Sunday, May 31, 2009

Sherrie's weekend

Sherrie had a reasonable weekend, but she hasn't started feeling noticeably better yet as of tonight (Sunday). She's still feeling a bit tired, nauseous, and not quite up to snuff. Hopefully a good night sleep and she'll be much better tomorrow.

Friday, May 29, 2009

What goes down must come up?

Sherrie threw up last night a couple of times. She seems to be feeling better this time than last, but one can't be sure. She held down a banana this morning and just tried some rice. She seems a bit weak, which is only natural considering what she's been through.

We're hopeful the ginger and anti-nausea meds will help her to feel better this time than last.

Thursday, May 28, 2009

Chemo 1 report

Today's chemo session was unspectacular, at least so far. The only thing of any import that happened is that the oncologist told us he would order Neupogen for Sherrie to begin the day after her chemo session next Thursday. He said that since she had demonstrated falling to a low white count during the first cycle, we should just assume it will happen again, and try to prevent it with a five-day course of Neupogen. Sounds eminently logical.

The chemo induction was relatively quick and relatively incident-free. Sherrie didn't feel much like eating her ice toward the end, but she came home and ate a nice dinner (provided by a loving friend and neighbor--thanks!).

So now the waiting game begins. Hopefully the combination of the ginger and the two anti-nausea drugs will make the beginning of this cycle easier than the last.

Chemo 1 today

Sherrie has a "chemo 1" appointment this afternoon. We hope that she is well enough to do the chemo; her fever came back yesterday a little bit (around 99F), but it was gone this morning. So we'll see what the doctor says.

Sherrie's been taking ginger the last few days, which hopefully will help wit the nausea (see ). She's not too excited about the beginning of the new cycle, but she has to get through it to get to the other side.

She's growing accustomed to wearing scarves and her wig. I think she looks awesome in both.

Look for an update later today.

Wednesday, May 27, 2009

White fever?

Sherrie didn't feel super-well the last few days. She had a near-continous headache since receiving the Neupogen injections. The last of these was given on Monday, but the headache persisted beyond that.

Sherrie had a CBC on Monday and her reported white count was 17.0! Normal is anything above 6.5 or so, and her white count had gotten as low as 1.7 late last week. The Neupogen must be doing its job.

Of moderate concern to us is that she had a slight fever (around 99.5F) beginning Tuesday around noon. We watched it rather closely throughout the day and evening, but it never got higher. By Wednesday afternoon, the fever and headache were gone, and she was feeling better. It seems rather odd that she would have a fever when her white count was so high. This will be a question for the doctor on Thursday.

We're hoping that she'll be feeling 100 percent for the beginning of the next round of chemo this Thursday afternoon.

Thursday, May 21, 2009

General, the ranks are thinning ...

Sherrie had a blood test today, and within 30 minutes the oncologist's nurse called and informed her that her white count has fallen alarmingly low. We had to go this afternoon to their office to receive a shot of Neupogen. Neupogen is an amino acid which promotes the growth of white cells in the marrow-producing bones. There's an interesting website at which describes it nicely. It's definitely a high-tech drug; it's produced by recombinant DNA techniques in E. coli bacteria.

Sherrie has to have a shot of Neupogen each of the next five days. Since one of those days is a Sunday (and the office isn't open), she gets a larger size dose on Saturday. Her white count was down to 1.7 (in whatever units they measure white count). Normal is above 6.5 or so. Last week, just before the chemo 2 injection on Thursday, her white count was 4.5. They want to get her white count up to 10.0 by the beginning of the next chemo cycle on Thursday of next week.

Apparently this isn't a rare thing for chemo patients. The oncologist told us that about 60 percent of patients have to have Neupogen (or equivalent) injections during chemotherapy.

The funny thing is Sherrie feels great, with no apparent ill effects. It's kind of scary that one's white count can be so low, and yet feel fine.

She may have sore bones (back, sternum, and hips) as a side effect of this drug.

Wednesday, May 20, 2009

Hair today, gone today

This morning was a traumatic one for Sherrie. Her hair started coming out in small bunches last night. She could run her hand through her hair and pull out little clumps. This morning, the clumps were a little bigger, though it didn't look as though her hair was thinning yet. She struggled with the reality of the situation ("maybe it won't all fall out, but will just thin a little"), and in the end, she asked me to shave her head. So, we had a head shaving party this morning, and after a few minutes with the hair trimmer, it was all on the floor. It was an emotional experience, in spite of the mental preparations of the past few weeks.

Other than that, Sherrie has been feeling quite well. She's not really experiencing much (if any) nausea, and she seems to have sufficient energy each day. Her white count is surely low right now, and we have illness (colds) in the home, so those of us who are ill are keeping our distance as much as possible. She's beginning to dread the beginning of chemo cycle number two next Thursday.

I'm very proud of Sherrie for her great attitude and indomitable spirit. She's being put through the wringer, but she weathers the storms with strength, dignity, hope, and a positive outlook. She's a great example to me.

Thursday, May 14, 2009

"Chemo 2" report

Sherrie had her "Chemo 2" today. We got a bit of a late start because we had to wait for the CBC blood work report to come from the hospital. After that, it went relatively quickly.

Sherrie had several questions about side effects and what it means to "overdo it." On the latter, she had been told not to "overdo it" when exercising, but didn't really know what they meant by that. Basically, they meant don't work so hard that she gets really tired or is really sore the next day. I joked that I always feel like that after exercise ;-)

On the issue of side effects, we found out that the nervous jitters are caused by the steroids used to enhance the effect of the chemo drugs. We're grateful that our doctor uses a smaller dose of the steroid than some others (according to the nurse). The nurse told us that most patients don't have that kind of reaction at the lower dosage Sherrie is getting.

The nurse also told us that Sherrie's brain will become accustomed to the nausea associated with the chemo, and even though the drug today shouldn't cause the bad nausea of last week, she might still experience it. The nurse told us a story of one patient who saw one of the nurses in the mall some three years after treatment and had the dry heaves! Evidently, the brain learns to be nauseous, even though the drugs are long gone, and the brain exhibited a learned response on the sight of the nurse.

Sherrie's in good spirits right now. She had a milkshake on the way home from the doctor, and a good lunch, so if she gets ill, she should be able to last a while ;-) Last week, she didn't start throwing up until around 9:00 the evening of the treatment, so we won't know for sure until tonight or tomorrow what kind of reaction she'll have.

They did tell her not to let the nausea illness to get ahead of her, as it's difficult to recover once you start throwing up. On the way home, we wondered what we could have done differently last week. Not much, if anything.

Wednesday, May 13, 2009

"Chemo 2" tomorrow

We've taken to labeling the first "chemo day" of the cycle as "Chemo 1" and the second chemo day, a week later, as "Chemo 2." So tomorrow is Chemo 2 day. Sherrie will receive one injection of 5-FU (we think). Hopefully the reaction won't be as bad as it was last week (she didn't start feeling well until late Sunday or Monday). Sherrie's nervous about tomorrow, "but not nearly as nervous as I will be in two weeks!" (for the next Chemo 1 day).

Monday, May 11, 2009

A better day on Sunday

Sherrie had a better day on Sunday. She felt well much of the day, and ate reasonably well. She still has some antsy, nervous feelings, and has remarked on the irony of being tired,worn out, and jittery all at the same time.

It's Monday morning; the queasiness hasn't gone away, and she's still quite tired. She's wondering what she's going to do with all the time now that she's not going to school anymore.

Saturday, May 09, 2009

Not a good day ...

Sherrie didn't have the best day today. She was quite tired and feeling queasy all day. She hasn't eaten much at all the last couple of days, and is feeling weak from that as well. She was quite tired, and suspects that the anti-nausea meds are zapping some of her strength. She will probably try not taking the meds tomorrow and see if that helps.

Although she hasn't vomited since Friday, nothing sounds good to eat, and when she does eat, she doesn't eat much. We're hopeful that things improve in the next day or two.

On a related but sad note, we've learned this week that Sherrie's sister-in-law Laura, who lives a few blocks away, also has breast cancer. We hope the best for her and her family.

Friday, May 08, 2009

The worst is over ... ?

The worst appears to be over. Sherrie is feeling much better and has kept down her brunch (egg and toast). She seems in good spirits. If the bad nausea only happens for ~12 hours each time, it won't be that hard to stomach ;-)

Nausea ad nauseam

Sherrie was ill all night and didn't get much sleep. She ate part of a banana this morning, but tells me now that she's feeling some rumblings.

I've called the doctor's office twice, and I'm still waiting for them to call me back to confirm they've called in the prescription.

Hopefully it only lasts a couple of days and she can start feeling better.

Thursday, May 07, 2009

Nausea update

Well, Sherrie felt okay for a while, but slowly started feeling worse through the evening, and has just thrown up most of the day's intake. She feels better now, and we're hopeful that she'll be able to keep down her meds and eat enough to keep her strength up.

The nausea is supposed to last 2-3 days. We'll call in the morning and get the second anti-nausea prescription.

She was surprised that the vestiges of lunch were still there ;-)

Report: first chemo session

Sherrie had her first chemotherapy session today. It's been about 90 minutes since the last drug finished dripping, and she's feeling no ill effects yet. The IV-administered anti-nausea drug is about to wear off, and she's taken her first anti-nausea pill, so we'll see how things go.

We first spoke with the doctor for a while. He reviewed the same information we received earlier about the treatment and the drugs. He re-emphasized the importance of treating a fever as a medical emergency. If she gets a fever, we are to go to the hospital right away and not wait around to see if it turns into anything nasty. He talked about the side effects of the chemo drugs. He then gave her a medical exam, reviewed the blood work results, and pronounced her ready to go.

We had quite a bit of excitement when we started to receive the IV. Another patient there, an older gentleman who is quite heavy, had a sudden urge to go to the bathroom. Evidently, he'd had a reaction to some drugs earlier, and was quite sleepy and drugged up due to the counter-reaction drugs they gave him. He had a lot of trouble getting to the bathroom and had fallen (without getting hurt) and was having trouble getting up. At one point, they had *five* people, including the oncologist, in the restroom trying to help him. In the end, it took 45 minutes to get him situated, so Sherrie's treatment was delayed that long. It wasn't a big deal to us; we each had something to read and we waited patiently.

The nurse talked to Sherrie for quite a while while she administered the drugs: about the treatment, what to expect in terms of side effects, how to manage side effects, etc. I had expected the drugs to be administered by IV drip, but two of the three drugs were "pushed" in the IV in a relatively short time (about five minutes). Evidently, the have done studies to determine how best to administer the chemo drugs. It depends on the drug and the type of cancer. For example, they pushed 5-Flourouracil in a quick burst, but other patients have to have the same drug pumped into them over a 48-hour period (with a take-home pump). So, for Sherrie, "5-FU" as it's called, and Epirubicin, are pushed in just a few minutes, but the last drug, Cyclophosphamide, was dripped over about 45 minutes or so.

Sherrie felt no real effects during the session, however, when the nurse started Cyclophosphamide, she said that a sinus headache is a common side effect, and a few minutes later Sherrie thought she felt a headache coming on. The nurse gave her some Tylenol and that seemed to help.

One thing we learned is that to prevent mouth sores common to Epirubicin, Sherrie should suck on ice while it's being administered. The drug affects the digestive track, starting in the mouth, and sucking on ice will reduce blood flow to the mouth and lessen the effects. Given that Sherrie has braces and has been prone to mouth sores since she got the braces, we thought it would be good to have a cupful of ice, so I ran to McDonald's before the treatment began. It turns out a large cup of ice is just the right amount to last through the treatment.

The nurse recommended taking the anti-nausea drug every six hours for three days, whether or not she's nauseous. Once the vomiting begins, it's tough to stop it because one can't keep anything (i.e., the pill) down. If the pill she's taking doesn't help, we're to call and get a prescription for a second pill to take in addition to the first. We should know more later tonight as the IV drug wears off.

We might expect Sherrie to feel worst after the first week of the cycle, not so bad the second week (when just 5FU is administered), and best the third week. Her white count will be lowest 7-10 days into treatment, so she'll have to be most careful then. We are all to wash our hands frequently, and Sherrie should avoid large crowds and anybody with an infection.

Sunday, May 03, 2009

Chemo this week

Sherrie's infection has abated and is basically gone. We saw the doctor again this week and she inflated Sherrie's expander a little more. The pressure pushed out a bunch of yellowish "serum" or pus. The doctor also subscribed more antibiotics, and they seem to have gotten rid of the vestiges of the infection, as the redness and swelling (at least from the infection!) are gone.

We have a great deal of uncertainty this week with the beginning of chemotherapy. We don't have any idea what to expect. We've heard about the side effects and things that happen, but they are always couched in terms of "everybody reacts differently." So we are anxious and a bit pensive and nervous. We really have no idea what will become of this summer and how well Sherrie will feel. She hopes to be able to do normal things like work in the garden, help care for her mother, and have fun outings with our family. Time will tell.

We'll post an update after the first treatment on Thursday of this week.