Monday, July 21, 2014

Bumpity, bump, bump.....

Sometimes, it seems, things just aren't meant to be, such as my July 14 appointment at M.D. Anderson Cancer Institute in Houston.

Several weeks after my UAMS oncologist, Dr. Issam Makhoul, made the arrangements for me to see the cancer team at M. D. Anderson for possible inclusion in a trial drug protocol and/or new treatment program, I noticed six to eight hard, pea-sized nodules on my scalp.  Since my appointment at M.D. Anderson was still more than three weeks away, I decided to call Dr. Makhoul’s office and tell his nurse, Brenda, about the bumps on my head. It was Friday afternoon. She told me that Dr. Makhoul was out of town but she would let him know the first thing Monday morning.
marla crider, cancer, chemotherapy, advice, patient's blog
Marla and Don - July 4, 2014

After fighting cancer off and on for more than a year, I knew that the bumps on my head, and now a new one on my back, were related to the metastatic breast cancer.  Having cancer improves one’s health instincts. More times than not, the least little change in the body is usually a pretty good barometer that something isn't right. Late Monday afternoon, I finally received a call from UAMS.  It wasn't Brenda, Dr. Mak’s nurse; it was the good doctor himself, which alarmed me just a tad.

When I answered the phone, Dr. Makhoul wanted me to know that he had placed a call to M.D. Anderson Cancer Institute to inquire why my appointment was scheduled more than six weeks after he requested their medical team see me.  He promised to contact me after he spoke to someone in Houston

About an hour later, Dr. Makhoul phoned me to share what he had learned.  It seems that M.D. Anderson recently changed its policy when accepting and scheduling patients.  Texas residents are seen first, followed by patients from other states, then international patients.  Since I’m from little old Arkansas, my appointment was delayed for six weeks, without considering how aggressive the cancer had become. Dr. Makhoul was incensed that no one from M.D. Anderson had notified the UAMS oncology department about the new policy, especially since the doctors there refer lots of patients to them.  The oncologist with whom Dr. Makhoul spoke went on to tell him that I wasn't a candidate for any of the trial treatments being offered and he encouraged Dr. Makhoul to continue treating me in Little Rock.

Dr. Makhoul told me that we could no longer wait to start a new treatment plan.  He directed Brenda to schedule an appointment for me on Wednesday, as well as time in the infusion room for chemotherapy.  Things were moving fast, as they always seem to do with cancer treatment.  I must admit that I was actually relieved to learn that the appointment at M.D. Anderson had been canceled and I was back in the hands of the doctor I trusted the most. Even Don was satisfied with the current turn of events.  He understood the urgency and was ready to stand by me, yet again, as I endured another series of chemo treatments.

As they had done a year earlier, my brothers decided that one of them would be with me for each chemo treatment.  My older brother, Mike, and sister-in-law Barbara, drove from Springdale in Northwest Arkansas for my first treatment.  As I have mentioned before, family support is key for those of us battling cancer.  Never will I ever be able to verbally express my gratitude and unconditional love for the sacrifices of time and travel mine has provided me.

We all arrived at UAMS for my appointment with Dr. Makhoul to learn what his plan of action would be.  It was early enough in the day that I only had to wait for an hour before seeing him.  When Dr. Mak entered the exam room, I was very glad to see him.  It had been more than a month since we had talked about my diagnosis.  The first thing Dr. Mak did was examine the bumps on my scalp, as well as the one on my back, and acknowledged what I already knew; the cancer was spreading…quickly. 
marla crider, little rock, arkansas, breast cancer, triple negative, advice, patient blog
Back in the Infusion Room

The plan included a double whammy of carboplatin and gemzar – two chemotherapy drugs that Dr. Makhoul said had rendered very good results for other patients.  It may seem odd to be excited about taking chemotherapy, but I was.  It meant that I was no longer going to have to sit idly by while the cancer cells dined freely on my liver, lungs and bones.

My family, Don and I made our way to the very familiar surroundings of Infusion 1, located on the first floor at the UAMS Cancer Institute’s Outpatient Clinic. As usual, the waiting room was almost to capacity and our wait was long.  When my name was finally called, I almost skipped to the recliner where I would begin treatment. 

How appropriate that Mr. Nurse Ratched would be the RN assigned to administer the newest round of chemotherapy. He greeted me with a smile and requested I tell him my current status. When I shared that the cancer had spread to my lungs, liver and pelvis, he said, “Yep, that’s where breast cancer likes to go, but rest assured Dr. Makhoul has an arsenal of chemo drugs to get you back on the right track.”  I was somewhat surprised that Mr. Nurse Ratched was actually trying to make me feel better.  Who knew that the guy was capable of compassion? 

As Mr. Nurse Ratched prepared to start pumping the intravenous poison into my system, I noticed two new RNs in the infusion room – both were male.  I remarked that it appeared he was no longer the token male in Infusion 1.  He replied, “Yes, I have two new roosters in my hen house.”  I laughed out loud.  My nemesis with the questionable bedside manner had acquired a sense of humor since our first encounter more than a year ago.  

Mike and Barbara shared “sitting” duty, while the carboplatin and gemzar dripped into my bloodstream, each drug taking approximately 30 minutes. Mr. Nurse Ratched told me the usual side effects from the drugs were fatigue, constipation, and a possibility that my blood counts might be affected. Some hair thinning was also possible.  I have determined that side effects are what you allow them to be and I refused to let them interfere with my daily routine or my job.  Dr. Makhoul scheduled me for chemo two consecutive weeks, then off the third week to allow my body to recover.

Fatigue and a few achy bones were the side effects that I noticed after the first treatment.  Also, I was experiencing some insomnia.  Even with that, I felt blessed that the side effects were minimal and prayed that this would be the norm, not the exception. 

Treatment number two was scheduled on July 3.  My middle brother, Marion, and sister-in-law Carolyn journeyed to Little Rock to provide support.  Don was expecting 19 family members for the Fourth of July, so we agreed that he should spend time preparing for the mass of people and leave the care giving duties up to Marion and Carolyn.  Whether necessary or not, it is always comforting to have family nearby, should something unforeseen happen.  

The most important thing I observed after the second treatment was that the bumps on my head were all but gone.  The nodule on my back was still noticeable but felt smaller.  I was ecstatic.  After only two treatments, it was apparent the carboplatin and gemzar were killing the cancer cells!  God bless Dr. Makhoul!!

My miracle worker of a doctor requested to meet with me on July 18 - week three - to discuss my progress.  This time, it was Mike and Barbara’s turn to make the trip to Little Rock. Since Don’s ability to walk has become more burdensome, due to numerous knee replacement surgeries and old sports injuries, I encouraged him to let my family do the walking, sitting and waiting with me and he agreed.

Mike decided to accompany me to meet with Dr. Makhoul. As usual, the wait took about an hour.  In his usual hurried state, Dr. Mak entered the exam room anxious to hear how I handled the first two treatments. When I shared that the bumps were gone, he almost didn’t believe me.  He requested that I sit on the exam table for a quick check of my heart, lungs and bump patrol.  To say that Dr. Makhoul was surprised and elated would be an understatement.  He was almost giddy.

I told him that I was hopeful the chemo was working as hard to destroy the cancer cells internally as it had done externally.  To determine if that is the case, Dr. Mak scheduled a PET scan for August 4 that will provide the answer.  He ordered the third round of chemo and confirmed that I am still his poster child for chemotherapy because my blood work is excellent and the side effects are manageable, which is uncommon for the type of chemo I’m taking.

Before Mike and I left the exam room, I heard Dr. Makhoul use the “R” word – remission.  He enthusiastically told me he had several patients who had experienced remission after receiving the one-two punch of carboplatin and gemzar and I might just be one of them.  I could feel the warmth of God’s embrace after that comment and even heard a faint “praise the Lord” coming from the direction of my brother.

As I sat through the 90-minute intravenous drip of my two, new best friends – carboplatin and gemzar – I prayed silently that the “R” word would trump the “C” word and become a frequently spoken description of my health status.  I certainly don’t want to get ahead of the PET scan results, but I keep repeating the word…remission.  It has a nice ring to it, doesn't it?


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