5/28 - Cycle 4, The Hard Part's Over

Kristine finished her 4th chemotherapy cycle this weekend. She was a little more tired, a little less nauseous, and a lot more emotional than in previous cycles. She's managed to stay strong and positive through every stage of this fight, but the medication and difficult regiment periodically constrain her optimism. Her emotional struggles are short and she always bounces back with an amazing amount of fight and courage in her.

One of her weak moments came on Thursday at the cancer center. Nothing in particular triggered the breakdown, it was more provoked by an accrual of constant discomfort and exhaustion. Linda, our oncology nurse, consoled Kristine and confirmed something that we had all suspected since her first cycle. She told Kristine that hers is one of the most difficult chemotherapy regiments that a patient can go through. She emphasized how amazing it's been to see the stamina and strength Kristine has shown over the past couple of months. It's encouragement like this that helps Kristine to move forward.

The fact that Kristine's nights have been less than satisfying in the sleep department hasn't helped her emotional state. She's been consistently waking up in the middle of the night in cold sweats and in general discomfort (fortunately without fever). She eventually gets back to sleep but it's not without a pill and bit of restlessness.

We're headed into the second week of the cycle -- the nadir week. Kristine has an appointment with the Oncologist on Wednesday to check her blood counts as well as another CT scan that afternoon. This scan will give us another data point on how the disease has progressed. It will also arm us with the latest information to discuss with the Cardiology surgeon, with whom we have an appointment a week from Wednesday. This will be the first of many consultations to determine possible next steps.

5/22 - Continued Port Trouble

We were both pretty exhausted this morning after our long night. Kristine slept through most of our time at the cancer center. Even I dosed off a couple of times. Tomorrow is another early morning.

Linda, our oncology nurse, attempted to access the second, rear port after several failed attempts yesterday. Today's outcome was no different. Linda said that it was as if the port, which is a tiny puck-shaped canister with a rubber access gasket on top tucked just beneath the skin, had flipped over. Linda suggested that we get a port study done to understand the problem better, but having gone through this a few cycles ago Kristine was in not mood to cause further irritation to the area (the last port study the hospital poked her with a needle about thirty times before calling it unsuccessful only to have Linda access it a week later). For now it was decided to continue with just the one port and try again next cycle.

Otherwise, Kristine seems to be more tired than past cycles. Hopefully the extra sleep she got yesterday and last night with help.

5/21 - Cycle 4 Begins

Each chemotherapy cycle follows a similar formula, but like a game of Plinko the chips never quite follow the same path. (As bad as it is, I couldn't resist the Price Is Right simile after the tribute to Bob Barker the other night.) Monday morning starts at around 9am at the cancer center. We check in, settle our co-pay with the reception desk and within a few minutes Kristine is called in to give blood for analysis.

We proceed to one of the examination rooms to wait for Dr. Staddon and his nurse practitioner. When they arrive they begin by reviewing Kristine's blood work and clinical condition. Today they pay particular attention to Kristine's INR or International Normalization Ratio. This is the standardized measurement of time for blood to coagulate (clot). Since Kristine has recently changed her blood thinning medication it's important to calibrate her dosage to achieve an optimal coagulation level -- in her case 2.o. Last week, at a special office visit intended solely to gauge her INR, her reading was 1.0. This news sent the oncology team into a mini frenzy until Kristine disclosed her negligence in taking Coumadin for the two days prior. Her level this morning was 1.4 so her dosage was increased.

Discussion regarding longer term next steps typically follows. Dr. Staddon feels strongly about getting a cardiac specialist involved in Kristine's case early to, as he puts it, "start thinking about [Kristine]." He has encouraged us to have an initial consultation with one of Penn's top cardiac surgeons and a favored colleague of his, Dr. Bridges. Getting an appointment so far has been difficult as Dr. Bridges has been traveling in China for the last few weeks demonstrating state of the art techniques in "bloodless surgery"--techniques of which Penn is on the leading edge. We look forward to meeting Dr. Bridges and getting his perspective on Kristine's condition. Of course, given her rare case and the magnitude of risk with a potential procedure we'll also be exploring options for a second opinion -- it's important to both of us to find someone who has experience in operating on a similar situation.

With the examination and some dialog about possible next steps complete, we head across the hall to the treatment area, a large room with about 25 reclining chairs, most separated by a shallow frosted glass partition, all encircling a large central nurses station. Kristine is privileged in her seating arrangement. The port used to administer her medication is in her hip rather than in a more typical shoulder location. Since this is a sensitive and more private placement, she gets dibs on one of a handful of small private rooms.

Mondays usually starts with some delay. The nurses often have new patients who aren't yet familiar with the process and need more education. Linda is our oncology nurse today. We've requested her the last couple of cycles. She is one of the few nurses who seems to really understand Kristine's atypical port placement and has had success accessing it with minimal discomfort. Today, however, even Linda had trouble. One of the access points was implemented seamlessly but would not return blood through the tube. The other proved troublesome, as it has historically, this time producing a painful stinging in Kristine's side when accessed. Linda was able to get a blood return at the first access point after treating it with "clot buster." But as for the second, she thought it best not to irritate it any further and try again tomorrow. Kristine appreciated this decision.

With one port access in place Linda began administering the pre-meds. It was 12 noon at this point, an indication that this would be a late night. Kristine gets five pre-meds before receiving her chemotherapy drugs. These include Aloxi (a long lasting anti-nausea drug), Decadron (a multi-purpose steroid used in part to prevent swelling and allergic reactions), Ativan (another anti-nausea drug), Lasix (a diuretic or "water pill" that aids in the elimination of water retention) and Mesna (a drug that bonds with a harmful byproduct of one of the chemo drugs, IFEX, to render it inactive). Once the pre-meds have been administered the chemo drugs can be given. First Adriamycin (Doxorubicin) is given, which comes in the form of an injection tube, then IFEX (Ifosfamide, chemically related to the nitrogen mustard and most active in the resting phase of the cell). Ifex is given via an IV drip bag combined with a saline solution. Finally, a Sodium Bicarbonate and electrolyte mixture is given intravenously to prevent other side effects and replace fluids.

We didn't leave the center until around 4pm today and since Kristine needs to receive two additional doses of Mesna intravenously at home each four hours apart from one another, we didn't finish until around 12:30am. This makes our 8:30 start tomorrow a bit more difficult, but hopefully we will have a smoother day.

5/14 - Week 2, Cycle 3: Lovenox and Lucas

Week two of Kristine's third cycle is complete and she's been feeling very well with an amazing amount of energy. Her nadir appointment with the Oncology team went well last week. Her blood cell counts were almost as low as they could go, but this was as expected. She received a shot of Aranesp to stimulates her red blood cells in order to prevent anemia.

Since February 13th when we were skiing in Colorado and first learned of Kristine's condition, Kristine has been getting a shot of Lovenox (a blood thinner administered subcutaneously) to prevent further clotting in her blood vessels. She has received the shot twice a day for 81 days, once first thing in the morning and again before bed. She was taken off the injection about a month ago and given a pill form called Coumadin. However, the swelling in her neck and chest increased and we immediately resumed the shots (I, and a few other lucky visitors, had taken on the task of administering the shot to Kristine's abdomen since she understandably had trouble giving it to herself). But a little over a week ago Kristine started taking Coumadin again in lieu of the shot and this time it seems to be working well with no related side effects. As you can probably imagine, this was a huge relief to Kristine and for me.

I was careful to say "related" above since new side effects consistently crop up. The latest is a swollen, white-coated, tender tongue. It is not painful but is causing Kristine some discomfort especially when she eats. The doctor prescribed Fluconazole, an antifungal medication used to treat several types of yeast and fungal infections. The doctor believes that Kristine has Thrush a common side effect of chemotherapy. All of us naturally have fungus in our mouths which our bodies, under normal conditions, defend against. However, with Kristine's immune system at it's lowest point she is susceptible to even the most commonplace, and otherwise harmless, infections. The medication seems to be slowly relieving her symptoms.

On a note not related to Kristine's health but certainly to our daily lives, Lucas, our foster dog of almost 5 months, was picked up on Saturday by his new parents. Before we were ever aware of Kristine's condition we agreed to take on a foster puppy. At the time the 7 month old Catahoula Leopard Dog had been rescued from a house in Tennessee where he had been malnourished. Kristine had left our names with an organization called abuddyforlife.com that finds foster and adopter homes for rescued dogs. In January, we got the call to help Lucas.

It has been a long several months never mind the addition of a second dog and an abused puppy at that. Nonetheless, we had nearly resigned ourselves to the idea of keeping the pup. But a couple of weeks ago a woman from Rochester, NY inquired about Lucas' profile on the rescue website. She and her husband went through the adoption process and drove down 5 hours on Saturday morning to pick him up. It was a bittersweet ending for Kristine and I. As much as we had grown weary of cleaning up his accidents, calming his hyper, playful spirit and handling 2 dogs during daily walks each morning and night, Kristine and I couldn't help but get attached to the little guy and feel guilty for passing him on to yet another home. Even Rufus has been hanging his head realizing that his little pal may not be coming back. Ultimately, with all that has hit our lives we know it's for the best. We're happy that we were able to save his life and find him a good home out in the country where he can run and get some of that extra energy out.

5/2 - Day 2&3, Cycle 3: All is well

Days two and three of this cycle have gone smoothly. Kristine's been able to leave the cancer center around 2 each day. Our departure time is important since there are medications and fluids to administer at home. The later we leave the center, the later into the night she has to be hooked up to the IV. (On Monday, our 4:30 pm departure kept us up until around 1am.)

Kristine's appetite is strong and she's been getting out for a walk each of the past few days after treatment to enjoy the beautiful whether. Nausea is starting to set in sooner than it did the last cycle. However, we know now to be more disciplined with her anti-nausea medication which should help.

Other than that not much to report.