CHEMO DAY 8 OF 20

Today is Wednesday, Dave's 8th day of treatment.  He had a good weekend, highlighted by the arrival of his brother Jeff and sister-in-law Bobbie from Houston.  Dave was fatigued, but able to function all day Saturday and Sunday without taking naps.  Then came Treatments Week Two.  Jeff took Dave to the ACI Monday and Tuesday while Bobbie and I played. Week Two is not going as well as Week One.  Dave's white blood cell counts are down and he has neutropenia.  He has to take precautions being around people and eating raw fruits and vegetables, and he has to wash his hands as often as possible.  However, his chemo regimen will not be changed for a while to see if the counts improve.

Dave routinely gets chilled when getting the interferon (INF) (but not the saline or other drugs) and we've come up with a fairly good way to combat it.  We take his 'neck warmer' - a fabric bag full of cherry pits (I believe) that can be put in the microwave.  We get it nice and warm, then Dave lays it on his chest and zips up his fleece vest.  He has a blanket on top of him as well as his windbreaker/jacket.  That combination seems to work until he can finish the bag of INF and the following bag of saline solution.  He was getting uncomfortably cold just as he finished up today, so I'm thinking of taking a second neck warmer with me tomorrow.

While they were here, Jeff and Bobbie were looking forward to visiting with Jeff & Dave's sister Sandy. They stopped by to see her Sunday and Monday, and Bobbie and I had coffee with Sandy on Tuesday.  It was a Howell reunion - though we were wishing Candace could have been here, too.

Bobbie took this picture on Sunday 10/13/13.  I love it that the Howell siblings are all smiling.  I'm not sure Dave has had the energy to smile today - so far.

A DAY OFF

Hurray, today is Saturday and Dave has a day off from chemo.  The previous two days were fairly uneventful, especially Thursday.  Friday Dave felt he was starting to get the chills again, so I made him more hot tea, the nurses put hot towels on his chest under his vest and added another blanket.  He made it through okay.

Dave was shivering so badly on Tuesday he thinks he pulled a muscle in his shoulder,  or perhaps somewhat damaged whatever repair was going on.  It's the same area where he had his lymph node surgery under the collar bone.  His shoulder area has been aching badly since then.  For two nights now he has been using a heating pad which seems to help.

Dave has been very fatigued and has taken a nap every afternoon except Thursday, as we had workers at the house.  We had an awning installed over our westerly facing sliders, and the workers needed supervision.  And a ladder.  And a broom.  And I don't know what else, I left it to my supervisor.

Friday was busy.  After the chemo, I was instructed on how to flush the picc line, and did it once so a nurse could watch me.  I'll be doing it once each day over the weekend.

Then we took Sandy out for lunch.  She was having a very good day although her arm (fractured in two places weeks ago) was bothering her near her elbow.  After taking her back to Savannah Square we stopped at Kroger's then the recycling area.  I had loaded the car days earlier with our paper, cardboard and plastic.  I was glad to get it out, as something didn't smell good, though everything should have been clean.  The car sits outside in 85º+ heat while we're at ACI, so something got ripe.  I was glad to get rid of that trunkful of junk.

Dave napped, our dear friend Liza, chef extraordinaire, brought over home made vegetable soup and a baguette which we had for a delightful dinner.  We sat outside under our new awning and enjoyed a drink, talked to our friends across the fairway who just returned for the winter (such as it is in Savannah), and decided all is right with our world.

Before

After

 After writing these first paragraphs, I went out to do errands and drove over our new, high, FINALLY opened bridge!  Dave was mowing the grass when I drove in the driveway.  Wow.  I cleaned up the front patio, put more water in the fountain, and tried to get a picture of our visiting hummingbirds, but I guess they are shy.

Now it's noon, and time for flushing Dave's picc line.  I did it!  Pin a badge on me.

CHEMO DAY 3 OF 20

I am happy to say today's treatment went very well.  Dave wore warmer clothes, he drank 3 cups of hot tea, and everything went smoothly.  His blood pressure was a little low, possibly due to the Demerol he had yesterday and not enough fluids to wash it all out.  He had been wanting a bowl of French onion soup, so we went to Panera's for lunch where he could satisfy his craving.

Dave took a nap in the afternoon and later we checked on a neighbor's house (which we do while they are away), walked to the dog park then home.  We covered about two miles, the first exercise either one of us have had in several days.

The main entrance to Memorial

This evening Dave has had a slight temperature, his shoulder is bothering him, and he is feeling very sluggish.  He said this is the worse evening he's had.  We know the effects of the drugs can be cumulative, so we can expect even more symptoms as time goes on.  We'll try to combat them, though. You've heard, "Better Living Through Chemistry"?  I believe it!

One correction - the hospital we go to is Memorial Health University Medical Center.  When I wrote yesterday, I left out the most important word, Health!

Associated with the hospital and on the same campus is the Curtis & Elizabeth Anderson Cancer Institute (ACI), which is where Dave's oncologist has his office, and where Dave gets his chemo.

CHEMO DAY 2 OF 20

A little housekeeping --

1. For those of you new to the blog, the very simplified background is that we discovered Dave has metastatic melanoma, Stage IIIC, and is undergoing chemo (more accurately immunotherapy) to hopefully kill off any remaining melanoma cells in his body.

2. I learn as the days go on.  Today I learned the 'vein pick'/'pick line' is actually a "PICC line" (peripherally inserted central catheter).  You will just have to bear with me as I spread my misinformation then try to correct it.

3. I don't intend to write every day, as I hope the daily visits to the Anderson Cancer Institute become routine and uneventful. When there is something I think is interesting, I'll write.

Now for the update --

Dave had a good night last night and felt just the slightest bit achy this morning, but after taking Tylenol he felt fine.  He did not need his additional nausea medicine last night.

With a tourniquet on his arm awaiting the ultrasound.

I think this is my first selfie.
If I wanted to watch Dave
getting the picc, I had to
wear the mask.  Or maybe the
nurse thought I had bad breath.

We left this morning in the pouring rain for a 7:30 AM appointment to get his PICC line.  We thought it would be easier on Dave and his veins to get one since he has to have IVs for 20 days.  I dropped him off at the door to Radiology (Memorial University Hospital), where he would get the picc, and I parked the car by the Anderson Cancer Institute.  The parking lot was flooded and there was no hope of keeping my feet dry.  Once in the ACI, there was no one around to give directions to Radiology, most of the hallway doors were closed, I kept running into dead ends, so I had to go back out in the rain to get to the place where I dropped Dave off.  Oh well, such a minor problem.

The PICC in Dave's arm.

Between the paperwork, sterile preps and the actual insertion, about an hour went by.  I am so unfamiliar with hospital procedures, I thought it would take about 5 minutes.  I learn as I go!

The tube inside Dave's arm is 28 cm (about 11 inches) long and goes to the basilic vein, a large vein in his chest near the heart.  An ultrasound was used to locate the vein it was going in, then the nurse just pushed it in.  Oh my.  The line needs to be flushed with heparin daily, but I'll have to do it only on the weekend, as otherwise the nurses in the chemo treatment center will do it. Thank goodness.  I get squeamish about this bloody stuff.

Dave was able to start his daily infusion about 9 AM.  He was almost finished but about noon he started getting cold and suddenly had the shakes.  He kept asking for blankets, and ended up with three on him, all doubled, another folded up on his chest, a zip-lock bag of hot cloths on his chest, and the vest he brought for warmth.  I even texted Chad to see if he had a jacket in his office.  Dave was given more Benedryl and hot tea, but he was shaking everywhere, his feet, his hands, his lips...  The nurse then gave him Demerol, and in about 2 minutes he was out.  Totally relaxed and asleep.  One of the other patients heard me say I'll bring a warmer jacket for him from now on, and he said we should bring a cap, and wool socks, too.  It was scary to me, but the nurses said this is not an uncommon side effect.  When Dave came to, he could hardly speak as his tongue wouldn't work.  I felt so sorry for him but I was also laughing.  He kept asking how to flush his picc line (which I wasn't going to worry about until Friday).  He also said if there's an outlet, he wants to bring an electric blanket.  He was given extra fluids to wash out some of the drugs, and we were finally on our way home at 1:15.  Whew.

Dave ate a bowl of soup when we came home, and now he's napping.  The nurses told us again Dave needs to keep the Tylenol in his system around the clock, but not to wake him up to take it.  I'll make sure it's handy in case he wakes up at night.

CHEMO DAY 1 OF 20

So far so good!  It's just after dinner and Dave has survived without nausea today, knock on wood.  He was drowsy this afternoon and took a nap as soon as we arrived home.  (He said he slept okay last night, though I did not.)  This evening the skin on the back of his neck is feeling "raw" and it looks a bit reddish.  We were told some people have a mild allergic reaction to interferon (INF) so maybe that's what it is.

Selecting a book to listen to from his iPad
Oct. 7, 2013

We arrived for our 9 AM appointment and met with Rosemary, Dr. S's nurse practitioner.  She was surprised Dave didn't have his pick line (what I previously referred to as a vein pick).  Turns out there was a little snafu trying to get it arranged on a Friday afternoon after our last appointment, but it is now scheduled for 7:30 AM tomorrow.

It was not a problem; Dave has good veins and the IVs were started by 9:30.  First he had a bag of a saline solution for hydration, then Atavan for anxiety, an anti-nausea drug, Benadryl for any allergic reactions, then the INF (the smallest bag of all) and finally another bag of the saline.  He also had two Tylenol tablets when the IV was put in, and is supposed to continue taking Tylenol around the clock.

Dave was seated in a recliner with two pillows and a blanket.  He listened to his book-on-iPad, had a little cat nap, and I went through the Savannah News, four magazines and did a little bit of emailing.  We don't have wi-fi there, can you believe it???

Dave ate a small lunch and dinner and has been drinking lots of water per instructions.  He didn't get any exercise today though.  I went out this afternoon as I take Coleman to an art class on Mondays, but on days I'm home I hope to get Dave out for a walk.  We even talked about going to the pool this afternoon as it was 88º and sunny, but that's when Dave needed his nap.

We've been told to expect nausea, aching, and probably a fever as the INF kicks his immunity system into high gear.  Let's hope none of this comes into play and we both get plenty of rest tonight!

MEETING WITH THE NURSE RE: CHEMO

I'll start at the end - Dave begins his chemo on Monday, Oct. 7 at 9 AM.  The first event will be getting the pick in his arm which will remain there for the month he's getting the IV infusions. After getting the pick he'll have about an hour's worth of fluids, then an anti-nausea drug and finally the interferon.  The nurse practitioner, Rosemary, told us to expect to spend about 3.5 hours there the first day, and subsequent appointments may drop to 2.5 hours.

Now I'll back up a bit.  Rosemary has been with Dr. S only 5 days; she worked elsewhere previously.  She seems very knowledgable and organized though there were just a few procedural items she needed to learn e.g. she wasn't quite sure how often Dr. S expected Dave's blood to be drawn to check on his cell counts and liver.

Dave will be getting a dosage of 40 million international units/m2 by IV infusion for 5 consecutive days per week for 4 weeks, then he'll move into the maintenance phase with 10 million international units/m2 given subcutaneously (self-injected) 3 times per week for 48 weeks.

We were given a book on chemo, its side effects and what we can do to alleviate them; a book on nutrition "before, during and after cancer treatments" and a sheet that is specifically on interferon and its side effects.  Rosemary answered every question we had, from "how high a temperature reading should result in a call to the doctor?" (101º) to "how do we know if the anti-depressant isn't working?" (he won't want to get out of bed, see people, etc.).

Although an anti-nausea drug will be given intravenously, it may wear off during the day so Dave was given a prescription for Promethazine that he can take as needed.

He was also given a prescription for Sertraline (Zoloft).  Both Dr. S and Rosemary strongly recommend using it, as depression is a very common side effect and it is better to stay on top of it rather than try to manage it later in the process.  We stopped at Target on the way home to fill both prescriptions.

Dave is to drink 3-4 liters of fluids a day (though the first month he will get one liter intravenously), take no more than one 30 minute nap per day, and exercise - even if it is just walking - as much as he can.

Rosemary seemed confident that whatever side effects Dave has can be managed so he will not be "sick" during his treatment.  He is expected to feel fatigued, and perhaps achy, very similar to feeling like he has the flu.

We stopped in to look at the treatment room and met the nurse who will get Dave hooked up on Monday.  He will also be seeing Rosemary every morning before his daily treatment. We're feeling more optimistic about the upcoming month than we were (or at least I was) after reading story after story online.

And now, it's after 5 o'clock!  We're headed to LandingsFest for dinner, tomorrow Dave is kayaking, Sunday is church and a family dinner.  We have lots to do before 9 AM on Monday!

WE HAVE A PLAN

We met with our Savannah oncologist today.  I'm going to call him Dr. S (for Savannah) from now on. The only reason I hesitate to give his real name is because if I don't accurately describe what he tells us or if I don't precisely describe his treatment plan, I do not want you to question his ability.  I may get things wrong or simplify too much, and that is my error.

Back to the visit.  We told him what our MD Anderson doctors recommended - the 'standard of care' adjuvant therapy - which was what he also recommended.  Dr. S also told us radiation was an option, and MD Anderson told us surgery was an option, but Dave has decided to go with the interferon therapy.  He is ready to get started and hoped he could be in the chair on Monday, but Dr. S said there were a few things that had to be done first.

One, we have to be sure all the insurance plans are notified and are in place.  This should be no problem with Medicare and Dave's very good supplemental BC/BS plan he was required to purchase when he decided to stay on TVA's plan so I could be covered.  Whew.  (He has quit complaining about the expense of the supplemental after seeing the first round of EOBs.)

Two, he has to speak with a Nurse Educator about the process, the medications, the administration, etc. His appointment with the nurse is next Friday. He will also get a vein pick in his left arm (his tumor was in his right arm) so the nurses don't have to find veins to inject the IV every day.

Third, they had to draw blood for baseline data, so they can watch, in particular, his liver function and blood cell counts.  Dave asked if that could be done today, so after talking to Dr. S, he had his blood drawn.

Assuming the other two items get done next week, Dave will start his therapy on Monday 10/7.  He will have infusions 5 days a week for 4 weeks at a high dosage level.

I asked Dr. S if Dave can take benedryl (minimizes his snoring), have a cocktail, and get a flu shot.  He said, Yes, yes and yes.  From what I read on the internet, I was surprised he is allowed to have alcohol.  Dr. S said 1/day is okay, although Dave may lose his taste for it.

I asked about anti-depressants, and as I said to Dr. S, Dave has never exhibited depression, but I've read it is a very common side effect.  Dr. S said anti-depressants are a routine part of the treatment, as is anti-nausea medication.

It was an educational and motivational meeting, and now we'll have to cool our jets for another week.  It gives Dave time to get in more kayaking, swimming, loading up his iPod with books to listen to, etc. etc.  It will be a busy week!