No, I Haven't Been Ignoring Breast Cancer Awareness Month

I haven't, really. In fact, I have been busy. My daughter and I walked the 5km CIBC Run For The Cure a couple of weeks ago. Between the two of us, we raised nearly $2,000 for the Canadian Breast Cancer Foundation, thanks to the generosity of our family, friends, neighbours and teachers. Much of that money will go to research. In fact, have a look at this video about how the Foundation uses the fund that are raised.

I have also been reading posts by my favourite bloggers. I have even written a guest post for "Telling Knots" which was published today. The timing is apt, as yesterday was the two year anniversary of getting my biopsy results, the day we told our daughter I had in curable breast cancer. Please stop over at "Telling Knots" to read my post and the other guest posts she is publishing this month. Like many bloggers this month she is putting the focus on those of us living with mets (that is, advanced breast cancer).

Stage IV Snapshot -- Now Asthma

With cancer, if it isn't one thing, it's another.

I managed to catch my dear daughter's cold this week. It came on strong. Within days, all I could do was sleep -- if I could sleep over the noise of my breathing. My voice is frequently a mere squeak. Fortunately, I had an appointment with my GP on Friday. He diagnosed me with virus-induced asthma. I have had "noisy breathing" off and on but never realized what it was. Now I have two puffers that generally keep my breathing silent.

I'm Not Doing It, The Port That Is

Just a quick update, folks. After much thought, and discussions with nurses and my husband, I have decided not to go ahead with the insertion of the Port-a-Cath on Thursday.

The key factor for me was that my current treatment is oral Tamoxifen daily and infusions of Herceptin and Pamidronate every three weeks . These drugs don't damage the veins like chemo does. So I don't really need the port now. At some point, I should expect that this treatment will fail. Eventually I will have to go back on chemo. At that point, I will need either a port or a PICC. But I will wait until then.

For those of you who are deciding whether to get a PICC or a Port-a-Cath, here are the pros and cons as I see it. Please check with Dr. Google to learn about other aspects that I didn't experience:

Note: as soon as I hit "publish" I thought of more items for the list. They are marked with a "*".

Port-a-Cath

Pros

• Protects veins from chemo.
• Once the incision heals, you can shower and swim normally.

Cons

• Both inserting and removing the port require minor surgery. Healing from the port insertion feels like you've been kicked by a mule. I was aching and taped awkwardly, which made me walk like Igor from the old horror movies.
• *The port site is exactly where your child's head cuddles you. Seat belts and bra straps will also irritate the site.
• The port may erode the skin above it. In my case, I had persistent bruising at the port site (not normal) and later an infection.
• I could feel where the wire looped up my neck. It was a little painful. Definitely icky.
• In Ottawa, an appointment with a nurse is required to use the port for a blood test. If you want to leave the Gripper needle attached between the blood test and treatment, sterile dressing is required. So much for showering normally.
• If your port isn't accessed every four weeks, you need a nurse to come to flush it.
• The incisions (there are two of them) and the port site could form keloid scars. At the suggestion of my dermatologist, my doctors injected Kenalog (a type of cortisone) at the incision site to reduce the chance of keloids forming. It worked, so far.

PICC

Pros

• Protects veins from chemo.
• Painless accessing of the PICC for blood tests and IV medication.
• Removing the PICC is easy. They slowly pull it out. I watched; it was cool.

Cons

• You walk around with a bit of tubing sticking out of your arm the whole time. This is covered with sterile dressing. It is annoying in the summer. I had a weird tan that year.
• A nurse must come weekly to change the sterile dressing and flush the PICC line.
• You can't swim.
• To shower you have to wear a plastic sleeve to keep the dressing dry. Your arm never gets a good scrubbing.
• In Ottawa, an appointment with a nurse is required to use the port for a blood test.
• If you are sensitive to adhesive, like I am, you may need to use Mepore (paper dressing) to avoid irritation. I later changed to IV3000. My skin was fine while I had the PICC, but I had some scabs form after the PICC was removed and the dressing taken off for good.

No PICC or Port

Pros

• No holes in your body.
• You can swim and shower normally.
• You can walk in for blood tests either at the hospital or a local blood lab. No appointment necessary.

Cons

• Chemo can damage your veins.
• Blood tests and treatment will require a poke in the arm. If your veins are hard to find, as mine sometimes are, maybe two pokes. You may bruise at the site of the poke.

That is all I can think of. I hope these pros and cons will be helpful to someone that's just starting out with cancer treatment. I know I will come back to the list when I have to start chemo again.

Please add a comment with your experience with PICC lines and ports.

Bye-Bye Port-A-Cath, Forever?

Well, so much for that Port-A-Cath. After only ten months, my Port-A-Cath abscessed and had to be removed. Apparently this usually happens in patients with little extra fat. I guess I just got lucky, not thin.

The removal surgery, two weeks ago, was fairly straightforward. It was done with local anaesthetic and dissolvable sutures. I needed to be careful not to lift too much, which is hard with a new puppy who isn't confident on the stairs. Afterwards, I had to have my Herceptin and Pamidronate by IV, which went well.

Next Thursday, I am scheduled to have a new port inserted on the right side, just in time for my next treatment. But I am having second thoughts. I have been off chemo nearly a year. The Tamoxifen is keeping my tumours stable. I get Herceptin and Pamidronate every three weeks. If I understand right, they aren't as hard on the veins as chemo is. I don't know if I have mentioned it before but I form keloid scars -- scary scars that keep growing for years, long after an injury has healed. Did my skin's nature play a role in my port's abscess and erosion?

I could really use some advice. Do I really need to get a new port put in? Should I just wait until the day when I need chemo again? Or should I be protecting my veins from the Herceptin? What do you guys think?

Stage IV Snapshot -- Emergency?

None of us wants to go to the Emergency Room, but Tuesday night I was pretty sure I should. A sore erupted on the edge of my Port-a-Cath. That's not just unsightly. The catheter could take the infection straight into my bloodstream. I've been septic before and don`t want to risk it again. (Can you guess I spent some time with Dr. Google while waiting for a home care nurse to return my call?)

I have had persistent bruising at my port site, particularly to one side. It just wouldn't disappear between treatments, which are every three weeks. In fact, at my last treatment, I'd discussed it with my chemo nurse. She didn't have any advice for me. Earlier this week, I noticed that there seemed to be a small sore over the bruised area. I showed it to my Sweetie and we both said "hmm?" We were on our way to Montreal for a short visit and thought nothing more of it. Then when we returned to Ottawa I took a closer look at it after getting out of the shower. It was now clearly infected. The home care nurse wasn't sure what to make of it and wouldn't be able to see me until midnight or later. I called my family doctor's after-hours service and that nurse was more definitive: I should have a doctor examine it within the next four hours. Great.

We asked my daughter to hastily repack her backpack for a spur of the moment sleepover at my mom's and off we went to the hospital. Four hours later, the ER doctor assured me that I had no signs of sepsis, but certainly needed antibiotics, starting with an immediate double dose. He also suggested I give the Cancer Centre a look at it the following day. The nurse dressed the wound with antibiotic cream and gave me enough Cloxacillin that we didn't have to stop at the pharmacy on the way home. Instead we were allowed a few hours of sleep.

The next day, my Patient Designated Nurse put me in touch with Sheryl of the hospital's Port Team. She was able to meet with my when I came early for an unrelated specialist appointment (verdict of that after three months and two hours of waiting: no hip surgery). Sheryl has arranged for daily nursing to change the wound dressing. And she broke the news that my Port-a-Cath probably needs to come out. I now have an appointment next Tuesday to have it examined. It sounds like the infection needs to have subsided before they will risk the surgery. Whether they will put a new port in at the same time, I don't know. All I can tell you is that I`ve learned a few things in my ten months with my Port-a-Cath:

• The ones on the left side have more problems.
• Bruising isn't normal.
• And sometimes they erode the skin over top them.

Stage IV Snapshot -- Bad Girl!

We have been talking about getting a dog. So when we found out our neighbours were going away, we agreed to look after Lily. She is one of the most lovable dogs on the planet. Although it is certainly a big adjustment having a dog in the house, I see the upsides to the extra work.

Lily is a young dog, a one year old Golden Doodle. She loves to play. Sometimes, all it takes is to toss the ball for her. She even does this crazy dog thing when you make a sudden movement. But Lily also likes tug of war. The other day, I made the mistake of trying to play tug of war with her. I lost. I also hurt myself. I hope I didn't cause a new vertebral fracture. With the amount of pain killers I'm on, it's hard to tell. Not good. Bad girl!

Paying the Price for My Vanity

Vanity isn't the only reason I didn't bring my walker to lunch today, but it was a part of it. I feel like I look so much older and sicker with my walker. Then there's convenience. I would rather use the stairs and escalator than go around to the ramp and elevator. There is another reason. My back. I hurt it the other day (ignoring my limits) and didn't think I should lift the walker in and out of the trunk.

So I went to lunch downtown with my cane and had a great visit with my friends from work. After lunch, I stopped to chat with most of them in their offices. I didn't sit down often enough. That's why I should have had the walker, for the seat as much as the handholds.

Before I even got back to my car, I was wiped out and had to stop and sit down. I called my Sweetie on my way home and asked if he wanted me to pick up any groceries for dinner. Then I begged him to say no. I just couldn't face the grocery store. Accelerating and braking were painful. Sigh. By the time I got home I needed to drag myself inside. Straight for the couch.

I suppose that it made matters worse to have taken the dog for a walk, again with cane not walker, this morning. I'm not very bright, am I?

Honestly, There is a bright side to my foolishness. I won't shut myself in the house and wither. My nature is to regularly forget or ignore my limits. I just like to know where they are.