Tuesday, December 10, 2013

Cancer Free - Yippee!

Marla Crider, UAMS, breast cancer, invasive ductal carcinoma
Marla Crider with her new friend,
Ms. Coco Chanel
Thanksgiving has come and gone, and December has made an entrance like a confused lion –
70-degree temperatures one day, and 28 degrees the next with sleet and snow.

Oddly, the Thanksgiving holiday continues to be front-of-mind nearly two weeks after the fact, rather than the ever-present Christmas season. Never has “turkey day” meant so much to me than it did this year – the year in which I endured a breast cancer diagnosis, 4 ½ months of chemotherapy, and a double mastectomy. Instead of just once a year, which seems to be the custom for all of us, I now give thanks everyday for my blessed, cancer free prognosis. 

I was fortunate enough to spend Thanksgiving this year with my family in northwest Arkansas, where more than a dozen loved ones gathered to express their own blessings.  A few months ago, my nephew, Lane, and I talked when he was in Little Rock on business.  I mentioned to him that my mom, Happy, made me promise to never let the Crider family holiday dinners become a thing of the past.  Since her death in 2006, we had all been lax in gathering to share our lives, especially me.  Between my job responsibilities and sharing holidays with Don and his family in Dallas, I hadn't pushed to spend equal time with the Crider clan in Fayetteville.  No longer will that be the case.  Had it not been for the amazing support and physical presence of my brothers and sisters-in-law during my health crisis, I’m not sure my recovery would have been nearly as successful.  I encourage my friends and colleagues to never, ever take for granted the family bond that could mean the difference in sickness and good health, or even life and death.  I know from whereof I speak.

On October 11, my breast cancer was eradicated, when my rock star surgeon, Suzanne Klimberg, strategically removed the diseased tissue from the right breast, and as a precaution, the left breast tissue was removed, as well.  After only 24 hours in the hospital, I recuperated at home with the help of my physician mate, Don. 

For more than a week following surgery, I managed to maneuver around the condo with the bulky drain tubes attached by a single stitch under each arm.  Showering was especially challenging.  I had minimal arm movement; therefore, I had to have assistance.  Trust me when I say that romance and intimacy are not emotions you think about when you have a partner in the shower with you under these circumstances.  It was an awkward and frustrating experience that was, fortunately, short-lived.

About a week after the surgery, Dr. Klimberg called me with the pathology report.  My heart raced as she began sharing the results.  She explained there were a number of “hot” spots found in the right breast tissue that were only weeks, if not days, away from turning into full blown cancer.  That was the bad news.  The good news was that the sentinel node dye test conducted during the surgery indicated the cancer had not spread to the lymph nodes or other parts of the body.  Praise the Lord.  And, the left breast showed no signs of cancer, whatsoever. 

Before we concluded our phone conversation, Dr. Klimberg said she and the director of the genetics department at UAMS had conferred and they both agreed that I needed a genetics work up because the pathology report confirmed the dreaded triple negative diagnosis.  Since the type of cancer I had was aggressive with no known drug available to deter a reoccurrence, it's important to find out how my cancer diagnosis might affect my family members.  According to Dr. Klimberg, the type of cancer I had could mean my brothers and nephews might be at risk for prostate and colon cancer, while my great nieces could inherit the gene that caused my breast cancer.  The genetic work up would serve as a cautionary road map for my family to review and share with their own doctors. 

It should be noted that only 15% of women diagnosed with cancer are triple negative. The majority of women with cancer are in the hormone receptive category. These women are prescribed drugs, such as Tamoxifen, to be taken for years after chemotherapy and/or surgery as a means to disrupt another episode of cancer.

Ten days after my surgery, I returned to UAMS for a follow-up visit to have the drain tubes removed.  Since Dr. Klimberg was in Florida attending a breast cancer conference, her resident, Dr. Tummel, had the chore of cutting the stitches holding the tubes in place. The left tube had dislodged from its original internal placement during the surgery and hurt like the dickens when he pulled it out.  Fortunately, there was no problem removing the right tube. I suddenly felt as free as a bird without the drain tubes and plastic receptacles attached to my side. I was almost giddy with excitement to move my arms – ever so slightly - without restrictions. Dr. Tummel carefully examined the surgical incisions and said everything looked good, including my very swollen and dark nipples that Dr. Klimberg surgically re-positioned in anticipation of the forthcoming reconstruction procedure.  Don had mentioned to me that he was concerned the right nipple “may not make it” because it appeared to have restricted blood flow.  After everything I had been through, there was no way I was going to tolerate even the thought that my nipple was going to reject being moved and stitched into its new location.  Dr. Tummel was more positive and thought it might take longer to heal but the nipple would survive.  Another appointment was made for me to see Dr. Klimberg the following week.

That night, I was anxious to try sleeping on my drain-free side, but I couldn't.  There was still too much swelling and pain when I tried to roll over. Apparently, if and when I slept, it would have to be on my back, which ached constantly from the surgery, as well as my inability to take the pressure off of it when in a horizontal position.  It was another five days before I could roll onto my side. 

A few days later, I had an appointment to see my oncologist, Dr. Makhoul.  While I trust him implicitly, I was rather apprehensive about seeing him.  He stated during the last appointment that another round of chemotherapy might be in order, depending on the findings of the post-surgery pathology report. 

When Dr. Makhoul entered the exam room, we greeted each other with an affectionate “long time, no see” hand shake.  He immediately logged on to the computer and pulled up my file.  He quietly read through the pathology findings, which seemed like an eternity.  Finally, he turned to face me and said he was comfortable with the report and “at this time” did not recommend further treatment.  What a relief!  He scheduled a follow-up PET scan in February to confirm there were no hot spots in other parts of my body.  But prior to the scan, he requested I have a colonoscopy because I was still experiencing digestive issues.  Dr. Makhoul mentioned the questionable spot on the colon that was identified on the first PET scan performed months earlier.  He was an amazing doctor and I was his patient and would do whatever he suggested.

Two weeks and two days after my surgery, I was cleared to drive and was provided a written release from Dr. Klimberg to return to work.  My colleagues seemed surprised to see me; after all, it had only been a couple of weeks since I had undergone major surgery. Never the less, I was glad to see them and more than ready to get back into a routine. 

On the second day of my return to work, I was scheduled to see Dr. Klimberg again, this time to have the stitches removed. I was anxious to be one step closer to normalcy.  When my surgeon strolled into the exam room, we quickly began bantering with each other, which had become a habit with us.  She was anxious to review her surgical handiwork and see how I was healing.  She poked and prodded where my breasts used to be and took a closer look at both nipples.  She was pleased with how the left one was looking.  The right nipple still gave her reason for pause but was not so concerning that she thought it would have to be removed.  She told me to dab antibiotic ointment on both nipples to keep them soft and free of infection.  It would also help them slough off the dead skin, which was the reason they appeared dark and “dead.”

The good doctor and I chatted up a storm as she removed the stitches.  It was a good thing that I was still numb from the surgery and couldn't feel her digging around in the incisions in search for stray threads. While we were talking, I asked Dr. Klimberg when she wanted me to make an appointment to see Dr.Yuen, the plastic surgeon who would reconstruct my breasts in a few months.  She determined that I should see him on the same day that I see her again – January 14.  She wanted me to completely heal before Dr. Yuen had a chance to scrutinize her work.  Without saying so, she was still annoyed with him for not considering doing the reconstruction while I was already on the operating table, which is the routine for most non-diabetic patients.  The longer the surgery is delayed, the more likely there will be skin wrinkling.  Even though Dr. Klimberg performed a new technique to prevent that type of result, she was still concerned.  She wanted Dr. Yuen “to get on with it.” I’m not sure who is looking forward to the forthcoming appointment with Dr. Yuen more – Dr. Klimberg or me.

Ms. Coco Chanel
Since the surgery and recuperation had gone so well, I decided that I deserved a treat – a new kitty.  Having to put down my 22 year-old pet, Ms. Fluffy, the day after my first chemo treatment was, perhaps, the most difficult part of my cancer journey.  It was time to bring a new furry friend into my life. The Sunday after Thanksgiving, I stopped by PetSmart “just to look” at the adoptable cats.  When I walked out of the store, I was carrying a sack of cat toys, a new litter box, Purina cat food and Ms. Coco Chanel – an elegantly attired, three year-old female feline with a shiny black coat, fashionable white-tipped paws and piercing green eyes… just like her new mom.  We bonded immediately.  It has been one week since her adoption and there is no question that she was meant to be.

Tuesday, November 5, 2013

The Surgery: It Takes a Village

When I awoke on the morning of October 11, I was surprisingly calm and ready for what the day would bring.  My brother and sister-in-law, Marion and Carolyn, had driven from Northwest Arkansas the day before and spent the night with me.  Their presence provided me with much needed emotional support as I prepared for life-changing surgery.
Marla Crider, breast cancer, mastectomy, surgery, UAMS, Little Rock, Klimberg
Marla Crider, post-mastectomy surgery.

Even though the mastectomy procedure was scheduled on my older brother Mike’s birthday, he and my sister-in-law, Barbara, made the trip from Springdale to be with me, just as they had done when I had chemo treatments.  They met Don, Marion, Carolyn and me at my condo about thirty minutes before we were to all depart for UAMS.  As we sat in my great room talking and laughing, I looked around me and became a little misty-eyed. I knew my parents were observing from heaven and proud that their sons were still looking after their baby sister.

We left the condo at 9 a.m. in order to find the visitor parking deck and patient registration area at the med center’s main hospital before my assigned check-in time of 9:30 a.m.  Fortunately, living only10 minutes from the University of Arkansas for Medical Sciences campus allowed us plenty of time to find our way. Don and I departed in his vehicle and my brothers followed in theirs.  We were given directions of where to park by a nurse the previous day; however, it should have been a red flag when she used the term “loop-de-loop” in the details.

When we approached said “loop-de-loop,” we learned quickly that it was an employee only parking deck with no access.  There we were in a three-car caravan all trying to back-up and figure out what to do next.  Then, my sister-in-law saw a sign that suggested we go further up the drive.  Sure enough, there was the second “loop-de-loop.”  Really?  Who designs a double-looped entry into a parking deck?  Aren’t they confusing enough without making it worse? It was now 9:25 a.m. We made our way into the deck and searched for parking.  We lost Mike and Barbara somewhere in the parking garage and decided they were on their own.  We located two parking spaces in close proximity to each other.  Our next challenge was to find elevator B that would take us to the patient registration area.  Don, Marion, Carolyn and I wandered around the loop-de-loop, or should I say “blankety blank” parking garage and finally located the elevator by accident. Just as we stepped inside, my cell phone rang.  I recognized the number as the UAMS exchange.  I answered.  It was the pre-op nurse wanting to know where I was.  “Lost,” I said with an exasperated tone.  She tried to instruct us where to go but the elevator doors closed, which disconnected the call. It took us another five minutes but we finally found our destination. A few minutes later Mike and Barbara appeared and reported that they would never find their vehicle again.   

After filling out the obligatory paperwork, I was escorted to the pre-op area and taken to a prep room.  My assigned RN gave me a gown, circulation stockings, no-slip socks and an elasticized cap to put on in preparation for the surgery.  As I disrobed and looked at my reflection in the glass of a medical equipment cabinet, I couldn’t help but stare at my breasts one last time.  I wasn’t really sad, just relieved that phase two of my wellness plan was about to get underway. I bid “the girls” good-bye and finished dressing in my surgical attire.  The nurse returned and started taking my vital signs then gave me a small dispensing cup with a pill in it.  She explained that it was a marisol capsule – marijuana – that would help me relax and eliminate post-surgery nausea. Hmmmm. Marijuana in a red capsule.  I wondered if I would have a case of the munchies when I woke up after the surgery.

The nurse beckoned my family from the waiting area and told them they could see me before I was moved to surgery.  My brothers, their wives and Don were in the small room along with my pre-op nurse and the nurse anesthetist.  The door opened and Dr. Klimberg entered. She looked a little surprised to see so many people.  Before I could introduce her to my family, she immediately acknowledged them, introduced herself and then walked to my bedside.

“What’s your name and what are we doing to you today,” she asked with her typical dry wit.  “Very funny,” I responded.  She smiled, patted me on the arm and told my family they would take good care of me. At that very moment my vision began to blur and I couldn't stop smiling.  It was the marisol.  One by one, my family and Don kissed me on the forehead and returned to the waiting room where they would spend the next four hours. 

The pre-op team transported me to the operating room as I struggled to focus on what they were saying. The marisol pill had really affected my senses. I saw a clock on the wall.  It was 10:50 a.m.  It was the last thing I remembered.

I was desperately trying to open my eyes when I heard a voice ask if I was in pain. “I’m hurting,” I responded in a whisper. “I’m going to give you some morphine before we move you to your room,” the post-op nurse said. 

A few minutes later, five people were lifting me from the gurney to the hospital bed in my assigned room, trying with all their might not to cause me any additional discomfort because the morphine had yet to kick-in. A certified nurse’s assistant (CNA) quickly placed pillows under each forearm, which helped alleviate some of the pain.  She raised the head of the bed so that I was in an upright position.  The clock on the wall showed 5:20 p.m. What a long day for my family, I thought.  About that time, Don, Marion and Carolyn entered the room.  I didn’t see Mike and Barbara. I assumed they were searching for their car. Marion explained that after Dr. Klimberg came out of surgery to give them an update, Mike and Barbara drove back to Springdale for Mike’s birthday celebration with their kids and grandchildren. I was glad his special day wasn’t totally upstaged by my surgery. 

I could smell food in my vicinity, which made my hunger pains even more severe.  Yep, I had the munchies.  There were no symptoms of nausea, which cleared the way for me to receive a food tray. I hadn’t eaten in 24 hours. Since I couldn’t move my arms, Carolyn fed me.  Dinner was a lemon pepper chicken breast and rice and it was yummy.  Dessert was sugar-free, cherry Jell-O.  I kept telling Carolyn it was the best I had ever had.  It must have been the marisol talking. 

The next 12 hours were filled with the medical team taking vital signs, monitoring my blood sugar and dispensing medications.  There was some concern because my blood sugar registered 250 and it should have been somewhere between 80 and 120, which is normal.  Dr. Klimberg left orders to give me several units of insulin to bring it down.  The RN noted that the glucose included with my intravenous meds was probably the culprit for the high reading. 

UAMS, breast cancer, Little Rock, mastectomy, surgery, recovery
Illustration showing how drains
are inserted post-surgery.
Marion, Carolyn and Don agreed that Don would spend the night in the room with me should I need assistance.  They planned to return early the following morning to relieve him. Don didn’t get much rest because I was monitored every two hours throughout the night.  That’s when I realized that the RN was checking fluid in bottles – one on each side of me.  As the anesthesia began to clear my brain, it dawned on me that the bottles were the infamous drains that I had heard so much about.  The plastic bottles had measuring units on them to determine how much blood and serum was draining from my breast cavities.  At one point, when I tried to adjust myself in the hospital bed, I felt a pull on my side and asked Don about it.  He explained that it was the drain tubes that were inserted and stitched under each arm.  

At 4:30 a.m., the CNA came in and had been instructed to remove my catheter.  At 4:30 in the morning?  After the task was completed, I was told to ring the nurse if I had to pee and someone would assist me to the bathroom.  I was not looking forward to getting up considering I couldn’t even lift my arms. 

At 6:30 a.m., I had to make the dreaded call to the nurse and request help to get out of bed for my first post-surgery trip to the bathroom.  There had been a shift change and a male CNA arrived to help. He coached me to use my legs, rather than my upper body, to change positions.  I managed to swing my legs off the side of the bed without using my arms.  When I returned from the bathroom, Don suggested I sit in a chair for a while and rest my back.  It felt good to sit up. 

Dr. Tummel, the resident who assisted Dr. Klimberg in surgery, was making rounds and stopped by at 6:45 a.m. to check my incisions and the swelling.  He said everything looked good but he wanted Dr. Klimberg to see me, as well. In the meantime, the RN came in to check my blood sugar; it was 230. He suggested that it was time to remove my intravenous line and the pesky glucose that was escalating my blood sugar.  I was thrilled because the needle was making my hand and arm ache. The nurse injected me with two units of insulin to help decreast my sugar levels. My usual daily dose is 32 units.  I didn’t expect there to be much change.

I was still sitting in the chair at 7:10 a.m. when my door opened and Dr. Klimberg came in accompanied by Dr. Yuen, the plastic surgeon who will eventually handle my reconstruction surgery. Much to my surprise, five or six med students followed Dr. Yuen into the room.  Dr. Klimberg sat on the edge of the bed and asked if she could show Dr. Yuen the first ever, modified “Breast Over Pants” procedure she did just for me. 

“Sure,” I said, “but I thought you couldn’t do the ‘Breast Over Pants’ because my breasts were too small.”

“You aren't going to let me forget that are you," she asked.  I shook my head no. "Well, I did a variation and wanted to show Dr. Yuen since he’s never seen it before,” she responded.  Both surgeons began pressing on my numb nipples as the med students moved in for a closer look.  It was definitely a Grey’s Anatomy moment, only Dr. McDreamy wasn’t among the McYoungsters. Dr. Yuen proclaimed that Dr. Klimberg’s skin-saving procedure would allow him to adequately insert the prosthesis without having to make adjustments.  I was pleased.  Dr. Klimberg was pleased. And the med students didn’t have a clue what he was talking about.

Before Dr. Klimberg left my room, she reassured me that the surgery went very well.  She instructed me not to lift, pull or raise my arms above elbow height for the next two weeks. The drains were scheduled to be removed in ten days at her office. She told me she would notify me as soon as she received the pathology report, but it was really good news that the cancer had not infiltrated any lymph nodes, based on the preliminary results during surgery.  I tried to high five her but decided that probably wasn’t a good idea.

After Dr. Klimberg departed, one of the med students returned to my room with camera in hand.  I couldn’t imagine what he was planning to do.

“Dr. Klimberg sent me to take a photograph of your chest and her handiwork,” he explained.  I laughed as I opened my hospital gown for the photo. 

“Will my boobless, yet well preserved chest be featured in one of her medical books,” I asked the young student. “Maybe.  You never know with her,” he responded. After two clicks of the lens, the Dr. Klimberg wannabe quickly exited my room.

The RN entered my room and reported that Dr. Klimberg had signed my release orders.  I was shocked but thrilled that she was going to allow me to go home so soon; however, there was one stipulation. My blood sugar had to drop below 200 before I could leave the hospital.  The nurse gave me another 30 units of insulin to help me meet the goal.  All we had to do was wait.

By this time, Marion and Carolyn had arrived to relieve Don.  They were stunned that I was on the fast track for going home.  In anticipation of my departure, Carolyn helped me change out of my hospital gown into leggings that she had to pull up for me.  Obviously, I didn’t think about my limited arm movement when I packed.  I brought a tunic for the trip home; however, there was no way we could fasten it over the drain bottles and tubing.  I had to wear my short robe over the leggings.  I was ready to go as soon as the nurse rechecked my blood sugar.

Meanwhile, the CNA came into my room with a black apron very similar to a carpenter’s apron.  I couldn’t figure out its purpose. The CNA helped me stand up then tied the apron around me.  She placed the left drain bottle in the left front pocket of the apron and the right one in the right front pocket.  It was the perfect solution to a bulky problem.

It had been 90 minutes since I received the 30 units of insulin.  The nurse came in and checked my blood.  It was 130.  Yippee, I was going home and it was only 10:45.  There was already a wheelchair waiting for me.  Marion left to get his car and planned to pick me up in front of the loop-de-loop. Carolyn gathered my things and walked beside the wheelchair as the CNA took us to the front door.

Getting me into the car was challenging but the marisol pill given to me before my departure from the hospital made it a non-event. I felt nothing. The short drive home caused me to be slightly nauseous but the pill helped. All I wanted to do was get to my condo and deposit myself in my recliner…and eat a batch of brownies.  I had another case of the munchies.  When we arrived, I managed to maneuver myself out of the car and up the front steps.  I headed straight for my recliner. In my marisol and Percocet fog, I reflected on how many people it had taken to get me through chemotherapy, surgery, and now post-surgery recuperation. I thought to myself, it truly does take a village to cure cancer. It was the last thing I remembered for several hours. 

Sunday, October 20, 2013

Surgery Pending, So is More Chemo...

It was exactly one week before my scheduled bilateral mastectomy.  I had been waiting for nearly an hour with more than a dozen other patients at the Winthrop P. Rockefeller Cancer Institute to see Dr. Makhoul, my oncologist, for the results of the recent breast MRI. The good doctor had recently been appointed the new director of oncology at the University of Arkansas for Medical Sciences and was busier than ever. Since being diagnosed with cancer six months earlier, I had learned the virtue of patience and it was a good thing.

Don had a conflict and couldn't accompany me to my appointment with Dr. Makhoul, but I was okay with going solo because I felt good about the pending results.  After being called to the exam room, I waited anxiously for Dr. Makhoul to enter.  A few minutes passed and the door opened, but it wasn’t Dr. Mak.  Instead, a new doctor entered the room.  He introduced himself as an oncology “fellow,” training with Dr. Makhoul. The young Syrian doctor was polite and engaging. I was impressed that he had read my medical history and was prepared to discuss the topic du jour – my breast MRI results. He informed me that the once large tumor now measured 1.6 centimeters by .6 centimeters and the second tumor, which had always been much smaller than the primary mass, appeared to be completely eradicated. I really wasn't sure how to interpret what I had just heard.  I missed Don.  The new doctor told me he was going to find Dr. Makhoul and let him answer any questions I might have.



It had been nearly a month since my last visit with Dr. Makhoul and I was actually excited to see him when he breezed into the exam room with his new protégé.  His jovial, yet soothing tone always worked wonders on those who might be wrestling with fear and uncertainty, like me. He wanted to know how I fared after my last chemo treatment and I told him that I did okay; however, I was thrilled to have the Taxol treatments behind me, because the drug was taking its toll on my weary body. He nodded his head in agreement.

Dr. Makhoul reviewed my medical file and reiterated the dimensions of the existing tumor. He said it was now a manageable size and my surgeon, Dr. Suzanne Klimberg, shouldn't have any problems excising the breast tissue.

And then he dropped a small bombshell.

“Depending on what the pathology report shows after your surgery next week, he said, "I may recommend another round of chemo."  He further explained that my triple negative diagnosis had everything to do with his recommendation.  Needless to say, I was having trouble processing what I had just heard but knew it was exactly what needed to happen.  “We won’t make a definite decision until I review the post-surgery pathology reports,” he reminded me.  Dr. Makhoul wished me good luck with my upcoming mastectomy and said he would see me on November 5 to discuss a future treatment plan...if necessary.

As I departed the cancer institute, my mind was a whirl with thoughts of surgery and the possibility of more chemotherapy.  That aside, I was prepared to do whatever my medical team suggested to rid my body of cancer, because I had literally placed my life in their healing hands

One Day Before Surgery: The Game Plan Changes

Less than a week after my appointment with Dr. Makhoul, Don and I reported to Dr. Klimberg’s office to fill out paperwork and consult with my surgeon the day before the scheduled procedure.  Upon arrival at the women’s oncology clinic, Don and I had to search for two chairs together in the overflowing waiting room.  As I scanned the crowd, I noticed that only a few patients were older than me and was stunned at how many were in their 30s and early 40s.  I was curious if the recent Angelina Jolie breast surgery phenomena had reached central Arkansas and was a reason for seeing so many young women in the clinic. Hopefully, they were there for preventative purposes, as Jolie demonstrated with her decision to have a bilateral mastectomy before she actually had cancer, and not because they had already been diagnosed with breast or gynecological cancer.

My appointment with Dr. Klimberg was scheduled for 11:00 a.m. and we expected a long wait; however, my name was called about 30 minutes later.  We were escorted to a small conference room, where an RN specializing in tissue research counseled me on the benefits of donating my breast tissue post-surgery to UAMS for scientific research.  I wholeheartedly agreed.  The fact that the type of cancer I had – triple negative – was found in only 15% of women offered a solid reason for me to participate in current and future research projects. My triple negative diagnosis was starting to weigh heavily on my mind after doing a little online research of my own.  If my tissue could help provide answers or even a vaccine, I was more than happy to help.

After I signed the release forms for the tissue donation, I was moved to an exam room, where I waited for my consultation with Dr. Klimberg.  Her nurse, Maureen, arrived first and handed me several forms to review about the surgery.  Then Dr. Tummel, a very young associate of Dr. Klimberg, entered the room and conducted a brief breast exam in advance of my surgeon’s arrival.  In typical Klimberg fashion, the dry-witted doctor made an entrance into the exam room wearing blue scrubs and accompanied by a timid, female intern.  “Let’s get this show on the road,” she directed her entourage.  One of her first duties was to explain to me all the things that could go wrong during surgery…including death…and handed me a pen to sign the consent form, which I did.  I was given additional forms to complete that would allow Dr. Klimberg and UAMS to use me in a lymphedema research project she is conducting.  Lymphedema is defined as arm swelling common in mastectomy patients.  I was familiar with the problem after observing a former colleague deal with a re-occurrence last year, which was a determining factor in me signing up for the experiment (Thank you, Renee).

After all the paperwork was in order, Dr. Klimberg pulled a permanent marker from her scrubs and began drawing possible incision lines on each breast as Dr. Tummel and the intern observed over her shoulder.  The first mark of significance was where she planned to move my nipples, followed by the “flaps” she would create for the plastic surgeon to insert the implants a few months later.  “Are you still going to do the procedure you created just for me?” I asked.  With her chin nestled between the thumb and forefinger of her right hand, she stared at my breasts and responded with a comment I wasn’t expecting.  

“I think your breasts are just too small for me to do the ‘Breast Over Pants’ as planned.”  

I started laughing and told madam surgeon that she is the first woman to ever tell me that I had small breasts.  “I meant it in a good way,” she said, trying to recover from her comment.  “Have you lost weight since I first suggested the new procedure?” she inquired. In fact, I had, but I didn't think it was a game changer.  She continued to discuss possible alternatives with Dr. Tummel for nearly 45 minutes.  Finally, they had a plan.  When I looked down at my apparently small breasts, all I could see were multiple black lines that resembled a web - and small, black dots where each nipple would be re-positioned.

Before leaving to see another patient, Dr. Klimberg told her nurse to call the surgery scheduler and make sure I was the first patient the following morning.  In a few minutes, Maureen returned and said Dr. Yuen, my plastic surgeon, already had the time slot reserved for one of his patients.  It was immediately apparent that Dr. Klimberg didn't like Maureen’s answer.  

“I’ll be right back,” she told me.  

Within a minute, Dr. Klimberg returned with a frustrated expression on her face and informed me that I would be second on the surgery schedule, which would be approximately 11:00 a.m.  “How long will the surgery take?” I asked.  “About four hours,” she told me as she hugged me before leaving the exam room.  

“I’ll see you before we put you to sleep,” she added.  “Don’t mess with my artwork,” she told me, pointing to my marked up breasts. After she left the room, I looked at my watch.  In less than 24 hours, I would be in surgery, receiving a life changing procedure.  It’s merely the next step in my treatment plan, I reminded myself, as I put on my favorite bra for the last time. 

Tuesday, October 8, 2013

Dr. Suzanne Klimberg: The Surgeon Schedules the Surgery

The aches and pains from my final chemo treatment were causing some discomfort when I reported for my appointment a few days later with nationally known breast surgeon, Dr. Suzanne Klimberg. I nicknamed the good doctor “Picasso” because of her penchant for drawing imaginary incision lines on my breasts as a way to explain the upcoming mastectomy surgery.
marla crider, UAMS, breast cancer, mastectomy, Dr. Suzanne Klimberg
Breast surgeon, Dr. Suzanne Klimberg.

It isn't unusual for Dr. Klimberg to have several medical students shadowing her every move and hanging on her every word.  These fresh-faced wannabes are eager to learn from the best in hopes of one day using their knowledge to create new, streamlined surgical techniques or, perhaps, to develop a vaccine that could eradicate cancer all together.  There’s no better reason to be a patient at the University of Arkansas for Medical Sciences – the state’s only teaching hospital – because you see the future of medicine in every young face wearing a lab coat and can’t help but think about the possibilities.

Don, an accomplished surgeon himself, accompanied me to my appointment to ask questions about the surgery and interpret the answers.  We had only been in the exam room a few minutes when Dr. Klimberg’s nurse came in to inquire about my chemo regimen and to confirm the date of my last treatment.  She surprised me when she requested to examine my breasts.  The nurse took a black pen out of her pocket and drew a circle very near the right nipple where she felt evidence of the remaining cancer (Hmmmm.  Apparently, everyone in the Klimberg clinic is an artist and my breast seems to be their favorite canvas). She explained that she was marking the area for Dr. Klimberg to evaluate. 

A few minutes later Dr. K entered the room with a med student at her side.  The doctor introduced her protégé to Don and me as one of her brightest scholars. The fresh-faced young woman blushed at the compliment. There were now a total of five people in the small cubicle, yet no one seemed to notice (or care) that I was lying bare-breasted on the exam table. It was all in a day’s work for them. I learned quickly after my first visit to the UAMS Cancer Institute six months ago that my breasts were no longer just mine.  I had to relinquish custody of “the girls” to my medical team in an effort to rid the right one of cancer.  Dr. K moved to the right side of the exam table and the med student was on the left. The RN was in the background making notes.

Dr. Klimberg immediately zeroed in on the black circle made by the nurse.  She palpitated my right breast, then the left, and moved back to the right breast where she found what was left of the once very large mass. She instructed the med student to feel the small tumor, as well.  I was beginning to get a little nervous listening to the two of them bantering back and forth until Dr. Klimberg explained that her concern was not the small remnant of the tumor but rather the close proximity to the nipple. She was uneasy about saving it. “Do you like your nipples?” she inquired.  “Heck, yea,” I replied rather shocked at her question.  “Why wouldn’t I like them?  We’ve been close pals for 60 years,” I stated rather matter-of-factly. “Well, in case you didn’t or should I not be able to save the blood supply to the right nipple, I want to assure you that Dr. Yuen (my plastic surgeon) makes a very nice nipple.”  (It’s comforting to know that my reconstruction surgeon is known for his nipple-making.) No doubt, that was the strangest conversation I have ever had with anyone.    

I asked Dr. K if she was still planning to do the new surgical technique created just for me in an effort to salvage more tissue and skin for the breast reconstruction that had been delayed for six months due to my diabetes. “Absolutely,” she remarked. Dr. K, or should I call her Dr. Picasso, took the black pen out of her lab coat and started drawing imaginary incision lines (Here we go again, I thought. It's “show and tell” time).  The med student listened intently as Dr. Klimberg explained the procedure to her, as well as Don.   The two surgeons in the room – Dr. K and my significant other – began to throw technical terms around until I reminded them that the bare-breasted patient didn’t understand a thing they were saying.  I interrupted their physician bonding moment and inquired if Dr. K had decided on a name for the new procedure. “Breast over pants,” my surgeon said with a straight face. Interestingly, Don knew exactly why she chose it.  He enlightened me that there is a hernia repair called “vest over pants” and it all had to do with making a flap that restores blood flow to the impacted area. 

Dr. Klimberg shared with me that several of her students were vying to assist her in surgery to observe this new technique. I asked how she would determine which young surgeon-to-be would be in the operating room.  “It all comes down to which one has the best bribe,” quipped my brilliant body artist.

Dr. Klimberg’s nurse jumped in and asked if she was really supposed to put the name “breast over pants” on the surgery orders because the medical staff would question it, having never heard of such a procedure.  “Even more reason to do it,” Dr. K responded with a twinkle in her eye.  After sitting up on the exam table and covering my bareness with an unfashionable gown, the nurse informed me that I was on the surgery schedule for Friday, October 11.  “Do you know if it will be morning or afternoon?” I asked.  Dr. K jumped in and said the team usually reserves the early morning surgeries for old people and diabetics and I qualified for both.  I couldn’t help but laugh out loud at her comment as did the others in the room.  The nurse handed me several pages of instructions and told me to return for a pre-surgery consult with Dr. Klimberg on October 10, followed by a meeting with the assigned anesthesiologist. 

“It’s really going to happen,” I remarked to Don as we exited the cancer institute.  “I just hope I’m emotionally prepared when the date rolls around.” 

“I have no doubt that you will handle the surgery with the same determination that you did the chemotherapy,” he said.  From his lips to God’s ears…

Monday, September 23, 2013

And Then There Was None...

Finally, the day had arrived – September 6 – my last chemo treatment.  I had been giddy all week in anticipation of this day. I had experienced many peaks and valleys during the four months of therapy, but I could finally see the light at the end of the tunnel.
marla crider, breast cancer, patient stories, patient story, UAMS, Little Rock
Marla Crider receiving her final chemo treatment at UAMS!

My brother, Marion, and sister-in-law, Carolyn, made the 180-mile trip from Northwest Arkansas to join me in what I hoped to be the afterglow of my final treatment.  My appointment for the routine blood work was scheduled for 8 a.m.  Fortunately, the early morning hour provided me an opportunity to visit the nearby Dunkin’ Donuts and pick up several dozen tasty treats for the staff at the infusion center and Dr. Makhoul’s office, just to express my gratitude for their exceptional care over the past four months.  This was one delivery I was looking forward to making.

When my family and I arrived at the infusion center waiting area, there were only a few other patients in the room. My name was called almost immediately. And just as I had done seven times previously, I walked through the infusion room door and stepped on the scales for my weigh-in.  I was pleased to see that my “fighting” weight had not fluctuated.  I was escorted to a vacant recliner and awaited the arrival of an RN to make the required blood draw.  A few minutes had passed when the Asian nurse, the professional who weeks earlier resolved my painful port issue, reported to my chair and began the process of filling vials with my poison enriched blood.  It surprised me when the efficient nurse commented that my final chemo treatment was scheduled in a few hours.  She congratulated me for making it through the past months with few problems.  Completing chemotherapy truly is an accomplishment, not just for the patient, but also for the medical staff.

The next order of business was an appointment with my oncologist.  When my family and I arrived in the waiting area, I was overcome with a sense of apprehension. For the past 18 weeks, I had placed my life in the capable hands of Dr. Issam Makhoul.  It suddenly dawned on me that he wouldn't be by my side when the next step of the treatment plan was implemented - surgery.  As strange as it may sound, I felt as though my security blanket was being taken away and it frightened me just a little. Don, my significant other and a consummate physician himself, explained that it isn't unusual for patients to bond with their doctors when in a life threatening situation, which made perfect sense to me.

After a short wait, my name was called and a nurse’s assistant escorted Don and me to one of Dr. Makhoul’s exam cubicles.  Brenda, his effervescent RN, came in and gave me a huge hug because it was graduation day…from chemo.  She made notes in my electronic file concerning my previous treatment and the side effects I experienced.  My response was becoming routine – extreme bone pain, diarrhea and insomnia.  I did share that the prescription Dr. Makhoul prescribed to help control the night sweatsVenlafaxine - was working quite well. The sweats had been less intense and frequent.  Brenda was pleased with the results.  She handed me a gown and told me to prepare for my exam.

A few minutes later, Dr. Makhoul entered the room and greeted Don and me.  “Today is your final treatment, correct?” he asked. “You better believe it,” I responded.  He laughed and accused me of trying to get rid of him (If he only knew it was quite the opposite).  He reviewed the blood work from an hour earlier and said it was “excellent.”  He said I had an amazing constitution to have come through more than four months of chemotherapy with so few battle scars. I told him it was due to lots of prayers from family, friends and acquaintances and my mom, Happy, encouraging me every step of the way from heaven above.  Dr. Makhoul’s comment also made me think of my dad, the man who said little but whose look and twinkle in his eye spoke volumes.  I could imagine him side-by-side with my mom, rolling an unlit Roi-Tan cigar in his mouth (are cigars allowed in heaven, unlit or otherwise?), smiling down at his baby girl with confidence that she was going to kick some cancer butt. It is those mental images that have kept me motivated throughout the process.

Dr. Makhoul examined me, carefully checking for any lymph node swelling in my neck or unusual breathing or heart activity.  He then manipulated my right breast to determine the location and size of the mass.  This time he didn't even bother to use his handy-dandy caliper to measure the tumor.  “The tumor is at .5 centimeters, even if that.  I’m not so sure that it isn't just scar tissue that I’m feeling,” he announced.  It was music to my ears.  Dr. Makhoul suggested scheduling an updated breast MRI to determine the status of the cancer.  In addition, he said that my breast surgeon, Dr. Klimberg, would need the MRI for review prior to the mastectomy surgery.

As our time together came to a close, I asked Dr. Makhoul the protocol for scheduling appointments with him in the future.  He said he would see me at least once more before the surgery and then he hoped he never had to see me professionally again.  From his lips to God’s ears, I thought to myself.  We exchanged good-byes and then he quickly departed to see another patient, while Don, Marion, Carolyn and I returned to the infusion center for my last intravenous procedure.

The early morning schedule for blood work and time with Dr. Makhoul allowed me the opportunity to move in and out of the appointments quickly.  But it also placed me back at the infusion room when the majority of patients were waiting to have their blood drawn. It was only appropriate that I would have to wait for my last chemo treatment. After more than an hour, a nurse’s aide called my name.  Carolyn and I followed her to a recliner in the front section of the room, which meant that Mr. Nurse Ratched would not be administering my last treatment. I was disappointed. Instead, the knowledgeable Asian nurse was assigned to my case. She handed me three steroid pills to take with water while she hooked me up to additional anti-nausea drugs intravenously.  In addition, she injected me with a large dose of Benadryl to counter any allergic reactions.  As soon as the antihistamine hit my system, I immediately began giggling, as I had done in the past.  It was as if I had been given the liquid form of laughing gas. When I started laughing, others around me joined in, as well.  It is said that laughter is contagious.  It’s true and what better place to have an epidemic of hilarity than in a cancer treatment center.

After five minutes or so, the laughter subsided and we moved on to the serious task of infusing the Taxol.  Carolyn, Marion and Don alternated sitting with me for the three-hour ordeal. As I watched the last of the Taxol drip slowly into my veins, my emotions fluctuated between joy and trepidation.  I was so ready to have this part of the wellness program behind me; however, I had yet to prepare myself mentally for the pending mastectomies.  One thing at a time, I told myself.  As the efficient Asian nurse unhooked the tubes from my port, I sighed.  Phase one of the treatment plan was complete. 

End of chemo celebration! Pictured (from right to left)
Marla Crider with boyfriend, Don Vowell, brother,
Marion Crider and sister-in-law, Carolyn Crider.
Fortunately, I had always felt pretty good the evening of my therapy so Don planned a celebration in honor of my accomplishment.  My brother and sister-in-law joined Don and me for dinner at a popular Little Rock restaurant overlooking the Arkansas River.  Even though I had not consumed much wine since the chemo treatments began, I decided it was a special occasion and that I deserved to clink glasses with my support team.  Each of them shared a toast that touched my heart and made me realize, yet again, just how lucky I was (and still am) to have them by my side.

Just like clockwork, the dreaded diarrhea hit me on day two after the treatment and the uncomfortable bone pain followed on day three.  My pelvis, knees and shins felt like there were little goblins inside trying to chisel their way out.  In addition, the fatigue peaked on day three, so much so that I didn't have the energy to report to work on Monday.  I took pain meds and slept most of the day, which enabled me to return to the office the following day. In week two after the final chemo session, I was energized both mentally and physically.  Part of that was due to the fact that I had started sleeping four to five hours a night without the assistance of medications. I was ecstatic and even had a bounce in my step.  I was finally on my way to feeling like the new and about-to-be- improved Marla.   

When I first received the cancer diagnosis in early May, I was filled with countless emotions, such as fear and uncertainty.  Of course, there was no question that I was going to fight with everything in my being to be cancer free, but there was a part of me that was dreading the cure – chemotherapy.  However, I can honestly say that the aches, pains, fatigue, diarrhea, hair loss, night sweats, sleep deprivation, and ummmm…… oh, yes, chemo brain have all been worth it.  Chemotherapy and the UAMS medical team who prescribed and administered it saved my life.  Now, on to the next phase of this journey…surgery.

Friday, September 6, 2013

Taxol: The Chemo That Keeps On Giving

Marla Crider, breast cancer, patient story, patient stories, UAMS, Little Rock, Arkansas, invasive ductal carcinoma
Marla Crider receives chemo treatment #7.
One more to go!
The calendar showed that it was August 23; however, it wasn’t just any old late summer day.  It was the date that I would receive the seventh of eight prescribed chemo treatments.  As odd as it might sound, I was anxious for what lay ahead of me: blood work, appointment with oncologist Dr. Issam Makhoul and the next­-to-the-last toxin infusion that would strategically rid my body of those insidious cancer cells.  Even though there were days after my most recent treatment that were uncomfortable and challenging, it didn’t matter.  I was on a mission and no side effects were going to deter me from being cancer free.

My brother, Mike, and sister-in-law, Barbara, journeyed from Northwest Arkansas to Little Rock to provide family support for what was sure to be a long day.  We reported to the infusion center at the University of Arkansas' Winthrop P. Rockefeller Cancer Institute and, as usual, the waiting area was full.  Many of the faces were familiar.  While we didn’t know each other’s stories, we all shared a common thread – cancer – and the routine of curing it. After a 45-minute wait, the nurse’s assistant called my name from the door.  I followed her to the scales, where she checked my weight.  It was stable and hadn’t changed from the previous treatment, which was good.  I was then escorted to a vacant recliner, where I waited for the assigned RN to draw blood. 

The Asian nurse, who was the first to introduce me to pain-free port access weeks before, appeared with her hands full of vials and tubes.  The efficient caregiver remembered me as the patient who had a port implanted on a nerve.  As she prepared to insert the needle into the small, round tube embedded near my left collarbone, she advised me to take a deep breath.  Once again, the process was painless.  I will always be grateful to this knowledgable healthcare professional for sharing the deep-breathing trick that eliminated the dread and discomfort from my twice-monthly treatments.

After the blood work, my family and I proceeded to Dr. Makhoul’s office for my appointment.  Again, the waiting room was at capacity but our delay was minimal before I was called back to one of the evaluation rooms.  When Dr. Mak appeared, he was anxious to discuss my side effects from the second Taxol treatment.  He said the severe bone and joint pain that I had experienced was not uncommon and would require that I continue taking pain medication to get me through the worst days.  Dr. Makhoul also inquired how well I was resting at night.  When I explained that the night sweats limited my ability to get more than two or three hours of sleep, he suggested that I begin taking a new medication – venlafaxine – that could decrease the intensity and frequency of the night sweats up to 50%.  Interestingly, the drug is classified as an anti-depressant but physicians learned from their patients that it also assisted in lessening menopausal symptoms, including hot flashes and night sweats.  I had suffered from sleep deprivation for more than four months and was ready to try anything that the good doctor suggested.

Following our discussion, Dr. Makhoul examined me to check the status of the breast tumor.  Using his handy-dandy measuring device he announced that the mass had decreased to 1.5 centimeters.  We shared a high-five to celebrate the news.  He commented that after my final treatment the tumor could totally disappear and show up on an MRI merely as scar tissue.  Wow! How far we had come in four months.  When we started this journey in early May, I had a large, fast-growing mass, measuring 5.6 centimeters that was categorized as grade 3, stage 3.  The current results are proof that chemotherapy works when you have the right physician prescribing the treatment. (Thank you, Dr. Makhoul!)

Mike, Barbara and I returned to the infusion center for my chemo treatment. Instead of being escorted to one of the recliners in the open “bullpen” area as usual, I was taken to a private room with an adjustable bed because it was the only space available. I sat on the bed and my sister-in-law occupied the companion chair next to me. As I settled in for the three-hour intravenous procedure, I heard a familiar voice approaching the room.  And there he was – Mr. Nurse Ratched – preparing to hook me up to the prescribed toxin of the day. 

He started the process by giving me more steroids to prevent nausea then injected me with Benadryl to counteract any potential allergic reactions to the Taxol.  As soon as the drug hit my system, I started giggling as I had with the two previous treatments.  I mentioned my uncontrollable urge to giggle to Mr. Nurse Ratched, who thought I said “wiggle.” He immediately decreased the flow of drug through the pump, thinking I was having a reaction.  When I repeated that the Benadryl made me giggle, especially when it was administered intravenously, Mr. Nurse Ratched started laughing at his misunderstanding and readjusted the drip to flow normally.  His dry wit fully engaged, he remarked that I was probably a cheap date if Benadryl had that kind of effect on me.  “A guy could ply you with Benadryl for a lot less than a couple of glasses of wine and have his way with you,” said my nemesis nurse, who I thought had no sense of humor whatsoever.  During the past four months, I had never seen that side of Mr. Nurse Ratched and it was a nice surprise.  Three hours later, I was unhooked from the pump and sent home to rest. 

Mike and Barbara stayed with me overnight just in case I experienced any nausea or side effects.  They departed the following morning when they were convinced that I was feeling pretty good for having just completed my seventh chemo treatment.

On the third day after the treatment, I began to experience bone pain that was concentrated in my hips, knees and shins.  It was a constant ache that at times would cause me to catch my breath.  By the fourth day after the treatment, the pain had intensified leaving me no choice but to take the pain pills Dr. Makhoul had prescribed.  I’m one of those people who can’t function when “doped” so going to the office that day was not an option.  Even with the pain medication, I didn’t get much relief.  The discomfort continued for several more days; however, I managed to go to work, which actually helped divert my attention from my aching bones.

The week following the treatment, I started to notice that what few hairs I had left on my head were quickly disappearing.  In addition, my eyebrows and eyelashes were falling out, which took me totally by surprise.  My arms and legs were now hairless and slick as a baby’s butt. Heck, since I no longer have to shave my legs or wash my hair in the shower, I can now complete the task in three minutes or less.  I’m saving money on my water bill, razor blades and shampoo.  Who knew there would be a silver lining to chemo-induced hair loss?  And just to add to that list of pleasantries, my fingernails have also undergone a change thanks to the chemo treatments.  They have become soft and spongy and have all but disintegrated, eliminating the need for a manicure anytime soon.  Yet one more reason to save a few bucks…

Venlafaxine reduces night sweats.
On a brighter note, after taking the venlafaxine for the hot flashes and night sweats for a week, I could definitely tell a difference.  Instead of waking up three to four times per night totally drenched with sweat, I was now sleeping up to five hours a night - something I hadn't done in months.  Once again, Dr. Makhoul came to my rescue with an appropriate medication.  When I asked him in his office how long the sweats would continue, he said approximately two years.  Oh, goody!

Let’s see…no hair, no eyelashes, no eyebrows, no fingernails, intense bone pain and drenching night sweats.  As unpleasant as those things may sound, I have been very unemotional about the changes to the exterior of my body. The side effects and annoyances associated with chemotherapy are temporary and worth enduring whatever necessary to kill the cancer within.  I am now only days away from my final chemo treatment and all I can say is “bring it on” because I can handle whatever the chemo gremlins throw at me.

Sunday, August 25, 2013

Taxol Renders Quite a Punch!

My sixth chemotherapy treatment was scheduled in mid August and began like the previous five…blood work, followed by an appointment with my magician of an oncologist, Dr. Issam Makhoul, and then my three-hour encounter with intravenous poison.
Marla Crider, breast cancer, patient stories, UAMS
Marla receiving her 2nd Taxol treatment. Only
two more to go! 

My brother Mike and sister-in-law Barbara drove from Northwest Arkansas to be with me for the treatment.  I can’t emphasize enough how important and meaningful it has been to have my family surround me with love and support as I battle breast cancer.  Mike and my middle brother, Marion, alternate trips to Little Rock every other week to ensure that I have family around each time I must endure another chemo treatment. I’m convinced they, and my beloved Don, are the reasons I have been able to tolerate the chemotherapy drugs with minimal side effects.  My family and countless friends have all contributed to my positive state of mind, which is extremely important in fighting cancer.

When Mike, Barb and I arrived at the UAMS Cancer Institute, we were handed face masks as soon as we entered the building and instructed to wear them as long as we were in the cancer wing.  A flu epidemic was spreading throughout the multiple myeloma section of the hospital and in order to contain the sickness, the public was asked to wear masks to minimize spreading germs.  Multiple myeloma patients undergoing chemotherapy virtually have no immune system because the treatment destroys the patients' bone marrow.  The flu can be extremely dangerous to all cancer patients in treatment but especially to those with multiple myeloma. 

The three of us donned our face masks and made our way to the infusion clinic where I awaited my turn for the blood draw.  It was an odd scene when we entered the waiting area.  Every person in the room was wearing a mask, just like us.  We were all trying to do our part to control the flu epidemic and protect my fellow cancer patients. I learned quickly that sporting a face mask escalates hot flashes.  My inclination was to rip the mask off my face and fan myself with it, but I didn’t.  Instead, I let the abundant perspiration drip off my chin and catch in the trough created by my bra, which was quickly becoming saturated.  Bras serve multiple functions and sweat-catcher is one of them.

As I fanned myself furiously with a magazine, I heard a nurse call my name from the infusion room door.  I was anxious to follow her into the (always) frigid treatment room.  Before I could reach my cool destination, I had to step on the scales and check my weight.  I had only lost a half pound and was still in the “safe” category.  I was delighted when the nurse told me I didn’t have to wear the mask in the infusion area because it was super sterilized. It only took me a second to remove the hot, contraption from my face.  I immediately began to cool down.  The nurse, who was unfamiliar to me, escorted me to a vacant recliner and began preparing for the blood draw.  Like a broken record, I told her about my port-on-nerve situation and requested that she not insert the needle until I took a deep breath.  She agreed.  Thank goodness, our in-unison approach produced pain-free port access.  Since learning about the deep breathing method a few weeks earlier, I no longer dreaded the blood draw.  It was now just a routine part of treatment day.

After collecting four vials of blood, I was dismissed from the infusion center and told to pull the protective mask over my nose before re-entering the waiting area to meet my entourage.  Masks in place, my group took the elevator seven floors up for my appointment with Dr. Makhoul.  As we exited the elevator, there were dozens of people in the clinic lobby all wearing white or yellow face masks and doing their part to eradicate the flu epidemic.  We found chairs together and began the wait. Surprisingly, I was called back to Dr. Makhoul’s exam area within 30 minutes.  It was another 20 minutes before the very busy doctor rushed into the cubicle to give me a hug. We bantered with ease about my remarkable response to the chemotherapy.  I was quick to give him credit for my progress because of his genius as an oncologist.  He is a humble man who uncomfortably accepts compliments.  I would have expected nothing less.

Dr. Makhoul was very curious how I handled the first infusion of Taxol.  I told him about the severe bone and joint pain, as well as the serious diarrhea.  He encouraged me to take the pain tablets – Tramadol – that he had prescribed to reduce the musculoskeletal discomfort.  He also instructed me to use Imodium, an over the counter anti-diarrheal medication for the first few days after chemo to help eliminate the symptoms. I assured him that I would.

He was anxious to examine me and check the size of the tumor after just one treatment of Taxol.  He used his handy dandy scale to measure the mass.  He looked up at me with a grin and said, “We’ve come along way from the 5.6 centimeters when we started.  There has been a significant reduction to 2.2 centimeters.”  I was overwhelmed with joy and felt reassured that that the tumor might actually shrink to nothingness.

Dr. Makhoul quickly signed my chemo orders and told me he was very proud of me.  I told him it was because we had a great doctor-patient relationship.  And I do believe that.  I’m convinced that if you don’t have faith in your medical team, the results of the chemotherapy might not be as effective.

Marla Crider, breast cancer, UAMS, Taxol, patient stories, chemo, side effects
Marla Crider with her brother, Mike Crider, at UAMS.
Mike, Barbara, Don and I returned to the infusion center and waited to be called back to the room where the magic happens.  Everyone in the waiting area was wearing a face mask, including all of us. As soon as I sat down, beads of perspiration began rolling down my face, neck and back.  I immediately started fanning myself with a magazine.  I had decided the mask was making me feel slightly claustrophobic, which was triggering the hot flashes.  Just for a few short moments I dropped the mask below my chin and began to immediately cool off.  It was at that time, the nurse called my name.  Thank goodness, I could remove the mask once I got beyond the infusion room door… and I did just that.  What a relief! 

Barbara accompanied me to my assigned recliner and observed the nurse as she prepared me for the treatment process.  Yet another new RN would be overseeing my treatment.  I learned that Mr. Nurse Ratched was attending a conference as were four other nurses I had come to know.  I rather missed them.  

My new caregiver provided me with three more steroid tablets (five total for the day) to prevent nausea.  (No wonder I was restless and felt as though I could dance on the ceiling.) In addition, the nurse injected Pepcid into my intravenous tubing to help calm my stomach before the Taxol was administered.  Following the Pepcid, she injected Benadryl into my port to prevent an allergic reaction to the Taxol.  As soon as the Benadryl reached my veins I felt a “rush” of sorts and started laughing uncontrollably for about three minutes.  My laughter was contagious as others around me started laughing, as well. Once my giggles were under control, the bag of poison was hung from the intravenous pole and the treatment began. A few minutes after the Taxol entered my system, my right breast started tingling.  The poison had already found its way to the cancer-ridden mass.  It was a rather remarkable feeling.  For the next three hours, my family alternated positions as my support team in the infusion room.  It certainly helps pass the time when conversation is exchanged.

I experienced no allergic reactions during the treatment and completed the process feeling pretty good.  Before leaving the infusion room, the nurse handed me two days worth of steroids to keep the nausea at bay.  While steroids are a God-send when it comes to the prevention of nausea and vomiting during chemotherapy, the medication also contributes to insomnia and wreaks havoc on diabetes.  After six treatments, I had finally learned how to adjust my insulin to compensate for the extremely high blood sugars.  As for the insomnia, nothing much helps with that inconvenience.

The day following the treatment, the diarrhea returned but I was able to curtail the seriousness of it by taking Imodium as soon as I had the first episode.  On day three the bone and joint pain returned with a vengeance.  The discomfort in my hips, lower back, knees and shins was debilitating and lasted three consecutive days.  As much as I deplore taking pain medication, I had no choice.  It was my only source of comfort.  I managed to go to work but not without a couple of Tramadol tablets to get me through the day.  By the seventh day after the Taxol treatment, the bone pain had finally subsided and I was (somewhat) back to normal.  No matter how uncomfortable the side effects may be, I admittedly welcome them as proof that the chemo treatments are doing exactly what they are designed to do – kill the cancer.  And if that means I might have to endure a few throbbing bones and a bout of diarrhea, then so be it.  My goal of being cancer free is just two treatments away.  And I can tolerate anything for that along.