I'm sorry if my last post left you with the idea that the chemo was going to go smoothly with no complications. In other news, I'd like to know who coined the phrase "fingers crossed" and punch him in the face.
Well, nevermind that. Since we last left you, Marye was doing pretty well after her chemo treatment. She had a little nausea, but it wasn't anything that we weren't used to at this point. A little phenergan and oxycodone, and she's fine.
But here's where it gets a little technical, so bear with me. The thing about chemo is its job is to kill fast-growing cells, which is what cancer cells are. Of course, there are other fast-growing cells in your body that are not cancerous, e.g. white blood cells, hair follicle cells, the linings of your mouth and colon, etc. So the chemo can't differentiate between good fast-growing cells and bad fast-growing cells. That's why you lose your hair when you take chemotherapy, as well as other side effects.
Well, with Marye's cancer in her liver, a big concern with her chemo is that it will cause damage to an already compromised organ. Add to that the stents which have already caused two bloodstream infections, and there are a lot of things to look out for. So, they took they a blood sample before her treatment yesterday, and it turns out that her bilirubin was elevated (telling us that her liver is struggling). So, last night her temperature started to climb. Now, this is often a normal effect of a tumor in the liver, but the doctor was adamant that we need to call them if her temperature hits 100.5 F. The reason for this is that she's very susceptible to infection since the chemo is now attacking her white blood cells.
Well, this morning, I got in touch with Dr. Riley about the fever, and that's when I first learned about the elevated bilirubin. So, Dr. Riley was a little concerned about the fever, and asked us to come in for a blood draw. Well, we're in the chemo lounge (looking at the parking garage), and Dr. Riley orders two hours of IV fluids, a chest x-ray, a urine sample, and another blood culture. She's looking for infection. Then the initial blood tests come back and Marye's bilirubin had climbed again, so there is definately a problem with her liver.
With this information, Dr. Riley calls over to Norton Hospital to get in touch with the biliary tract master, Dr. Vitale, only to discover that he's out of the country on vacation. Well, you can't blame the man for that, but Dr. Riley doesn't want the possible infection to take hold, so she orders two weeks of ampicillin. Being late in the day, she figures that she should admit Marye into the hospital at least overnight in order to get the antibiotics started, until I start to protest. Long story short (as if this wasn't a long enough story, anyway), we got in touch with Walgreens home health care pharmacy and set up a delivery of the ampicillin to the house. So, we're starting two weeks of home infusion (like last week), but at least she's not in the hospital, because no one ever gets well in the hospital.
In the meantime, Marye and I were talking about her chemo in 2005 and we remembered that she was taking Ativan to help with the nausea, as well as to help her relax and sleep. I mentioned that to Dr. Riley and she thought that was a good idea. So we now have Ativan. The only reason I'm mentioning this is because although it does a great job, it literally knocks her out like a zombie. But better to be a well-rested zombie than to be in constant pain and nausea. Maybe.
Ok, moving forward, I mentioned that we need to get the stent changed out pretty soon. Well, we're going to talk to Dr. Vitale as soon as he gets back in the office and have him check it out. Marye is back on antibiotics, so hopefully if she has an infection, we'll get that under control before it gets out of control. Again, the bottom line is, she needs to take the chemo to shrink the tumor. Then it will relieve the pressure on her bile ducts and liver, hopefully giving her some relief. Unfortunately, the chemo comes with its own set of issues that directly threaten the liver and a lot of other things, so it's a delicate balance. This is where I see that oncology is more than just following a flowchart of recommended dosages. When you have to take into account the condition of the patient and the many complications they may have, there's as much art as science involved.
Did I mention that cancer sucks?
-Chris
