No Complications

Ann had her first chemotherapy treatment on Thursday, May 20, as scheduled. Clinically speaking, it went smoothly and there were no problems whatsoever despite a few anxious moments.

Chemotherapy Demands New Routines

Before delving into this particular round of chemotherapy, we thought we’d share a little about the general routine a patient goes through each time it is administered. As you will see, there are an awful lot of details to monitor and new behaviors to adopt.

Each round of chemotherapy involves a rigorous regime of drugs to deal with side effects, mostly inflammation, nausea, and immunosuppression. A day before and for two days after each round, Ann takes Decadron (generic: dexamethasone) to prevent inflammation. Following each round and for several days, she takes several drugs to control nausea: Zofran (generic: ondansetron), Ativan (generic: lorazepam, and Compazine (generic: prochlorperazine) . The day after each round, a nurse gives her an injection of Neulasta (generic: pegfilgrastim) to boost her white cell count. Other ongoing measures to prevent infection include meticulous dental and skin care. For example, she gargles with Nystatin to prevent fungal infections and she applies cuticle cream to prevent the drying and cracking of her nails.

Throughout her treatment—a minimum of 12 weeks plus several months of recovery time—she must deal with the cumulative effects of chemotherapy. With each round, the side effects are more severe and last longer. Profound fatigue will undoubtedly be one of these effects and exercise is the only proven method of overcoming it. The biggest problems during her 2003 treatment were:

• Nerve pain in extremities: There is no treatment available for the pain in toes and fingers caused by peripheral neuropathy.
• Mouth and tongue sensitivity: Diet shifts toward bland, soft, non-acidic foods. Consistent and gentle dental care with a soft toothbrush and Bioteen mouthwash and toothpaste helps the gums and palate but the deep furrows in the tongue must be endured.
• Split finger- and toenails: Taxotere (generic: docetaxel) causes several changes in nails. Each round leaves a line on the nails, like the rings in tree trunks. By the end of her treatment, her nails turned dark and cracked. She kept them well trimmed and tried to avoid injuries that might cause the nail to fall off.

We are hoping that these problems will be less severe this time because her 2010 regime does not include Adriamycin (generic: doxorubicin), a particularly toxic drug that she had in 2003. (Notice that loss of hair wasn’t on the list; it isn’t a big problem. She just wore a wig, drew fake eyebrows, and didn’t have to shave her legs.)

Ann’s First Chemotherapy of 2010

Our day started at 8:15 am when we dropped Alison off at the home of our neighbor, Debbie. Ann’s chemotherapy appointment at the Kellogg Cancer Center in Evanston was at 9:00 am, the same time that Alison’s preschool, Glencoe Junior Kindergarten (GJK), started. Fortunately Debbie volunteered for some early babysitting and took Alison to GJK the regular time. Nello’s parents volunteered to pick up Alison from GJK and take care of her for the rest of the day. We were free to focus on Ann’s cancer treatment.

We arrived at the Center on time and the process began.

We met with Dr. Merkel for a pre-chemotherapy examination and consultation. He shared with us the Mayo Clinic pathology report: this second opinion confirmed that her tumor is HER2 negative. This was good news because such tumors are less aggressive and more successfully cured. If the tumor were HER2 positive, her treatment plan would include an additional drug, Herceptin (generic: trastuzumab). The confirmation meant that the treatment plan would go forward unchanged.

We returned to the waiting room and after an extended stay, a nurse came to get us and brought us to the infusion room. This room is part of the Center’s newly completed remodeling and didn’t exist during Ann’s 2003 treatment. At that time, patients were infused privately in an examination room. The infusion room is large, open, and brightly lit. It’s arrangement is a bit communal with patient infusion stations on three sides of the windowed perimeter and a nurse’s station in the center. Each infusion station includes a recliner chair and a television on a huge supporting arm. Curtains between each infusion station gave the patients some privacy from one another while preserving the line of sight to monitor all patients from the nurse’s station.

Outside of the infusion room, in a phlebotomy station, a nurse weighed Ann and inserted an intravenous line, which involved just a simple needle stick through her skin and into her portacath. (At future chemotherapies, a nurse will draw blood for an analysis to make sure Ann is healthy enough for that round. A blood draw wasn’t required for this first round because Ann recently had a complete blood count.)

Then the infusions began:

• Anti-nausea and anti-anxiety medication
  • Zofran (generic: ondansetron)
  • Ativan (generic: lorazepam
• Chemotherapthy
  • Taxotere (generic: docetaxel)
  • Cytoxan (generic: cyclophosphamide)
• Port flushing with Heparin

The infusions were finally complete by about 1:30 pm. By the time we arrived home it was about 2:30 and Ann took a nap. Later in the afternoon, Ruth, a friend our church, North Shore Unitarian Church (NSUC), arrived with a meal she’d made for us. We had a quiet dinner. Nello’s parents brought Alison home just before her bedtime. She fell asleep quickly and we settled in to watch an episode of Hercule Poirot, a chemotherapy tradition for us.

During Ann’s 2003 treatment, we watched these shows on DVDs that Nello rented from Netflix. In 2008, he bought boxed DVD sets of all the television episodes as well as all the movies featuring David Suchet as Poirot. Nello gave them to Ann as a Christmas present that year in recognition of her passing her 5-year mark without a recurrence. We hadn’t watched them much in the past two years; there wasn’t time and they had a bit of baggage. Fortunately, it’s been long enough since her 2003 treatment that we’d forgotten the plot and we very much enjoyed the story. So, we expect that once again Hercule Poirot will be a pleasant pastime during an otherwise unpleasant period.

Neulasta Injection

The next day, Friday, May 21, Nello took Alison to GJK as usual and returned home to care for Ann. Courtney, the mother of one of Alison’s classmates, volunteered to pick up Alison from GJK and host a playdate for the entire afternoon. So, again, we were lucky to have the day free to focus on Ann’s health.

After a restful morning, we returned to the Center for Ann’s Neulasta injection scheduled for 2:15 pm. Dr. Merkel had cautioned us that this drug might cause some bone pain as it kicked her marrow to overdrive producing white cells to replace those lost during her chemotherapy. He advised her to treat the pain with acetaminophen and and Norco (generic: hydrocodone) left over from her surgery medications. He said that the pain after her first round would probably be more severe than following other rounds.

A nurse gave Ann the injection as scheduled and we met with one of Kellogg’s pharmacists to discuss Ann’s first round. It was a short conversation since there were no complications. We returned home to rest.

Later that evening a Chinese restaurant delivered dinner to our home, courtesy of Lisa, the mother of another of Alison’s classmates. After dinner, it was bedtime for Alison and Poirot time for us.

Recovering from Round One

Ann followed her post-chemotherapy regimen religiously and, happily, kept nausea at bay.

Saturday was a day of rest for Ann. Cathy, a friend from NSUC brought us dinner.

On Sunday, we attended our church’s service and annual picnic but just standing and chatting for 1-2 hours was too much exertion for Ann; fatigue set in. She also noticed that chemotherapy had already affected her taste buds; water did not taste quite right. Fortunately, Breege, a friend from NSUC, volunteered to host a playdate for Alison so Ann had quiet time at home for the rest of the afternoon. By the time Nello and Alison returned home, it was bedtime for Alison and us.

The next few days, Ann was very uncomfortable with both fatigue and bone pain. Fortunately, Nello kept Alison busy and Ann was able to rest comfortably with her pain medication.

The First Round in Retrospect

Now a week after her infusion, Ann is feeling pretty good. Her strength is returning and the pain is fading. Overall, it’s a bit worse than we remember her first round in 2003. At that time, she went back to work after just a few days. And we don’t remember any bone pain until many rounds later. Even though the regime is less toxic now, it still packs a wallop.

Most important, Ann has one round down and only three more to go!

Thank you

As you must have noticed in reading the events of the past week, we are very lucky to have the support of our friends and families. Thank you very much for your help.

Nello & Ann

Posted by Nello at May 27, 2010 2:36 PM

Comments

1.  

2. On May 27, 2010 6:56 PM, Ron Dirsmith said:

   It is really terrific to hear such good news.
   Much love annd support to you all.
   Suzanne and Ron

3. On May 27, 2010 7:18 PM, Ann Nick said:

   Dear Ann and Nello...
   Keep breathing deeply and reminding yourselves that this will pass eventually. Kay McCarty reminded me to congratulate myself on resting well. My dentist prescribed a Colgate toothpaste for dry mouth; it's working well.
   My aunt reminded me to find beauty in something each day-- but then, you have it right there in Alison!
   Love to you all,
   Ann (& Paul)

4. On May 27, 2010 7:22 PM, Cherryl Crouch said:

   Hi, Ann and Nello, Thanks for the updates. I'm glad chemo is going as well as can be expected (it's hard to say well, when I know it makes Ann so sick). I'm glad also that you have so many friends and family stepping in to help. You are all three in my thoughts and prayers.

5. On May 27, 2010 8:28 PM, Tanya with Finnegan said:

   Thinking of you and praying for your strength and speedy recovery....

6. On May 27, 2010 9:17 PM, Claudette Dirsmith said:

   I am glad you have this one behind you. Thank you for the update and we are both thinking of you.

   Tim and Claudette

7. On May 27, 2010 9:40 PM, Lynn Frumet said:

   I read with great interest what Ann is facing and going thru.
   It is unbelievable the role all the drugs play in her recovery and
   still there is an unbelievable amount of pain to go thru.
   I so wish she did not have to go thru all of this tremencous
   shock to her system. I shall pray for her responding to this
   treatment.
   C.J. just started his radiation for prostrate cancer this
   Monday at Glenbrook Hospital so we are busy every day
   going there. I was told I have asthma and discovered in
   my computer medical records that I have a lung disease
   and that surgical clips were left in from the lumpectomy I
   had in Oct. 2003. I remember the sympathy I
   received from Ann during that time.
   I am so sorry for everything Ann has to go thru and hope
   to God she comes out a stronger person. You are by her
   side and that is the best medicine of all. Love to you
   both. Lynn Frumet

8. On May 27, 2010 10:22 PM, Marge Wellstein said:

   I have been thinking of you and am very happy for the up-date. Glad you made it through the treatment as well as you did and wish it were less stressful. I wish I were closer to help out, during these times. Please let us know if there is anything I can do for you. Try to keep your spirt up and remember that many of us are thinking of you. With many prayers, Love Marge

9. On May 27, 2010 10:29 PM, Holly Kerr said:

   I hope that the treatments do their job- I assume that someone from church is making sure what you need- I'm always happy to help out however I can. continue to feel better.
   Holly

10. On May 27, 2010 10:43 PM, kelley hughes-liao said:

    Thank you for sharing Ann and Nello. It is really informative as well as openly honest. I appreciate the updates and the information could someday really help to assist another in their research to recovery.

    3 more rounds yea.... it takes a village and glad you are surrounded by such friends and family.

11. On May 28, 2010 9:15 AM, Dr. Birgit Wellstein-Stahl said:

    Dear Ann and Nello,

    it is so good to read these news from Ann's chemotherapy. Compared with the treatment of the breast cancer patients I had in the late 80ies, all things are much better organized
    today. So we hope that Ann, surrounded by her family and helpful friends ,will have the next treatments in the same way.
    We think a lot of you and wish you all the best!
    Birgit & family

12. On May 28, 2010 9:55 AM, Nancy Wunderlich said:

    Wow what a journey you are on! Thank you for sharing your story. I feel touched and honored. Please know you are all in my thoughts and prayers. I hope for you to be surrounded by all the healing energy in the universe. Blessings to you. Nancy.

13. On May 28, 2010 11:38 AM, Bill Taylor said:

    Very glad to hear of improving news. You remain, as always, in our thoughts and prayers.
    -Bill and Gwen

    "Mesdames, Messieurs. What I am about to do may surprise you a little. It may occur to you that I am eccentric - perhaps mad. Ah! You may say, the little Belgian detective is taking leave of his rocker, hein. But I can assure you, behind my madness is, as you English say... method." Agatha Christie:Poirot:Problem at Sea (1989)

14. On May 29, 2010 9:07 AM, chuck & Cathy Ripp said:

    We thank you for the good news; it is good to hear things are going well, so far. We will continue to pray that things will work out will for you and that you continue to have the spirit and strenght to face these challenges.

15. On May 29, 2010 2:01 PM, Bill Muenster said:

    Ann!

    I am glad to hear that you are making good progress.
    I had no idea that treatment was so complicated. Nello's
    "blow-by-blow" account makes me grateful that modern
    medicine is finding more and better answers.

    Best wishes! Bill Muenster

16. On June 1, 2010 4:14 PM, Monica Freeman said:

    Thanks for keeping us in 'the know'. Peace, strength and hope to you all!

17. On June 5, 2010 7:24 PM, Mary Hensley said:

    Hi Ann & Nello,
    The Menomonie, WI family are happy to hear of your progress and pray the treatments will make you all well.
    Take Care! Love Mary

18. On June 9, 2010 2:19 PM, Eleanor Sunseri said:

    Nello - Ann - I have never met you and found you by pleasant accident through Nello's blog - I was diagnosed with breast cancer in April, had a lumpectomy with Dr. Winchester Sr. and will be beginning radiation any day - your story is of such help and Nello was so kind to tell me about his feelings on Dr. Winchester and Dr. Merkel (whom I have yet to meet). I pray each and every day that each of your steps brings you closer and closer to full recovery. Stay strong, you have wonderful friends and are an inspiration even to those you don't know. You are the morning smile that grows and spreads as the day goes by!

19. On June 9, 2010 9:16 PM, dorothy sybert said:

    Dear Ann, I wrote a lengthy post, and got kicked off. I'll summarize to say that I think of you every day, and pray for a complete recovery for you. I'm so sorry that you have to go through this again. As I read Nello's entries my heart is in my mouth, because I've been there.

    Love to you and Nello and to your dear child, Alison.

    Dorothy Sybert

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