Just got back from a very good doctor's visit with a lot to report. He agreed that the pills do seem to be the main thing causing her nausea and diarrhea, but wants to get her back on the drug as much as possible. Therefore she will start taking it again tonight at a reduced level- 1000 rather than 1300 twice a day. He also suggested she take 2 Imodium pills in the evening since she tends to have diarrhea at night. He indicated she can take up to 8 of those a day, but to back off if they are causing any other problems. He will see how she does on this dosage and if she does well, he may add back one of the 150 pills with each dosage. If she does not do well at the 1000 dosage, he will likely try the IV pump to see how she handles that. If that is a problem, not sure what to do next. She is going to try her best to handle it, but we will have to see.
We go back on Monday for an Iron treatment which will take a couple hours. He says her levels are good now, but probably has very little "in reserve" and once she starts the next treatment, it would be good to have some iron buildup in her system. We can also report on how she is doing on the pills at that point and he can potentially adjust from there.
The plan right now is to start Cycle 2 next Wednesday morning. This will include both IV drugs at the same dosage as the first cycle and likely continue the pills at some dosage depending on her reaction over the next few days. He wants to keep her at the highest dosage she can handle to give the drugs the best chance of killing off as much of the cancer as possible. This will likely mean the cold sensitivity and tingling in her mouth and fingers will get worse and she will likely be pretty miserable for at least a few days starting Wednesday. That will take several hours on Wednesday.
Depending on how she is reacting, some additional dosage tweaking or a change from pills to IV pump is also possible over the next week or two. If she goes to the pump, she would wear it for 46 hours and then it would be removed, so not continuous for 3 weeks as we had originally thought. The pump is the same drug as the pills essentially, but goes directly into the blood system and not through the gastro system. He thinks she could have the same reaction to the pump as the pills, but not positive as it depends on exactly what is causing the reaction in her as there are a couple possibilities.
I also clarified the plan going forward. Assuming no major problems with the second cycle, they will start the third cycle immediately at the end of cycle 2. During cycle 3 near the end or right after the end, they will do a new CT scan to look for any changes in the cancer, hopefully it will show no spread and some shrinking of the tumor. Depending on the results of that scan, she will either go to surgery or possibly do another Chemo cycle.
We do have another appointment with Dr. Emmons on 5/26 to set up cycle 3 which would start on 6/1 if everything goes OK in cycle 2.
This was a lot of data and I hope it was not too confusing. If you have any questions, please leave a comment or email me directly and I will try to clarify.
Thanks for everyones continued support.
Wayne
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