Today Ann had her 5th chemotherapy as scheduled and she is home resting.

We’ve fallen behind on our email announcements. Each cycle gets a little harder and it’s been hard to write about.

Medically, things are going very well. As Dr. Merkel, Ann’s medical oncologist, says, “It doesn’t get any better than this!” Let us count our blessings for all the side effects which have NOT visited Ann: there has been no vomiting, no mouth sores, no lost toe or finger nails...the list of all the bad things that have NOT happened is long and we are grateful.

We had mixed feelings on having her fourth chemotherapy fall on Good Friday. The good part is that many fewer patients were at the Kellogg Cancer Care Center than on a typical Friday and blood tests are done quite snappily. The bad news is...well, just think about the imagery of holding out your arm, opening up a vein, and getting filled with medicine that kills your dividing cells and makes you tired and nauseas. Good Friday is just NOT the day for this kind of thing.

The quick blood tests done as part of her fourth chemotherapy showed that Ann’s white cell count was normal in every respect. This is good because it means that she is not vulnerable to infection, a common side effect of chemotherapy. So, it looks like those Neulasta shots every Monday following her Friday are working as expected. Unfortunately, the blood work also showed that her red cell counts and hemoglobin were below normal resulting in anemia, a common side effect of chemotherapy which causes profound fatigue. Fortunately, there are drugs to promote the production of red blood cells and Ann has been getting injections every other week of the latest one, Aranesp, since her last chemotherapy on 4/18/03.

Aranesp (generic: darbepoetin alfa)

• http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500331.html
• http://www.Aranesp.com/patient/anemia_chemo/index.jsp

She is responding very well to Aranesp. Today’s red blood cell count priior to her fifth chemotherapy is up significantly from three weeks ago and is almost within the normal range. Next week’s injection of Aranesp may be her last.

Also after her fourth chemotherapy she had symptoms of a urinary tract infection which was treated quickly and effectively with Cipro.

Cipro (generic: ciprofloxacin)

• http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a688016.html
• http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202656.html
• http://www.ciprousa.com/

Prior to beginning her treatment we were very concerned about avoiding infections, a common side-effect because chemotherapy reduces white cell counts and thereby leaves the patient vulnerable to infections. As you recall, Ann gets injections every three weeks to promote the production of white blood cells and this medication has been extremely effective; her white cell count has never been below the low end of the normal range.

So the reversal of Ann’s anemia and the avoidance of any serious infections are also on our list of blessings.

But life is not just about the way things go medically. It is also about the emotional response to the stress of a rigorous treatment plan that will span most of a year before it is complete.

Emotionally, things are more difficult. As expected, each chemotherapy knocks Ann down a little farther and longer. She always has her treatments on Friday. On the first cycle she bounced back on the following Monday and went back to work on Tuesday. By the end of the second week she was fully recovered with almost normal energy level and sense of taste. In her last cycle she stayed in bed the following Monday. She worked from home on Tuesday and Wednesday but did so while still in bed with a computer on her lap and a telephone headset on her head. Thursday she went back to work but I drove her there. On Friday she was finally back on her feet and getting around independently. Only toward the end of the third week did her sense of taste return fully. But her energy level never recovers. She calls the fatigue her “drug drag.”

Because each treatment is getting harder, Ann started short-term disability today; she does not plan to return to work until the end of June or early July. She is hoping that staying home will give her the time and energy to focus on things that will make her feel better, both physically and emotionally.

We realize that Ann’s treatment is going well. We are thankful for all the support—meals, calls, cards, flowers, candy—from family and friends. Nevertheless, we are wearing down.

We try keep our spirits up with little distractions. We like walking around town and at the Chicago Botanic Garden; the exercise is also recommended to help combat fatigue. We go out to a movie or play. We’ve even been watching television!

Mostly we try to look forward. For example, Ann is planning on joining her chorus, The Melodeers, at its Sweet Adelines International competition in September in Phoenix, AZ.

• http://melodeers.com/

There is only one more chemotherapy left and we are starting to see the end.

Thank you for all your help and support.

Love,

Ann and Nello

Posted by Nello at April 22, 2003 6:49 PM

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