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Week 2 (Induction Phase)

rev.dennis

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So we got up at 5am to get our butts moving for our 7:15am scheduled appointment at Karmanos Cancer Institute in Detroit. Our actual appointment isn’t until 7:45am but they tell us to arrive 30minutes early which translates to someone in the military as 6:30am arrival time as Kate and I are hanging out in the parking garage.

Our boys had to help us out this morning by getting themselves ready for school and Alex has to get himself on the bus.

So this is our 2nd Chemo treatment as part of the 4 week Induction Process before they begin the aggressive chemo treatments. We aren’t sure what that will entail but we know it is the same process they perform on kids with a higher success rate than an adult treatment.

My worry for this week is how Kate’s blood count will do being not monitored for a week. We know after last week that her count for hemoglobin and platelets and white blood cell count all decrease pretty quickly. I just don’t believe she will be able to go a full week without a blood transfusion.  I suppose a question for Dr.Yang when we see him today.



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When my mom went through cancer and chemo she had me get her a calendar from the dollar store. She wrote down everything in that thing; what treatments started when, reactions, test results, etc. when the doctors would come in and ask her questions she would hand them the calendar.  The doctors said it was very helpful.  She also made a Summary list that we both carried around for years after to let doctors know her history. Will keep you busy keeping track and save time! Wish I would have thought of it earlier to tell you.. 

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7 minutes ago, Sandy said:

When my mom went through cancer and chemo she had me get her a calendar from the dollar store. She wrote down everything in that thing; what treatments started when, reactions, test results, etc. when the doctors would come in and ask her questions she would hand them the calendar.  The doctors said it was very helpful.  She also made a Summary list that we both carried around for years after to let doctors know her history. Will keep you busy keeping track and save time! Wish I would have thought of it earlier to tell you.. 

Thanks Sandy..  we have heard the same thing

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Took bloodwork at 7:45am (we'll have to see how the counts are)...

Questions for Dr.Yang (assistant today was Nicole)

  1. headache (tylenol 3 with codine works to put kate to sleep but anything else.. reasons?) - could be from lumbar puncture
  2. week with no blood transfusion (signs to watch):
    • low white blood cells:
      • Have repeated fevers and infections.
      • Get bladder infections that may make it painful to pass urine, or make you urinate more often.
      • Get lung infections that cause coughing and difficulty breathing.
      • Get mouth sores.
      • Get sinus infections and a stuffy nose.
      • Get skin infections.
    • low red blood cells:
      • Feel a little tired or very tired.
      • Feel less alert or have trouble concentrating.
      • Have a loss of appetite or lose weight.
      • Have paler-than-normal skin.
      • Have trouble breathing.
      • Have rapid heartbeat.
      • Have reduced ability to exercise or climb stairs.
    • low hemoglobin:
      • weakness
      • shortness of breath
      • dizziness
      • fast, irregular heartbeat
      • pounding in ears
      • headache
      • cold hands and feet
      • pale or yellow skin
      • chest pain
    • low platelets:
      • Bruise or bleed more easily – even from minor scrapes and bumps.
      • Get heavy menstrual periods.
      • Get nose bleeds.
      • Get tiny, flat red spots under your skin, which are caused by bleeding. These spots are called petechiae.
      • Have bleeding gums, especially after dental work or from brushing your teeth. Check with your doctor before getting any dental work.
  3. what is new medicine being introduced and is it just this week?
    • pegaspargase (16 min infusion) (up to an hour could get hives (allergic reaction) which you can take benadrl 2 12.5mg tablets (take 2 every 4 hours, try one more time and if that doesn't work go to ER to get rid of hives). blood clotting possible (especially around PICC line.. look for arm swelling), could cause bleeding, adomoninal pain. given randomly during over the course of future treatments

next week adding RITUXAN (plan for long day.. several hours infusion but then 90minutes after that)  and this is given once per month throughout treatment.

lots of vincristine in future as well as other new medicines will be introduced.

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at 9:45am kate was given two regular tylenol and then they gave her a syringe of Benadryl..  now she is starting to recline in the chair... getting sleepy... so sleepy.

at 10am kate received zofran for the nausea via an IV drip (avg 30minute drip)

at 10:20am kate received for her headache  1 pill of fioricet

at 10:20am kate also received 1 potassium pill (huge pill.. broke in half)

at 10:40am kate began daunorubicin via Syring (avg 5min infusion)

at 10:50am kate began vincristine via IV drip (avg 5min infusion)

at 11:10am kate began pegaspargase via IV drip (one to two hour infusion with a one hour monitoring afterwards for side effects like hives) - took exactly one hour for drip, now monitoring for any side effects starting at 12:10

 

Questions for Dr. Yang?

  1. Can kate drink alcohol?
    • 48 hours after chemo and not within 48 hours before chemo and small dose.  Works liver to hard to have it working with chemo and alcohol.
  2. Can kate fly to Vegas in July?
    • time will tell but as long as blood count numbers are good and she wears a mask (especially on the plane) it shouldn't be an issue but will have to revisit as we get closer.

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1:17pm - completed everything and all is good.  Just finishing paperwork and heading home.  I'm starving so I hope to convince her of eating on the way home. :)

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This treatment is taking its toll on Kate. She doesn’t feel good, sleepy, sick to her stomach and all in all not in a good place.

Doctor said all I need to watch for is:

  1. hives (try 2 doses of Benadryl, if not gone away after 2 doses go to ER)
  2. fever (try cold wash cloth on back of neck if not down less than 100.4 in 60min bring to ER)
  3. bleeding. (Needs to stop in 30min or go to ER)

do. Said to drink lots of water

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Didn't sleep through the night and having a rough day. She feels very warm but taking temp every hour or so and temp is good.  I'm trying to get her to drink more water but most of us have a hard time drinking lots of water.. just boring.

She's napping now with her dog, sookie, cuddling with her. The dog knows somethings up with Kate and doesn’t leave her side.

 

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Another rough night. Kate feels sick to her stomach and head pounding and just all around feel yucky.

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Another night of no sleep for Kate.  Just doesn't feel good.  We have to go in for bloodwork (but just in Flint Karmanos today) which I'm assuming she'll need platelets since she was down to 17 last bloodwork they did which was prior to all the chemo.  Remember.. anything 10 and below is the danger zone.

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Kate experienced heartburn last night or acid reflux so she is going to try and take her daily meds earlier instead of before bedtime.  She slept until 4:30am and then is wide awake which is about 30min more than normal of sleep.

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Yesterday (March 1st) PICC line started bleeding and it was quite an ordeal getting McLaren home care nurse to show up. Kate called the OnCall at 1:30pm and no response...  finally after an hour and a half and several paper towels we get a call from the home care nurse stating she'll be there within 2 hours and the home care nurse took almost the entire two hours.  We asked her what should we do if it starts bleeding again and she says if it happens in the evening that someone could come out the next day.  What?  Dr. Yang said if Kate bleeds and it doesn't stop within one hour to just go to ER so thats what we would have to do and in any case even in an Emergency Room we would probably have a quicker turn around than how long it took the home care nurse to show up.

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    • Thursday's 9am appointment will include ********************* Chemo Daunorubicin via Syring (avg 5min infusion): NO Vincristine via IV drip (avg 5min infusion): NO Pegasparagus via IV drip (avg 1hr infusion): YES Cyclosphomine: NO Cytarabine: NO Rituxan via IV drip (avg 4hour infusion): NO
    • I don’t know where to start. I’ve had a challenging past week. I had a port put in and then got an infection and had to be hospitalized for a few days. It would be easy to look at these things at setbacks but Dennis and I continue to look for nothing but positivity. Since being released I have felt better and had a little more energy than I previously had.  About 2 weeks ago I had a very big test done. We’ve been anxiously anticipating the results. Today I received those. The test was done
    • ********************* Bloodwork Results Potassium:  Bilirubin(Liver Function):  White Blood Cells (WBC 4.0-10.0): . Hemoglobin (HGB 11.5-16.0):  Platelets (PLT 150-500):  Transfusions Blood: NO Platelets: NO Procedures Lumbar Puncture: YES BoneMarrow Biopsy: NO Chemo Daunorubicin via Syring (avg 5min infusion): YES/NO Vincristine via IV drip (avg 5min infusion)
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