The Week of May 15, 2006

The big appointment weeks are starting to become second nature.

Jim's Dermatologist

Monday Jim saw his dermatologist and had a pre-cancerous skin lesion frozen off. Follow-up in 3 weeks.

V's GP

Monday V saw her GP who gave her a new dosage (3 mg) of the second sleeping pill--Lunesta. Seems to be working. Now if Venita could find the off button on Max's stomach alarm, be wouldn't be waking Venita every 2-3 hours for a snack. Venita really created a monster with this 24/7 free feeding wet food solution to his diabetes. Speaking of feline diabetes, the blood glucose level for Ennis, Max's littermate, continues to be in a nondiabetic range since his dental procedure.

V's PT

Monday also was a PT day, as was Thursday. Because of the increased wound fluids drained last week at the mast site, we've cut range of motion exercises back to fewer reps and for the weight training exercises, either cut back to 1 lb. weights, or cutting the exercise out altogether. Seems to be a correlation between the ramping up of the exercise level and the increased fluids. Thursday also was a "slow" PT day because of fatigue from Tuesday's chemo. (V went to Dick's Sporting Good's and got herself those multicolored foam-covered barbells in various needed weights.)

Chemo

Monday's final appointment was a pre-chemo chekup with Dr. Chemo's nurse practitioner, Betsy. A few tweaks on side-effect medications. The biggest side effect is bone pain, which results from V's Neulasta shot on Wednesday, which helps to raise her white blood cell count. Instead of waiting until the onset of the bone pain on Friday pm/Monday am, V starts 2 Ibuprofen every 3 hours on Wednesday, the day of the shot. Then 2 Dilaudid every 3 hours is layered on top on that starting Friday pm. Here it is Saturday am and no bone pain yet. Betsy also approved the use of ginger capsules (as suggested by Martha and Alley Cat) as a supplement to help with queasy stomache.

Chemo #3 was Tuesday. Venita drove herself and slept through most of the procedure. Came away with a couple large bruises. One is in her hand where the nurses were trying to find a new infusion spot but "blew past" the vein. Another bruise in the actual infusion spot, which worries V because one of these chemical can cause tissue necrosis if it is released outside the vein. Big immediate side effect this time with fatigue. V came home and napped another 4 hours, and then got 14 hours overnight.

Wednesday, V went to crash at the home of local friends Ellen and Dick. She just showed up unannounced about 3 pm looking for a sanctuary from things to do and things to plan, and looking for someone to take care of her. V said just to leave her sleep except to wake her in time for PT the next morning. Ellen left V sleeping in this huge Daddy-Bear sized chair in the living room until 5:20 (dinner soon). Dinner was fried white-fish (V doesn't eat fish, but it looked and smelled great), asparagus, and twice-baked potatoes. V filled way up on the vegies. Watched two hours of TV--one of CNN evening news commentary and one of Baltimore Orioles baseball. V then headed home. She had had enough sanctuary time to rejuvenate her, and there were cats to care for and meds to take.

Dr. Boob

Venita saw Dr. Boob for another drainage on Thursday. He agreed there was fluid in there, but he couldn't get it out and the needle poked something inside that hurt (the first time that's happened) so he gave up that effort. Dr Boob had spoken with a colleague about the continuing fluid in V's seroma and that colleague suggested that Dr. Boob begin filling the temporary/expander implant--that might "squeeze" the seroma and "encouage" V's tissue to absorb her own fluids. Sounds logical, and that's what took place. He put 60 ccs of saline into the expander. The saline in the implants makes it feel more comfortable. It reduces the "hot spots" in the expander that were being caused by it sharp, 90 degree corners. But that's this time. Seems to V (from other Personal experience she has read) each fillling might bright "relief" or "discomfort."

Capacity for the temporary expander imlant is 450 cc, which at a weekly fill rate of 60 ccs would mean between 6 and 7 more fill-up sessions. That would finalize the filling about the same time Dr. Cutter wants to start planning the left breast mastectomy. So perhaps the swap-out of the temporary implant for the permanent implant could take place in the same surgery. Time wise it will work, but we need to talk with Dr. Boob about whether he also sees that as a possibility. He might have some concerns about cross contamination between the two surgical sites, or maybe concerns that V would have overly diminished strength/capability because of a bilateral procedure.

Sick Bailey

V's cat Bailey continues to be sick. Continuing inappetance, minimal bowel movements, dehydration (he's on sub-Q fluids). This has been going on now about 10 days. New current symptom--that wet-sounding breathing that he has had his entire life, but which he has not exhibited since he had been losing weight with the switch to an all-wet diet.

Yesterday V put the vet together with a compounding pharmacist. The meds are now in a Fancy Feast Savory Salmon-based oral preparation that V syringes in and most of it stays in. V also made an appointent with another Vet; the earliest she can get in is Tuesday later morning. We hope he makes it that long (euthenasia looks like a strong possibilty here), and are prepared if we need to take him to the ER vet.

Some Thoughts From a Sucky Couple of Days

V saw Dr. Boob on an emergency basis yesterday. Pain and swelling in the wound. He drained 120cc, the buildup in just 3 days.

TV programs (talk shows, news) are focusing on breast cancer--a big tie-in with Mother's Day. Venita's head keep screaming "I have cancer!" She has been trying just to stay in the moment and avoid those thoughts.

Bailey the feral cat is very sick. He's been losing weight and has had a run-in with inappetance, constipation, and diarrhea the last couple of days. When first observed, he also had frothing at the mouth. Two vet visits, most blood values normal, vets are stumped but still charge outrageously for their "professional services," guest room converted to a cat hospital, SubQ fluids for dehydration, Cypro to build appetite. Frankly, he doesn't look like he's going to make it. But he's had a good, long life for a feral cat.

Chemo #3 coming up on Tuesday; 3 appointments on Monday.

Quote from a teleconference sponsored by Y-Me: We see ultrasound as a secondary screen for women with dense breast tissue. When we compare cancers that are not seen on the mammogram in women with dense breasts as opposed to women with fatty breast, the false negative rate of a mammogram may be as high as 30 percent... . . ...Yep, we know that mammo is a lousy diagnostic tool for certain breast types and certain cancers. But the ultrasound and the MRI didn't turn out to be all that hot either.

Pain Management and Other Matters

Neighbor nurse Mary has been working with Venita on a pain management schedule for the bone pain. There has been some tweaking; at present the schedule is (a) 2 Ibuprofen and 1 Dilaudid followed (b) 3 hours later by 2 Tylenol and 1 Dilaudid followed (c) 3 hours later by 2 Ibuprofen and 1 Dilaudid, and so forth. Venita ends up in bed alot on this schedule. She will keep this schedule up through tonight, except she will not take Dilaudid if she has to drive within 4 hours.

V has been in bed so much that she is now having trouble being there. The clock seems to take four hours to go from 12:21 am to 12:28 am, all the time V is dozing.

Christine, a professional hairdresser and daughter of a friend, buzzed V's head on Sunday morning. V says her head now always feels wet, like she just got out of the shower.

Venita skipped her physical therapy on Monday because of the pain and pain meds, but plans to go today. We are naming the therapist P. T. Bruiser! Thanks Charlie, V's former husband, for the name.

V got drained 50ccs on Monday (a week's accumulation) so Dr. Boob doesn't want to see her for 2 1/2 weeks (for check-up and maybe saline infusion) unless V experiences continued fluid buildup.

V did get a little gardening in yesterday--planted 2 flats of impatiens. One flat of everbearing strawberries and 2 periennials in this morning. Hopefully the rest of V's nursery buying spree--one flat of impatiens and a broom bush--will go in yet today.

2 months today--no cigarettes. V wants one to "celebrate."

V is delevoping lists of OTC supplies and of soft foods for chemo. The lists are here. She also added a link from the "permanent" list on the right side of the page.

Week's End Update

Ouch! Bone pain and throat swelling started Saturday. V had a good morning working in the gardens and doing range of motion exercises, but she couldn't move much in the afternoon. She took some Dilaudid for pain and went to bed about 9pm. Maxwell (the diabetic cat) kept waking her every 3 hours for feeding. V will likely end up back in bed soon.

V didn't see Dr. Boob for the 2nd draining this week because he had a hospital emergency. V didn't need it though; looks like the draining is really slowing. She will see Dr. Boob on Monday.

We both saw Dr. Cutter this week. DR was impressed by V's overall condition, although concerned that the mast scar continues not to completely heal. She gave V a scrip for a super-duper antibiotic cream. Next follow-up with Dr. Cutter will be between chemo treatments 6 and 7 to plan the surgery for the left breast mastectomy.

V saw her GYN for her every 4 month PAP this week. V has a low-grade dysplasia caused by the Human Papilloma Virus (HPV). The dysplasia could turn into cervical cancer or go away. This has been going on for about 2 years.

V discussed with her GYN her disappointment about how his PA dismissed V's right breast lump in December. He said he would look into it.

V's hair is not long for this world. Today, May 7, is deemed the official fallout day. Bill P, a local friend, is the winner. Now we have to determine the prize.

V thought Donna B. would do the hair buzzing, but that isn't working out. V is looking for a substitute, and Jim is not an option. V may not be particularly attached to her ears, but she would prefer to keep them!

Chemo 2

Chemo 2 was fine. Jim came along, but V drove back and forth to make sure she could do it.

Real panic before we left for chemo. V is to take an anti-nausea pre-treatment. She went to open the blister pack and the capsule spilt apart and sprayed all over the kicthen. Thank God the onc ward had samples.

The onc nurse infused the Cytoxen really slowly this time because of V's side-effect of facial pain. Nurse said that effect is common with Cytoxen and that slow infusion helps minimize it. Jom wasn't prepared for the extra hour of treatment; got antsy and asked the nurse--does V have to get the whole bag? V asked Jim to go take a walk.

Onc nurse also explained that the facial flushing comes from one of the nausea medicines, and was more than willing to answer questions about why does this happen, why does that happen? Nurse been in this ward for 13 years--vast experience.

V gets her Neulasta shot tonight when neighbor nurse Mary gets home from work. V is going to give herself the shot but she wants Mary to watch to make sure she does it right.

V had PT again today. Range of motion already is improving. Got more exercises to do and starting to use "equipment" like weights, pulley, and treadmill. Also getting some massage to drain the lymph nodes.

Three appointments tomorrow--Dr. Boob, regular GYN, and Dr. Cutter.

Physical Therapy and Other Info

Venita started PT yesterday. So now we have a new player, and we'll need a new name to ID her. All suggestions welcome.

The therapist is a soft spoken woman, but she has something of a "take no prisoners" attitude. She warned Venita that she's menopausal and can have "postal" days. Also warned Venita that Venita also is, with chemo, now menopausal and will do the same.

Walked Venita through 4 arm/underarm stretching exercises that she has to do 3x/day, 5 reps. Discussed how critical posture is to avoiding lyphedema. Demonstrated how Venita needs to start gentle massage on her left breast biopsy scar and on the healed portions of her right breast mast scar to avoid having the scars "adhere" to the underlying tissue. The therapist also wants to see Venita ASAP after Dr. Boob drains her right breast wound so the therapist can demonstrate how Venita can "massage" the area to lessen the amount of fluid that accumulates. (Later in the day Dr. Boob said this was all stuff and nonsense in V's case because the fluid is collecting in a cavity in the "capsule" that is forming around her implant.)

PT is 3x/week for 2 months. There are 5 basic objectives to the therapy:

1. Scar flexibility
2. Posture (the pain in the incision and nearby sites/fear of being "bumped"/and embarassment can cause women with mastectomies to develop round shoulders
3. Range of motion
4. Strength
5. Cardio-vascular improvement (bodies that are CV healthy heal better and tolerate chemo better)

The therapist is a gardener and sees yard work as a possibility to expand therapy activity. Therapist thought it was right wonderful that Venita mowed her front yard yesterday.

Yes, V did mow the yard thanks to John K, a local man who did the spring service on V's mower free of charge and showed her how she could vice-grip the blade cut-out lever in the on position so that the mower (which has a slightly bent crank shaft after a run in with a stump last spring) would start easier. Thank you John!!

Dr. Boob drained V later in the morning. Jim went along; the first time he had seen this process. V's drainage is slowing down. Only 100cc in the 4 days since the last drainage. Dr. Boob says maybe only two more drainings.

Chemo #2 this morning. V is fearful for some reason, so Jim is going along. V thinks the fear is of the upcoming side effects, not the infusion itself. The mouth lesions with Chemo 1 were pretty serious, and we sure don't want a repeat. V bought antibacterial gel and has a bottle in nearly every room of her house, one for the car, one for Jim's house, and one for the neighborhood bar we frequent. She may develop OCD over this.