LET THE SHOTS BEGIN

Dave, a man who until recently took no medications at all, not even a multivitamin, now has to have a spreadsheet of all his meds so he won't forget to take them on the right days at the right times.  (This demonstrates a difference in how the two of us go about things.  I suggested he get 7 baggies, label them Sunday through Saturday and put all the meds and shots he needs for a day in each baggy, as sometimes he has 3 shots a day and 4 different medications.  Not his style.  He set up a spreadsheet so he can check things off as he pulls meds, vials, hypodermic needles, alcohol pads, etc. from the myriad of boxes in the bathroom.)  Dave is, and always will be, an engineer.  I don't know what you would call me.  A jackass of all trades, maybe.

We met with Rosemary on Monday, who  told us Dave's liver and blood numbers were great. Then we saw one of the chemo nurses, who was going to teach us how to do the injections for Intron.  She started with a demonstration on how to open the sterile hypodermic needle. We almost fell over when we saw how big the needle was.  Thankfully, it is used only to draw the right amount of Intron out of the little vial.  Then Dave replaces that needle with another smaller (!) sterile needle to inject himself in his stomach.  He will be getting 20 units of Intron three times a week for 48 weeks.  He is also getting heparin shots in the morning and evening every day, so as I noted earlier, he is injecting himself 3 times a day on Mon-Wed-Fri.  The heparin shots should end in a month.

Sandy and I had opthamologist appointments in the afternoon, so we picked her up and the three of us went to lunch then to the eye doc.  At the end of the visit, Dave was beginning to feel the effects of the Intron.  He took Sandy back to her cottage and came straight home.  He felt chills, as he always did when getting the interferon intravenously, and by the evening he had a fever.  He was feeling lousy in general, until the fever broke about midnight.

His plan is to take the Intron shots in the evenings from now on and hopefully the first 12 hours of not feeling well will be mostly gone by the next day.

Dave has another appointment Monday.  If his numbers stay in the good range for the next 3 weeks, he will be able to switch from weekly to monthly appointments.

Now for a few pictures  - if you want to see them.  I put them at the bottom of this post so you don't have to look.  :-)

The heparin hypodermic

The injection

Disposal in the sharps box

Feeling no pain

BLOOD CLOT

In the last two days, Dave has commented his arm was sore, and the tender region was right around where his picc line was.  With today being Friday, and even though we are going to Dr. S's office on Monday, he decided to go to the office, hoping to be seen.  His tactic worked, and it's a good thing, as they sent him for an ultrasound, and discovered he has a blood clot.

Dave was given a week's worth of heparin shots, which he will inject daily into his stomach.  It may take up to 30 days of shots to dissolve the clot.  Can you believe those shots are $100 each?  Dad had to take them, and I'm familiar with their effectiveness. We shall soon see how comprehensive Dave's supplemental plan is for prescription drugs - ha. The good news is, Dr. S. had these meds on hand because another patient gave them back (his/her clot must have dissolved), so these were gratis.  Thank you!

Other than that little wrinkle, Dave has been doing well.  He took a 5 mile walk on Tuesday. He went out to dinner with a group of guys on Thursday.  He's still napping in the afternoons, and sleeping about 9 hours a night.  He has really enjoyed his two weeks of no treatments!

CHECK UP

We didn't see Dr. S. today after all, but we did see Rosemary, his NP.  Dave had his vitals checked and they discussed when to start his self-injections.

Dave's weight was up 7 pounds from last Wednesday.  I have a sneaking suspicion his last weigh-in was in error.  I didn't think he had lost 8 pounds in 10 days, though that's what was reported, and I don't think he gained back 7 in 6 days.  Either Dave was severely dehydrated at his last visit, or there was a little blip on the scale.  Whatever -- he is down 10 pounds from where he started and I am certain he had added back a couple of pounds this week.  His appetite is returning.

All his blood counts are back in the normal range and in fact his white blood cell (WBC) count is exactly where it was before his first treatment (4500)!  That's a good thing, as Dave is tired of being a hermit, and we went out to dinner Saturday night (Coleman's birthday) and to church on Sunday.  He stopped on the way home today to get a haircut.  When his WBC count was so low, he not only had to avoid people, he certainly didn't want to get a scrape or cut and end up with an infection, so he felt he was overdue for a haircut.

Dave 11-11-13

Dave is not looking forward to the coming 11 months of injections, not that he minds injections, but he does not want to feel as weak and fatigued as what he experienced last month.  He could have started them today, but he and Rosemary decided they would wait one more week so he could recover a bit more strength.  Rosemary seemed to think that with the 18 or 20 unit dosage Dave will be getting, he may not have to inject 3 times a week, it may be less. She is going check with Dr. S. and we'll know for sure next Monday when he starts.

I'm assuming there may not be much to report in the next week as Dave plans to take it easy but also start exercising a little, maybe even going to the pool.  I will update next Monday after we get his injection schedule.  We will also know the results of how his liver is doing.

MUCH IMPROVEMENT

Saturday, Nov. 2nd, was not a good day.  Dave was as listless and weak as I've seen him. He felt terrible and could (or would) hardly talk.  He slept most of the day.  We were both so glad the high dosage part of this year-long treatment plan was over!

A turning point came between Tuesday and Wednesday, when we went back to the hospital for more blood work.  Dave was up in the morning, making his breakfast, saying a few cheerful things!  He looked better, he acted better and as we then suspected, his lab report was better.

In an average healthy adult, the total number of white blood cells (WBC) ranges from 4,000 to 11,000 per cubic millimeter - a pretty wide range.  Last Friday, Dave's WBC was 1,600.  On Wednesday it was 3,500.  Almost on the low side of normal!  I'll have to ask what his normal count was before he started treatment.

Dave has now lost 17 pounds.  That's an additional 8 pounds in 10 days.  Rosemary, the NP, was concerned about his weight loss, in terms of him getting enough nutrients.  Dave is not unhappy with the loss.  He is eating healthy meals, just small ones, no alcohol, and no snacking.  She suggested he try to eat some snacks such as nuts, apples with peanut butter, granola bars and even Boosts.  Dave has started with nuts, and I'm sorry to say, some ice cream.  That's my fault.  I bought some Pumpkin Pecan Spice ice cream and darn it is good.

His rash has almost completely cleared up.  He still has some "crackle" as Rosemary says, in his lungs and she gave him exercises to try to get rid of it.  We don't want no stinkin' pneumonia.

Dave has been wearing a fleece jacket in the house for weeks, even though the house temperature has been above 72º and it is usually higher.  He has an extra blanket on his side of the bed.  He's always cold which is so unusual.  Today he graduated to just a fleece vest instead of the jacket.  The weight loss probably contributed to his chilliness.

Dave took a walk yesterday - without me suggesting it - but not today.  I just asked him and he said he'd go with me in a little while.  He's not anywhere near his old self, but there is definitely a change for the better.

We see Dr. S. on Monday and we'll be deciding when Dave will start the injections.  He is not looking forward to it.  I'm hoping this physical improvement will continue and he'll be a little more ready to start Phase II.

CHEMO DAY 20 OF 20!

It's caboose day - the end of the infusion train!  The nurses cheered when Dave walked in the chemo room; either they are glad to see him go or they are happy for him.  I believe it's the latter.

Dave's white blood cell count was lower today, near the 'danger zone' so Dr. S. recommended Dave get a half dosage of INF.  If Dave wanted to forego the last treatment all together, he could have, but the two of them decided to get in the last possible amount of INF while still being smart about it.

Now to back up a little, Dave seemed to have a mild allergic reaction to some spicy food he ate Wednesday evening.  His skin got slightly mottled and red, and this was in addition to the rash he's had.  The rash cleared up some, but has not gone away, in fact he is still getting some new breakouts.  We're not positive his new reaction was due to spicy food, but it is not an uncommon effect, so we suspect that was the culprit.

On Tuesday, Dave proclaimed he was tired of being a slug and agreed to go on a walk around our street/circle.  It's 1/3 mile.  Wednesday HE brought up the idea, and we walked the circle again.  Yesterday, he decided he would do a longer walk, and we went almost a mile.  He said he was struggling by the time we finished, but he didn't feel like a slug!

Dave lost another pound or two.  With all the fluids he gets, it's hard to gauge his real weight because it can vary by two pounds every 24 hours, but he was down over a pound this morning.

Dave will be back for blood work on Wednesday to see if his white cell count has improved, and we'll meet with Dr. S on 11/11 for a review and decision on when to start the 48 weeks of injections.  I've been saying the injections will each be 10 units (of whatever scale is used) but Dr. S. said today they will be 20 units each.  My understanding is that he is getting 40 units intravenously, so going down to 20 units isn't as much a drop as I thought it would be.  I will have to clarify.

Dave is in the chemo laz-y-boy; I hope he doesn't miss these comfortable chairs when he's not coming here every day.  I am not buying one for his den, even though he deserves a treat after this ordeal.  Maybe I'll get him a new pair of walking shoes.