Back to Chemo

Where has the time gone? I don't even have an excuse for not posting since October. Well, a little excuse. I was scared to face the truth.

Like I mentioned in June, my breast lump grew back. Since then, we have been talking a lot about it, considering options. Initially my oncologist suggested that if the lump was problematic, the options were surgery and radiation. I saw my radiation oncologist in the fall. She wasn't inclined to radiate the breast unless it was causing a lot of pain. I had pain, but intermittently, and mild. Later in the fall, one of the physicians who supports the oncologist felt the lump and suddenly, a chemo trial was on the table. It was a trial with Xeloda and either Tykerb or a new anti-Her-2 drug. I will admit the prospect of chemo surprised and scared me. I didn't expect that, since I've felt quite positive about my experience with Taxol at the beginning of my treatment. Taxol and Herceptin was my first line of treatment. After a year of that, I took a short break and then started Tamoxifen with Herceptin. The Xeloda trial required two previous lines of treatment, I learned that only chemo counts as a line of treatment in the trial world, so I was ineligible. Tamoxifen didn't count.

The physician ordered another round of scans. I did a bone scan and the results showed stability in my bone mets. I was starting to think the breast mass was simply necrotic (dead) tissue. I wanted a biopsy before stating a new treatment. Then we got the CT scan results. Not only had the breast lump returned, it was continuing to grow. And, there was a second breast tumour I hadn't noticed. And there was some thickening in the abdomen that could represent new small tumours. And there is a mass next to my uterus. Chemo it is!

Ten days ago, I started Vinorelbine, with Herceptin. Clearly systemic treatment is required. Vinorelbine, which I like to call vanilla bean, is known to have milder side effects than chemos like Taxol, for example. So far, I've had some indigestion and constipation. So far, my hair hasn't gone anywhere, but it is too soon to tell if I'll lose it. I pray that the vanilla bean will be effective, with few side effects. I could use your prayers as well.

I will be in Vinorelbine for as long as it works and I can tolerate it. An ultrasound is being scheduled to investigate the uterine mass. And, I hope, I will get back to blogging, both here and on my family history blog. It has been too long between posts. Glad to be back.

A Milestone: 20,000 Page Views

Wow! Sometime in the last couple of days, this blog has hit a milestone I never anticipated: 20,000 page views. This is something that merits celebration, and gratitude.

I started my cancer blog after a short career as a geaneablogger (about family history) mostly as a way to keep family and friends aware of how my treatment was going. I knew many were getting the info through my mom and their parents. I'm sure some details got lost in translation. It was also difficult to tell the whole story over and over. My blog gave me a chance to write it down, once and for all.

My secondary purpose for the blog was to raise awareness of breast cancer. For a while, I gave my readers a monthly reminder to "check your boobs!" I think I felt that I might have caught my cancer earlier if I had done regular self-examinations. Then, as I became more educated about breast cancer, I realized that self-exams and mammograms aren't the be all and end all for finding cancer. That's when I dropped the words "breast cancer awareness" from the blog's title and went for the straightforward "Kate Has Cancer."

I received some criticism for the change. Is it defeatist to call myself Kate Has Cancer on the blog and Twitter? No, it's realistic. Remember, I have Stage IV breast cancer. I have had advanced cancer since they found it. Chemo, radiation and the other therapies have shrunken my tumours -- you can't even feel the one in my breast -- but many of them are still there in my liver and bones. My blood tests are fine. so I figure, if my liver can live with these tumours, then so can I!

Over time, another purpose for my blogging has emerged. I hope that others with advanced breast cancer can find, in my blog, some peace, some information and some hope. I don't focus on the latest news from clinical oncology. I talk about my treatments and the resources available to me here in Ottawa. Judging by the Blogger Stats, my most popular post, with nearly 600 page views, is perhaps my most practical one, on PICC line covers. I hope my link to a crochet pattern helped someone with cancer or even someone who wanted to help someone with cancer. I've had 800 views of my About Kate page, which I imagine could use an update. Almost 400 read my early post about how I started onto this cancer roller-coaster. Around 300 read two of my glimpses into the terror of Stage IV cancer, Reflections on Recent Deaths and Someone Took the Monster Out of the Cupboard. I have seen my readership rise to, on average, 200 page views per post. I never expected this. I may be Italian, but I don`t have that many cousins!

That brings me to the grateful part. I thank you readers for continuing to read and support me. Your comments on the blog have given me new perspectives and great support. I also thank God that I'm still here to write! Every day, every post is a blessing. I must also express my appreciation to my fellow bloggers who have directed considerable traffic my way: Ann at Breast Cancer? But Doctor....I Hate Pink!, Nancy at Nancy's Point, Jenny at Putting the GRRRRR in Grimes, and Nancy at The Dirty Pink Underbelly.

I hope to be here many more years. And I hope you stick with me. Thanks for coming.

I Spoke Too Soon

Uh-oh!  I spoke too soon about having minor side-effects of Round 16 of chemo.  Nausea just started.  I'm feeling pretty terrible, walking around with my shoulders slumped -- like my dramatic neice who is turning three.  I'm dragging myself to cook supper, only because my Sweetheart has come down with a bug.  I don't really want him infecting my food.  I can't risk catching his cold.  Plus he's exhausted.  He hadn't yet fallen asleep last night when the earthquake hit at 4am.  Mercifully, I was sound asleep.

So for my nausea, I have taken a dose of my Stematil tablets.  I can feel that it's starting to work; I only feel crappy, not lousy.  Or is it the other way around?

Oh, and I have a sore toe.  I forgot to ask the nurse for the iced booties during the Taxol infusion.  Darn.  That's going to make it more difficult to find new shoes for the wedding.  I hope I don't have to wear my granny shoes.

Enough typing.  Supper is in the oven.  I have 15 minutes to lay down before I have to check on it and turn on the potatoes.  TTFN!

Power Outages, Cancer-Style

Yesterday, I heard cancer fatigue described as a "power outage."  The term hit me. That is exactly how it feels.  The fatigue hits out of the blue.  You can be quite active, and have plans to do more, when all of a sudden you just NEED to lay down, and then you're out of commission for a few hours.

I had a power outage last week, before chemo. I had had lunch with a good friend and picked up groceries on the way home.  Then I puttered for a bit.  Just when I was about to lay down for a rest, my Sweetheart asked if I could make supper early, so he and the Bean could carve the rest of the jack-o-lanterns. Uh, sure, I said. Big mistake. By the time supper was ready (and all I had to do was reheat a couple of things), I was drooping at my plate. I laid down on the couch as soon as I finished eating. I tried to read some blogs on the laptop, but my eyes kept closing. Next thing I knew, I had slept for two hours! That is a cancer power outage.

Last round, I had a mental power outage. It was the day after chemo and I had to pick the Bean up after school to take her to an appointment. I screwed things up from start to finish. I went over to a neighbour's and got into my mind that I just needed to pick Lena up at the bus stop. Sweetie called me in time to make it to the school as planned. We were to pick up a vegetable for supper on our way home. Well, we poked around the mall longer than we should have, got caught in traffic and ended up at a different grocery store than where I aimed to go. In short, we came home with a vegetable after Sweetie had finished making... and started eating supper. Neither of us was happy with the way things turned out. Bad night.

Power outages like this, mental and physical, make me worry about my ability to work in the future.  The Bean pointed out that the power outages come out of the blue, making it difficult to stick to a work schedule.  What will the future hold?

Round 16

Amazing.  On Friday, I had my 16th round of chemo.  Again, I had a dose of Taxol, with Herceptin and Pamidronate (for my bones).

I haven't posted much about my chemo in a while for two reasons.  One is that, for a number of reasons (not readily apparent to me), I wasn't scheduled for chemo at the end of September.  Then my next chemo was delayed to a Monday due to a mixup about when we returned from Disney.  I had just more than a five week gap between treatments.  The up-side of it was that I'm on a new three-week schedule that doesn't have me getting chemo the day before my nephew's wedding in Calgary.  I am very glad that I can go with my family to the wedding.  In addition to a family reunion on my husband's side, it will also turn into a high school reunion with the same BFFs who came to visit me last November for my birthday. 

The other reason I haven't blogged for a while about my chemo is that it's going quite well.  Knock wood.  This round, I had very little in the way of side effects.  There was no nausea.  I had less fatigue than usual.  The only real problem is that Taxol can give you diarrhea, while the stomach medicine Zofran can cause constipation (as can my pain medication).  This round, I was able to experience both. 

Also, sometime in the last couple of weeks, my swelling went down.  I could wear my wedding rings for the first time in nearly a year!  My watch is now spinning around my wrist in a very annoying fashion.

So the chemo itself isn't hitting me too hard, but I realize that what has depleted my batteries is the fact that I've been on chemo for a year and had cancer for a year.  I am coming to realize that I'll ever be the same. 

More on this, in my next installment, "Power Outages, Chemo-Style."

I Don't Just Feel Old, I Look It Too

I've been grumbling lately about the weight I have gained since my diagnosis with Stage IV breast cancer.  The research I did tells me my experience is not unique. 

There are several reasons for the weight gain that is common to breast cancer.  Part of it is water weight and swelling due to steroids.  It was so bad last winter that I needed to buy men's size 10 boots and wear compression stockings.  Much of that weight came off when my oncologist changed the steroid dose I get with my chemo, but it's not all gone.  You should see my ankles when I take my socks off at night.  Put it this way:  they are shapely in a bad way.  While I was able to wear my sandals this summer, my size 8 closed shoes no longer fit.  I had to buy two new pair of size 9 shoes.

And then there's my belly.  I will admit that part of my weight gain comes from overindulging in sweets last Christmas.  You, my friends, gave us a lot of really delicious cookies!  Not that I'm trying to shift the blame.  Well maybe just a little. 

Chemo put me straight into menopause.  According to an article on WebMD, menopause causes changes in metabolism and body composition.  It is typical to lose muscle weight and gain fat.  Guess where?  Right in the belly.  Yesterday, I had to buy a new rain jacket, because my old one would barely zip up past my belly.  I had to buy a man's extra large to fit me.  That's depressing... and the sleeves are outrageously long!

I had hoped with my training for the five kilometre Run for the Cure that I would shed some of the weight I had gained.  It isn't happening.  I will try to keep walking regularly.  I'll try to be better about the sweets.  But I think this belly is here to stay.

In addition, my hair colour has changed.  My gray hair came back white, and my brown hair has come back a washed out steel-grey colour.  I have been feeling like I aged 10 years since I got sick.  Guess what?  To my disappointment, but not surprise, WebMD says, "a woman having chemotherapy ages the equivalent of 10 years over the course of just one year." Tell me about it!

What the Future Holds

I may have mentioned in previous posts that I understood that if my tumours continued to shrink, I might get a break from chemo this fall, while I would continue with the drugs Herceptin and Pamidronate (the cancer-stopper and bone-builder, respectively). I knew that because I have advanced breast cancer that I'd be on and off chemotherapy for the rest of my life.  Apparently it will be more "on" than "on and off."

Last Friday, Geoff and I met with my wonderful oncologist to get the results of my latest CT scan.  We got good news. The tumours in my liver continue to shrink. They are still numerous, but under 1cm in size, except for one. That last large tumour has continued to shrink and is now about the size of the end of my pinkie finger. By the way, my blood tests for some time have shown that my liver is functioning well despite the tumours.  I figure that if my liver can live with cancer, so can I.  The tumours in my bones appear to be stable; no better, no worse.  Contrary to what I was expecting, there were no new fractures. I believe the CT looked at my breasts too. The results didn't give any measurement of the original breast tumour. I don't know if that means it's completely gone or if they just didn't measure it.  It doesn't really matter.

My oncologist reminded me that Stage IV breast cancer is a chronic disease. Like other chronic diseases, such as diabetes and even depression, medical treatment doesn't take a break. He also explained that the unfortunate reality of breast cancer is that, eventually, each chemo medicine stops working. He hopes to get as much benefit as possible from each chemo treatment.  So, I will continue to get Taxol every three weeks, "as long as it is working and it is well-tolerated."

I have to be honest, I was disappointed to get the news. Somehow, I'd dreamed up a chemo-free future where, for one thing, it might be easier to return to work. I have to rethink things. I have to accept that the chemo will continue. So every three weeks I will have a few days where I feel tired and nauseous, and have sore fingers and toes (my weird side-effect).  I don't know how well my hair will continue to grow.  My chemo-brain syndrome will continue to interfere with my speaking.

I get a tiny break though.  No chemo on September 28; I start again October 12.  That means I won't be recovering from chemo when I do the Run for the Cure on the 30th, that I can attend a retirement party on the 28th, and that my nephew's wedding won't be on a chemo weekend.  See?  All good.

"Don't Count Spots!" and Other Friendly Advice from my Oncologist

I saw my oncologist yesterday and he took the hammer out to get it through my head to stop worrying.  And I have been worried.  I have a lot of tumours in my liver and bones.  Unlike some Stage IV women with a single spot here or there, mine are "numerous."  The radiologists can't even count them all.  And what if they move into my lungs or heart or brain?  Dr. G said, "Don't count spots!"  Stage IV is Stage IV as soon as there is one tumour outside the breasts or lymph nodes.  There is no Stage IV and a half.  No Stage V.  It's Stage IV and the treatment is the same whether it's one spot or "numerous" ones.  I need to relax...

He also clued me in to some more of the side-effects I've been suffering.  My runny nose and constantly tearing eyes?  Chemo.  I thought it was my allergies but no... which means it's not going to stop anytime soon.  I can try artificial tears, or if necessary, the doctor can give me steroid eye drops.  And the swelling I feel on my back, near the latest fracture, is just swelling.  That's common after radiation.  By the way, my back is still "tanned" and itchy from the radiation I got in November.  I had no idea it would last so long.

I asked my doctor if it was OK to try to lose some weight.  He was ambiguous, to be honest.  It sounds like it's not necessary for me to keep on extra weight as an insurance policy -- because if I stopped eating suddenly, he would treat it right away.  On the other hand, women gain weight with breast cancer, and in truth I had lost weight since December, back when I was at the worst of the ankle and leg swelling.  I think the bottom line is that I can do what I want.  Next question is for me:  do I want to work at losing weight?  Hmm.

Next, the big question:  could I have a drink?  Because of my abnormal liver results and "numerous" tumours, I haven't had a drink since the early Fall.  And some days I really would like one.  Dr. G said "absolutely!"  My liver results are now normal, despite the tumours.  I can have one to two drinks a day if I want.  That would be more than I need, but now that the sun is shining, I am thinking of sitting in the yard with a cold glass of hard apple cider.  Mmm.

About that new chemotherapy treatment that has been in the news, TDM1, he says it's available in Ottawa.  Clinical trials are continuing; approval should come relatively soon.  He'll look into whether and when I might get it.  That said, he did agree that it makes sense to continue the Taxol, Herceptin, and Pamidronate combo as it is still working.  He says all good doctors have Plan B and Plan C at the ready.  And he's taking good care of me.

Losing Your Hair Hurts

When my hair started to fall out again on Saturday it hurt emotionally.  Since my hair had started to regrow this winter, I was close to going wigless.  Saturday's discovery meant that one piece of normalcy in my life had been snatched from my grasp.

By Sunday, I experienced a new pain, on my scalp.  Various parts of my scalp were sore when hair moved or touched a pillow.  Today, before showering (and plugging the drain), I pulled off as much of my hair as I could.  It took a long time, about my limit for standing. And it hurt, particularly on the top of my head.  Washing my hair was awful.  I stood under the shower wincing, nearly whimpering, as the water hit my tender scalp.  And even more hair fell out, short little bits that I could tell were from the new growth -- little guys that were just getting their start in life.

Maybe by the fall, I'll be off chemo and my hair will grow back for good.  Until the next round of Taxol.

P.S.  We saw my oncologist today and in response to the hair loss and aches and pains (which I hadn't realized were Taxol related), he is going to reduce my dose for Friday's chemo.  He's always trying to balance my quality of life against getting the cancer under control.

I Guess I Should Have Known

Warning:  this is definitely a TMI (too much information) post.

I guess I should have noticed that when I shaved my armpits the other day there wasn't much to shave.  I can hardly see without my glasses, but I should have known.  And this morning I should have noticed that my leg hair stubble wasn't very long considering I hadn't shaved in a couple of days.  But I just figured it hadn't been so many days.  And yet, when I washed my hair this morning I was shocked that it fell out in my hands. 

I was actually planning to go to out for breakfast without a wig for the first time since the fall.  I thought that my hair was growing back really well.  I almost went for a trim when Geoff went to get his hair cut yesterday.  But I should have known.

I thought I wasn't having any side-effects from the switch in my chemo dose.  Remember, the doctor combined my Taxol into one "serving" rather than splitting it over the course of two weeks.  At first I thought that doubling up might give me greater side-effects like nausea or fatigue.  But nothing happened after chemo, so I thought I got off lucky.  I should have known.

I wonder how comfortable my wigs will be now that the warm weather is here?  I wish I wasn't going to find out.

New Treatment Approaches for May

I went to the Pain Clinic on Tuesday, where they were able to check out my MRI results and let me know about the new compression fracture, which explained the pain in my back.  The Clinic gave me a new prescription. This time, for Naprosyn, aka Aleve, three times a day, with meals. I had stopped the Celebrex last month after it, paradoxically, made my joints feel swollen. The last straw was when my knees felt weak going down the stairs -- if I fall down the stairs now, I'll end up in a million pieces! I went back to ibuprofen until last week's appointment at the Clinic switched me over to Aleve. It took a couple of days to make a noticeable difference, but it's working now. It makes it much easier to get up of the couch to get another cup of tea!

Further to the April test results, on Wednesday, my oncologist has switched me to chemo once every three weeks. They had previously been splitting my dose of Taxol over two weeks. As of last Friday, I was given the full Taxol dose in one sitting.   I was a little concerned that my side-effects would be greater, but so far they have been minimal.  On Saturday, I had the standard moon face with hot, red cheeks.  My stomach felt a little iffy Friday night and Saturday night, so last night I took my Stematil.  I was expecting to feel quite tired today, more from Lena's marathon birthday party yesterday than from chemo, but I feel well.  I'm moving around well, without pain.  Feeling steady on my feet. 

I'm having one of those moments when I feel "like myself" and it feels good.

Chemo Update: March 7, 2012

As you can tell by this late post, last Friday's chemo didn't go as well as some.  The actual session was normal.  This time, there were no delays in getting the medications.  As usual, I slept through half the session due to the Benedryl.

Saturday wasn't great though.  Around lunch time, I developed chills.  Serious, teeth-chattering chills, plus nausea.  One blanket wasn't working.  A second blanket didn't help.  Lena brought me a thermometer, but my temperature was normal. Geoff brought me a cup of hot apple cider and my Stematil (anti-nausea pills) and then I started to recover.

Sunday would have been a fine day, I expect, if I hadn't goofed.  I picked up my pill box the wrong way, so instead of taking my afternoon pills, I took my night time pills. Yeah, including my sleeping pill (Atavan).  So much for me making supper!  I didn't come too until 6:30.

Monday, the nausea returned as supper was cooking.  I took two Stematil and took to my bed!  Lena joined me at 8:00 for a cuddle.  Then, I got up at 9:00, just in time to watch my favourite mystery and make Lena's lunch before heading back to bed.

I'm hoping that's it for my reactions to Friday's chemo.  Remember, the doctor reduced the amount of Taxol and changed the steroid dosage too, all to improve my quality of life.  Well, compared to the weeks when I couldn't stomach anything, I am doing better.

Chemo Update: February 19, 2012

I had my chemo treatment again last Friday.  As promised, the doctor reduced the Taxol dose by 20% and I believe he changed the dose of steroids given before the Taxol.

The session went as normal.  What was new was that my mom and dad came to visit, to see what the chemo was like.  They left as the Benedryl drip was ending.  At that point, Geoff came in and watched me sleep through the rest of the session.

Early in session, I noticed a dietitian speaking to some of the other patients.  Given the lost appetite I've been suffering after chemo, I may ask to meet with her myself.

That said, I haven't yet noticed any loss of appetite since Friday's chemo.  From the previous week's chemo session, my appetite left on Saturday and returned on Thursday.  I expected it to be gone by now, but it's not.  In fact, I really enjoyed my cereal for breakfast this morning.

The other thing that is new is that I noticed this morning that the swelling in my feet was virtually gone.  You wouldn't have believed the swelling I had on the tops of my feet.  But now I have a normally shaped foot.  You can almost see my ankle bone too!  This is incredible.  In fact, I went over to the scale and was amazed to see that my weight had dropped about 12 pounds since I was at the doctor on Wednesday.  That's really something!  A lot of water gone.

I have one non-chemo update for you as well.  I've virtually stopped using the walker in the house.  And I've been forgetting my cane here and there, which means I can walk short distances without either cane or pain!  To be truthful, I can't get very far without some pain in my lower back, but I feel like I have regained the strength I had in November before the pelvic fracture and my hospitalization.  Again, this is great progress.

Pretty much all good news.  Hope that pleases you as much as it does me!

Update: February 15, 2012

I'm overdue to update you on last Friday's chemo session.  Plus, I met with my oncologist this morning and got some unexpected news.

First, chemo.  It went pretty much the same way the last couple of sessions have gone.  The chemo itself is fine.  Afterwards, though, I end up tired and lose my appetite.  I haven't eaten much since Friday.  Even my favourite things, like Saint Hubert chicken and cream of wheat, I could only eat a bite or two of them.  My cousin Sam mailed me some of my grandmother's best cookies, genetti.  Even the genetti I have to eat slowly to get them down.  It's a shame.  Still, considering how difficult chemo is for so many patients, I know I'm getting off easy.  I can't really complain.  And that is why my appointment with my oncologist was somewhat surprising.

His focus is on maximizing my quality of life while controlling my disease.  He wanted to get my liver metastases under control and then reduce my chemotherapy.  The last CT scan showed that the liver mets have shrunk significantly, but it appeared that the bone mets had grown.  My oncologist pointed out that it takes months for bone mets to heal, and for the healing to be visible on a scan.  His interpretation of the CT results is that the bone mets may have grown while my chemo was interrupted in November/December, but they are probably responding as well as the liver mets are -- we just can't see it yet.  He's now going to reduce the amount of Taxol I'm getting by 20% to improve my quality of life (that is reduce the extent of tiredness and lost appetite I'm experiencing).  On another note, he will be reducing the amount of steroids I'm getting with the Taxol, which should reduce my swelling.

In a couple of months, he'll repeat the CT scan and if the results are good, he expects to cut my Taxol to once every three weeks, rather than twice.  Eventually, if my results remain good, after another couple of months, he'll cut the Taxol entirely and stick with the Herceptin for "maintenance."

He also mentioned that the liver is the most important organ in my treatment, the one he was most concerned with controlling.  This makes me feel much better, given the dramatic results I had on the liver mets.  I had been worried about the bone mets, but his comments this morning made me less concerned.  I just have to be more patient with the bone mets.  The fact that my pain levels are greatly reduced is probably a more accurate reading on my bone health than the CT scan was.  That's good.

What Breast Cancer Looks Like: Lucia Alloggia

Geoff and I have often mentioned how wonderful our neighbours are.  We've focused on how kind and generous they are, but one, in particular, is also very talented. 
Let me introduce you to Lucia Alloggia.  In 2010, Lucia was diagnosed with breast cancer and underwent surgery, chemo and radiation.  On her website, her 2010 gallery is made up of four paintings chronicling her experience with breast cancer:  The Mastectomy; The PICC; Chemo; and Radiation.  They are fantastic paintings. 

Chemo is particularly touching.  With Lucia's permission, I will reproduce it here:

If you have had chemotherapy, even if it's gone well, you will recognize yourself in this picture.  To me, the slumped shoulders say it all.  Like they say, a picture tells a thousand words.

I encourage you to visit Lucia's website here.  In addition to the cancer series are many portraits, and paintings modelling the styles of the masters.  And did I mention that Lucia is as generous as she is talented?  You'll also see paintings she has donated to the restoration of an earthquake-damaged church in the Italian town of Camarda, where she is from.

I hope you enjoy her paintings as much as I do.  Lucia can be reached by email through the contact form on her website.

Chemo Update: January 20, 2012

After having a chemo break on Friday the 13th of January, I started up again last Friday.  As usual, my first chemo session gives me all three drugs:  taxol, herceptin and pamidrinate.

This was a very usual chemo session.  Just me and Geoff and a few things to read.  And as usual, after the benedryl drip, which always precedes the taxol, I fell asleep.  Of course, I've been sleepy for a week or more.  We're not sure if it has to do with the levels on my pain pump.  In any case, the drowsiness has continued through the weekend.

I took zafron Friday and Saturday to prevent nausea, which it has, but it's usual side-effect of constipation has also been the result.  Let's hope that doesn't last too long.

I realize this isn't a very interesting post, but let me tell you, a chemo session with little to report is a good thing!

Chemo Update: January 6

I had chemotherapy again on Friday, January 6.  As usual, Geoff came with me, but this time two old friends visited as well... somewhat to the chagrin of my otherwise cheerful nurse.  We are really only to have one person accompanying us to our chemotherapy treatment.  I suppose that keeps the noise down for everyone else.

This session, I just received the Taxol, along with the drugs that are given with it.  One is a steroid and another is Benedryl.  The Benedryl is given right before the Taxol.  The result is that I get really sleepy pretty quickly.  I always bring books and puzzles to while away the time during chemo, but every time, I end up getting drowsy or falling completely to sleep and if you would believe it, later on, I get drowsy at home trying to re-read the same part of the book or trying to do the same puzzle.  Very frustrating.  I would think that this doesn't make me a very interesting person to visit, but my old friends didn't seem to mind -- as far as I could tell through my droopy eyelids.

All those drugs are given through the PICC line, which is convenient enough, except that it can interfere with my pain pump delivery.  During certain IV treatments, I have to disconnect the pain pump.  Given that I'm spending that time sitting quietly on a bed, it's not generally a problem that I'm not getting my pain medication.  But with all the saline they pump into me, I do generally have to make a couple of trips to the bathroom down the hall.  With luck, I can reconnect the pain pump and give myself a shot before dragging my bad leg down off the bed and down the hall.  If you're curious, I don't use the walker for these trips.  I have to bring the IV stack, as it's still infusing medication as I head to the bathroom.  So I just unplug the IV power pack from the wall and put my weight on the pole to make it to the bathroom and back.  Haven't had any trouble so far; I just don't look very graceful.

Friday's chemo session started at noon, so I had some lunch there in the hospital bed.  I packed a light lunch of celery and peanut butter, crackers and clementines, with a cup of milk. And a cookie too; it's Christmas.  I've been choosing the hospital bed over the chairs for chemo lately.  I like being able to change positions easily in the chair.  Plus they have convenient tables on either side for your stuff.  But with the swollen ankles I've got, I figure I am better off in the bed, where I can keep my feet up higher in the hope the swelling will lessen.

So, Friday's session was pretty routine at the hospital; the only change being my extra guests.  I wasn't as tired as last week, but I was unsure how I would feel in the evening.  We were invited to attend a friend's bonfire that night.  It sounded like a lot of fun, but I wasn't sure how accessible it would be for me in my current physical state and I wondered if I'd be exhausted like after the previous week's chemo.  So I let Geoff and Lena go with one of Lena's friends and I stayed on the couch at home.  Just as well.  I ended up with stomach cramps just after they left.  Nothing too bad or too long lasting, but I was uncomfortable for about a half an hour.  Geoff later assured me that the layout of his friend's bonfire would have been easy for me to access, so I hope to be able to attend the next one.

Overnight, I had more problems.  I woke up feeling hungry, I thought, but not quite wanting to eat.  And I'm not "authorised" to go down the stairs alone, so I just lay there in bed hoping the discomfort would pass.  It didn't really.  It became more of a stomach ache, even nausea.  I didn't like it a bit.

Eventually morning came and I took the Zofran pill the doctor recommended.  Zofran is one of the anti-nausea pills that is available to chemo patients.  My doctor had cut my dose from one or two for each of the five days from the start of chemo to only taking one dose the day of chemo and the following day.  My doctors tend to be of the "if you need it, take it; if you don't need it, don't" school.  As a result, and hoping for a better night, before going to bed Saturday I took another Zofran and I brought upstairs my bottle of Stematil, another anti-nausea medication that I'm prescribed on an as needed basis.  It turns out I didn't need the Stematil overnight, but I'm glad I had it at hand.  All I had was my usual sore back by 5am.  It's not easy to find 8-plus hours of comfortable sleep positions when you have a broken pelvis and several broken vertabrea.

Awareness note:  In addition to the Stematil pills that are prescribed to chemo patients, we are also given vials of injectable Stematil which we can call the community/home-care nurses to come and inject anytime if we find we can't keep anything down.  It really is comforting to know that the system is working to take care of us from all these angles, day and night.

Guest Post from Geofftakeson: The Early Days of Kate's Cancer

I suppose that there were periods of my illness when I was sufficiently out of it that I couldn't really describe it to you now.  Nor did I understand how sick I was at the time.  So, my Sweetheart, on his Geofftakeson Blog had described that period up to when I first started chemotherapy.  With his permission, here is Geoff's view:

As I have written about before, those early days after Kate's breast cancer diagnosis were the most difficult of our lives, not that I want to speak on Kate's behalf. We didn't really know what we were faced with, but what we did now was that Kate was very sick. Our GP was the lucky fellow who got to break the news to us. We could tell he was devastated. He had had Kate as a patient for nearly 20 years, me for almost ten and the Bean since she was born. Before we left the appointment, he got on the phone with the Ottawa Women's Breast Health Centre, which got us into the system of cancer care. He hugged Kate long and hard with tears welling up.

The people over at the Breast Health Centre ordered more imaging, tests, biopsies to confirm the diagnosis and and referred Kate to Medical Oncology at the Ottawa Cancer Centre and gave us that first taste of hope. This was treatable over the longer term.

That initial hope, though, was dashed over the ensuing days and weeks. Kate became increasingly symptomatic and was very sick indeed. She had a hard time keeping food down and her mobility was getting worse and worse as her cancer-riddled vertebrae began to fracture. If I am being honest, I didn't think she was going to make it to her first appointment with the medical oncologist. We had a pre-scheduled appointment with our GP, and when we went to see him, I fairly near begged him to see if he could get her into see an oncologist before her scheduled appointment which was still two weeks away. Turns out, I didn't need to beg, he worked the phone and ended with assurances that they would see what they could do. By the time we got home, we had a message that she could see an oncologist in two days.

The day of our appointment, Kate was even sicker than usual. She was in a lot of pain and vomiting frequently. When we finally met the Oncologist, Dr. G, he told us that the news wasn't good in that a stage four diagnosis was never good, but he thought there was a good chance, though no guarantees, that the cancer could be brought to heel and treated as a chronic disease. He is an endearing man. with a dark beard and hair and that day was sporting a red plaid flannel shirt and black jeans. He looked for all the world like a lumberjack. Both Kate and I liked him immediately.

First things were first at that initial appointment and Dr. G began trying to get her nausea and pain under control. As the day progressed, Kate remained violently ill and was in and out of sleep as the doctors tried to control the pain. Kate was in a gurney the whole day before she was feeling well enough, though still not great, to be released. Meanwhile, Dr. G had arranged to start Kate on chemo therapy the very next day.

The next day, still vomiting frequently, we showed up for Kate's first chemo session. One of the first drugs they started her on had nothing to do with killing the cancer. Dr. G explained the day before that Kate was hypercalcemic, meaning that she had excess calcium in her bloodstream. This was a result of the cancer metastases attacking her bones, and could be part of the culprit for her nausea. So they were giving her a drug originally designed for patients with osteoporosis called Pamidronate. The goal was to repatriate to her bones all that calcium circulating in her blood. That part of the treatment went well.

Next, they started her on Herceptin, a biological concoction that binds to the Her2 receptors on the cancer cells and keeps them from dividing. That, too, went well. Next, though, they started her on another drug called Paclitaxel. Within seconds of starting her on that, her face and arms started turning an alarming shade of deep pink. They had to abort the treatment. Turns out, reactions to the medium the Paclitaxel is dissolved in is fairly common. This was on a Friday. They rescheduled the remainder of the treatment for the following Monday and started introducing the drug at a slower rate, which did the trick.

The most amazing part of that first Friday treatment, though, was that Kate's nausea disappeared, the Pamidronate doing its job. Also, while she was undergoing that first round of treatment, she met with a RN, Nurse J, who was able to get her pain to a tolerable level. Nurse J has continued working with Kate and the pain is fairly well controlled now. Also amazing is that with just that one round of treatment, the primary lump in Kate's right breast shrunk noticeably.

Finally, the fear subsided quite a bit and we began to hope that, yes, this might go our way after all. Those first few days, though, with Kate so incredibly sick, I had to consider the unimaginable. That's a place I hope to never have to go again.

What is that bump on her arm? The PICC Line

If you have seen me since the end of October, you may have noticed a bandage on my upper left arm or maybe you saw a bump under my sleeve.  What's up with that?  It is a PICC line, or a peripherally inserted central catheter.  Essentially, it is an intravenous access to my superior vena cava.  What it looks like is an IV tube sticking out of my arm, with a bandage behind it.  I like to think it makes me look a little like Seven of Nine, but maybe not.

By the time I first saw the medical oncologist back in October, my arms were black and blue from all the blood tests I'd had.  The technicians were having a really hard time getting at my veins.  Sometimes two, three or four attempts were needed before they could get the blood they needed.  Meanwhile, blood was pooling under my skin and the bruises were lasting up to a month.  That didn't bode well for chemotherapy.

But there are options for chemo, since they expect our veins to get a rough workout.  Sometimes a Port-a-Cath is used.  In that case, a device is implanted below the skin near the collarbone and injections are made directly through or into it.  The Port-a-Cath has the advantage of being totally sealed, so bathing and even swimming are no problem.  Unfortunately, I develop keloid scars, which could easily be triggered either by the implanting of the devise or by the repeated injections into it.  I didn't want to take that chance, so chose to go with the PICC line. 

The PICC line involves a single injection in hospital, followed by a chest X-ray to ensure the line is in the proper place.  There was no pain at all involved in the installation of the PICC line and I don't feel it all (a very, very few people do feel it).

PICC line care is fairly straightforward.  I need to keep the dressing dry, so I have bought a bunch of plastic sleeves at the hospital to wear during showers.  The dressing also needs to be changed weekly.  A home-care nurse comes every Friday to change it.

No more injections, no more bruises.  The nurses use my PICC line for everything now.  The chemotherapy IV is connected to the PICC.  My blood tests, required a day or two before every chemo session, are also taken through the PICC line.  My pain pump, which was originally installed in another part of my arm subcutaneously, is now connected to the PICC line, which I am told works more effectively.  And when I was in the hospital in November, they used the PICC line for my IV fluids, antibiotics, blood transfusion, and other medication.

One time that I was at the Cancer Centre for blood tests, I was given a fabric PICC line cover that volunteers had provided.  It was made of a subtly patterned white material.  It dresses up the PICC line a bit compared to the hospital's usual elastic bandage.  Geoff and I were thinking, however, that it would be easy enough to make up a bunch of fabric PICC line covers in a variety of attractive colours and patterns.  I even bought some yarn with the intention of crocheting a black cover.  Black goes with everything, of course.

Apparently, the PICC line can be left in place for as long as a year.  If that saves me the poking and prodding and bruises of the average blood test, I'm happy to have it!