A lot to talk about today. We went in for what we thought would be a couple hours to get an Iron infusion and updated training for cycle 3 since the regiment was changing some. Turned out we were there for 4 and a half hours and the regiment changed more than we thought.
When first got there and the nurse inserted the needle into her port, she did not get any blood back flow which is something they do initially to make sure the port is working properly. After trying several flushes and inserting another needle in case the first one was not in exactly the right place, she decided that a thin membrane had likely formed in the port and was blocking the blood from returning back up the needle. This is not uncommon especially after a few weeks of not using the port (it has been almost 4 weeks since her last infusion), but they have to follow a specific protocol to clear it which includes getting a doctors orders for an X-Ray to check the port is still where it should be and then to inject the port with a drug that should dissolve the membrane and clear it up. She has to wait a half hour after the drug is injected to give it time to work and if after a half hour there is still no blood return, they will then wait another hour and a half. Fortunately, the port cleared after a half hour. Unfortunately, it took them over 2 hours to get the order from the doctor who was in Augusta today and very busy. She ended up giving Barbara a regular IV in her arm for the Iron infusion so that it could get done while waiting for the doctor and then the port to clear. The port being cleared is critical for the treatment on Wednesday so it was good it got cleared to day. If this had happened on Wednesday, it would have made the day even longer (see below for the plan for Wednesday). As it turned out, the Iron infusion and port getting cleared completed at about the same time.
Now for the plan for Cycle 3. We had thought she would be switching to ECF (I will list what these letter stand for at the end) with the F being given over 2 days with a pump. Turns out that she will not be getting the E at all and the F will be given over 5 days instead of 2. Because of the dosage they want her to take of the F (5FU), they could not give it to her over just 2 days and either had to do it over 21 days (probably not any better than the pills she was taking in the first 2 cycles) or 5 days. I think that giving her that dosage of F over 5 days combined with the E on day 1 was considered too much for her and that is why they backed off including the E. She is also getting the C drug instead of the O because they believe the O caused the allergic reaction last time. The C drug is similar but has some potentially different side effects including reducing white blood count and possibly some hearing issues (rare), but should not cause the cold sensitivity she had with the O. It is also supposed to be one of the worst for nausea and is one reason they are increasing her pre and post treatment regiment (below). Evidently any new protocol changes go through several Oncologists who work together along with the surgeon to optimize the benefits of the drugs as well as the tolerance of the patient and this was their agreed recommendation. These are all part of the National standard set of treatments of stomach cancer, but give them some flexibility given every patient is different.
The new regiment also includes a significant increase in the pre and post preventative drugs. They are really trying to reduce her nausea as well as other potential side effects from the Chemo drugs. Because of this, Wednesday will be a very long day given multiple IV (Port) drugs and a lot of just flushing liquid through the Port as well as some wait times between drugs. We get there at 7:30 in the morning and if things go well, may get out by 1 or 2 in the afternoon with a pump attached that she will wear for 5 days. If any problems or just delays, we could be there longer. Of course, there is always the chance her initial blood work will show that she cannot take treatment at all that day, but we do not expect that since everything seems to be OK so far in that area. We also plan to hang around for another half hour to an hour to make sure no allergic reaction like last time.
Assuming no issues for the next few days after the treatment, we will go back on Monday afternoon(120 hours after pump is started) to have the pump removed. We then have to go back Tuesday (at least 24 hours after pump is stopped) to get a shot of Neulasta which is supposed to help her recover from any white blood cell drop caused by the C drug (help prevent her from getting sick because her white blood count is low). So as you can see, the 7 days will be very full.
They are then planning to do a new CT scan (in Farmington) the week of the 20th. The surgeon also wants a new EUS (Endoscopic Ultra Sound) to take a close look at the stomach tumor to look for any changes in the actual tumor or other areas of the stomach. These two tests combined with a special blood test which they will do on Wednesday, will give them the data needed to do a re staging. With that data, they can then make a determination of what they want to do next. The next steps will likely be surgery on the stomach followed by more Chemo, but until the re staging is done, that could change.
This got long and I hope it makes sense. If not, please let me know. Below are some of the drugs she has been or will be taking. Off course, I will continue to do updates with how she is doing each day starting Wednesday (Cycle 3, Day 1) and with any changes in the plan or firming up of future dates.
Wayne
Chemo Drugs:
E stands for Epirubicin which she took in the first 2 cycles, but not this time. (Given in IV over about 10 minutes)
O stands for Oxaliplatin which was also in the first 2 cycles, but not this time. It is being replaced with C since they think the O caused her an allergic reaction. (Given over 2 hours via IV)
C stands for Cisplatin which she is getting this time in place of the O. It is considered one of the worse Chemo drugs as far as potential side effects although most tolerate it OK. (Given over 2 hours via IV)
F (or 5FU) stands for Fluorouracil which she was getting through pills the first 2 cycles, but will be getting via an IV pump through her port for 5 days this time.
Here a some of the pre and post treatment drugs:
Famotidine and Diphenhydramine (dramamine)- Mainly for nausea
Fosaprepitant- I think also for nausea
Palonosetron (Aloxi)- I belief also for nausea
Dexamethasone- steroid to help body recover from the Chemo drugs
Pegfilgrastim (Neulasta)- Help body regenerate white blood cells which C can destroy
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