It's called "ascites" and it is the pooling of excess / fugitive fluid pooling in the abdominal cavity - and Cathy has developed it over the last two weeks. The 5-6 month "pregnancy" look is the result and Cathy could no longer tolerate the pain. Thus, we spent 7 hours of today in the ER at Delnor awaiting tests, results, and finally the "paracentesis" whereby the fluid was removed.
Cathy didn't sleep last night so when they finally gave Cathy some Dilaudid [pain killer], she rested deeply ... for ten minutes at a time as I had to "force" down the solution she needed to drink before another CT scan. That, in and of itself, was not easy as Cathy already was so swollen that she didn't have the room for more, and yucky at that, fluids in her abdomen.
The paracentesis / tummy tap was very painful even with local anesthetic as they poked a needle into Cathy's abdominal cavity. A lot of fluid was removed and she's a tired ragamuffin so I'm hoping sleep will breathe new life into her frame tomorrow.
Saturday, January 30, 2010
Thursday, January 28, 2010
If You Could See Her Now ...
Wow, what a difference a day can make when you have metastatic breast cancer in your liver! Cathy was awful on Wednesday and by the time we reached the U of C clinic today, she had double the energy and "voice".
We met with Dr. Suzanne Conzen and staff and were very pleased with her professionalism, candor and competency. Due to additional bleeding [cancer loves sources of blood], trauma, potential infection, and a firm belief that the underlying liver issue causing elevated enzymes is the cancer, Dr. Conzen thought it wiser NOT to biopsy the liver.
Since most chemotherapies are metabolized / processed IN the liver and Cathy's bilirubin is elevated to the point she can NOT receive most chemos, Dr. Conzen prescribed a much less toxic [to the hair, fingernails, etc] ORAL chemo [XELODA] that Cathy can self administer and is not processed in the liver. Additionally, there is strong evidence that this drug can be highly effective in helping to restore better liver function [proved by reduced bilirubin].
Like any drug, this one has potential side effects but a patient of Dr. Conzen's has been on this chemo for 40+ weeks and her bilirubin has fallen from 18 to ~1.5 [normal]. As usual, Cathy will follow the Drs. regimen and we will remain faithful and look forward to seeing what this treatment will yield. Praise God!
We met with Dr. Suzanne Conzen and staff and were very pleased with her professionalism, candor and competency. Due to additional bleeding [cancer loves sources of blood], trauma, potential infection, and a firm belief that the underlying liver issue causing elevated enzymes is the cancer, Dr. Conzen thought it wiser NOT to biopsy the liver.
Since most chemotherapies are metabolized / processed IN the liver and Cathy's bilirubin is elevated to the point she can NOT receive most chemos, Dr. Conzen prescribed a much less toxic [to the hair, fingernails, etc] ORAL chemo [XELODA] that Cathy can self administer and is not processed in the liver. Additionally, there is strong evidence that this drug can be highly effective in helping to restore better liver function [proved by reduced bilirubin].
Like any drug, this one has potential side effects but a patient of Dr. Conzen's has been on this chemo for 40+ weeks and her bilirubin has fallen from 18 to ~1.5 [normal]. As usual, Cathy will follow the Drs. regimen and we will remain faithful and look forward to seeing what this treatment will yield. Praise God!
Wednesday, January 27, 2010
In God's Hands
Today Cathy had her follow up appointments with the infectious disease Dr. [Lewis] and Dr. Bayer, and not a moment too soon. Cathy has been very fatigued, in increasing pain, itching from elevated Bilirubin and uncomfortable from distended abdomen - an "expert" in mothering, Carol Casey having given birth to 7 children, estimated Cathy's girth to resemble a 5-6 month pregnant women. While Cathy's vitals were all good / within range, her weight has increased around 11 # in the last 9 days. Cathy has also been concerned about increasing yellowing of her skin due to jaundice, and it was confirmed to her today as a result of yesterday's blood draw results - her bilirubin has increased from 6.2 on 1/18 to 9.9 as of 1/26.
The daily intravenous antibiotic Cathy has been administered for the last 9 days has proven, if anything, only to exacerbate her liver malfunction [or perhaps of no assistance at the very least]. Cathy's other elevated liver enzymes have not come down since her hospital stay so the antibiotic was discontinued.
Carol Casey was along for both appointments and like us, she was impressed with the candor, compassion and efficient manner in which Dr Bayer got things going. Two bits of good news came out of this meeting. Although he admitted the current regimen has proven unsuccessful, Cathy's WBC is up to 10 [WOW!] and he has moved Cathy along to the University of Chicago for them to conduct tests, evaluate Cathy, and potentially get her in the PARP Inhibitor phase III study.
We have a 4:00 appointment on 1/28 through which we hope and pray the U of C Drs. can biopsy Cathy's liver, drain excess fluid, and determine that she is a viable candidate for the study [the cancer in her liver is rather "diffuse" / integrated front portion of her liver and not an identifiable and measurable tumor].
I believe this is a "double blind" study [the Drs. don't know which patients are initially prescribed the PARP inhibitor] and the recipients of it are chosen by lottery [she has a 50% chance of receiving chemo with placebo or a 50% chance of getting chemo and PARP inhibitor].
Though much has to be done [and this might presume she is ABLE to get chemo at all in light of her elevated liver enzymes] we gratified to know she is being cared for and the Drs. are being proactive rather than having Cathy languish at home without being monitored. We're also praying that a biopsy of the liver might provide better direction for her care. Additionally, IF Cathy can receive chemo, even if she doesn't get the PARP inhibitor, at least she'll get more than she has received in the last three weeks because of low WBC or elevated liver enzymes.
Finally, Lord willing, if Cathy does get the PARP inhibitor, it has shown great promise in fighting triple negative breast cancer: http://www.wavy.com/dpp/news/health_news/health_wavy_norfolk_parpstudy_20090909
When we've been successful in distracting Cathy from her pain, we've seen glimpses of her trademark sense of humor and love of life and others. Please pray with us for compassionate and good doctors, test results that provide hopeful treatment, that Cathy would receive the PARP inhibitor and that we would remain in God's care and loving hands.
The daily intravenous antibiotic Cathy has been administered for the last 9 days has proven, if anything, only to exacerbate her liver malfunction [or perhaps of no assistance at the very least]. Cathy's other elevated liver enzymes have not come down since her hospital stay so the antibiotic was discontinued.
Carol Casey was along for both appointments and like us, she was impressed with the candor, compassion and efficient manner in which Dr Bayer got things going. Two bits of good news came out of this meeting. Although he admitted the current regimen has proven unsuccessful, Cathy's WBC is up to 10 [WOW!] and he has moved Cathy along to the University of Chicago for them to conduct tests, evaluate Cathy, and potentially get her in the PARP Inhibitor phase III study.
We have a 4:00 appointment on 1/28 through which we hope and pray the U of C Drs. can biopsy Cathy's liver, drain excess fluid, and determine that she is a viable candidate for the study [the cancer in her liver is rather "diffuse" / integrated front portion of her liver and not an identifiable and measurable tumor].
I believe this is a "double blind" study [the Drs. don't know which patients are initially prescribed the PARP inhibitor] and the recipients of it are chosen by lottery [she has a 50% chance of receiving chemo with placebo or a 50% chance of getting chemo and PARP inhibitor].
Though much has to be done [and this might presume she is ABLE to get chemo at all in light of her elevated liver enzymes] we gratified to know she is being cared for and the Drs. are being proactive rather than having Cathy languish at home without being monitored. We're also praying that a biopsy of the liver might provide better direction for her care. Additionally, IF Cathy can receive chemo, even if she doesn't get the PARP inhibitor, at least she'll get more than she has received in the last three weeks because of low WBC or elevated liver enzymes.
Finally, Lord willing, if Cathy does get the PARP inhibitor, it has shown great promise in fighting triple negative breast cancer: http://www.wavy.com/dpp/news/health_news/health_wavy_norfolk_parpstudy_20090909
When we've been successful in distracting Cathy from her pain, we've seen glimpses of her trademark sense of humor and love of life and others. Please pray with us for compassionate and good doctors, test results that provide hopeful treatment, that Cathy would receive the PARP inhibitor and that we would remain in God's care and loving hands.
Wednesday, January 20, 2010
The [Mother] Eagle Has Landed
Cathy was released from the hospital tonight. Although she screened negative for Hepatitis A, B or C from her 1/15/09 blood draw, the infectious disease doctor called in on Cathy's case seems to think the recent elevation of liver enzymes was due either to:
"Hepatitis" as a reaction to the medication designed to combat THRUSH, Flucazanole OR
Yeast / Candidiasis in her liver [thrush migrated there]
So, fun for us, we will be administering the same intravenous anti-fungal medication she has been receiving while in the hospital the last 2 or 3 days. Thankfully, our insurance provides for Home Health Care that will get us set up for it and instruct us how to do it.
Our "matriarch" is tired from inability to sleep in the hospital, dried out in her mouth / nose from the dry hospital air and now eating quite well again! Her liver enzymes are coming down, WBC is up and should continue to rise through lack of chemo the last two weeks and for the foreseeable future and platelets are well into normal range.
Another prayer concern is that Cathy will not get chemo until her liver enzymes are under control. This cancer has been aggressive and fast growing, we hope and pray that the cancer will be held in abeyance while her enzymes retreat.
"Hepatitis" as a reaction to the medication designed to combat THRUSH, Flucazanole OR
Yeast / Candidiasis in her liver [thrush migrated there]
So, fun for us, we will be administering the same intravenous anti-fungal medication she has been receiving while in the hospital the last 2 or 3 days. Thankfully, our insurance provides for Home Health Care that will get us set up for it and instruct us how to do it.
Our "matriarch" is tired from inability to sleep in the hospital, dried out in her mouth / nose from the dry hospital air and now eating quite well again! Her liver enzymes are coming down, WBC is up and should continue to rise through lack of chemo the last two weeks and for the foreseeable future and platelets are well into normal range.
Another prayer concern is that Cathy will not get chemo until her liver enzymes are under control. This cancer has been aggressive and fast growing, we hope and pray that the cancer will be held in abeyance while her enzymes retreat.
Monday, January 18, 2010
What a day - renewed hope!
With rising liver enzymes, jaundice and concerns of Hepatitis or liver failure [signs looked to the former, fears "imagined" the latter], today has been quite the rebuttal. And we praise God for answered prayers!!
The day started with another blood draw at the chemo station since Cathy's blood from Friday, 1/15 was still inadequate to allow for therapy. Results came back with a solid 3.6 well above the cautionary point and platelets exceeding 200 [160 being the low point of "normal].
The next stop was to meet with Dr. Bayer and get the full results from the liver enzyme and tests for hepatitis. Cathy was negative for hepatitis A, B or C and the cancer marker even ticked down slightly! However, many of her already significantly elevated liver enzymes more than doubled. The CT scan from 1/13 could reveal any clues, Cathy can't get MRI scans now, so Dr. Bayer had Cathy admitted to the hospital for more tests and to be seen by a gastroenterologist and infectious disease doctor. The concerns being a possible blockage causing the increased enzymes. Chemo was not administered and won't be until the liver enzyme conundrum is deciphered.
The intake procedure, subsequent scans [EKG, X-ray and ultrasound] and visits by doctors was done with remarkable precision and timeliness. Both doctors, as well as Dr. Bayer, suggested the Flucazanole for THRUSH may have contributed to these elevated enzymes and the ultrasound did not indicate any blockage. Additionally, blood drawn today showed one of the key enzymes even retreated between last Friday and today ... and Cathy took her last Flucazanole this morning! If subsequent tests on Tuesday, 1/19 show enzymes continuing in a decreasing fashion, Cathy will be released from the hospital and will not need and ERCP procedure to be done.
This sure looks like great news and should allow chemotherapy to resume sometime soon. HOWEVER, with weekly chemotherapies resuming, the concern is now focused on a way to keep Cathy's WBC from degrading to the point that she gets THRUSH again as the treatment [Flucazanole] may be as disquieting as the ailment!
For now, the patient is resting [as best possible] in the hospital and we'll fight tomorrow's battles with renewed optimism! Praise be to God for answers to many faithful prayers!!
The day started with another blood draw at the chemo station since Cathy's blood from Friday, 1/15 was still inadequate to allow for therapy. Results came back with a solid 3.6 well above the cautionary point and platelets exceeding 200 [160 being the low point of "normal].
The next stop was to meet with Dr. Bayer and get the full results from the liver enzyme and tests for hepatitis. Cathy was negative for hepatitis A, B or C and the cancer marker even ticked down slightly! However, many of her already significantly elevated liver enzymes more than doubled. The CT scan from 1/13 could reveal any clues, Cathy can't get MRI scans now, so Dr. Bayer had Cathy admitted to the hospital for more tests and to be seen by a gastroenterologist and infectious disease doctor. The concerns being a possible blockage causing the increased enzymes. Chemo was not administered and won't be until the liver enzyme conundrum is deciphered.
The intake procedure, subsequent scans [EKG, X-ray and ultrasound] and visits by doctors was done with remarkable precision and timeliness. Both doctors, as well as Dr. Bayer, suggested the Flucazanole for THRUSH may have contributed to these elevated enzymes and the ultrasound did not indicate any blockage. Additionally, blood drawn today showed one of the key enzymes even retreated between last Friday and today ... and Cathy took her last Flucazanole this morning! If subsequent tests on Tuesday, 1/19 show enzymes continuing in a decreasing fashion, Cathy will be released from the hospital and will not need and ERCP procedure to be done.
This sure looks like great news and should allow chemotherapy to resume sometime soon. HOWEVER, with weekly chemotherapies resuming, the concern is now focused on a way to keep Cathy's WBC from degrading to the point that she gets THRUSH again as the treatment [Flucazanole] may be as disquieting as the ailment!
For now, the patient is resting [as best possible] in the hospital and we'll fight tomorrow's battles with renewed optimism! Praise be to God for answers to many faithful prayers!!
Sunday, January 17, 2010
Long Overdue [2 of 2]
The events of this past week warrant a post all their own, so strap in! January 11 proved to be, almost on queue, another week without chemo [it seems the story is the same every third week]. Cathy's WBC was at 0.9 [again, normal is 4.1 - 10.9]. Additionally, Cathy experienced excruciating THRUSH in her throat again, almost immediately following the last dose of Flucazanole from her prior bout with THRUSH - but this is just one more result from such low WBC. Because the Dr and nurses all thought Cathy looked strong, and she is such a good patient and can rebound on her own, Dr. Bayer elected to avoid the cost [and PAIN] and forego the Neupogen shots.
Not knowing why he did this and [with the incorrect misunderstanding about previoius transfusions], I contacted the Dr. on Tuesday for clarification. I also mentioned that Cathy and I had compared the last three "liver panels" against the original blood draw from 9/14. While some of the key liver enzymes had come down slightly over the last 6 weeks or so, they were all SIGNIFICANTLY higher than those from 9/14 and one key measurement went up.
Dr. Bayer had been on some task that took him away from seeing patients for several weeks, so after we hung up he reviewed Cathy's liver measurements. He called me back within 2 hours on Tuesday to suggest a new CT scan ASAP and another blood draw on Friday, 1/15. En route to the CT scan on Wednesday evening, Cathy mentioned some new symptoms she had noticed that were abnormal. By Thursday when the Dr. called to inform us of the CT scan results [no new growths, but no reduction in the size of the tumor in her liver], Cathy also informed him of her jaundiced eyes and skin - signs of additional compromise in her liver.
Full results of Friday's blood draw should be known by our late AM chemo appt on 1/18. These last few days have been very difficult not knowing what else is wrong with Cathy's liver and if this will affect her ability to continue with chemo. Amidst all the fatigue [so UNlike Cathy], I did see some strength from her for a short period this afternoon and it gave me hope that we can still address these issues.
The goal is to get Cathy to the point that she can receive the "PARP inhibitor" that is in final testing now. The test is going so well that our Dr. is optimistic it may receive FDA approval by mid-summer '10. We have, to this point, opted against getting in the test as there's a 50% chance she would get the chemo and placebo instead of the chemo and PARP inhibitor and there are vastly different and apparent results that all can see, even though it is a double blind study. Please pray with us to this end. Thanks for caring, encouraging, helping and praying.
Not knowing why he did this and [with the incorrect misunderstanding about previoius transfusions], I contacted the Dr. on Tuesday for clarification. I also mentioned that Cathy and I had compared the last three "liver panels" against the original blood draw from 9/14. While some of the key liver enzymes had come down slightly over the last 6 weeks or so, they were all SIGNIFICANTLY higher than those from 9/14 and one key measurement went up.
Dr. Bayer had been on some task that took him away from seeing patients for several weeks, so after we hung up he reviewed Cathy's liver measurements. He called me back within 2 hours on Tuesday to suggest a new CT scan ASAP and another blood draw on Friday, 1/15. En route to the CT scan on Wednesday evening, Cathy mentioned some new symptoms she had noticed that were abnormal. By Thursday when the Dr. called to inform us of the CT scan results [no new growths, but no reduction in the size of the tumor in her liver], Cathy also informed him of her jaundiced eyes and skin - signs of additional compromise in her liver.
Full results of Friday's blood draw should be known by our late AM chemo appt on 1/18. These last few days have been very difficult not knowing what else is wrong with Cathy's liver and if this will affect her ability to continue with chemo. Amidst all the fatigue [so UNlike Cathy], I did see some strength from her for a short period this afternoon and it gave me hope that we can still address these issues.
The goal is to get Cathy to the point that she can receive the "PARP inhibitor" that is in final testing now. The test is going so well that our Dr. is optimistic it may receive FDA approval by mid-summer '10. We have, to this point, opted against getting in the test as there's a 50% chance she would get the chemo and placebo instead of the chemo and PARP inhibitor and there are vastly different and apparent results that all can see, even though it is a double blind study. Please pray with us to this end. Thanks for caring, encouraging, helping and praying.
Long Overdue [1 of 2]
For those who might still be following, I'm sorry for the delay in updating. Though our holidays were much more low key & "abbreviated", most of what was done was done by me so its been busy.
To update, Cathy received her chemo on 12/14, but again on 12/21 her White Blood Cell [WBC] count was too low to get chemo. During Cathy's original bout with cancer in fall of '08, Cathy received Neulasta to help her body create sufficient WBC to keep her on the schedule of chemo every other week - but using Neulasta does not allow for chemo on a weekly basis as Cathy is doing now. So on 12/21, with her WBC count at 1.1 ["normal range of 4.1 - 10.9], Dr. Bayer scheduled Cathy for daily Neupogen 12/21-12/23 . This stuff brings up the WBC but at the cost of flu-like symptoms and BONE PAIN. Tough trooper that she is, Cathy felt the pain the evening of 12/21. The evening of 12/22, however, was AGONY. Cathy lamented that she just couldn't do it again on 12/23. Although the "stand-in" Dr. ordered Cathy to have the shot, the nurses who know my wife's resilience insisted on taking blood labs first - praise God she was at 5.6, didn't need to get the shot, and had an extra day to recoup for Christmas.
We enjoyed time with family and friends for Christmas and the New Year. Cathy once again had consecutive chemo on 12/28 and 1/4 and we marched into the New Year. We hope your Christmas, like ours, was joyful and filled with the love of family and friends at the celebration of our Lord's marvelous birth.
To update, Cathy received her chemo on 12/14, but again on 12/21 her White Blood Cell [WBC] count was too low to get chemo. During Cathy's original bout with cancer in fall of '08, Cathy received Neulasta to help her body create sufficient WBC to keep her on the schedule of chemo every other week - but using Neulasta does not allow for chemo on a weekly basis as Cathy is doing now. So on 12/21, with her WBC count at 1.1 ["normal range of 4.1 - 10.9], Dr. Bayer scheduled Cathy for daily Neupogen 12/21-12/23 . This stuff brings up the WBC but at the cost of flu-like symptoms and BONE PAIN. Tough trooper that she is, Cathy felt the pain the evening of 12/21. The evening of 12/22, however, was AGONY. Cathy lamented that she just couldn't do it again on 12/23. Although the "stand-in" Dr. ordered Cathy to have the shot, the nurses who know my wife's resilience insisted on taking blood labs first - praise God she was at 5.6, didn't need to get the shot, and had an extra day to recoup for Christmas.
We enjoyed time with family and friends for Christmas and the New Year. Cathy once again had consecutive chemo on 12/28 and 1/4 and we marched into the New Year. We hope your Christmas, like ours, was joyful and filled with the love of family and friends at the celebration of our Lord's marvelous birth.
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