That Natural Glow

Last week on yet another gray Monday morning, I made my way downtown to my treatment center for my tri-weekly herceptin infusion. This process feels so routine now that the full blown chemotherapy has ended.

In some regards, a lot happened during the three weeks between infusions – and, in fact, during the time since I finished chemotherapy on March 7th.  After a few weeks break, I met with my radiation oncologist on April 6th at my cancer center’s satellite site in the western suburbs, to do a mock-up of my radiation therapy. As always, I went armed with a list of questions – some gleaned from the American Cancer Society web site, others from information friends sent my way.  My friend, Joan came over the day before my appointment to give me a preview.  She was diagnosed a month before I was and was fortunate to be able to forgo chemotherapy.  She did undergo the 6 weeks of radiation therapy under the care of the same doctor I am seeing, Dr. Z, whom she liked very much.  It was great to visit with someone who has recently gone through much of what I was preparing to experience.

At my pre-radiation appointment I became a coloring book for the doctors and the technicians.  I was drawn on with markers by several hands as they outlined the area to be targeted.  I received numerous pen tip sized tattoos to help them line me up with the device that delivers my daily dose of radiation, five days a week for six weeks.  Ouch!  They even took photographs of my decorated chest for help in calibrating the treatment area.  

Abstract art marks the spot!

Since then, I have taken my own photographs to share what the treatment area looks like.

The Linear Accelerator, which delivers radiation treatment

The treatments are flying by with no major ill effects. I have had 17 treatments, with 13 left to go, and my skin is only marginally pinker than before.  I slather my chest each night with a prescription steroid ointment and moisturizing cream that the doctor provided.  The only downside of that is putting on my nightshirt afterwards – it sticks to my slightly gunky skin.  In the mornings I apply cornstarch to the treated area to reduce friction, and then I’m good to go. I do get tired a little more easily, but it’s not the major fatigue many radiation patients experience.  I’m not sure why I’ve been so lucky, but I certainly won’t spend much time worry about the whys on this one.  I just thank my lucky stars and feel very fortunate -- and grateful for whatever it is about me that has made this easier than it could have been! 

What's Up?

For those of you who have ever listened to Car Talk on NPR, you know that the "Puzzler" occasionally goes "on vacation". Well, that is what this blog did for a few weeks. I wish it had taken me with it, but it went away alone for a bit, while its author stayed put, for the most part. That is until I flew off this past weekend, my first trip in 16 months, which is a long time for me to stay put, for a fabulous family gathering in honor of my cousin Bill's 90th birthday.  

I will provide a quick update now, and once my taxes are done (cutting it a little close, aren't I?!), I hope to catch up on posts.  The long and the short of it is that I took a little longer to regroup from my final round of chemo than had been the case previously. I felt somewhat puny for an extra week or so, before suddenly turning a corner. My energy level is quite good, although I was fortunate throughout chemo in that it was never really very low, even when my hemoglobin levels were down. So things are coming along.

I have started taking anastrozole, an aromatase inhibitor, which I will take daily for 5 years to block estrogen production in hopes that it will keep further breast cancer at bay. I am still receiving herceptin infusions, but the schedule has been changed from a weekly dose to a triple dose once every three weeks. I had my second triple dose on Monday. Saving the best for last, tomorrow I start radiation therapy, which I will receive every day, Monday through Friday for 6 weeks. Throw a bone scan and another heart scan in there and it really is quite a schedule!


Between recuperating, getting ready for the next steps, working, my weekend trip, pulling together a monthly newsletter, taxes and applying for some grants, I have had a busy 5 weeks since chemo ended. I hope to write about some of that over the next few weeks.  In the meantime, keep your fingers crossed that I won't glow in the dark or suffer major skin burn.  Oh, and wish me luck!  

Is Nothing Really Ever As Easy As It Seems?

Four days after my last round of chemo on March 7th, I received a $1,500 bill from the physicians’ billing department at my treatment center.  In the fall, I had applied for, and received, full financial assistance for covering my out of pocket expenses for a year from the time of my cancer diagnosis.  I was eligible because, since leaving my job of 20 years in 2007, my income has been substantially reduced and I have a high deductible health insurance plan. 

I was certain that the bill was sent by mistake. When I was originally approved for assistance, I was told to call the billing department if I received any bills and they would take care of it. So, on Friday morning the 11th, I called the financial office, only to be told that the one thing they don't cover completely through financial aid are the chemo drugs.  A minor detail!  The chemo drugs cost about $8,000 per round, and, apparently, the physician's assistance program only covers 40% of that cost.  I am responsible for the other 60% until I meet my annual deductible, which is $5,000. This was news to me.

Well, after six rounds of chemo, and being pretty much an emotional rock from my diagnosis through surgery and chemo, that was enough to tip me over the edge. I had a bit of a meltdown after I got off the phone. The financial assistance supervisor said I should speak to the oncology social worker, but I was too wrought to speak to anyone intelligently about the issue that day. I finally made some calls the following Tuesday, and discovered that because it's after the fact there is only one foundation that will take a "look back" at previously incurred expenses. (Gee, if they had let me know this before the fact, I might have applied for additional help up front, and it wouldn't be after the fact!) To complicate matters, this particular foundation only opens the application process on the first of every month at 11:00 a.m. Eastern Standard Time -- standard, not daylight, not moonlight, not eclipse -- no matter what time of year it is. The phones are open until they run out of the allotted funding for the month.  So, on April 1st, I will be among the many people sitting by the phone, waiting for the stroke of 11 EST, to call and apply for additional assistance to cover the gap in my 100% financial aid!

Despite my initial shock upon learning that I am responsible for this bill, I do know how very fortunate I am to get the aid I'm receiving and I don't want to sound ungrateful. My treatment has spanned two calendar years, and could have cost me $10,000 out of pocket, so $1,500 is a relatively low price to pay. I just can't quite get over the irony that here I was sailing along, so relieved not to have to worry about the fiscal implications of cancer, and then five days after my last round of chemo the "other shoe" dropped. In this case it was a good sized financial one!  This begs the question – is nothing ever as easy as it seems?

P.S.  For those of you who might now be inclined to reach for your checkbooks, please know that if I don’t get the foundation funding I have other options, including an extended interest free payment plan. So put your checkbooks away, or write a check to NPR or the Red Cross’ effort in Japan instead, since I don’t have as much to give them at the moment as I would like.

Monday Monday

Monday again, and here I am back at the hospital.  However, with chemo now over, today is the end of one regimen and next week will be the start of another.  Today was my last weekly herceptin infusion.  I am scheduled to go back next Monday and have a three-week infusion, meaning that I will get a triple dose of this anti-clonal antibody.  Then, I will only come in once every three weeks after that for hour long herceptin infusions.  This routine will continue into November, until I've had a year's worth of treatments.  It will be a welcome change from having to turn up at the hospital every Monday.

I have been coming to the hospital for treatment for the past 19 Mondays. Each week I have carried my pocket-sized camera in my pack, with the intention of photographing the Gateway Arch from the treatment floor every week. The Arch is located just about three miles east of the hospital. Today, March 14th, an unexpected thick wet snow has obliterated any hope of seeing that monument let alone photographing it.  Oddly, this is in keeping with most of the Mondays I’ve been here. Not that we’ve had snow every week, but there has been a preponderance of gray, cloudy Mondays, which have made the Arch a dull subject.  As I look back on the days I did shoot the structure, I see that we had at least one beautiful clear sunny day – on Monday, February 14th.  Here are a few of the images I’ve captured of the varied moods of the Arch.

This last one was taken from the 14th floor of the hospital -- not the 7th where the treatment center is located. The 14th floor provides an amazing view and a very different perspective of the area. With at least a dozen more visits to the treatment center between now and November, perhaps I'll have some better opportunities to capture the St. Louis icon under better light through the seasons. It would certainly be a great venue for viewing the fireworks on July 4th!

Chemo: Round 6, Take 2!

I'm happy, and a bit surprised, to report that I am sitting in a lounge chair in treatment pod 7, hooked up and nearly ready for my 6th and final chemo treatment.  I certainly didn't expect to pass the platelet or hemoglobin tests this week, and was mentally prepared not to receive chemo.  In fact, I was almost sent home to wait another week. My hemoglobin is awfully close to the point where I should get another transfusion, and, although my platelets rebounded from an all time low of 34,000 to 78,000 per micro liter of blood, that was still only a mere 3,000 over the no chemo zone. But after consulting with the study coordinator and the fabulous Nurse Shannon, the doctor agreed to give me the taxotere and carboplatin at slightly reduced levels, so we can get through this, without having my platelets won't fall off the chart.

When I came into the pod of 4 recliners and 2 beds, the place was full.  One nurse had to leave -- she'd lost two teeth, or rather a bridge with her front two, and needed to get to the dentist. It was 2:30. The other poor nurse was left alone with 6 study patients to monitor, which makes a slow process even slower.  I started to get the infusion at 3:30, and before I knew it the benadryl had knocked me out.  Every time I opened my eyes at least one person had left and been replaced by another patient.  When I awoke again at 6:30 I was the only person in the pod, finishing up my cocktail.  It is now a bit after 7:00 and I'm having a final saline flush, before they pack me up and send me off.  My last chemo was, in the end, very anticlimactic, but I'm happy to have it done, nonetheless! 

I flunked chemo!

Well, I flunked chemo today, or more accurately, my blood test.  Both my platelet and hemoglobin counts were below the minimum level for receiving chemotherapy, so no treatment this week, except for Herceptin. Needless to say, I'm disappointed.  I was so hoping to finish this second leg of my tetrathalon today.  I am trying to focus on the fact that an extra week's wait isn't much in the larger scheme of things, but I haven't totally convinced myself of that yet.  I will!  In the meantime, keep your fingers crossed that my counts are above the threshold next Monday and I can receive my final round!

Preparing for the Final Round of Chemo

I sit here writing this through a veil of tears.  Not emotional tears -- just the overflow of tears from having clogged tear ducts.  I finally gave up the notion that this problem would resolve on its own, as it has after previous bouts. I guess my tear ducts are more clogged than before, perhaps from the cumulative effects of the chemo. So, on Friday I gave up and called my oncology nurse to see what she suggested. Apparently, this is a more common problem than the literature I’ve referred to suggests. The nurse told me that they can refer me to an ophthalmologist at the cancer center, who will do a procedure to open up the tear ducts. Although I don’t generally like any procedures having to do with eyes (mine or anyone else's), I am looking forward to this one, because this is one of the greatest nuisances I’ve endured since my cancer treatment began. 

In any event, tomorrow is my last round of chemo (fingers crossed it’s a go) and I look forward to having it behind me. Today, I am doing a few of the usual things to prepare. I’m working on a list of questions to discuss with the doctor about what to expect over the next few weeks.  I’m drinking a lot of water, have upped my fiber intake a bit – although I’ve found that this is a balancing act, so I’m not going overboard, and I have just cooked up a batch of Apple Mash as both a treat and a treatment should the often present side-effect of constipation become an issue. Even if it doesn’t, this is a great dessert, especially with a little vanilla ice cream served with it, and when the taste buds go south, as they always do after treatment, I add a good drizzle of maple syrup to enhance the flavor. (This could be why I've managed to put on weight, rather than lose it over the past 18 weeks -- or the weight gain could have something to do with the steroids I take for a week during and after chemo!)  Here’s the recipe in case you want to try it:

Apple Mash

2 lbs. apples, cut in large chunks (I like to use granny smiths)

½ cup apple cider

¼ cup raisins (I like golden)

¼ cup sugar (I tried dark brown this time – it’s a good addition)

¼ cup cinnamon (I use a little less)

Mix all in a 3-quart saucepan.  Heat to boiling over medium-high.  Reduce the heat to low.  Simmer 15 minutes or until very tender.  (I cook it at least 30 minutes – sometimes more) Mash coarsely with a potato masher.

Other than that, things are pretty much routine around here.  I will have labs at 11:00 tomorrow morning, meet with the doctor at 11:40, and, with any luck, will head into treatment at 12:30.  I should be done with my final chemo by 5:30 or 6:00, and then it’s home to relax and let this last round do its work, causing one last cycle of side effects before my body can start to regroup and gradually make its way back to normal!