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. 

Monday, August 12, 2013

Taxol Equals Tumor Reduction

My brother, Marion, and sister-in-law, Carolyn, arrived in Little Rock from Northwest Arkansas on July 25 to accompany me to my scheduled chemo treatment the following morning.  Under normal circumstances, Don would have been with me, as well, but he was scheduled to undergo a medical procedure of his own, which I am happy to report generated good results.

My family and I arrived on Friday morning at the UAMS Cancer Institute for the routine blood work required before meeting with Dr. Makhoul’s nurse practitioner, who was filling in for him while he attended a medical conference. We reported to the infusion waiting room, as usual.
marla crider, little rock, arkansas, breast cancer, patient stories, UAMS
Marla Crider having celebratory dinner with brother Marion
and sister-in-law Carolyn.
While dressing earlier that morning, I made the decision to wear a scarf and huge flower as my head cover. It was the comfortable choice for the long day ahead of me. While I was waiting to be called for the blood draw, a lovely black woman tapped me on the shoulder and asked me to tell her how I tied the scarf and secured the flower to it.  Her goal was to duplicate the effort for Sunday church.  Our conversation made me feel more confident about wearing scarves in public, rather than the hot wigs that had become a part of my everyday work attire.

A few minutes later, a nurse of Asian decent called my name from the infusion room door.  I followed her inside, where I stepped on the scales for my twice monthly weigh-in.  I had lost another pound but was still within the limit of no concern.  The nurse escorted me to an empty recliner and said she would be the one accessing my port for the blood draw. It was our first nurse/patient encounter; therefore, I would have to caution her about my port-on-nerve malady.  The nurse said she wanted to try something that might eliminate the discomfort I usually experience.  She instructed me to take a deep breath and I complied. Simultaneously, she quickly inserted the large gauge needle into the port.  It was a flawless and painless procedure.  It made perfect sense; taking the deep breath expanded my diaphragm and lifted the port from atop the nerve. I was almost giddy with the outcome.  She quickly finished her task then taped the dangling port lines to my chest in preparation for the chemo treatment.

My family and I departed for the appointment with Dr. Makhoul’s colleague.  The waiting room was filled to capacity.  It was going to be “one of those days.”  Almost an hour had passed when the nurse practitioner finally arrived in my cubicle to tell me that my blood work was in the “normal” category, indicating that I would not have to endure another Neulasta injection in the belly to help stimulate white blood cell production. She asked if I would be receiving my first treatment of Taxol that day.  I nodded my head in the affirmative. She warned me that the most common complaints about the drug included flu-like symptoms, bone and muscle aches and tingling of the hands and feet.  I thanked her for the details and departed for my first one-on-one with the toxin.

After only a minor delay in the infusion waiting room, a nursing assistant summoned me.  It was time to experience a new chemo adventure – Taxol. Carolyn accompanied me with the intention of helping pass the time during the three-hour, intravenous process. As soon as I occupied the recliner, the male version of Florence Nightingale, aka Mr. Nurse Ratched, approached my chair and said, “You’re here for your first Taxol treatment, right?”  “Yes,” I replied. “Bring it on.” 

“Get comfortable because you’re going to be here a while,” he responded.  I pulled out a book of crossword puzzles and settled into my chair.  In his loud, booming voice, Mr. Nurse Ratched started rattling off all the things that could happen with Taxol, such as hives, swollen tongue, breathing issues, and low blood pressure to name a few.  He explained that I would be given Benadryl intravenously along with the Taxol to counteract any possible allergic reactions.  “The Benadryl will probably make you sleepy,” he warned me (for someone who sleeps very little, I welcomed the possibility). Before he hooked me up to the drugs, he brought me six pills to take – the anti-nausea cocktail that included more steroids. As soon as I swallowed the meds, Mr. Nurse Ratched injected Benadryl into my port and proceeded to hang the bag of Taxol on the pole next to me and dialed in the rate of drip.  “If you’re going to react, we will know shortly,” he said. 

Carolyn watched me closely to see if she could detect any changes as the Taxol dripped into my veins.  Instead of making me drowsy, the Benadryl just blurred my vision.  Then I started giggling as if I had consumed one glass of wine too many.  There was an internal battle going on in my system between the abundant steroids and the Benadryl.  Apparently, the steroids were winning because I wasn’t sleepy… darn it.  Mr. Nurse Ratched continued to check on me to ensure I wasn’t reacting to the Taxol. 

For the next three hours, I read and worked crossword puzzles, while Carolyn and Marion alternated sitting with me.  Fortunately, there were no signs of an allergic reaction.  What I did notice was a tingling feeling in my right breast accompanied by little sharp jabs… a sensation not experienced with the previous chemo drugs. Could it be that the Taxol had already found its way to the cancer cells in my breast?  After all, the drug is known for reducing the size of malignant tumors.  The tingling continued throughout the treatment.

Carolyn and I were chatting away as the last of the Taxol dripped from the bag.  Suddenly, a small, white feather floated from above and landed in my lap.  “The chemo is either causing you to molt or it’s a sign from above,” Carolyn remarked.  We started laughing.  The feather was from my festive flower affixed to my scarf.  It was the perfect way to end the three-hour ordeal.

Since I didn’t experience any allergic reactions to the Taxol, I knew that new side effects could be a possibility the first few days after my treatment.  I awoke the following morning with slight tingling in my hands and feet, which is considered a common response. The feeling subsided within a few hours.  The next day, fatigue and digestive issues were the side effects du jour. After taking medications throughout the day to deal with the diarrhea, a new condition cropped up – severe bone pain in my upper spine, hips, knees and shins.  I was so uncomfortable during the night that I had to take pain medication and place pillows under my knees to take some of the pressure off the joints. I went to work on Monday morning but the pain was ever-present.  I checked the side effects on the Internet just to confirm that what I was experiencing was normal…and it was.  The pain lasted two more days. The days following I felt great.  Well, maybe that’s an exaggeration.  I did feel pretty good and actually had some energy.  The fatigue was still present but only at night.  I was even sleepy at normal bedtime hours; however, the night sweats continued to wake me up and disturb my slumber.  After two and a half months of chemotherapy, I was accustomed to the minor inconveniences associated with ridding my body of cancer.

About ten days after the Taxol infusion, I decided to check the size of the mass in my right breast.  It was significantly smaller and could no longer be felt along the outer tissue, which was very exciting. The Taxol was responding exactly the way Dr. Makhoul said it would and after only one treatment, too. There is no question that the Taxol causes more issues than the adriamycin and cytoxan cocktails taken during the first four treatments; however, I felt confident that it was going to eliminate the tumor completely and make it easier for the breast surgeon, Dr. Klimberg, to do her job. There is no question in my mind that the positive results of chemotherapy far outweigh any of the pesky side effects.  And with only three more treatments to go, I’m determined to persevere.