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.