Friday, June 14, 2013

Treatment Two - Good News and Great News!

The second chemotherapy treatment was scheduled on June 11.  It was also the day I would receive the long awaited results from the PET and brain scans.

I learned quickly that the first order of business on treatment day is to report for blood work in the UAMS Winthrop Paul Rockefeller Cancer Institute infusion center.  The blood is quickly processed with the results forwarded to Dr. Makhoul in time for my scheduled appointment with him.

Marla Crider, Little Rock, Arkansas, breast cancer, patient stories, Clinton
Marla Crider, chemo treatment #2
After I signed in at the infusion center, Don and I waited a little longer than usual.  The waiting area was overflowing with patients waiting for blood draws, as well as their chemo treatments  I observed a young, Hispanic girl sitting in the corner of the room in a recliner.  A wheelchair was located directly in front of her.  Her mother was seated on one side of her and a male companion on the other side.  She was eating French fries very slowly and drinking a milk shake.  I noticed that her cheeks were very swollen, probably from the steroids given to prevent nausea and vomiting.  Within a few minutes, a tech called the young lady’s name.  I noticed that the male accompanying her had gently removed the food from her hands, then slowly lifted her under her arms and moved the patient into the wheelchair.  It was only then that I noticed she had a major scar on her skull, which explained her inability to walk.  When I watched the male attendant wheel her into the infusion room for her umpteenth chemo treatment, I told myself that my problems were minimal compared to what this young lady was facing.  I said a prayer for my waiting room acquaintance that happens to share a cancer diagnosis with me.  You see, we are all family, even if we have never met.

A few minutes later, I heard someone announce “Marla Fay Crider” from the infusion room door.  My mind immediately retreated to my childhood years, when my mother, Happy, would call out my full name because of something I probably shouldn't have done or when she was trying to find me at a neighbor’s house.  Even today, few people call me by my full name - mostly childhood friends.  So, when I turned around, I was halfway expecting to see one of those childhood friends in the doorway.  But, no, it was Mr. Nurse Ratched.  Immediately, I thought, “Why me, Lord?”

I met my nemesis at the door, where he immediately began barking orders at me. He reminded me that the first order of business on my return visits every two weeks is to step on the scales and get weighed.  I complied.  He marked on my chart that I had lost four pounds then wanted to know why I had lost weight.  Nausea? Vomiting?  No. No.  I explained that my roller-coaster blood sugars contributed to the loss of weight. That generated a “humph” from Mr. Nurse Ratched. As we were walking to my assigned recliner for the blood work, he asked, “Is that your hair I still see on your head?” I didn’t miss a beat and replied, “Interesting that you noticed.  I would like to remind you that this is day 15 after the first chemo treatment and I still have my hair.” He asked, “Is it thinning?” Darn it, I was going to have to fess up that it was – by the handfuls.  Being the curmudgeon that he is, he gloated and said, “I bet the second treatment gets it all.” (I could almost hear him laughing like the Joker in a Batman movie.)

I settled into my assigned recliner and Mr. Nurse Ratched starting pulling tubes and butterfly needles from the cabinet drawers beside me .  He asked me to expose my port.  Damn!  I thought they would take it from my arm, like the last time. He could see the anxiety in my face.  “You didn’t put the numbing cream on the port site, did you?” I shook my head no.  “I bet you don’t forget to do it the next time after I stick you this week,” he said.  And, before I had time to catch my breath, Mr. Nurse Ratched forced the rather large needle into my port.  It was extremely uncomfortable. The old fart said, “Hurt didn’t it.”  Hell, yes, it hurt and was still hurting.  He drew the amount of blood he wanted and attached tubes to the port for the infusion of chemo a few hours later.  “See?  We won’t have to re-stick you later.”  Did he really think that little tidbit of conversation was going to make up for him bringing me to my knees in pain only seconds earlier?  He told me I was all done and he would see me later.  I wonder if he could see the look of dread on face.  Must have.  He was smiling at me.  If this was his way of flirting with me, I felt like turning him into the police or the equivalent thereof.

After making it out of the infusion room without kneeing my cocky, male RN in the testicles, Don and I were now ready for the appointment with Dr. Makhoul.  We were actually about 15 minutes early when I signed in with the receptionist.  About 40 minutes had passed when I finally heard my last name – Crider - called out. (Take note, Mr. Nurse Ratched.)

We were escorted to one of the cubicles marked with “Dr. Makhoul” on a nameplate. The usual routine is that Brenda, Dr. Makhoul’s handy-dandy RN, will come in first and ask questions pertaining to side effects and any other “oddities” after the first chemo treatment.  Brenda has a very engaging personality and quickly puts her patients at ease.  She started pelting me with questions:  Any nausea or vomiting? No. Night sweats?  Hell, yes. Insomnia? Absolutely! Hair loss?  We’re still debating that one.  She filled in all the responses on the computer that Dr. Makhoul would be accessing later.  Before leaving the room, Brenda asked me to take off my top and put on a gown.  Dr. Makhoul would want to examine me.  I asked if he had an intern with him.  She said she hadn’t seen one during the morning rotations, but he might have one for the afternoon appointments.  I put in a special request for a male intern, since the ta-tas would be examined.  I just hate wasting that experience on a female intern. That comment did generate an eye roll from Don and an outburst of laughter from Brenda. I disrobed and waited.

Dr. Makhoul made a quick entry into my cubicle and with a male intern, I might add.  I love UAMS.  Ask, and you shall receive.  He immediately went to the computer and started reviewing my online file. Hmmmmm, he said.  No serious side effects.  He said the precedent had been set and I would probably be free of nausea and vomiting for the duration of my chemotherapy.  I clapped like a little girl.  (The anti-nausea regimen of meds really does the trick, at least for me.)  He basically told me I would have to endure the night sweats and insomnia.  I’ll take that over nausea any day of the week!

Next, Dr. Makhoul started pulling up the test results.  First, the brain scan.  “You have one and it looks just like cauliflower on the image and it’s cancer free," he laughed.  I clapped like a little girl, again.

I couldn’t contain my eagerness to know about the PET scan and asked about it next.  He reiterated that the right breast was glowing brightly, which we expected from his general review two weeks earlier.  The spot in the colon turned out to be a misalignment on the scan. He was convinced it was a false reading.  Yippee!!!  More hand-clapping from me.  Dr. Makhoul did say there was some inflammation in a lymph node under the right arm pit.  Don quickly jumped in with his medical demeanor and asked if the inflammation could have been from the lymph node needle biopsy I received just days prior to the PET scan.  “Very well could be,” he said.

Then, Dr. Makhoul and the scruffy-bearded male intern, who looked a little like Doogie Howser, M.D., examined me.  He checked the lymph nodes in my neck and listened to my heart.  He then pulled the measuring device for sizing the tumor out of his pocket.  Dr. Mak measured the tumor vertically then looked up at me with surprise. He looked back down at the device and said, “I believe it’s shrunk one whole centimeter.”  He marveled that it was incredible results after only one treatment.  He gauged the size of the tumor as 4.6 centimeters (down from 5.6) by 4.2 centimeters (reduced from 5.2 centimeters).  There was lots of hand-clapping on my part at that revelation and even a verbal “Yippee.”  Dr. Mak stated that if we continued to see these kinds of results every two weeks, the tumor would basically be gone at the end of the eighth and final treatment, which is exactly what the breast surgeon, Dr. Suzanne Klimberg, had hoped.  The masterful Dr. Makhoul did caution me that we shouldn’t get the cart before the horse because cancer does its own “thing.”  He said it may get to the fourth or fifth treatment and refuse to shrink any further.  He just wanted to prepare me for that possibility.  Dr. Makhoul provided me with some great news and I wasn’t going to let that one comment deter me from my “afterglow.”

Marla Crider and Dr. Don Vowell
There was one last pressing question that Don wanted to ask Dr. Mak pertaining to the markers in the tumor, meaning what, if any, receptors attached themselves to the breast tumor when the original needle biopsy was performed.  For example, if estrogen was a receptor, I would be treated with Tamoxifin for several years to ward off a recurrence of breast cancer in the left breast or from cancer metastasizing in another part of my body. Unfortunately, my breast tumor was negative to any receptors.  However, Dr. Mak offered a ray of hope.  He said that I might be a good candidate for a breast cancer vaccine that UAMS is close to putting into the trial stage.  Sign me up!

Dr. Mak asked me one last question before he left.  He wanted to know how the fatigue was affecting me.  I explained that the fatigue I was currently experiencing was insomnia driven.  He warned me that after the second treatment and, especially after the third, I would really begin to feel the effects and not to fight it.  He encouraged me to leave work when I felt like the proverbial “brick wall” was approaching.  I assured him that I would. 

Don and I reported to the infusion center again and prepared for treatment two.  My name was called quickly by a tech and she escorted us to a recliner in the front section.  I scoped the place and didn’t see any signs of Mr. Nurse Ratched.  Suddenly, sweet and lovely RN greeted me and I exhaled with relief that she would be the one administering the toxin.  I settled into my chair and she quickly gave me the anti-nausea pills (bless their little hearts) and hooked me up to the red poison, Adriamycin, otherwise known as the hair-follicle-killer. It took about 15-20 minutes for the concoction to drip into my veins and do its magic of killing the cancer.  Following the Adriamycin, I was given cytoxin, which took about 35-40 minutes to dispense. After she flushed my aching port, sweet and lovely RN gently (did you hear that Mr. Nurse Ratched? Gently.) removed the needle and sent Don and me on our way.

I arrived home where my wonderful brother, Mike, and sister-in-law, Barb, had spent the day cleaning my condo, not because it needed it (they said), but as a gesture of making me feel more comfortable when I returned from treatment number two.  I am blessed to have such a loving and supportive family as I continue through this journey.  Truly blessed.  And, based on the great news I received from Dr. Makhoul regarding the reduced tumor size, their prayers and those from other friends and acquaintances have made the difference in my status. I am grateful. Very, very grateful. 

My office gal pal, Gloria, drove me to UAMS the following day, June 12, to receive the dreaded Neulasta shot for stimulating the bone marrow to make an over abundance of white cells.  Dr. Makhoul told me if I had side effects from the first shot on day seven the last time to count on that being the routine.  He mentioned in our appointment that the cancer team likes to keep the white cell count at about 15,000 and gave me a pat on the back because my white blood count was at 17,000.  A new RN appeared at my chair to administer the shot.  She was pleasant but unfamiliar with my chart.  It took her a few minutes to get up to speed. While waiting for the shot, Gloria got a glimpse of Mr. Nurse Ratched and is in agreement with me regarding his crotchety ways.  I’m going to “break” him before this journey is over.  I’m determined. And, I'm going to kick cancer's butt while I'm at it.


  1. Hi Marla, I landed here today via Watchdog Causes... still have the Dogs Against Romney sticker on my refrigerator. I'm having major deja vu while reading your story. This was me exactly 7 years ago, down to the triple-neg and the freaky red Adriamycin (we called it "the Frankenstein juice"). As you can see, I'm still here! My advice - Get lots and lots of rest, let other people do things for you (and play the Cancer Card to get out of doing things you don't want to!), and think in terms of WHEN you beat this, not IF. Having a sense of humor about the whole process really helps... your nephew is right to be proud of you. I'll be cheering you on from the perspective of someone who's been there, done that, and got the radiation tattoos to prove it.

    Linda T

  2. Hey Marla, don't sweat the hair thing, 'cause YOU'LD BE BEAUTIFUL BALD! just an "over the years observation". a shallow one but true

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