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Six Treatments Down, How Many More to Go? – June 29, 2015

I’ve had a busy week!  There’s a lot to tell!

After a relatively quiet weekend, I went in for my breast MRI on Monday.  I don’t know whether it’s because I’ve already had one or not, but it felt like the time flew by.  I also stayed somewhat cool; the last time I had a breast MRI I sweated so much I felt like I was cooked.

After the MRI, I went to the infusion center to get a blood transfusion.  Actually, “transfusion” is incorrect – it’s an infusion.  I received 2 units of blood of O negative blood (I’m O positive).  I’m an 8 gallon donor myself, but it felt odd to be on the other end of a blood donation.  I was also surprised that I received 2 units – that’s a lot of blood!  The blood was refrigerated, so it was also cold going in.  My friend Alissa dropped by with lunch and cinnamon rolls from Ikea (who knew Ikea made cinnamon rolls?).  That night, I felt kind of odd – whether it was all that extra blood or just the idea of all that blood, I don’t know, but I crashed early.  They said I would feel better almost immediately, and indeed, by Tuesday I was feeling much more peppy.

I received some great news Monday night before I crashed; Dr. K sent me a message to let me know that the breast MRI showed that my tumor had “melted away.”  We’d hoped this would happen; in fact, it’s why Dr. Ching (breast surgeon) had a clip put in where the tumor was, so that she could identify the location of the tumor if the chemo did its job. This does not mean I can forego any treatment – I will still need to finish chemotherapy, and I will still need to have surgery and radiation. The fact that the tumor is gone, though, is a relief.

The rest of the week was busy, busy, busy!  I went to the Lady A concert 2.5 hours away on Thursday, which means I got home at 2 am.  I met my friend Angie at the concert, and drove up with friends Liz and Eric.  I had chemo on Friday; another six hours at the infusion center to get Taxol, Herceptin and magnesium.  Then I headed off to see Lady A again, this time with my niece Natalie.  Our 6th row seats were on the aisle, which meant we had plenty of opportunity to press the flesh with the artists.  In fact, I received a huge hug from Charles Kelley, which was amazing.

As if that weren’t enough, on Saturday was the California Clasico – the soccer match between the San Jose Earthquakes and LA Galaxy at Stanford Stadium.  The match was a sellout this year, with almost 51,000 people attending.  The Quakes won, which was great, and the fireworks after the game were spectacular.  On Sunday Natalie, and friends Karen and Amanda came over to watch the 2nd half of season 1 of Outlander.  Sunday night we welcomed a weeklong foster, Sadie, whom we are driving to Elko, NV on Friday.  Sadie is a tiny, dainty Siamese/Tonkinese kitty of 6 pounds.   I’m having a wee problem with my friend diarrhea the past few days, but hopefully that will clear up soon.

I lost a third fingernail on Sunday.  While it’s not pretty and goodness know how long it will be before my nails are ‘normal’ again, it actually is far less painful to have no nail than it is to have a nail which is just hanging on.  There’s also the inconvenience of not having a nail – try scratching an itch with no nail – but it’s actually kind of painful to have these nails which are not attached to the nail bed. 

I have an appointment with Dr. Ching this week, and I have to say I’m kind of excited about it.  It means I’m nearing the end of my chemo treatments (except for Herceptin) and moving onto the next phase of treatment.  The real question, though, is how many more treatments do I have?  Dr. Priya is out of the office until July 13, and I haven’t had a chance to discuss with her how many treatments I’m to have.  The last time we talked about it, she mentioned 10 treatments, but apparently my chart says 8.  I have an appointment with one of the other oncologists, Dr. Colocci, on Wednesday; I suppose we’ll discuss the number of treatments left then.  For now, I’ve got chemo scheduled through July 17, which would be 9 treatments total.  That would be just fine with me.

A Good Week! – June 19, 2015

With a week off from chemo, and just receiving Taxol and Herceptin last Thursday, this week I felt pretty good.  My BP hasn’t dipped low (I stopped taking my high blood pressure meds), and I’ve been making sure to drink plenty of fluids.  Basically I drink 30 oz first thing in the morning, which ensures that I get at least 1/3 of the 90 oz they want me to drink every day from the start of the day.

On Friday I had my appointment with Dermatology, to look at all of my nails.  I wouldn’t say that was the most productive appointment:  I received an antibiotic  ointment to use when my nails start falling off; the doc told me to keep my cuticles super moist (she suggested using Aquafor, which I’m discovering is the solution for everything) to try to keep the seal that cuticles create with the nails.  She did say that my skin looks terrific for undergoing chemo, so that was a plus.  I’d already lost one fingernail by last Friday, and today I lost another when I hit the gear shift in my car just right.  Both on my right hand, I’ve lost the nail on my forefinger and 4th finger.  I think I should have invested in Band-aids! Neither nails were the ones which were infected and caused the fever.  I guess it makes sense that I’d lose fingernails first because the hands get used for all sorts of things. The toenails were first to start separating from the nail beds, but for now they’re all still there.

I was able to go to work Monday-Wednesday this week.  Yesterday I had to take my car for servicing, so I worked from there and then home.  I got a blood draw first thing in the morning.  I’ve felt pretty good all week, and had very little diarrhea.  Once was when I forgot to have some yogurt while taking antibiotics and once when I couldn’t resist and ate a lot of cherries.  I love cherry season, but eating them in the quantities I can (and do) gives me diarrhea when I’m not undergoing chemo, never mind now!  Either way, I’ve learned to manage the diarrhea pretty well.

While I was at the car shop, Dr. Priya called to tell me that she was able to prevail and that the Perjeta was approved from this point forward.  PAMF will have to apply to have the May 15 treatment retroactively approved; on my insurance site that claim’s status has changed from “Denied” to “Pending” so I’m thinking that’s a good thing.

When I got home, I got a call from Velia, who informed me that while my counts looked good (mag was low at 1.2), my hemoglobin had fallen from 9.4 to 8.1 and that I would need a blood transfusion. At today’s infusion, they took blood to be typed and crossed, and I’ll have the transfusion after my breast MRI on Monday.  A transfusion takes 4-5 hours, and there is no time for a directed donation.  I need the transfusion on Monday, and for a directed donation, Stanford Blood Bank would need to do all sorts of tests – which would take a week.  Plus, insurance won’t pay for a directed donation transfusion (surprise, surprise).  So I have to trust that Stanford Blood Bank has done its job in screening and testing the blood I’m going to receive.  Because I’m getting chemo weekly, I’m figuring that my hemoglobin doesn’t have time to recover, which also explains the urgency in getting a transfusion on Monday.

The approval of Perjeta meant that today’s infusion was Taxol, Perjeta, Herceptin, and the ever present magnesium.  We had a little trouble drawing blood from my port, which is very unusual, but eventually we got what we needed.  After the pre-meds, the blood draw, and the chemo and mag, I finally left after 7 hours.  I woke up at 4 am this morning and couldn’t go back to sleep, so I’m super tired tonight.  I suppose I might have taken the Decadron a little late last night, which could be why I didn’t sleep well.  I don’t think that will be a problem tonight.

I’m off cycle a little:  I should have received Perjeta last week.  I don’t know what that means for how many more treatments I will get, and how many more treatments of Perjeta I’ll get.  I did get a phone call today while in the center from Jennifer the nurse educator, who said that it looks from my chart that Dr. Priya was planning on 8 treatments total, and that meant I should see Dr. Ching (breast surgeon) to start preparations for surgery.  I thought Dr. Priya wanted 10 treatments, so I’ll have to ask her when I see her next, but in the meantime I’ll be scheduling an appointment to see Dr. Ching soon.

Did you catch that I mentioned a breast MRI on Monday?  Yep.  I’m going to have another one to see if the chemo is doing its job and reducing the tumor.  Neither Dr. Priya nor I can feel it anymore, so the chemo has got to be reducing it, but we can see by how much.  Dr. Priya also wanted to make sure that the chemo WAS doing its job, because why put me through all this chemo if it wasn’t working.

I’m really happy that I had the forethought to go to Sephora before I started chemo to learn how to draw eyebrows.  It’s kind of shocking to see just how few eyebrow hairs I have!  and I have exactly 1 eyelash on my left lower lid.  I wonder how long that lone soldier will last.  The hair on my head is what I’d call just really, really thin – Ted hasn’t shaved my head for a couple of weeks, so I can see the hair growing.  It’s mostly white 😦 and just thin all over my head.   I may keep a shaved head even after I’m done with chemo. I like looking badass, and I’ll save a ton on hair product!

We have a relatively quiet weekend ahead of us, which is good.  I need to finish online traffic school, write performance evaluations, and work on my conference presentations. Aside from a late lunch tomorrow with our friends Jess and Matt, we’re homebodies.  And it’s a good thing – I have an incredibly busy week ahead.  I’ll tell you all about it next time!

If It’s Not One Thing, It’s Another – June 11, 2015

Let’s start with the end today.  I received Taxol, Herceptin, 2 grams of magnesium and 1 L of saline.  I was at the infusion center for 6 hours again, and my friend Nancy brought me lunch because I forgot my lunch at home.  Thank you, Nancy!

Astute followers will note that I did not receive Perjeta which I should have this time, every 3 weeks.  I did not receive it because some lackey at Anthem Blue Cross decided to deny the Perjeta for the Taxol protocol, even though it was approved for the Taxotere protocol. It also means that right now I’m on the hook for the round of Perjeta I received in the first round of the Taxol protocol on May 15, to the tune of $26,000. I sure hope Dr. Priya is able to prevail.  It makes absolutely no sense to approve it for one protocol and not the other when both protocols are NCCN (National Comprehensive Cancer Network) approved.

Why did I get 1 L of saline?  Because when I arrived at the infusion center, I was obviously struggling and did not look great.  Indeed, my BP was 84/54.  Why was my BP so low? Apparently I didn’t drink as many fluids as I thought I did yesterday, but I also had a fever from Sunday until late Tuesday night.  Turns out that the fever was probably caused by infected fingernail beds.  I got antibiotics on Tuesday, the infections have seemed to have cleared up, and I have an appointment with Dermatology tomorrow.  I don’t know what I’ll be told, but I estimate that I’m going to lose 8 toenails and 4 fingernails. The nail loss is an extreme side effect of Taxotere. Seems I got ALL the extreme side effects of Taxotere. Lucky me.

Because I looked so terrible when I arrived, and my vitals were terrible (in addition to the low BP my pulse was 125, which meant my heart was working way too hard), Dr. Priya thought about delaying my chemo today.  Her compromise was to give me 1L of salne, recheck my vitals, and run the rest of my labs while I received the saline (over 2 hours).  I got a blood draw on Tuesday, but only a CBC to check my white blood count – to see what the fever was doing.  My WBC was fine, which is why I showed up today for my infusion. So they ran my magnesium and a basic metabolic panel, mainly to see how my potassium was doing. My potassium was normal at 3.8 (yeah, the oral meds are going the job), but my magnesium, while better, was still low at 1.3.

When I’d received about 750 mls, my vitals were taken again, and my BP was 95/66, and my pulse was lower at 116.  So we went ahead with the Taxol and Herceptin today, which made me happy.  Amazing how sleepy IV Benedryl makes me – I always end up taking a nap!  By the end of the infusions, my BP was 107/79 and my pulse was down to 109.

The facepalm of the day was the realization that I’ve still been faithfully taking my high blood pressure meds…so I’m off them for now (upon Dr. Priya’s orders and notifying my PCP), and I’ll be checking my BP every night. Hopefully that will help.

The other piece of news I received this week is that my hemoglobin is on a steady decline, and is currently 9.4.  If it goes down below 9.0, there’s a very good chance I’ll receive a blood transfusion.  It’s yet another reason for my increased dizziness, especially from a sitting to standing position; for my shortness of breath, and why I get tired more easily. Just another side effect of chemo, but having to receive a transfusion doesn’t make me very happy.  I’m hoping I can get a directed donation, which at this point looks like Ted, who is the universal donor.

I’ve had kind of a crappy 2 weeks, between the low potassium and magnesium and delay of chemo, followed by fever…At least I had a great day on Saturday.  We delivered a cat which was being transported to Arizona (I’m involved in volunteer animal transport) and then took a drive over to the coast.  It was a gorgeous, glorious day – the kind you can only find in California, and we had a lovely day.  All is not lost.  Things are looking up, and I just have to focus on the next week.  I can’t worry about things currently not in my control (like insurance approvals), and I just have to live each day at a time.  That’s how I’ll get through this.  That, and a wonderful support network of family and friends.  I’m still blessed, and I know things will be okay.

Good, and bad – June 5, 2015

I went in for my infusion of potassium and magnesium, and the 4 hour drip was a breeze.  My BP was 108/80 today, and while my pulse was 128 when I arrived by the time I finished it was down to 99.  All good signs that the drip did its thing.  The question now is whether I can keep my potassium and magnesium levels okay.  Given that I had diarrhea today, I’m not very confident, but I’ll be more careful about what I eat and much more diligent in taking Lomotil or Imodium after every bout.

The bad news is that currently I’m scheduled for chemo on Thursday, which means I’ve essentlally missed a week.  The reason, other than to give my body a chance to recover, has to do with insurance.  If you recall, the reason I’m having chemo first then surgery was that one of the drugs for my type of cancer – Perjeta – is only approved by insurance for neoadjuvant therapy, so the typical order of surgery, chemo, radiation was altered to be chemo, surgery, radiation.  The reason it’s important to have insurance pay for Perjeta is that it’s $26,000 a treatment.  My insurance has paid for the Perjeta I received in January; I received it again when I started this new protocol of Taxol with Perjeta and Herceptin 4 weeks ago.  It’s not clear whether that treatment was approved, but I do know that Dr. Priya needs to do a peer-to-peer justification for me to receive more.  That justification is on Monday, and in order to give the review some time, PAMF didn’t want to schedule me for chemo on Tuesday.  By the time this was all figured out, Wednesday was booked, so here I am, scheduled for chemo on Thursday.  My infusions are super long, 5-6 hours, so it’s not like they can slot me anywhere for an infusion.  Still, I asked if there was a cancellation on Tuesday or Wednesday and if my treatment was approved if they could call me.

I know I shouldn’t be so focused on the timing for my vacation, but while I am going to relax and heal, I still want to have some fun.  I just have to relax and have faith that it will all work out.  One option that Dr. Priya mentioned is that I could also have chemo after surgery – but if that’s the case, I won’t be receiving Perjeta, unless that therapy is approved for adjuvant therapy in the intervening months.  She could decide that 6 rounds of Taxol is enough.  (I think my body would agree with that…)  The puzzling thing is that Taxol is supposed to cause constipation; Perjeta can cause diarrhea, but any Perjeta when this protocol first started is well out of my system.  The diarrhea has gotten worse, so I’m convinced my body simply does not like the Taxene family of chemo drugs.  I’ll gladly take the Red Devil over any Taxene drug…but there’s a lifetime maximum of Adriamycin.

So…good and bad.  I’m feeling tired but okay right now.  Certainly I do not have any dizziness, some weakness is normal.  I’m drinking a lot, and need to remember to continue to drink a lot.  I probably am not drinking enough, especially considering the diarrhea.  Let’s hope things improve this weekend.

Disappointing News – June 4, 2015

I had my usual blood draw today, and then an appointment with Dr. Priya.  While my blood counts are good, my potassium and magnesium levels are low.  I’m sure it’s due to all the diarrhea I had this week.  In addition, my blood pressure was extremely low – 88/61. In order to help with the blood pressure, I need to drink more fluids, but with the low potassium , more fluids can make the potassium even lower.  Dr. Priya wants to give my body a few more days to recover, so I won’t be receiving chemo tomorrow.  I will go to the infusion center, but to get fluids, potassium and magnesium.

I’ll have a blood draw on Monday, and if all is better, I can have chemo on Tuesday.  The delay is disappointing, but in the end, what’s important is my health.  The labs and low blood pressure explain why I’ve felt so weak and dizzy, with headaches.  So this weekend I need to try to get the diarrhea under control, drink plenty of fluids, and eat well.

Dr. Priya is going to order another breast MRI, to make sure that the chemo is reducing the cancer.  Why continue to go through this if the chemo isn’t having an effect?  I haven’t been able to feel the lump since the first treatment, though, so it will be interesting to see what the breast MRI will show this time around.

Here’s to hoping I have  a better weekend, and that the only delay in getting chemo is until Tuesday.

Cumulative Effects – June 2, 2015

Not much to update, except that the cumulative effects of the chemo are definitely being felt.  Sunday I couldn’t keep anything down – in either direction.  That meant the Monday I was feeling extremely weak. I went to work, but had to stay home today while I gathered my strength.  I was able to eat more today, and while I still have diarrhea, I no longer have nausea.  I feel better.  I will have to figure out a way to control the nausea for the few days after chemo.

I managed to get myself to my scheduled echo in the afternoon.  The echo checks that the chemo isn’t doing any damage to my heart.  It was painless and fairly quick.   I have an appointment with Dr. Priya on Thursday.  Sometime soon I hope to have a definitive answer on whether the Taxol rounds of chemo is going to be 10 or 12 weeks.

Onward!

2nd Part of New Protocol Starts – May 16, 2015

Yesterday I received the first dose of the 2nd part of the new protocol.  Confused?  Don’t worry, Ted can’t even keep it straight.  When my original chemotherapy (Taxotere, Perjeta and Herceptin) didn’t agree with me after 2 (of 6) rounds, the oncologist switched me to a new protocol, which is comprised of 4 rounds of Adriamycin and Cytoxan, followed by 12 rounds of Taxol, Perjeta and Herceptin.

My day actually started very early…with a 3 am wake up to catch a 5:30 am flight from LAX to San Jose.  I was in Santa Barbara for a meeting on Thursday, but needed to be back in time for an appointment with Dr. Priya at 8:40, followed by chemo at 9:45.  Because I was early, I started my chemo early at 9:15, which was a very good thing.  I was in the infusion center for 9 hours!

The infusion always starts with saline, and pre-meds.  This time the pre-meds were Benedryl and Pepcid, both of which are supposed to help with the Taxol.  That was followed by Decadron, a steroid, which I’ve been getting each treatment.  Next was Perjeta, which I received at my very first treatment back in the end of January.  It’s also the reason I am having chemo before surgery; Perjeta is approved for insurance if given before surgery, but not after.  The Perjeta was given as if I was receiving it for the first time – slowly, and I had an hour waiting period to ensure I didn’t have an adverse reaction.  Then I was given Herceptin, followed by Taxol.  And, of course, magnesium.  The 2 hour infusion of magnesium didn’t start until 3:40, and by the time it finished, and then the wrapup of flushing my port and Heparin all finished, it was 6:15.

Dr. Priya decided to go “all in” and give me the full loading doses of Perjeta and Herceptin. Velia, Dr. Priya’s nurse, came by the infusion center and said that she expressed skepticism to Dr. Priya about the wisdom of that.  She said, “You weren’t here when Caroline went through this last time…” (Dr. Priya was on leave for the first 3 months of my treatments.) Basically, Velia thought that Dr. Priya was crazy to try it.  We’ll see who’s right!

Today I’m feeling great, but I know from experience that if I start to feel poorly it’s about 3 days later.  On the other hand, I also know what to expect, what I should and shouldn’t be eating, how to handle the diarrhea and/or nausea if it starts, so my hope is that things may be okay.  I do feel fortunate that the Adriamycin/Cytoxan treatments went so well that I was able to continue working with few incidents and go on my business trips.  My trip to Charleston was highly successful on many fronts. We had successful business meetings, did a little sightseeing in the pouring rain to Fort Sumter, and transported 2 cats home! I am involved in animal transport in my spare time as a volunteer, and I love it.  One cat was a military reunification, and the other was an outright adoption of a kitty from New York.  My next trip isn’t until August now, although work is heating up with a go-live date of July 15 for a database conversion.

At my appointment with Dr. Priya, I asked her if she’d had a chance to discuss with the tumor board about shortening the Taxol treatments from 12 weeks.  She said there was general agreement that it could be shorter, but how much shorter is the question.  She said that it would be at least 8 weeks, but that she was leaning more towards 10 weeks. It will depend on how well I tolerate the Taxol.  So let’s hope I do well, and that there are no complications so that the Taxol treatments can be 10 weeks long rather than 12.  If you recall, I have a vacation scheduled in September, and would love to be as far past my surgery as possible when I go to Maui.  I know, first world problems…but I can’t tell you how much I’m looking forward to some relaxing, healing time in Maui.

It will be interesting having chemo weekly. Cramps my life a little, but it is what it is. Let’s just hope I tolerate Taxol well!

All done with #4! – May 1, 2015

Woot!  Today was the 4th and last infusion of AC (Adriamycin & Cytoxan)!  It went really well; as has been true for the last few infusions, I also needed magnesium, so I was in the infusion center for another 6 hours or so.  Adriamycin is the “red koolaid” drug that I’ve been posting on Facebook – such a pretty red color.  It’s interesting to note that there is a lifetime maximum that I can receive of Adriamycin…just think how toxic it much be! Hopefully lifesaving toxic!

So how have I been doing?  It’s so clear that within 24-36 hours after coming off Decadron (steroid) and Zofran (anti-nausea) I have 2-3 bad days.  I was able to work through most of those days this last round.  There was only one day that I really could not deal with going to work, as I was feeling just all around crappy.  Not exactly nauseous, but feeling really icky and weak.  Already not a morning person, the chemo makes mornings even tougher.  Between the icky stomach and weakness, mornings are not my favorite time of day for 4-5 days.  The weakness has persisted some, but Dr. Priya that’s expected – the cumulative effect of the chemo.  I didn’t have diarrhea this time around (yay!) and ate much more normally than in previous rounds.  I mean I had vegetables!  Part of the success this time was that I am taking iron, which can cause constipation, so I think the effect cancelled each other out.

The worst effects have been neuropathy in my fingers and toes, and canker sores at the corners of my mouth.  I get canker sores at the corners of my mouth even when not undergoing chemo; probably a herpes virus whose effects are exacerbated by lack of leafy green vegetables in my diet coupled with stress.  However, the chemo also causes sores, usually mouth sores (in the mouth as opposed to externally), but Dr. Priya wasn’t surprised and suggested some topicals I can try in addition to my usual to try to help the pain.  For the neuropathy, Dr. Priya suggested taking L-glutamine.  She says it helps 50% of patients with neuropathy, so it’s worth a shot.  I had to pick it up at a GNC store-wow that was an eye opener.  The stuff they sell in there is not in my realm of experience.  On top of that, the dosage on the powder I got is 5000 mg, and Dr. Priya wants me to take 10!  So just a few grains, I guess?  The neuropathy isn’t terrible:  mainly in the tips of my fingers and toes, it does not prevent me from walking, and it usually mostly goes away on my right hand by the next infusion.  It’s never disappeared in my left hand since the first treatment.

So what’s next?  I leave for Charleston, SC on Sunday night and am there until Thursday.  I hope I can handle being at this conference and the effects of chemo at the same time.  At least I’m not presenting!  I’ll have my first treatment of the second phase of this protocol on May 15. The next protocol is Taxol, Herceptin and Perjeta.  Since Taxol is in the family as Taxotere, I’m a little concerned about the side effects.  I’m hoping that since the dose is lower and it’s a different drug that I won’t have the same problems.   I guess we’ll just see what happens.

During today’s treatment I had a craving for Jamba Juice; through the magic of social media, my friend Michael brought one.  My hero!  Then I had a hankering for pho, and poof! through the magic of social media, 7 of us had dinner tonight.  What serendipity!  It was great to have dinner with good friends, and I had a great time.  Life is good.

#3 Down! – April 17, 2015

I had my 3rd infusion of the new protocol today, and as with the other two, it went just fine. I was done with the premeds and chemo in three hours, but then had another three hours for more magnesium.  My magnesium was better, but still low.

Before the infusion, though, I had an appointment with Dr. Priya.  It was so good to see her again.  She told me that everyone loves me, or at least my attitude.  She said that where the clinic is located…well, patients tend to complain about everything, even when they don’t have anything to complain about.  Me, on the other hand, had every right to complain about everything and never did.  She asked me how I did it!  That was nice to hear.

I asked Dr. Priya about the length of the second part of the protocol (Taxol, Herceptin and Perjeta).  The reason I’m concerned about when I finish chemo is that affects when I can have my surgery.  And the reason I want to have my surgery as close to the week of August 10 as possible is that I’ve scheduled some recovery time in Maui.  Someone was kind enough to give me time at a condo, and someone else upgraded me to first class.  (Yes, I’m extremely blessed)  Moving the time in Maui would be possible, but not without a lot of hassle and additional costs. Dr. Priya said I would be fine to go to Maui in my third work of post-surgery recovery, but then we also discussed the length of the Taxol protocol.  I wondered if the 2nd part of the new protocol could be shorted:  I’d received 2 doses of Herceptin, and 1 of Perjeta.  So was it the Taxol of which I needed 12 weeks?  And my questioning was confirmed when I spoke with Jennifer Glover, the nurse educator who works with Dr. Ching, my breast surgeon.  I asked her whether I really needed to wait 4 weeks after chemo to have surgery (Dr. Ching insists) because I had this vacation planned. Jennifer was surprised that I was going to have 12 weeks of Taxol, and that confirmed my suspicion.  Dr. Priya said that 1 dose of Taxotere is equivalent to 3 weeks of Taxol, so it’s possible that we could reduce the Taxol by 6 weeks!  She also said that I could have Taxol after surgery if needed, and that this is where it’s the art of treatment comes in. I can appreciate that.  She said that she’d discuss it with the tumor board and let me know. We also talked about Perjeta – we’re not sure if the Perjeta or the Taxotere was what gave me such bad diarrhea.  I said that since I was approved for it, I’m game to have it again.  After all, I’m also much better about what I eat to avoid, or at least minimize, any diarrhea. So we’ll do that.

Speaking of diarrhea, I haven’t had any problems with it for a couple of weeks.  I was able to enjoy thoroughly New Orleans cuisine, and that was the blessing behind the tooth infection and extraction.  I love New Orleans:  the only bummer was that it rained pretty much the entire time I was there.  I was able to carve out some time to go the Quarter Stitch, a fantastic yarn store in the Quarter, and go to Cafe du Monde along with Emeril’s, Cochon and Clancy’s.  Oh, and fantastic breakfast at the Ruby Slipper.  And yes, I did attend sessions at the conference, which was why I was in New Orleans in the first place.

So all in all, things are going pretty well!

One Less Tooth – April 7, 2015

This new protocol is definitely better for me.  On Wednesday, which is usually when I start feeling badly from treatment, I did feel crappy towards the end of the workday, so I took off a little early, got home, and then took a 3 hour nap!  The next day we got early release at work in preparation for the Good Friday holiday.  I managed to do a volunteer training and still watch my beloved Cardinal win its 2nd NIT title in 4 years. I took it easy on Friday and thought I escaped any bad side effects from this round of treatment.  Oh well.

I think I didn’t eat or drink enough on Saturday – my routine was off a little because I was home, and it all caught up for me on Sunday.  I felt weak and shakey, but we had a day of activities planned.  I had to make my famous bourbon yams for Easter dinner, drop that and a ham off at my sister’s, then go to the San Jose Earthquakes match.  On the way down to the game – at the worst possible point on the drive down – I told Ted that he needed to pull over because I was going to vomit.  And vomit I did.  Good thing I had a cup in the car, because Ted couldn’t pull over in time.   I was still able to enjoy the game, despite the Quakes’ loss and a crampy stomach; by the time I got to my sister’s for Easter dinner I was feeling a little better, except for the diarrhea…I was able to eat Easter dinner, which was awesome.  It was good to spend time with my family.

Yesterday I had a blood draw and the counts were heading the right direction.  My magnesium is still low, but Dr. K gave me the okay to have my tooth pulled.  I thought I was going to get Versed for the procedure, and arranged for my sister to drive me home.  Turns out it was just a local.  The whole procedure took less than 20 minutes, and half of that was waiting for the Novocaine to kick in.  The infection definitely took it toll on my tooth – it came out very easily.  The dentist didn’t put a spacer in, so it feels odd to have a missing place.  The throbbing was pretty bad last night and this morning, but right now it’s very manageable.

Dr. H (dentist) explained to me why he insisted that I delay my next treatment until a week from Friday.  He said that if he allowed me to have chemo this Friday that my counts would start to head south, and I’d be unable to fight off the 147 different types of bacteria which live in a mouth.  He said that he could guarantee that he’d see me at Stanford Hospital with an infection I couldn’t fight if I had chemo.  So no chemo for me on Friday. The downside is that this potentially delays my surgery, and I have a very good reason for wanting my surgery to be the week of August 10, which I’ll explain later.  The upside is that I leave for New Orleans on Saturday – one of my favorite cities – and so I should be feeling really great and can enjoy myself.  And maybe enjoy that famous NOLA cuisine.

Dr. Priya, my oncologist, returns from medical leave on Monday, so now my appointments are with her.  I’ve like Dr. K a lot, but I love Dr. Priya, and I’m happy to have her back.  In the meantime, there shouldn’t be much happening between now and April 17.  At least I hope not.