Tuesday, April 28, 2009

Taking a break

Things are on a even keel at the moment; mom isn’t taking the Coumoudin any more so she’s down to the Lovonex shots. They don’t have to measure the INR level any more either, so hopefully the Lovonex will be enough to dissolve the blood clots. At some point she will have another CT scan to see if the clots are still there. She’s giving herself the Lovonex shots every morning so she doesn’t have to make the hospital visit every day.

Last week Lois and Connie took her to the boutique to check out the wigs. The boutique was able to order her the color and style that she wanted, and it should be in sometime this week… I think they were going to go back over and pick it up. I haven’t seen it but from what mom said it’s pretty tame. So, there won’t be a flaming redhead walking around Geneseo that’s for sure. I thought she should do something different, but then again if it was me, I wouldn’t.

Tuesday, April 21, 2009

More clots

Yesterday mom still had some nausea, as well as aching bones, but she seemed to be feeling a little better.

Today she found out she has another blood clot under her arm in a spot that had been bothering her and had been sore. The hospital in Geneseo was able to find it without a scan, I can’t remember what she called the contraption they used… something with a lot of tubes. So now, she is off the Coumoudin and just going to go with the Lovonex shots on a daily basis to dissolve the clots. It has been very hard to regulate her INR level this last week, so backing off of that and using the Lovonex should bring the clots under control and prevent others from forming.

Sunday, April 19, 2009

Rainy day

Well I didn't make it out to mom's, the rainy day turned me into a Spring Cleaning machine. I got the upstairs done at least... maybe next weekend I'll get the other half done. Or not!

Today the nausea was worse. Mom got a good night’s sleep for the most part, however woke up not feeling so good. She took one of the prescription nausea pills to take the edge off. Her bones were aching again (from the Neulasta shot). She was feeling about the same the whole day, but managed to eat some small meals and snacks and drank one of her Boost shakes. For as little as the bottle is, there's about 390 calories and 15 or so grams of protein, so that does her body some good.

There was nothing to do today anyway, she got yard work done on Friday when it was sunny. Hopefully tomorrow will be a better day.

Saturday, April 18, 2009

One more shot

Mom got her Neulasta shot yesterday – each time she has chemo, then the next day she has to go and the Neulasta shot which is a drug that will prompt her bone marrow to produce more white blood cells. It didn’t take that long and we were back home in time for Jeopardy ☺

I talked to her this morning and she was a little nauseated but not too bad. She took her last of the $300 nausea pills (they were $100 each) ((she has a good co-pay w/insurance )) so she's hoping the nausea won't hit her too hard this weekend. She said that cancer treatment has really come a long way over the last 20 years... her good friend Jan, who passed away when I was a freshman in college, had a terrible time with the side effects of chemo therapy. Mom remembers how hard the nausea was for Jan at the time, and I think she has that in the back of her mind. BUT between all the pills, the bag of medicine during treatment and the steroids, I'm sure the edge has been taken off.

Her hip ached a little, and the nurse said yesterday that the Neulasta would make her bones ache for a day or so, but mom said it wasn’t that bad. Aunt Carol is coming for lunch today and bringing something that I’m sure is compatible with their persnickety digestive systems, so I’ll probably go out and see her tomorrow since it’s supposed to rain pretty much all day. Maybe she’ll feel like getting out or not, we’ll see.

Friday, April 17, 2009

One down...

Slow start to the day. Mom’s port wasn’t cooperating and it took two hours for them to clear it out, so we didn’t get started until about 10:30 a.m. First they gave her a drip of some nausea preventative medicine and some saline. The she got a bag of Benedryl to curb any allergic reaction to the Paxitel. The about 11:15 she got the Paxitel drip. That was the largest one and they let it drip slowly to watch for reactions.

The Benedryl hit her hard. I gave her a neck pillow and a blanket and she was out.

The room hubbub quieted down, earlier there were two chemo “veterans” in who were just chatting it up about whatnot. They both had been through chemo treatments, surgeries and other medical processes. The worst part about the morning was a woman with a nasty (worse than mom’s) cough and SHE WOULDN’T TAKE ANY WATER. Her husband, who is receiving a chemo treatment, is a cute little farmer with a John Deere hat. He’s retired, but he still likes to tinker around outside as much as he can.

The Paxitel finished at about 3:15, and then it was time for the Carbopatin. That only took about ½ an hour to go through the bag. After that was done they kept her on a saline drip for a few minutes. They had that bag going the whole time with the other stuff anyway, but they gave her some extra at the end for hydration purposes.

Then to finish off everything, more nausea pills. We got home at about 4:30 I think. Her treatments are more spread out that we thought they were going to be: One week on; then three weeks off. Her next one is May 6.

All-n-all, the first chemo treatment went fine, very smooth with no reactions or side effects (apparent), but we'll see this weekend what kind of side effects she will have. From what the nurses say, seems like nausea is to be expected.

Wednesday, April 15, 2009

Big day tomorrow

Today at Dr. Porubcin’s office his nurse Sherry (sp?) went over the chemotherapy drugs, additional prescriptions and side effects mom could expect over the course of treatment. Sherry is a cute little lady with a sunny personality so I’d say she’s perfect for the line of work she’s in.

The two chemo drugs they are going to give mom are Praxitel and Carbopatin. Both are used for the treatment of ovarian cancer and in mom’s case also primary peritoneal cancer (high probability that that is where it is as well). I looked up the drugs when I got back to my office, there’s a good web site http://www.chemocare.com/bio/ that does a good job of describing the drugs. Be careful – there are more chemo drugs out there than you think.

It’s going to take about three hours to infuse the drugs. They will be watching her closely to see her reaction with the Praxitel – if there is an allergic reaction they will have to find another type to go with. Dr. Porubcin will be there to see if there are any reactions. Doesn’t seem to be the same concern with the Carbo drug, however there are other side effects such as nausea and a general achy feeling. The side effects don’t normally show up the day of treatment, more likely 3-5 days later. And the first two times will be the easiest – she can expect around the 6 or 7th treatment to start feeling it more.

The other medicines that she is going to take to prevent the side effects are a dose of steroids before the treatment, then a pill for the nausea right before the treatment, and then she’ll have a second prescription for nausea if it gets too bad. She is free to take Tylenol as needed for any aches and pains. Other general instructions: drink a lot of water, small frequent meals throughout day are best, sleep when tired, get around and move (mom won’t ever have a problem being a couch potato that’s for sure)

Hair loss will start happening after the first couple of treatments. Mom has some wig resources in Moline and there is a specialty boutique called “Always A Woman” that is very good with “cranial prosthesis” (aka WIG) and the nurse actually had some coupons that mom can use there.

We took a tour of the room where the treatments will be. It was a very busy place. There were at least 10 chairs with IV hook ups and an assorted range of people receiving their treatments. There is a big picture window facing a small lake at one side. As packed as the room was, it was a good atmosphere. There are at least four nurses in that room at all times.

Mom felt good about the fact that she’s getting started on the chemotherapy. I told her by Christmastime this would be all behind her and she can look forward to starting 2010 in a healthy way!

Monday, April 13, 2009

Chemo this week!

We had a nice time on Sunday and went into church for the 9:00 a.m. service. Everyone was very happy to see her. Pastor Bill was there (the one who came to the hospital) and he gave a good Easter talk with a lot of humor in between. Scotty even got up which was a feat because I know he only got a couple hours of sleep. He wanted to see his Grandma.

Mom went in for an appointment today with Dr. Mullin to see how her anti-coagulating is going and to talk about the next steps. She had an INR of 1.6, so not quite where he wants her to be (between 2-3). There will be lots of blood monitoring when she starts chemotherapy.

Speaking of chemotherapy, she has an appointment on Wednesday at Dr. Porubcin’s office to discuss the treatment and what drugs they will be using, so that on Thursday she will be able to start chemotherapy FINALLY. Sounds like they will be prescribing a couple of things to curb the side effects as well.

Thursday, April 9, 2009

Good scope

The gastroscopy went fine today, and all and all it took about 10 minutes for the surgeon to take a look. They didn’t find anything other than a hiatal (sp?) hernia (not serious) and a small patch of gastritis (irritation in the lining of the stomach; not serious). They also took a small tissue sample and sent it off to the lab for inspection. She should hear something on Monday if they find anything suspect. The surgeon didn’t think there was any concern.

So now that the scope is over, we’re back to ovarian cancer, possibly peritoneal cancer. The surgeon was going to call Dr. Porubcin’s (oncologist) office today to discuss the gastroscopy. From there hopefully mom will get in next week for her first chemotherapy session.

Her INR was up over 3.0 so they want her to back off of the Coumadin again today. They’ll test her INR tomorrow morning, and if it’s down then she can start back on the Coumadin.

Tuesday, April 7, 2009

Gastroscopy date

Well mom reached an INR of 2.6! I told her to think really hard about a high INR when the nurse was drawing her blood so it must of worked. She’s back down to 5 mg of Coumodin a day and no more Lovonex shots for the time being. Whatever tush she has left was getting pretty sore from the shots, so she's happy to be off the Lovonex.

We didn't go for a consult today as originally planned. Mom was able to arrange to have the Gastroscopy done in Geneseo on Thursday. This a much better option and she is more comfortable having it done at Hammond Henry (and I'm quite comfortable there as well it's a nice hospital). It's a simple procedure, and not a lot of prep work involved... most of the time is just getting her ready for the scope and then bringing her out of anesthesia. Should go just fine.

Monday, April 6, 2009

One step back

Today was a hard day. Just when mom thinks she is moving in the right direction, things change. Dr. DeGeest (Iowa City Doctor) wants to do a Gastroscopy - examination of the gullet and stomach. The procedure is painless and is usually done under a light sedative as a day-case. There is no risk to her blood clots with this type of sedative, and they will be able to give her something temporarily to counteract the Coumodin.

She goes in for a consultation tomorrow afternoon for the gastroscopy. The office is in Moline near Trinity. Mom wants to see if they can do the procedure in Geneseo.

Dr. Porubcin’s office won’t do the chemotherapy until the gastroscopy procedure is done, so that’s a minor setback. We were hoping to start chemo this week definitely, but now it looks like it won’t happen until next week.

Friday, April 3, 2009

Surgery postponed

The surgery has been postponed. Mom needs to be on the anti-coagulating meds that are being used to dissolve the blood clots for at least three months. For the next four days she will be taking Lovonox by injection and then build up on Coumadin so that her INR level is between 2-3. The INR means International Normalized Ratio and measures something about coagulation. As long as her ratio reaches 2-3 that is the point they want her at before she can start chemotherapy.

Coumadin partially blocks the re-use of vitamin K in your liver. Vitamin K is needed to make clotting factors that help the blood to clot and prevent bleeding. It can help stop harmful clots from forming and keeps clots from getting larger. The Lovonox is taking care of dissolving the clots, and the Coumadin is preventing any more clotting. She needs to watch eating her leafy greens, because eating too much Vitamin K will throw things off, but other wise if she keeps eating like she always has things will be fine. She needs to gain weight and the doc said it was ok for her to drink a protien supplement once a day.

Dr. DeGeest told me on the phone yesterday that he would not be operating with blood clots in the picture now. Thank goodness they looked at the scans again.

Looks as if now she will have to go back to Plan A: Chemotherapy first, surgery second. Dr. Porubcin's office has been keeping in touch with her and will call her on Monday to talk about starting chemo.

Thursday, April 2, 2009

Another issue: blood clots

Yesterday mom and I got back to Rock Island about 3:30 ish from Iowa City, and then headed back to Geneseo to get some things done, stop at the store, etc.

About 1/2 hour later the University of Iowa calls me and says that I need to take mom to the emergency room right away because on the last CT scan that was done of her whole chest area (on April 1), there were two blood clots on the right lower lobe and she needed to get some treatment right away. Dr. DeGeest was concerned about the clot breaking loose and would go to her heart or cause a stroke. If he would have gone ahead with the surgery it would have been a bad thing.

So I jump in Jeep and drive to Geneseo to find her because of course she's not home..."I've got some things to do" were her words to me before she left my house.

I found her, neighbor Marion had taken her to the emergency room in Geneseo. The doctors gave her a big shot of a clot-dissolving Lovonox and did another CT scan. The scan confirmed that there were two clots on her right lobe.

She was admitted to the hospital (in Geneseo) and will stay the night, maybe tomorrow as well. We have to consult with U of I again tomorrow to see what to do know since she can't have surgery with the clots.

The next step: University of Iowa

The Cancer Center at the University of Iowa is a very busy place!

We spent the day there, talking to the gynocologist/oncologist/surgeon, Dr. DeGeest. He said that it would be best to do surgery soon, he really can't say what the cancer is, possibly ovarian, however he's concerned that it may have attached on to small bowel, peritoneum, omentum or pancreas based on her fluid buildup and some other symptoms. To determine the type of cancer they need to open her up and look. They really can't get enough information from the CT scans or the Physical exam.

Some points of the cancer may not be removable. After her recovery, then chemotherapy. They were talking about doing surgery next Monday (April 6) or Tuesday (April 7), which was the earliest she could get in. The surgery will take 3-6 hours, and then about 5-6 days recovery.

After the visit with the gyn surgeon, she took care of the preoperative processes so she’ll be ready to go next week: did an EKG, visited with the anesthesia doctor, more paperwork, etc.

We also need to possibly look into skilled care after they discharge her from the hospital. Especially if they have to do a bowel resection in addition to taking out the uterus/ovaries and debulking (removing cancer).

Dr. DeGeest's office will call to confirm a day and time for next week.

Wednesday, April 1, 2009

Second option: surgery then chemo

The second Oncologist visit went very well. Dr. Porubcin, at Trinity in Moline, was very thorough with his reading of the full range of test results. His first theory is that the cancer is ovarian, however there are other areas that the cancer could be attached: stomach, peritoneum and even the small bowel. It’s very puzzling that there is no bulk or mass to deal with. The cancer could be very thin and attached in many places. Some cancers do grow that way.

He recommended surgery first and foremost. First, to determine what type of cancer is in the abdomen; Second to get all/as much of the cancer out as possible. Then, after a recovery period, chemotherapy to specifically treat the cancer.

Mom is in great health and is a good candidate for the surgery. Now would be a good time to use this window of opportunity since the fluid has been drained and chemo has not started. He recommended taking a trip to the University of Iowa to talk to a very well trained surgeon there who specializes in gynecology oncology and treats cancer specifically in a woman’s reproductive system. This cancer will definitely need good surgical hands.

Dr. Porubcin wants another scan of the upper chest area to rule out anything in the lung area.

Mom commented that another gynecologist she had talked to a few days ago said doing surgery first should be the priority. Now that she has heard it twice, that sounds like it could be the answer to treating the cancer.

The office set up an appointment for Iowa City tomorrow 10:00 a.m.