Monday, April 27, 2009

Quick update

We don't have much new to report. Sherrie has been fighting a minor infection the last several days. She was given an antibiotic by the plastic surgeon late last week after a checkup. She wasn't feeling too well on Saturday, but felt better on Sunday and seems to be okay today, though the redness and swelling isn't completely gone. We go see the surgeon again on Friday of this week.

Last night, Sherrie slept in her bed for the first time since the surgery! She can only lie on the "non-operated" side, but she was happy to be out of the Lazy Boy (even though she likes it a lot).

We are anxiously awaiting the chemo to start on 7 May, and hoping she's strong and well (i.e., the infection is gone) by then.

Monday, April 13, 2009

"Port-a-cath" procedure

Sherrie had a "port-a-cath" installed this morning in an out-patient procedure at the hospital. The "port-a-cath" is a catheter inserted in a major vein near the heart, buried under the skin. It allows clinicians to administer IVs and take blood easily, safely, and relatively pain-free. It's a lot better than having an IV on a regular basis during the chemo cycles.

The procedure took less than an hour. Sherrie had a less powerful form of anethesia; the surgeon said, "it gives you amnesia." She remembers nothing between going into the operating room and waking up in the recovery room. She had none of the ill effects of general anesthesia, except that she was sleepy for about 90 minutes after the procedure.

She's sore now and resting (sleeping) in her easy chair. She has a bandage over the affected area, and can take it off in a day or two. On Friday, we go see the surgeon to have him check it out to be sure all is well (the same day she gets the rest of her stitches out).

At one point during recovery, we were small-talking about nothing much in particular, and Sherrie remarked, "It sure is sleepy in here."

Thursday, April 09, 2009

MUGA scan report

Sherrie had the MUGA scan this afternoon. From my perspective, it went fine, but Sherrie had to hold her arms over her head while they were taking pictures, which made her sore. (She was lying down on the detector table.)

Briefly: a MUGA scan is a "multi-gated analysis" (or something similar) in which the blood is infused with Technetium-99m (a gamma source). The detector is prompted by an EKG to count photons (gamma rays) at various parts of the heart's cycle (eight times per cycle). The system integrates the counts for about 5-10 minutes per scan. The system makes the scans from three different angles, constructing a 3D model of the beating heart. From the data, the system can measure the heart's efficiency. A healthy heart is about 60 percent efficient, meaning that it "moves" about 60 percent of the blood in the ventricles per heartbeat.

The technician was nice to us and talked to us about the procedure and the pictures in real-time. As soon as he started taking the pictures, we noticed a black spot right on top of Sherrie's heart. It showed up in the scans from all three angles. At first, the technician thought that Sherrie must have had some metal on her body or inside her. He later decided that it was coming from the expander which was placed inside Sherrie's chest. At the end, we looked at the detailed pictures and could see a perfect ring about 1/4 inch in diameter, lying in her skin above the heart. We're still not sure what it is. Presumably there is no metal on the expander, but I'm not really sure. Perhaps it is some other material which absorbs the gamma-rays.

Sherrie's heart efficiency was about 68 percent, which is better than the expected "threshold" of 60 percent. Assuming nothing untoward comes up in the more detailed analysis, we believe she should be good to go for chemo.

The technician showed us "moving pictures" of the heart's beating cycle. It was really cool.

Progress update

Sherrie got her drain and half of the stitches removed this morning; the other half of the stitches will come out in one week.

Sherrie was excited to get the drain out in the hope that some of the soreness would go away. Removing the drain hurt quite a bit, and she was quite sore immediately afterward. We hope that quickly goes away and she starts feeling better soon.

This afternoon, we have the appointment for the MUGA scan. In two weeks, she goes back to the plastic surgeon and may have a little fluid put into the expander before the chemo begins.

Getting the drain out today was big.

Friday, April 03, 2009

A couple more notes re: oncology appointment

For the interested student, the three drugs that will be administered to Sherrie are 5-Flourouracil, Epirubicin, and Cyclophosphamide. Yes, the known,common side effects are many and undesirable.

Another side effect I forgot to mention in the previous post is fatigue. She can expect to feel 80-90 percent during much of the time she is on chemo, but that will go up and down with the administration of the drugs.

First oncology appointment

We had our first appointment with the oncologist today. In summary, I would say the appointment was sobering but hopeful, punctuated by a few light moments, mostly dealing with hair loss.

The most sobering point was that the "micrometastatic tumor" in the lymph node was bigger than we had been told. It's still not clear in my mind exactly what happened in the surgery, as the oncologist told us that the surgeon took out and tested three lymph nodes. I wonder now if he was confused with the three stains the surgeon recounted (?), or maybe the surgeon didn't clearly inform us that in fact three lymph nodes had been removed. In any case, one of the three tests (nodes?) had cancer cells in it. The oncologist told us that the cancer cells were in a mass about 2mm in size. Not big, but definitely bigger than "one or two cells" as the surgeon initially said (or implied).

Another sobering point came when the oncologist told us that in some cases, the cancer will return in either the other breast or in another part of the body, and if that happens, they can't cure it--only fight it and prolong life. Without chemotherapy, for Sherrie's circumstances, the odds are one in three that the cancer will return somewhere at some time.

The good news is that if Sherrie has chemo, the odds of a recurrence are cut in half (to one in six). So, chemo is definitely indicated for us.

Another piece of good news is that tumors which are estrogen-positive like Sherrie's respond better to the chemo than the ones that aren't estrogen-positive.

Sherrie needs to heal before beginning chemotherapy. The oncologist said we should begin four to five weeks after the surgery, so we are scheduled for our first treatment on the 7th of May.

The course of treatment will be six cycles, separated three weeks apart. In the first week of the cycle, she will receive three drugs via IV. The next week, she will receive one of the drugs again, and the third week is a "rest" week. Concurrent with the administration of these drugs will be frequent blood tests to measure counts, particularly white cell counts. We had been expecting the chemo to last six months, so the fact that it will be over around the first of September (assuming no problems) is good news.

Prior to beginning the course of treatment, the oncologist wants Sherrie to do a nuclear medicine imaging test of the heart. Evidently, the chemo drugs can be hard on a heart that isn't healthy, so he wants to be sure her heart is strong.

Sherrie will have a semi-permanent catheter installed in her upper chest near/under the collarbone. This provides an easy and safe way to draw blood and to administer the IV drugs. The surgeon will install this catheter in an out-patient procedure sometime soon, and it will be removed after the course of treatment.

She can expect to feel quite nauseous for one to two days after each treatment. The oncologist will give as many anti-nausea medicines as are required ("we just keep adding them") until she is able to deal with the nausea.

A serious concern for patients on chemotherapy is infection. Sherrie could literally go from feeling fine to being in a life-threatening situation within the course of a couple of hours. A fever of over 100.5 is a medical emergency, necessitating a trip to the emergency room. If her blood count is low, she'll be in the hospital on IV antibiotics for a few days. School in May might not be recommended--too many germ carriers!

Sherrie will lose her hair, within days of the first treatment. It won't really start growing back in earnest until several weeks after the last treatment. Summer is probably not a bad time to lose one's hair and wear a hat.

Through all of this ordeal, I've been grateful for Medicine and its ability to help people. Modern medical care saved Sherrie (and Jared) when Jared was born, and it's saving her life again. For that I am profoundly grateful.