from Billy Graham, "Mountaintops are for views and inspiration, but fruit is grown in the valleys.

Round Two: Days 4 and 5 (Sun and Mon)

My mouth is sore; my taste buds are altered; my lips are peeling; my body is weak and tired from yesterday's severe body aches - however thanks to ibuprofen and my loving husband I have survived Day 4.

Yesterday could have been worse; today is better and tomorrow will be even better.