Christmas

Chemo Treatment #1

My mom had her first chemo treatment on Monday morning. She was scheduled to begin infusing at 8:45am. She was triaged at 9am began the treatment shortly after that. I was not able to stay back there with her as there were other patients getting meds and it was close quarters. I stayed out in the waiting room, and by waiting room I mean 4 chairs against a wall out in the hallway outside the Infusion center. Super tiny. Super thin foam cushions.

I was able to go back and check on her throughout the day. Every time that I went back there, I was so pleased to see that she was holding her own against those drugs. She was even chatting and cutting up with the other ladies that were in the room with her.

Her nurse, Marjorie, was AMAZING. I don't think that I have ever known anyone that could get an IV started on my mom the very first try AND have her not even realize that it was in. She didn't feel a thing!

There are 4 nurses that work in the Infusion center, we have met 2 of them so far. I've been very impressed with the bedside manner and the level of care and compassion that is shown to anyone that walks through those doors. I was even shown the same level of compassion on Friday when we went in for the chemo class. I guess they are aware that being the caretaker for someone with cancer is a very difficult job title. It is stressful and worrisome, but yet you have to hold it together and be strong for others around you. The charge nurse, Joyce, took me into her arms and gave the biggest tightest hug on Friday and told me that I ever needed anything for me to not hesitate to call the center. There is always someone there for us, both as patients and as caretakers.

Back to Monday and the infusion...she was there for 7.5 hours getting her meds. It was a very long day and we were both exhausted by the time it was over.

I took her home with me and she has been here since.

Yesterday, she had to go back to the Infusion center to get a shot of medication that is meant to boost her blood counts during this crucial 48-72 hours after chemo, when they are at their lowest. The medication is potent and causes bone pain.

It is now 11:20 on Wednesday morning and she is just now starting to feel the nausea and weakness. She was sent home with 2 prescriptions for nausea meds, one that she takes twice a day for 3 days and the other only as needed. I made her take the as needed one just a little while ago and told her to go lay down and rest. She was wobbling through the house like she was drunk and slurring her words some.

I have to make sure that she keeps drinking water so that her kidneys continue to filter the drugs through her system. Dehydration is a very bad thing when on chemo.

She had been eating like I haven't seen her eat in a while, up until this morning. She has yet to eat anything, though I keep pushing her because despite feeling sick, she will feel better with something on her stomach. If we stay on top of the nausea, it will be easier to treat and prevent than if we let her get to the point that she is truly sick.

Things are Going to Get Pretty Rough Very Soon

We had an uneventful Thanksgiving, medical wise. Dr. Porcase (her regular doctor) did a conference call with Dr. Ali (the cardiologist that put her on Coumadin), Dr. Kilkenny (the surgeon), Dr. Xu (the radiation oncologist), and Dr. Zaiden (the medical oncologist). They were all in agreement that there is no reason anymore for her to have to take Coumadin!!!!!!!!! It comes as such a relief to know that by the time she starts the chemo treatments, the Coumadin will be gone from her system.

This past Monday, the 7th, she had to go down to Shands for an abdominal CT scan. We were there for almost 6 hours, but hse managed to keep the barium that she was required to drink, down, and that is a very good thing.

On Friday, the 11th, she is scheduled for a MUGA scan of her heart, because the one chemo drug, Adriamycin can have the potential to be toxic to the heart muscle.

Here is a link to a site that goes into detail about this scan. http://heartdisease.about.com/cs/otherriskfactors/l/blmuga.htm

When that test is done, we have to go across the street to the Pavillion at Shands and attend a "Chemo Class". This is where any questions that we have about the chemo will be asked. They are going to be going over every detail with us.

The first cycle of the dreaded chemo starts on Monday, Decmeber 14. She will be staying here at our house the first few days after the chemo is infused, so that I am nearby during the times that are going to be the hardest.

Please keep her in your thoughts and prayers, especially come Monday and the early part of next week.

The Finishing Touches

We had the appointment with the Medical Oncologist (Dr. Zaiden) yesterday. He informed us that the particular cancer that my mom has is called Triple Negative Breast Cancer (TNBC).

Most breast cancers (about 80-85%) are fed by either estrogen, progesterone, or the protein HER2. TNBC is not fed by any of these thins. More than likely it is caused by the BRCA-1 gene being mutated, which means that it is more than likely inherited. This makes it a harder cancer to treat because there are fewer treatments options.

As far as we know, it has not metastasized out into the body, although it is in the lymph nodes. We are waiting to hear back from the oncology office with an appointment for an abdominal CT scan to check for metastasis. We are also waiting for an appointment for an ultrasound of the heart to check for structural defects and the overall health of the heart, since the chemo can potentially caused weaken heart muscles. She is going today to have a ton of blood work done to check her liver and kidney functions, since the chemo is filtered through the kidneys and cleared by the liver.

Once all of this is done, she will start on the chemo. The regimen that she will be put on is called TAC (taxotere, adriamycin, and cytoxan).

The taxotere slows or stops the cell division, or keeps enzymes from making the proteins the cells need in order to grow. The adriamycin both blocks DNA production in the cells, and also inhibits the enzymes responsible for repairing DNA. The cytoxan stops cancer cells from replicating.

She will need to be closely monitored, more so than a "normal" chemo patient, due to her being on Coumadin and the clotting factor that she has. Chemo lowers platelets, making you more prone to bleeding (which the Coumadin does as well), lowers white blood cells, making you more prone to infection, and lowers red blood cells which makes you more prone to anemia.

All of that combined with the fact that she can not have IVs in her right arm due to the reconstruction surgery that she had a few years ago and the fact that her veins in her left arm are really bad, she will more than likely end up with a port-a-cath inserted under the skin just below her collarbone.

After chemo is done, which she will get once every 3 weeks for 6 cycles, she will have surgery and then radiation for 6.5 weeks.

There is an 80% chance that after 2 or 3 cycles of chemo that the tumor will disappear completely. This won't mean that she can avoid surgery and radiation though. it will all still be done since all it takes for the cancer to come back is one single cell left behind.

The chance of recurrence and distant metastasis is higher with this type of cancer, so everything will be done to prevent that as much as possible. This cancer is also pretty rare in older white women, mainly being diagnosed in African American women in their 30s and 40s.

Details

The appointment with the Radiation Oncologist lasted for 2 hours. An incredible amount of details were discussed at this appointment. It was almost mind-boggling really. Here is a quick rundown of those details.

As far as radiation goes, she will be getting conventional radiation. It will be the last step in this long process.

We also have a tentative game plan. After the appointment next Tuesday with the Medical Oncologist, this game plan will have the "finishing touches" added and everything can begin.

The plan is that she will get chemotherapy, most likely for 16 weeks. After the chemo will come surgery. What type of surgery it is will depend on how well the tumor responds to the chemo and how much it shrinks. Then, after the surgery, she will receive radiation therapy. This will be 6.5 weeks of daily, Monday through Friday treatments. Each treatment will last approximately 20 minutes.

The Radiation Oncologist

Surprise!!! We have an appointment to see the Radiation Oncologist (Dr. Xu) tomorrow at 12:30. We were not aware that she would be seeing this doctor, at least not for a while. We will be discussing the treatment options, one of which includes Proton therapy. I will go into more detail about what that is once we have a treatment plan in place.

The New Mammogram Guidelines Proposed by the U.S.Task Force Are Horrible!!!

The American Cancer Society recommends the following (for women of average risk for breast cancer):

*Yearly mammograms starting at age 40 and continuing as long as a woman is in good health.

The U.S. Preventive Services Task Force has now decided that women should not begin having mammograms until the age of 50, if they are at an average risk, and that it should be every 2 years. They also feel that self breast exams have no benefit and recommend that doctors stop teaching this technique to patients.

This task force has no authority to enforce these recommendations, but many doctors look to them for reviews on the effectiveness of screening tests and preventive care.

The American Cancer Society says that the number of women diagnosed with breast cancer in their 40s account for 17% of all breast cancer deaths. There is an estimate that this number will go up by as much as 3%, to a total of 20% of all breast cancer deaths. Think of the number of women that would be saved by early detection by beginning mammograms at the ACS recommended age of 40 and not 50 like the Task Force recommends.

Starting mammograms at a later age will result in the finding of cancers that are in later stages, decreasing the survival rate.

Right now as it stands with the ACS guidelines, an estimated 40,170 women will die in 2009 from breast cancer. A whooping estimated 192,370 new cases of invasive breast cancer and 62,280 cases of non-invasive breast cancer will be diagnosed in 2009.

Does the Task Force really feel that these horrendous numbers going up is okay???

This makes me very sad.