Chemo Cycle 4, Round 3

Something much more important than my trip to MD Anderson Cancer Center (MDA) happened before my visit there this morning. I learned that a long time friend of mine passed away from breast cancer which had spread to many other parts of her body. The doctors gave her 9 months to live 9 years ago. Her motto was, “every day is a good day.” She leaves behind a wonderful family. Her husband and I are close and used to work together. I was fortunate to spend time with both of them this past December. Her girls are about 10 and 12. She got to know them and vice versa. She was incredibly strong and had the will of an elephant, was extremely generous, and had a good sense of humor. I will miss her tremendously. My best wishes and hopes go out to my friend and his family.

So it was with sadness that I made the forty-two mile, one-way trek to MDA. My visit was good. I had blood drawn. From the time I walked into the blood center to the time I left, it was less than 4 minutes. They have their act together.

I then had my clinical exam with my chemo doctor. Again, he is one of the world’s best. There are a few pre-exam steps before getting into see him. I have to register. When I register, I get an Internet user ID and password for my laptop. The entire facility is wireless, something they added about 9 months ago and a terrific benefit to those addicted to the web and staying in touch with others via e-mail. I went to the waiting room. I was then called and had my vitals checked. All were in good condition. I went back to the waiting room. I was called shortly thereafter for a pre-exam check in. We review current medications, new concerns, and new side-effects. Both the vitals and the pre-exam take about 5 minutes. The waiting can take anywhere from minutes to hours. Today they took minutes. I go from pre-exam to an exam room. The Physician’s Assistant (PA) examined me. She is also terrific. PAs have extensive medical training, act as a sounding board for the doctor, and take some of the burden off of the doctor. We spoke, she listened to my lungs and heart, felt my upper body for new tumors, and advised me on how to use one of my medicines. She thought I looked great. My white blood cell count was low and she was concerned about me being able to receive my chemo as planned. I’m taking Neupogen shots 2 times per week to keep my white blood cell counts up. These are the cells that help fight infection. A bit later, my chemo doctor came in. We talked, he examined me for new tumors, none were found. We can still feel the one under my jaw line. If anything, it has remained the same size or is slightly reduced. We agreed on a set of scans (PET, maybe a CT) for the first week in June. The important thing for me and what he is hoping for is that no new tumors appear while on chemo. He said this will be a very positive outcome. I asked if chemo could go on forever. He said that this chemo had to stop (I’m guessing it is too toxic), but he is hoping, with the right outcome over the next month, to try a chemo maintenance program. He also increased my Neupogen shots to 3 times per week. That means a shot on a Saturday, the logistics of which I’ll have to work out tomorrow. He too was pleased with my status. As a side note, I’m 80% recuperated from the prior week’s chemo by the time I see him on a Wednesday. I expect to feel “okay” tomorrow and then the side effects will start kicking in on Friday. Different people react differently to the same regimens.

I went to the chemo unit. Checked in, waited about 30 minutes and then began my treatment. They missed the first vein, so we switched arms and got it successfully on try two. No big deal. There’s nothing like chemotherapy to cure you of your fear of needles. I received my 4 pre-meds, my two chemo drugs, and a bit of flushing in between at times, and was done about 3.5 hours later. One of my pre-drugs is Benedryl. All are delivered via IV. The Benedryl makes me sleepy and so, after watching the end of a pretty good video (Annapolis), I fell asleep for about 2 hours. The machinery there is fascinating; it measures the IV flow per drip and shows one how much quantity remains a few times per minute. The IV procedure and drug verification are efficient and effective. That gives me comfort. It’s like going to McDonalds; you know the fries will be perfect.

I was late for my appointment with my radiologist. But, his nurse paged him and he made a visit. I had not seen him in 18 months. It was a really good visit. He said that my surgeon keeps him updated on me frequently and if it has been awhile, he makes an inquiry. He said he has looked at my scans from Q4 2006 and was very disappointed that the cancer re-occurred. I told him the reason for my visit. Bottom line, so that he can have a current picture of me and my will to live when they discuss my case as a group next month. We discussed some radiation alternatives to surgery or in conjunction with surgery and chemotherapy. I feel very comfortable that he will be able to represent my interests. I thanked him and left.

In summary, it was a good day. I’m always uplifted by the good news---no new tumors, but emotionally cautious as to how long it will last. It was great seeing my doctors and their staff. As you can probably see, as important as the chemo is, it is mundane for me at this point.

In closing, my heart goes out to my friend and his family who I wrote about at the top of this entry.