Tuesday, November 30, 2010

New three-week series

Mom's veins in her neck looked better today. We had a great Thanksgiving - inlaws Tim and Lisa hosted it at their cabin on the Mississippi. There were two different types of turkeys - Tom's version and Tim's version. Both were delicious and I got my cranberry sauce.

We met with Dr. Porubcin before chemo first to talk about her blood counts and general overview of her treatment. Dr. P said her counts looked good. Her blood pressure was a little high today, but not too concerned about it.

He talked about continuing to manage the "thrombosis" (clotting inside the vessels) with a twice a day shot of Lovenox. Since she's doing that for the last couple of weeks, she should have a one-up on this round of chemo and preventing any problems with the clots. I've got to think that there can't be much more to break free and make their way upward.

Mom requested a CA125 count yesterday so that should be done in the next couple of days. That test takes longer than the rest of the counts.

We talked a little about genetic testing and decided to put that on the back burner. Mom's case isn't really typical since there is no family history of breast or ovarian cancer. And the fact that it developed late in her life is another factor against it. I'm going to do some more reading about it and maybe bring it up again in a couple of months.

The chemo session went fine and we'll see how the next couple of days go. Hopefully better than the last month.

Sunday, November 21, 2010

Week off

It seems that by the time the third week of chemo hits, all the symptoms and the clots are at their worst.

Even though she ended Friday on a good note, yesterday mom wasn't feeling well again yesterday. Her neck was still sore and more body aches and pains (more than the usual). The veins in her neck were still a swollen.

She was feeling better again this morning and got up and went to church. Hopefully this week will be much better and she can get some strength back before the next round starts (Thanksgiving dinner will take care of that). Luckily, the next break (three weeks on; one week off) will fall on Christmas week so she'll have a good holiday week without a lot of symptoms or worry. Fingers crossed.

Friday, November 19, 2010

More clots

Chemo weeks are always rough... mom has had a rough couple of days with blood clots dislodging from her lungs and moving up into her head. She had to get checked out yesterday as her neck was sore and there were veins bulging out... and sure enough there is a clot there (right side of neck). We went to Trinity where Dr. Porubcin could take a look at her and decide what to do from there. He increased her dose of Lovenox to 100 ml; which equates to 50 ml twice a day. She will do one shot of 50 ml in the a.m. and one shot of 50 ml in the evening. There isn't anything else they can do about it except just wait for it to dissolve.

We were reminded that this is a side effect of the chemo/Topotecan and that is something that mom's body is doing because of the drug (clotting). Increasing the Lovenox should keep on dissolving the clots accordingly. Each chemo session aggravates the clots which is a theory of why they keep breaking off after each time. She had her last chemo session on Tuesday, and felt ok but yesterday (second day after chemo-typically the hardest day) the symptoms arose.

I stayed over last night just because of the fact that she had a blood clot in her neck and I was afraid that the entire thing was going to dislodge and wanted to be there if any more symptoms happened. She was very tired and fell asleep early. This morning the vein looked a little bit better - she said it felt a little stiff, but better than yesterday. AND she didn't have any pressure in her ears... which is a good thing b/c that is one of the more annoying factors.

About 1/2 an hour ago she said she was feeling ok and went out to run an errand. I may go back out tonight or wait until tomorrow.

Tuesday, November 16, 2010

Chemo day

Today went well, nothing out of the ordinary. Mom was feeling ok and there was a slight sensation in her ears, but it didn't get any worse by the time the chemo was finished. Hopefully this week will be better than the last few.

Next week mom has the week off from chemo - so that makes a nice Thanksgiving Day holiday. Tim and Lisa (in laws) are hosting this year and Tom is making a turkey (professed to be better than Tim's but I think they both do a good job) and of course mom is bringing the Cranberry Sauce. We had a conversation about cranberry sauce today when she was in the room at Trinity. One of the guys from the local Gilda's Club always comes and visits the cancer patients, and we were talking about Thanksgiving. He described mom's cranberry recipe to a T and said that it was his favorite kind (the sauce with orange, apple and sugar in it). Too bad I won't be saving any leftovers as I'm sure he would love to have a sample, but I only get it once a year so he'll just have to dream about it.

Thursday, November 11, 2010

Good day

Mom had a good day yesterday and today (so far). No sort of pressure in her ears or anywhere in her head, so hopefully that is behind her now.

Dr. Spector, the other oncologist (in the same office as Dr. Porubcin), said that maybe what is happening to mom has something to do with the clots in her lungs breaking away a little piece at a time and going to her head. Even though she has the filter in place now to prevent clots from reaching her lungs, she still has clots in her lungs and those are dissipating into her blood stream. Some smaller ones can still make their way through her system before they dissolve, so that may be what is happening with the pressure in her head... it's a clot.

The clots will dissolve in time. Mom just has to make it through until they do. There's nothing to do but wait... all the other preventative measures are in place. She got a prescription to help alleviate the anxiety when the symptoms start up, so hopefully that will help.

Tuesday, November 9, 2010

Chemo day

Mom had a pretty good day Monday, although she is still feeling some pressure in her ears. This morning before chemo the pressure wasn't there, but soon after (about 15 minutes into it) she started getting that sensation in her ears again.

One of the nurses, Carrie, said that she would speak to Dr. Spector (the other oncologist in the practice... Dr. Porubcin is out until Thursday) to see if there should be some other tests to run or a way to pinpoint the cause.

Now that mom has the IVC filter in place, I think her stroke concerns are alleviated a bit, however there is still something that is bothering her about the pressure in her ears.

I've searched a few cancer discussion boards about the side effects of Topotecan and ear/sinus pressure and other cancer patients who have been through Topo and there was only one response that said that the person had terrible sinus pressure and had to sleep upright until the treatments are over. Mom is keeping her head elevated at night so that is going for her, but not working in the morning when it seems like the pressure strikes.

I forgot to ask about a CA125 count. There are so many things on my list and cross off and re-circled again that I need to make a new sheet.

Saturday, November 6, 2010

Back home again

Mom went home on Friday after lunch. They didn't give her a Lovenox dose that morning to offset any more potential bleeding.

This morning when she woke up she had the pressure feeling in her ears again - not as bad as the other day, but I was surprised to hear her say that when she felt so good after the filter procedure on Thursday. It subsided a little bit during this afternoon but would come back again.

If it happens more tomorrow she is going to call Dr. Mullins office and see if they can do any more exploring as to why this in happening. She has chemo again on Tuesday.

Thursday, November 4, 2010

Hammond Henry Hotel

Dr. Atwell came back in and said again that the procedure went well. They took an xray to check and see that the filter was positioned correctly (it was) and now the only concern is to make sure that the leg incision "behaves" and doesn't swell or bleed. They stitched the skin closed, but not the femoral vein where they inserted the catheter with the filter.

They are keeping mom overnight as a precaution, due to the fact that she is taking the Lovenox and that it prevents clots (as it should). In hindsight maybe she shouldn't have taken her dose of Lovenox this morning, but as the incision isn't that big nor did they do full anesthesia, there wasn't really a concern. Keeping her from clotting is more important, so they are going to continue with the Lovenox but there is a little risk of bleeding in her leg. She doesn't have any swelling in her leg and they have these "sandbags" on the area to keep the pressure on, so she's good.

The good news is that mom feels 100% better! This morning she had another one of those "throbbing" head episodes and it lasted about a half an hour. When I picked her up I could tell by the look on her face that she didn't have a good start. Her ears were bothering her also. But after she came back in the room after the procedure today her head and ears felt 100% better - no pressure at all. And she felt better also knowing that the filter was in place and that it would prevent clots from getting through. Peace of mind makes all the difference at this point.

She'll go home tomorrow morning. I think she will take it easy tomorrow and over the weekend - no straining - and she'll be good for chemo on Tuesday.

Out of surgery

It is 2:30 p.m. and Dr. Atwell (surgeon) popped in to say that the procedure went well, and mom should be back in the room momentarily. Apparently bleeding is an issue (incision in her leg) and with the Lovenox that is to be expected since it is an anti-clot med, so they are keeping a lot of pressure on the incision area. He'll be back in to check in on her in a moment.

IVC filter

The nurses just wheeled mom into the surgery area (2:00 p.m.) so she should be back in about a half an hour.

The IVC filter (or they have been calling it a Greenfield filter) is a little thing like an umbrella without the material attached. Picture is on wikipedia >>

The surgeon is going to insert it through an incision in her leg (about 1" incision very small) and then work it up to her inferior vena cava below the heart. This is the most typical type of filter used for people with Pulmonary Embolisms/PE's/clots in the lungs. I think that this is going to be a permanent thing... no one has said anything about retrieving it after a certain period of time (and I forgot to ask) but apparently people have had them in for years and have had no complications.

Tuesday, November 2, 2010

Week 1; round two

Mom got a late start today on chemo. She had a visit scheduled with Dr. Porubcin before hand at 9:30 a.m., however he was running late with his visits so we sat around for quite a bit. Mom made a pan of pumpkin dessert for the nurses and staff - that was well received and even some of the other cancer patients in for their chemo had some as well.

Mom had blood work done last week on the 25th, however I think some information got crossed because they didn't do a CA125 report. Other levels were normal except for her white blood cell count. They had to do another blood count again before they started chemo to check her white count again. If it was too low they weren't going to do the chemo. Luckily the white count was back up so they started the chemo at about 11:30.

Dr. Porubcin still comments on mom's constant coughing but I keep telling him it's been going on for 40 years of my lifetime and that's just the way it is. I can tell he's puzzled by it but I say let's just concentrate on the cancer forget the cough. I was disappointed that there wasn't a CA125 count available but we'll get next week.

Mom asked Dr. P about putting in an inferior vena cava filter (IVC) - a type of filter to prevent the blood clots from going where they shouldn't go. It traps large clot fragments and prevents them from traveling to the heart. It is used in patients with a high risk of Pulmonary Embolisms (PE's) and mom fits that category as her lungs keep developing clots. He agreed and said that she should get in in this week, so mom is going to Hammond Henry on Thursday to have the surgeon there put in the filter. I'm hoping that there aren't any more clots forming, but she has been short of breath quite often... and I'm not sure if it is because of the fluid build up or the blood clots, but if we can get preventative measures in place to keep the clots in check then there's no reason not to do it.

From what the nurses say in the chemo room, the IVC filter is an outpatient process and she should be in and out in an hour or so.