Tough weekend but better today

Sally had a rough weekend with nausea. She hadn't been taking all the meds regularly so we decided to really stick to a rigorous schedule for the Zofran, Prevacid, and Aromasin. She also needs tylenol fairly regularly for leg pains. Today was the best day she has had since coming home. Ate better and much less nausea. We are now 4 days out from the chemotherapy and so we are hoping that things will be getting better from now on. We go see Dr. Conlon on Wednesday so that he can check her platelet count.

Lorrie has been great fixing us food, shopping and generally taking good care of both of us. Craig is coming tomorrow to see Mom. It will be great to see him and for him to see Sally. I'll pick him up in the afternoon and come directly here. He will be staying over at Lorrie's which is only 15 minutes away.

Some days are better than others but every day with Sally is good.

Home Again

Sally was discharged from the hospital this morning. She had the two pints of blood yesterday and today her hemoglobin is 10 g/dl (normal about 13 g/dl). Her weight this morning was 123 lbs so that has responded remarkably to the hydration and increased diet. Part of her feeling so good in the hospital was the high doses of steroids that she was receiving. That was stopped yesterday afternoon and today she is not feeling so well. We need to keep pushing the fluids at least so we don't need to go back to the hospital. The Home Care nurse will be here tomorrow to help us maintain her PICC line and may have other tips for us. We see Dr. Conlon again on Wednesday to check the platelet count. I hope she can get some rest here since she didn't sleep much in the hospital.

Much Improved

Sally has felt much better since getting IV fluids. She received Decadron and dolasetron to prevent the nausea of chemotherapy, and it must have worked since she had no nausea all day yesterday or today. She has eaten fairly well both days. Lorrie and I brought her a turkey dinner this evening and she ate pretty well. Her weight has increased from 112 lbs to 120 lbs this morning, largely due to the fluid she has received. Her appearance is also much improved. With the dehydration, she looked terrible--sunken face and eyes, but now she looks like her old self. Her hemoglobin today was about 7 g/dl which is quite low. For this reason she is receiving two more pints of blood as of 10pm. If she continues to feel well, she may go home tomorrow. There will be a Home Care Nurse from the hospital who will come to our house the day after discharge to teach us how to manage the PICC intravenous line. I don't yet know when we will go back to see Dr. Conlon but he will need to keep a close eye on her blood and platelet counts. We take this day by day, but we are encouraged that she tolerated the chemo well and we look forward to seeing the tumor regress.

First day of Chemo

Sally went in the hospital last night for rehydration and chemotherapy with Taxotere. She received the pre-chemo anti-nausea therapy beginning with some steroids last night. Whether it was that or the IV fluids, she felt much better this morning although she didn't sleep well. She was able to eat some breakfast and drank fluids. She had some lunch as well. A PICC line was inserted in her arm (an intravenous catheter for infusion), and at about 1pm they started the Taxotere. She tolerated this well. I last talked with her at about 9:30pm and she was still without nausea and was getting tired and hoping to sleep. So with Thanksgiving coming tomorrow, we are thankful that Sally is currently feeling better and that she was able to take the first dose of chemo without much incident in terms of acute tolerance. Since her bone marrow is compromised with the tumor, a close eye will need to be kept on the blood and platelet counts in the coming days and weeks. The schedule is to receive the Taxotere once every three weeks--hopefully as an outpatient. Let's hope this will knock the tumor back!

Chemotherapy

Sorry to have been silent for a few days, but things have not been going well. After the EGD endoscopy, Sally had a good day on Friday but since then, everything has been downhill. She has not been able to eat or drink much and has felt miserable. We went to see the oncologist today who felt that the time has come to offer chemotherapy to Sally and furthermore to hospitalize her since she is dehydrated. She has lost about 8 pounds in the past week and is clearly very dry and weak. She has been nauseated, vomiting and miserable in spite of the Nexium and other meds. One of the biopsies of the stomach showed breast cancer in the wall of the stomach.

So Sally was admitted this afternoon to Memorial Southwest for hydration and to start on chemotherapy tomorrow. We are hopeful that this will result in some improvement. Sally deserves that!

Some Results

Talking with the gastroenterologist, it is pretty clear that Sally has GERD that has given her the stricture in the lower esophagus (now dilated) and the inflammation in the stomach and esophagus. She started today on Nexium and is to remain on it continuously. I don't know if it is coincidence or not, but about 3 hours after the Nexium, she said she was hungry for steak! So she fried up a steak and had it for breakfast. She then had a banana and a whole avocado. This may be more food than she has had in any full day for quite a while. So we are hopeful that much of her nausea may really be better on this therapy, but we will have to see how things are later and tomorrow.

We go back to see the oncologist on Tuesday and check everything and discuss future plans for therapy.

EGD endoscopy done today

Sally had her esophagus, stomach and duodenum examined through an endoscope today. The findings indicated an esophageal stricture at the junction of the stomach and esophagus. There was also inflammation in that region and in the stomach (gastritis). The stricture was dilated with a balloon and biopsies were taken at several sites as well as cultures for Helicobacter Pylori, the bacteria that can cause ulcers, gastritis and stomach cancer. There was no gross evidence of cancer in the stomach. The results of the biopsies will be available tomorrow afternoon.

The procedure itself took less than a half hour. Usually patients are anesthetized or sedated to make the procedure tolerable--but Sally decided she didn't want anesthesia or even sedation since she has gotten ill with anesthesia previously. So she had some numbing of the throat and then the procedure wide awake. The gastroenterologist, Dr. Stein, said she did great and thought that it was quite remarkable. Because there was no sedation, there was no recovery required and Sally could go home immediately after the procedure!! What a trooper.

I will discuss therapy further with Dr. Stein tomorrow, but it will likely be acid reducing therapy that she has recently started on and perhaps antibiotics if the bacterial culture is positive.

All in all a very satisfactory day. Sally wasn't allowed to eat before the procedure but has had some bland food this afternoon after getting home.

Pretty fragile today

Last night, Sally had to get up and vomited a small amount of liquid. Today she has not had any more vomiting but she does have a little nausea. It is mostly controlled with Zofran and Gaviscon, and she did eat pretty well. So Saturday was the best day and we hope for more days like that. We are both anxious to get the endoscopy done (Wednesday) and see if there is any obvious reason for her upset stomach that can be treated.

We both appreciate all the support and love that we have been given by all the friends and relatives following this blog and sending emails and cards. Thank you all.

Pretty good day

Not quite as good as yesterday. Sally still has much less nausea, but she is quite weak after having been in bed for so long. She is trying to stay up more to get conditioned again. Ate fairly well today but not as much as yesterday. Not much else new.

A Good Day!!!!

We went to he gastroenterologist yesterday and he suggested that Sally use Gaviscon Tablets after each meal. He thought that might work faster than Prevacid. So we stopped at Walgreens on the way home and picked some up. Sally went to bed at 8pm last night. She awoke at 3am feeling hungry. She came out to the kitchen and had part of a lamb chop from the previous dinner, a banana and something else. She came back to bed and when she got up again, she started cooking some sausage! I mean, this is unbelievable---All day she has felt so much better that the past month, I am holding my breath. We go for the endoscopy on Wednesday to see if there is anything in the upper GI tract. So I am encouraged and personally feel better and have more energy than I have had in weeks.

And on top of that Stanford slaughtered USC--what a great day!!

Endoscopy to be done

We saw Dr. Stein and Memorial Hermann hospital today and he discussed our case with the Dr. Conlon, our oncologist. Dr. Stein will be doing an upper endoscopy (often called EGD for esophagus, gastric, duodenum) to see if there is anything going on in that part of the gut. Until then, Sally will be taking things to decrease the acid output of the stomach or to neutralize the acid. She is still feeling better with less nausea. We had lunch today together for the first time in several days. We're encouraged that if the nausea can be controlled, she may be able to gain back some of the 15 pounds or so that she has lost. Fingers crossed.....

How to leave a comment

I have heard from several of you that you tried to leave a comment and it was not accepted or was hard to do. I was fiddling with this tonight. Underneath the post is the number of comments (like 0 Comments). If you click on that with the mouse, you will open another page where you can post. You may need some sort of account for this to work, but I tried it and it seemed to work fine. So good luck. Hope to hear from you --- and thank you for all the emails you have sent me at alannies@gmail.com

Doctor's appointment

We went to the oncologist today to check on the blood count after the transfusion of 2 pints of blood. The hemoglobin was 11 g/dl which is up from about 8. This is good news indicating that this should help Sally's strength. The platelets are still low, but no worse that before (about 56,000). The main problem with Sally's feeling is still the nausea. This is puzzling to us and the doctor. He suggests that we see a gastroenterologist to make sure that we are not missing something like an ulcer and suggested we take a proton pump inhibitor. He prescribed Prevacid. Sally will see the gastroenterologist tomorrow morning. She took a Pepcid when we got home and later when we got the prescription she took a Prevacid. Afterwords she felt better. The edge was off the nausea and she looked much more animated than she has in days. So we shall see.

The major problem

It seems like the major problem facing Sally is her nausea and inability to eat much. If we could get on top of the nausea feeling, I think she would be a lot better. She continues to lose weight even though she is forcing herself to eat as much as she can. Zofran helps a little and Mornings are best--she can usually eat a pretty good breakfast. We go see Dr. Conlon, the oncologist, on Thursday for a blood count and will see if he has any good suggestions about the nausea. It's not clear why she is nauseated.

Stable

Not feeling too well today. The best day was Saturday and since then Sally has felt yuckie. Hope for better tomorrow.

Thoughts about diagnosis

Not much different today so I thought I would give a few of my thoughts about the diagnosis of breast cancer based on our experience.

• Mammograms can miss even extensive breast cancer. Sally had a normal mammogram 2 weeks before her diagnosis of extensive cancer. An alert clinician examining Sally noted that the consistency of the breast had changed in the past year and suggested ultrasound. Ultrasound was equivocal so a biopsy was done at our request that revealed the cancer. Of course mammograms are useful for detecting early cancer in many cases and every woman should get them, but they are no guarantee that there is no cancer.
• If a biopsy is suggested, do it. Even if there is some equivocation about whether you could wait, don't. Get the biopsy and get the answer one way or another.
• Not all breast cancer is the same. There are many different types of cancer. With breast cancer there is ductal carcinoma (about 85-90% of cases) and lobular carcinoma (10-15%). Sally has lobular carcinoma. This type arises out in the peripheral parts of the breast, often is not detected by mammogram, and often does not form a discrete mass that can be felt. It may arise in several places in the breast or in both breasts and may not be discovered until it has spread. This was the case with Sally.
• Do not continue hormone replacement therapy (HRT) indefinitely. This definitely increases the risk of breast cancer and was a risk factor with Sally. If you can, don't use HRT at all.

I guess that is enough for now. Keep vigilant and don't ignore any suspicious changes in the breast--whether it is a change in consistency, appearance of the skin, or appearance of the nipple.

Where we are now

I thought it might be easier and more convenient for everyone if I kept a blog (whatever that is) to keep you updated on Sally's health. As you know, Sally was diagnosed with lobular carcinoma of the breast with bone metastases in May 2008. Because of the extent of disease she was put on hormonal therapy after her double mastectomy. On this therapy she did well and her energy, weight, and blood counts all returned to normal and all the lab tests looked good.

In May 2009 everything looked very good so we decided to take our usual summer trip to Carlsbad, CA where Kathie, Craig, Christopher and Gavin live. Toward the end of the summer Sally had some feelings of being unwell, but since there was a lot of virus stuff going around, we thought it was just that. Lorrie visited us in September and that went well. We planned a somewhat prolonged trip back to Richmond, TX that began in early October. By that time, Sally was getting tired easily. We spent nearly two weeks on the trip seeing family and friends in California and Colorado.

By the time that we returned home, Sally was exhausted and we went in to see the oncologist. He found her to be anemic and to have low platelets (the blood elements important for blood clotting). Her previous hormonal therapy was stopped and new hormonal therapy was begun. Over this past couple of weeks Sally has had a CT scan, Bone scan, a bone marrow biopsy and multiple blood tests. The results show that the tumor is in the bone but not in the liver or other abdominal organs and not in the lung. However, the bone marrow is about 80% taken over by the tumor thereby crowding out her normal marrow. The bone marrow is where the blood cells and platelets are made and that accounts for her anemia and low platelets. Yesterday she had a transfusion of 2 pints of blood since her anemia was quite severe (hemoglobin 8.2 g/dl). She feels a lot better today with the higher blood count.

We go back to the oncologist on Thursday. We think the new hormonal therapy may be working since Sally has begun having hot flashes again. She had them when the original medicine was started, but they had pretty much disappeared until now. Since the hormonal therapy is based on depriving the tumor of estrogen, this sign of low estrogen may mean that the new medicine is doing its job better than the old one.

So...there we are. I'll keep you posted periodically and hope to be sending some more upbeat messages in the future. Send healing thoughts.