Mouth Ulcers, Family Visit, Ennis Update

Mouth Ulcers

New side effect with infusion 3 (of 4) of the Taxol. Mouth ulcers. Venita had these with the earlier chemo, so she has tools in her toolbox, but unfortunately those tools are not very effective.

These mouth ulcers differ from the earlier ones. Those were swollen glands like from tonsilitis or the mumps. These ulcers are open sores like from chewing on your cheeks and tongue. Venita's face appears swollen.

Venita is taking an antiviral for the ulcers, and hoping that the Dilaudid that she is otherwise using for the bone pain will minimize the mouth pain. She will have to call the oncologist on Monday, and likely take a drive down there. Sigh.

Family Visit

Venita's brother Les and his wife Donna arrive on Wednesday for an almost week-long visit. We so hoped the weather would have cooled down some so that we could do some outdoor things, like the Philly Zoo. That may still happen, but we are looking into alternatives, like the NJ State Aquarium in Camden, across from Philly on the Delaware river.

Of course, Venita has her ever-ready "to do list" in case Les and Donna would like to do some chores around the house.

Cooking for and feeding this group is going to be a challenge. Venita has little to no appetite. Les is on a no-to-low fat diet, including no red meat. Jim's stomach is completely screwed up with worry about Venita and not being fed well. Donna is trying to support Les's diet, but really, if you don't have to, how many broiled fish/seafood and fresh fruit dinners can one eat?

Venita put Les and Donna on notice: Venita will cook the first night, but after that, they can have the keys to the car to go to the grocery/butcher/Trader Joe's/farm stand.

Venita and Jim are very excited about having Les and Donna visit. It's been almost a year since they've been together, and everybody is worried about how everybody else is taking Venita's cancer diagnosis. This will give us all a chance to talk/walk/hug through all those feelings.

Ennis Update

It's likely that only those from the feline diabetes community will understand this detailed babbling. For others, the bottom line is that Ennis still has severly diabetic blood glucose levels, but for the most part is acting like he feels OK

Venita's attempt to aggressively slam Ennis's blood glucose (BG) numbers down into a normal range is not working well. She started using Dr. E. Hodgkins' protocol and sliding scale on Sunday, but she is getting mostly high numbers--at midnight Ennis's BG was 372, +6 after a 2U shot. So Venita gave him 4U. Venita is not sure how much she trusts this "shooting into rebound" theory, but she'll try it for a couple of days.

Meanwhile, Tuesday's vet visit for an exam and to draw blood and urine to look for an infection can't come too soon. Venita wants to get Ennis on antibiotics ASAP.

Dr. Chemo Visit and Other News

Not Dr. Chemo actually; another oncologist in the practice. We'll call him Dr. ChemoReplacement (CR).

Venita got the go-ahead for chemo tomorrow (#7 of 8). Blood counts are good. She's going to start methyl B-12 for her chemo induced peripheral neuropathy, if Maxwell will share his pills. Since maybe chemo 3, Venita has had tingling in her fingertips and toes, but now she is starting to get weakness in her knees.

Dr. CR agreed with Venita's concern that her breathing problems might be heart related, and ordered a MUGA scan (see MUGA scan defined here). Venita had one of these scans before the Adriamycin chemo because that drug is contraindicated with a weak heart. Adriamycin also can damage the heart.

Dr. CR explained that the MUGA scan measures the efficiency of the heart at pumping blood out of the left ventricle. "Normal" is around 60%, meaning that each beat/constriction of the heart moves 60% of the volume of blood out of the left ventricle. Venita pre-chemo rate was 72%, which could be indicative of high blood pressure. (Venita was running somewhat high on blood pressure before she got on Paxil for stress.) The follow-up MUGA scan rate will be compared to the pre-chemo MUGA scan rate.

Other recent events:

Venita had a pulmonary function test at Dr. Primary's office last week. No official results yet, but the tech indicated that Venita's breathing is weak. (We guess Venita telling them that wasn't proof enough.) The deep breathing for the test put Venita down for 2 days.

Yesterday was Maxwell's one-year anniversary of his diagnosis of diabetes. As part of the celebration, Venita did blood glucose tests on both Max and his littermate Ennis. Max was fine; Ennis showed diabetic numbers (in the mid 300s). Ennis is back on insulin, but the bottle in the fridge is old and doesn't seem to be doing much.

A friend took Venita for a ride on a Harley motorcycle last week. She hadn't been on a bike since the early 1980s. It was a short safe ride, and Venita really her brief stint as a biker chick.

Dr. Cutter Follow-up

We saw the breast surgeon, Dr. Cutter, yesterday. The purpose of the meeting was a check-up and to plan the left breast (LB) mastectomy. The big news is that the LB mastectomy will likely be the week of September 18.

We asked Dr. Cutter to explain why the LB mastectomy was needed. It hadn’t registered with us that the biopsy sample taken was almost 8x6x3 centimeters—-huge for a biopsy sample. The invasive lobular carcinoma in that sample was only 2 millimeters and excised with clear margins.

However, when the full sample was dissected onto 10 slides, 7 of the slides showed ductal carcinoma in situ nearly all the way up to all of the edges of the sample. There also was lobular carcinoma in situ present. Therefore, the educated guess is that such “peppering” of in situ cancer was throughout the breast, perhaps even past the area that would be excised in a mastectomy. (In situ cancer is basically a precancerous condition; in situ cancer is not know to metasticize.)

Dr. Cutter warned us that the in situ cancer may not show in a pronounced way in the pathology on the mastectomy tissue because Venita has been through chemo, which will have shrunk the cancerous tissue. We are aware of that, and do not plan to play the “we didn’t need a mastectomy” second-guessing game after the pathology is back. Because of the chemo, Dr. Cutter also expects no sentinel node involvement.

We also asked for the staging group on Venita’s right breast cancer. We hadn’t really been prepared for this information before. It is Stage IIIA. According to some statistics, the relative 5-year survival rate for patients diagnosed from 1995 to 1998 with that stage was 67%. That means that that 33% of the women diagnosed with Stage IIIA breast cancer during that 4-year period died from their breast cancer within 5 years of diagnosis. (Yes, this scares us.)

Breast cancer treatment has improved, so Venita’s odds are better than this average. Venita is undergoing aggressive treatment, so her odds are better than this average. Venita has an aggressive form of breast cancer, so her odds are worse than this average. Overall, we think her odds are better than this average, probably around 75%.

Information about staging breast cancer and survival rates are here.

Nearly 75% Down the Chemo Road

Yesterday, Venita had the 6th of her 8 chemo treatments!! Almost at the 75% mark (she doesn't count a cycle done until the beginning of the next cycle).

The Taxel is much easier with side effects than the Adriamyicin/Cytoxin, although the infusion is tougher. Tougher infusion of Taxol because of the pre-chemo infusion of Benadryl, which makes Venita hyper. Also, Venita is running out of veins for the infusion. Yesterday, it took 3 sticks, and she came away with 2 very large bruises. Easier side effects if the last Taxol cycle is any indication; Venita is planning to again have bone pain and abdominal cramping this weekend, but hoping against it.

Venita is starting to get her overall energy back. Today she is multitasking with laundry, some house cleaning, and work-work. It's been maybe 4 months since Venita did any serious housecleaning (she's had someone coming in recently), and although she is not a housecleaning diva, she enjoys a clean house and is enjoying the cleaning of the house today.

Venita's breathing also continues to improve; it's at maybe 75% of normal. Dr. Primary is going to give Venita some sort of breathing capacity test next week.

Dr. Chemo said Venita should not have chemo and radiation therapies at the same time. He said it would result in a bad cosmetic outcome. He did not expound, but Venita plans to ask Dr. Cutter at her followup appointment next week.

Venita is looking forward to, but with anxiety, the mastectomy on the left breast. Looking forward to it to advance this whole unpleasant but necessary process. Anxious because (1) the delay in surgery may have allowed the cancer to spread to the lymph nodes, thereby making radiation on the left breast necessary; (2) the possibility of serious post-surgical complications similar to the ones (hematoma, wound necrosis, and drainage problems) that she had with the right breast; and (3) potential complications that might happen by placing an implant on top of the intercostal (between the ribs) neuritis. But we are trying to be positive and take the attitude that those things won't happen.

Hot Flashes

You may be aware that chemotherapy induces menopause. Before chemo, Venita flirted with menopause; now she's full blown into it.

Biggest problem is hot flashes. It has mostly happened at night when she goes from a sitting to a reclining position--lasts 20 to 30 minutes, feeling hot and sweating. Now it's starting to happen during the day and without a position change.

Any suggestions besides a fan to reduce the hot flashes? No hormonal suggestions please; hormones are contraindicated with breast cancer--fuel to the fire, hormones feed the cancer.

July 8 Update

Nine days past her first Taxol infusion, Venita is doing OK, but disinterested in much besides sitting and resting. She has, however, been able to get some work done this week.

There were side effects from the Taxol. Two days after the infusion, Venita had bone pain in her skull and pelvic bone, and strong cramps throughout her abdomen. She took Dilaudid, and rotated Tylenol and Advil, and went to bed for about 48 hours. She then was constipated (maybe a side effect of the Dilaudid, maybe a side effect of the Taxol), and played the Fibercon/Immodium dance most all week trying to get her GI tract back to a reasonable balance. Venita also has a hardened and tender vein where the Taxol was infused.

Eating is going better. More foods are starting to taste like themselves and not sawdust. Venita had a pizza for lunch yesterday and it was good.

Venita's breathing is also better. Seldom does she need to stop to catch her breath. Head hair also seems to be growing a tad.

Venita doesn't know whether the improvements are a temporary result of having taken a 3 week break from chemo, or instead a permanent result of moving onto recreational chemo. We are so hoping it's the latter.

Venita saw her primary care physician on Thursday. She got the paperwork for a 90-day handicap placard for the car and a scrip for an inhaler that would make breathing a little easier. Dr. Primary didn't want to reduce Venita's Paxil; in fact she wanted to increase it, so it's staying the same. Dr. Primary dealt with Venita's concern about her trouble breathing and possible heart damage by addressing her lungs and prescribing the inhaler.

Next week, Venita sees Dr. Boob for a final fillup of the expander implant and Dr. Chemo for approval for chemo infusion 6 of 8 on Thursday.

We've scheduled out the remaining chemo infusions (if they stay on schedule), and found that the final chemo is on Venita's 54th birthday! August 10 is going to be a major celebration day.

Venita's thinking that if Dr. Boob is now going to wait to change out the implant until after radiation, then maybe Venita can get started on radiation concurrently with chemo. She'll be talking to both Drs. Boob and Chemo about that next week. She'll also likely have to talk with Drs. Cutter and Nuke if she gets OKs from the first 2 doctors.

You all take care.

Venita and Jim!!

First Taxol Infusion

Venita had her first Taxol infusion yesterday. Three "pre-med" IV infusions and then the Taxol. Two of the pre-med infusions--Benedryl and something else for nausea--had an odd cold burning feel going in--like the cold burn of BenGay or IcyHot.

The Benedryl put Venita into hyper-mode. She normally avoids Benedryl because of that reaction. The first hour of the Taxol infusion, all she could do was squirm around in her recliner, wanting to crawl on the ceiling. She was finally able to get to sleep and the final two hours of the Taxol were in slumberland.

Venita has had no Taxol side effects yet and is feeling remarkably well today. She got about an hour's worth of garden weeding done and plans to do a little garage clean-up. Not noticing shortness of breath. No fever; last night experienced hot flashes (which is "normal"). There were thunderstorms last night so Max and Ennis hid downstairs rather than waking Venita up every two hours for food, so she slept fairly well.

Saw Dr. Boob last Thursday and got another 60 ccs infusion in the expander implant. (340ccs so far.) Dr. Boob says one more infusion in 2 weeks. The implant now is just about the size of Venita's real left breast. He also said he's not going to replace the expander implant in the right side with the silicone implant during the left breast mastectomy this fall. He says he will wait and "change out" both the left and right side expander implants at the same time--after radiation. (Keep your fingers crossed that radiation won't been needed on the left side because if it is, it has to be done after the expansion, and that would put the implant change out into the spring instead of the winter.)

Only one doctor's appointment next week--Venita's GP. Venita is looking forward to that. She thinks it is time to cut back on the Paxil because she's been getting really low blood pressure readings.

Venita also wants to find out whether there has been cardiac damage from the chemo and because Dr. Chemo won't order the tests, she's hoping the GP will either talk to Dr. Chemo or order the tests herself. With Venita's pre-chemo EKG, stress test (echocardiogram), and Mugga scan, there should be plenty of baseline to evaluate potential cardiac damage from the chemo.

Back to Chemo

We saw Dr. Chemo this morning and he cleared Venita to start Taxol, the recreational chemo. She starts Thursday, and will get infusions every two weeks. She will have training on Wednesday to find out what drugs she has to take with it and the possible side effects, but so far we've heard it's relatively easy and only causes muscle aches.

Venita's temp has only broken 100 degrees four times in the past week. She still has serious shortness of breath, but it is getting slightly better. And it seems her taste buds might be coming back some; she ate soup the last couple of days, a big step up from juice and jello. When asked, Dr. Chemo suggested Venita smoke marijuana. Although medical marijuana is not legal in Delaware, he said that "people manage" to get hold of it.

P.T. Cruiser called today to get details on Venita's failure to show up for therapy. (PT's been on a 2-week vacation and Venita thought moving from the chair to the bed was therapy.) PT released Venita from therapy and told her to show up with a new scrip once she started feeling up to it.

Dr. Boob put more saline in the expander implant last week. It's now up to 280 ccs (capacity is 450). So the end is drawing near on that process.

Thanks to all who have offered words and thoughts of encouragement during what has been a very difficult time.

BTW, Bailey's cremains came home last Thursday.

"A Touch of Pneumonia"

...According to Monday's chest X-ray, says Dr. Chemo's office. That might explain the fever and shortness of breath. Venita is now back on oral antibiotics.

Home from the Hospital

This week, Venita spent from Monday night until Thursday noon in the hospital on IV antibiotics. Dr. Chemo and a doctor who is an infectious disease specialist kept trying to figure out what is causing the fever.

Venita had blood, urine, and stool cultures, chest X-Ray, CAT scan of the chest, abdomen, and pelvis. Nothing that would be a possible cause showed up. On Thursday morning, Venita asked to come home because there was nothing happening at the hospital that was improving the situation. Dr. Chemo seemed somewhat pissed, but OK'd the release.

This was Venita's first ever hospital admittance. She was in the oncology ward. Food was so bad she asked food services to stop bringing her a tray. Her roommate got a DX of lung cancer the morning Venita was leaving. Why couldn't they have done that somewhere private?

So the fever continues, but it is not peaking as high as it was. Now it is only peaking in the 102 degree range. and it is taking longer to peak; sometimes 6-8 hours instead of the previous 3-4 hours. Last night, for a brief period, Venita felt like the fever had broken. She could think clearly, and move without pain and fatigue.

Venita is on Tylenol therapy, but no oral antibiotics.

Venita sees Dr. Chemo on Monday morning. Chemo is on temporary hold for now.

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Goodbye Sweet Bailey

Adopted on Venita’s 42nd birthday, August 10, 1994.

Euthanized June 9, 2006.

Bailey came to us as Brad. He was a perfect Tuxedo; beautiful. He had been “in custody” at a no-kill shelter since May 29, 1992. When he was trapped at a truck stop in Danbury, CT, he was believed to be about one year old. He was at least 15 years old when he was put down; we think he was older, maybe 18.

Brad resided in the “shy guy” room in the shelter and not handled or socialized to people. His first adoption a month earlier failed.

Brad was feral. He was terrified of people. Often, Venita wondered whether he was autistic.

Venita didn’t like the name Brad. She wanted to name him Crocker or Crosby. But he wouldn’t respond to a name unless it started with B. So Bailey he became. Jim nicknamed him Buddy. Venita nicknamed him Bail and BailButt.

It probably took about two years before we could even look at Bailey without terrorizing him. He would camp himself under the kitchen table and watch us. If he ever saw us looking at him, he would take off for another location. Should he have ever gotten out of the house, he would have been irretrievable.

Although declawed in the front, Bailey was a holy terror to corral for the annual vet visit. Once, as Venita was going up the stairs to corner him in an upstairs hallway, he jumped onto her back and pushed off with his back claws. He was strong! The only way to get Bailey in the carrier in the early days was to outlast him during the chase around the house.

As Bailey got older, and arthritic, we were able to approach him more easily, but he still let us know when we were not welcome by growl, or full-mouthed hiss, or getting up and leaving. Where Venita now lives, Bailey had 2 ½ rooms. For the winter, he had beds next to the furnace registers in the dining and living rooms. For the summer, he had the Florida room, where he could lay in sunbeams and next to the screen door for most of the day. His dining room bed was his “safe place;” and it was often there that Venita could approach him for petting, headbumping, and brushing. Looking back, Venita did not approach him nearly often enough. Out of the way like that, he was easy to forget. Sometimes, a couple days would go by without Venita seeing Bailey. He would sneak into the kitchen for food when Venita was on another floor of the house or sleeping.

There were times over the years that Bailey would join Venita in bed, but only after she had laid down and usually only while the light was still on. He was ever vigilant against the terror of people, even though he desperately wanted to love and be loved.

If Bailey hadn’t gotten along with the three other cats (Maxwell, Ennis, and Lily), he would have been returned to the shelter. But Bailey loved our cats. Small problem was that he wasn’t socialized to cats either. He would walk straight up to Max and Ennis and give them a full frontal headbump at anytime, even when they were eating. This lack of feline socialization persisted to the end. Bailey also didn’t realize that at 15 pounds, he didn’t have to be subservient to the bitchy little 9 pound Lily. She would haul his ass around the house, showing him that she was not the lowest kitty on the pole. But that was Bailey; a most gentle soul.

We got Bailey so that we would have an even number of cats. Venita thought that with four cats, everyone would have the chance for a friend. It didn’t work out that way, but the dynamics of four was very different from the dynamics of three, and we would not have missed a day with Bailey.

Bailey always had been overweight, but he got grossly obese the last couple years. The swinging cow belly look. With his weight, coupled with his arthritis, it was painful for him to get around. But Bailey NEVER failed to make it to the litter box, even though it meant having to painfully negotiate steps and sometimes brave a gauntlet of Jim and Venita watching TV in the family room. Starting in November 2005, Venita withdrew Bailey’s dry food and he slowly lost weight and became much more active again. He started jumping into the bedroom window about 2 months ago, an activity he enjoyed but had given up some time back.

Bailey’s desired weight loss continued past ideal and he started to look boney. About a month ago, Venita noticed a housewide bout of black-green diarrhea and mouth foaming, but she was on her way out the door to therapy. When she returned, she found Bailey on the chair in her room foaming at the mouth and oozing diarrhea. Directly to the vet that day and the next, but nothing but “no result tests” and shoulder shrugs. In the course of 6 months, Bailey had lost about a third of his body weight.

The day of the diarrhea/mouth foaming, Bailey stopped eating and didn’t eat again. Never pooped again either. Despite Venita’s best efforts at things like trying another vet and getting probiotics, appetite stimulants, SubQ fluids, and food soup into him, she was completely unsuccessful at turning his condition around. Yesterday, he “slid” down the stairs to the litter boxes, because he could command his back legs no longer. He was skin and bones. Venita scooped him up, put him in the “sick room,” and called the vet for an appointment today to put him down.

This morning Venita put Max into the sick room with Bailey. Bailey loved Max the most, because Max came to put up with the headbumps and would let Bailey eat and drink from a plate/bowl with him. Max didn’t want to go near Bailey (we suspect Max could “smell” the nearing death), but Bailey loved just having Max in the room. He started purring.

At the vet’s office, Bailey pulled himself around the room exploring and trying to give us his loud angry meow, which he could not manage except as a nearly noiseless chirp. The alternative vet and the vet tech were very kind with the procedure. Venita stayed in the room watching and crying; Jim couldn’t stay.

The vet sat with Bailey on the floor and gave him a rubdown to the sound of new wave music. He loved that vet and her touch. She gave him the first shot to put him into a “coma.” He really fought the effect, but finally rolled over onto his right side. She rubbed him more, and then inserted the IV line into his rear leg. As she started to inject the barbiturate, he took a final deep breath. The vet checked for a heartbeat, pronounced him gone, and invited Venita to stay as long as she wished. Venita stayed, petting Bailey’s silky black fur, feeling how pliable his body now was, headbumping him, until his foot pads started getting cold. She did not give him a belly kiss. Bailey had never allowed that in life, and Venita had promised him long ago she wouldn’t violate his dignity when he died.

Even though Venita would like to know what took Bailey, she is not having the vet open him up. The vet suspects diffuse cancer.

Venita will pick up Bailey’s cremains a week from Tuesday.



Saturday update: Overnight Venita had shaking chills and a temp of 103.6. She’s under orders to call the oncologist with that type of condition. She may just end up in the hospital this weekend.

Into the Fire

And we thought the frying pan was bad. Venita white blood cell (WBC) count on Tuesday morning was 300 (normal is 3800 to 10,800). Dr. Chemo called her in on Wednesday, and she showed up in 3 layers of clothes plus jacket, ski cap, neck scarf, and shivering like a naked polar bear. Temp was only 102. Dr. wanted to put her in the hospital for two days for IV antibiotic. Venita declined; the cat Bailey is on ABs and fluids and may need to be put down when he returns to the vet on Friday.

So Dr. Chemo sent Venita to an outpatient procedure unit for the IV ABs. At release, her temp was 104. She continues in bed and on Tylenol. This morning's temp was close to 99 and the bed sheets weren't soaked. Maybe there is an end to this tunnel.

We'll call Dr. Chemo this morning for followup. Good chance he'll want a stat CBC to assess whether more IV ABs are needed.

Been AWOL

Where have they been? Where are the updates?

First of all, we want to recognize Robin’s distress and her post on the FDMB asking for prayers for herself. Called back on her mammo, Robin has an area in her right breast for which she will receive a sterotactic needle biopsy on June 21. Robin you know that you are totally in our thoughts and that we will be walking with you every step of the way through your challenge.

The week of May 22, being the second week of Venita’s 3rd chemo cycle, usually would have been her good week as side effects diminished and she regained her appetite. She had looked forward to a Memorial Day picnic where she could enjoy eating a grilled cheeseburger and corn on the cob.

But certain side effects became worse, in particular major fatigue, alternating chills and sweats, an incidence of vomiting (no associated nausea), and hardly any food that didn’t smell like cat food or taste like sawdust. All in all, it was nearly impossible for Venita to function. She cancelled two of her 3 physical therapy appointments, and PT Brusier sent Venita home from the one she was able to drag her butt to.

Friday, Venita saw Dr. Chemo, and the reasons for many of these problems became clear. Near the end of the appointment, Venita asked what the white blood cell (WBC) count from her Tuesday blood draw had been, and it was only 1200. (Normal range is 3800–10,800 and the previous Tuesday, her count had been 4800.) Dr. Chemo surmised the fatigue and chills/sweats are the result of an infection and put Venita on antibiotics. She also spent several full days in bed. Bought a digital thermometer and found her temp was fluctuating between 96 and 105 degrees.

Dr. Chemo surmised the vomiting without nausea so late in the cycle was not chemo-related, but rather reflux. His office had advised Venita to take a particular over-the-counter product for this two-weeks before, but once Venita learned the cost, she had called back in for something prescription, but that had fallen through the cracks. Dr. Chemo wrote and Venita filled a scrip for Prevacid. No more vomiting since.

Through the Memorial Day weekend, Venita remained pretty low key. She was able, thankfully, to have her 4th chemo session on Tuesday, May 30. Getting the infusion was touch and go for a bit because Venita’s fever had been up to 102 degrees the previous day, but a WBC count of 12,000 saved the day.

That is the last of the brutal Adriamyacin/Cytoxin chemo, and Venita now moves on to the recreational chemo—Taxol. Everyone promises fewer side effects—likely achiness only. Four session; one every two weeks. Last chemo should be on July 25. Seems only a short 8 weeks away!!

Venita also is taking a break from physical therapy until after brutal chemo is completely out of her system.

Bailey the sick feral cat is not doing well and also needs your thoughts. He is starting his 3rd week of not eating. His blood tests are now showing distress/disease in his liver. He is getting (yesterday and today) IV fluids and antibiotics at the alternative/conventional vet. Hopefully, he will be able to undergo a dental procedure this afternoon; the guess is that an inability to chew set him on this failing course. He is either going to rally here soon, or we will lose him. If the latter happens, we will be very hurt, but he will have had a great run!!

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.