You can call me SUPER Woman!

So I guess the Neulasta shots paid off. I walked into the BMT unit on Monday to have labs drawn for a hopeful stem cell collection to start on Tuesday. The nurse accessed my Permcath and sent the labs for analysis. She told Mark and I that we were free to leave and just to come back in the morning. I, however incisted that we stay to find out if I was still neutropenic. I was on neutropenic precautions for close to a week and was determined to spend the day out if I could. I was very happy to hear that my WBCs were at 7.26, smack dab in the middle of normal! :) And I didnt have to wear that goofy blue mask! We spent the day at The Summit mall. We had lunch at Chuy's Mexican Restaurant and then saw the movie "The Help". It was so good! I recommend everyone see it! I still laugh about it. For dinner we had The Cheesecake Factory of course and I did have a piece of my red velvet cheesecake :)

On Tuesday morning we arrived at the BMT unit. The nurse took more labs. I was happy to hear that my labs were good and I was ready to collect! I was connected to the "phresis" machine and the process began! It was very similar to dialysis in that the machine took what it needed and gave me back the rest. In this case it was taking the stem cells from my peripheral blood stream. The process wasn't bad at all. I felt a little light headed but that was from my blood pressure. As silly as it may sound, with each new procedure that I go through as "the patient" I think of the patients that I have taken care of. I think that this whole experience will give me an insight that no other experience could and in turn make me a more compassionate nurse. Isn't it amazing how our God uses us for his purpose.

After about 2 hours the nurse took a sample of the collection to send to the lab. They would determine actually how much of the collection was stem cells. During the process the machine not only collects stem cells but other blood cells and electrolytes. That's why this analysis is important. If the numbers come back showing that the proportion of stem cells is where it should be then the collection process would stop at 4 hours. If not it would continue until it reached 6 hours and for days after until it reached enough collected stem cells. I was very shocked and happy to hear that I would be coming off of the machine at 4 hours. Considering that most people take at least 2 days for collection, I couldn't of been happier. The nurse began calling me "super woman" at this point :)

Thankfully, I didn't need any IV electrolyte or blood product replacements! The nurse couldn't believe that either. She said that most people need at least one electrolyte. I only had to take 1 potassium and 2 Magnesium tablets with dinner. I was so happy to have the process over with! Mark and I celebrated by having dinner at Jim and Nicks BBQ in downtown Birmingham. I usually don't care for BBQ but that was the best BBQ sandwich that I have ever had! I had to stay in Birmingham for the night because they had to do more labs in the morning.

The next morning we packed up and went to the BMT unit for labs. They all came back great!! I didn't need any further oral electrolyte replacement either! We met with our new Nurse Practioner, Melissa. She's a sweetheart! I forgot to mention that we had to fire the old NP Christine. That's another story that I'll have to share later. I feel much more comfortable with Melissa. She seems to be much more compassionate and I'm more confident in her care. After meeting with Melissa we were free to go! We were on the road by 10:00 and home by 1:00! Now I am just waiting to hear from my clinical coordinator for the next steps in the process. For now I'm just enjoying life and praising God for all of his many blessings! :)

*I forgot to take a picture during the process so I found a picture of an aphresis machine to post.

Mobilization Chemotherapy

Day 3: We arrived at the BMTU around 0700 where we were greeted and put into a room. The nurse came in and said that they didn't have a bed for me at the moment because of an unexpected admission during the night. She said they would be able to start the chemo in the outpatient room. She then started my IV fluids at 236cc/hr. I guess they really wanted me to be hydrated. I was also started on a Dopamine drip to keep me from going into fluid overload. Mark got us breakfast and we just hung out until they begain "pre-meds" around 1100. I got a dose of Zofran and Solumedrol and at noon the chemo began. The first drug was the VP-16 (Etoposide) and it infused over 2 hours. The worse part of this drug was the metallic taste it left in my mouth. The best way I can explain it is that taste you have in your mouth after leaving the dentist. You know, the taste that comes from the gloves and floss they use.

Around 430pm I got my room. It was nice and spacious. Mark immediately requested a different recliner. The upright flowery pattered chair wasn't going to do it for him. Soon after my nurse David began the second drug, Cytoxan. This drug can cause heart problems so I was connected to telemetry and my vitals were monitored during the 2 hour infusion and for 1 hour after. That damn machine beeped the whole time, I thought it was pretty funny. Later my night nurse Kaci disconnected me and I took a walk and then worked on crocheting Allie's blanket. Later I attempted to sleep. Between vitals being take every 4 hours and having to urinate every 1-2 hours, I got no sleep.

Day 4: After change of shift David came in and did his assessment and let us sleep until like 1130. The day went by pretty fast. I got my second dose of VP-16. It was the last of the chemo but I had to stay until the next day for hydration. I enjoyed the hospital dinner of blackeyed peas, macaroni and cheese, corn, and salad. It was actually pretty good. Kaci stopped the Dopamine drip and instantly the urinating every 1-2 hours stopped. I enjoyed a pretty good night sleep.

Day 5: After seeing Dr. Salzman, David came in and disconnected my fluids. I was free from the IV pole!! lol. About 45 minutes later I got my discharge paperwork and we were on our way home!

Life has been great since we have been home! I haven't really had any fatigue or side effects. This chemo was much better than the last. I began the Neulasta shots and they have went well. I haven't had any flu-like symptoms or bone pain. Today was day 6 of the shots. A friend advised me to take Claritin while on the shots to counteract the flu-symptoms. I don't know if it is the reason for my doing so well but I'll give it some credit! I've been on neutropenic precautions since Thursday but it hasn't been that bad. I just have to be very careful of what I eat and can't really go out in public places.

We have to go back on Monday for labs and to begin the stem cell collection process. I'm hoping it will only take one day. I'm excited to be getting closer and closer to getting all of this done so I can go back to normal life. Thanks for the continued prayers and support!

Part 1: Consents and Permcath Placement

Day 1: Last Tuesday we traveled our nice 2 1/2 hour drive to Birmingham for the purposes of having my Permcath placed and having chemotherapy. It always sucks leaving Allie but I knew it would be over in no time. Upon arrival to the Bone Marrow Transplantation Unit (BMTU) I was greeted, had my vital signs and weight taken, and was asked to wait in one of the rooms. Over the past few years, I have learned a lot about myself. One thing is that at times I don't have a lot of patience which leads me to speaking my opinion and not caring who is around. After about an hour of waiting I kindly asked the lady at the desk what were we waiting on. She responded, "The doctor but your appointment isn't until 11:00 and it will be a little while after that. At this point it's like 10:00, meaning we got there when I thought the appt was at 9:00. As mentioned above, I don't have a lot of patience and I let the lady have a piece of my mind. Probably wasn't the right thing to do but she understood when I apologized to her. I think it was because I really didn't want to be there in the first place and I hate waiting hours for a doctor and feeling like just a number. Also, we got up at the crack of dawn to get there on time which added to the time away from home and my Allie. Just frustrating. Mark suggested we go get a Starbucks drink and after enjoying my luscious White Chocolate Mocha we made it back by 11:00.

Later on, around 12:00 or so the Nurse Practioner, Christine walked in and asked a ton of questions. I could probably answer them all in my sleep by now. I met Dr. Salzman, who is lovely. And with the both of them there, I signed a consent for the collection of my stem cells and 2 others for purposes of keeping records and statistical data. That was it. All of that waiting for 30 minutes of signing papers and reviewing my medical history. So, off to the UAB townhouse it was.

First I must say how grateful I am to UAB for the free townhouse to stay at during our many upcoming trips to Birmingham. It makes life easier when you don't have to fork out tons of money each time you come over for a hotel room. Food and parking is expensive enough. However, upon arrival to the UAB "townhouse" i realized right away that it wasn't going to be the Marriott. We walked in and went to our room #606. When we walked into the room there was a table and chairs, a small kitchen, a bed, a desk and bathroom. The motel like comforter, the sideways photo above the bed, and the whop sided recliner were too much for me. And did I mention the roach catchers in every corner. LOL. Mark and I couldn't help but laugh and just take it all in. The best part was looking out of our window and seeing a Marriott and Doubletree across the street. Again, I am very greatful and know that there are many people who would consider this place a palace but it was just different from what we are used to. Later on that night I felt bad for feeling this way at all after seeing the many homeless people around downtown Birmingham. I felt so selfish and stupid. When we arrived back at the townhouse, I realized that it wasn't that bad and I had a bed to sleep in. It made me sad to think of the man that I had just saw on the corner. I just wanted to share the irony of the situation and remind everyone to be thankful for what you have because I promise that there are many who have it way worse and would love to be standing in your shoes.

Day 2: I woke up to the sounds of the city. It was 0630 and we had to be at the hospital by 0700. We arrived on time and went to Interventional Radiology as my paper said. After registering and waiting for 45 minutes, the girl at the desk told me that I would need to go to the BMTU and they would get me set up there. Again, I'm furious but this time I just say a few un nice words to myself and let it go. Mark and I then go to the BMTU. There they take my vitals, stab me in the chest (access my power port), and the transporter took me to IR. The procedure only took about 45 minutes but I was awake the whole time! I swear Versed is not what they make it out to be. I remember everything. From the time I got on the surgery table, the doctor numbing my neck, pushing the catheter in, me asking for more meds, and him sewing me up. The worst part was feeling the catheter (permcath) going into my neck, its an undescrible feeling. This is the catheter that will be used for stem cell collection and then for chemo and whatever else during the BMT. I feel for my patients who have to get a Permcath. It feels like a rod sticking out of your chest. Imagine a tube the size of a pencil tunneled under your skin and then left to hang out. Not a fun image, huh.

I only waited in the recovery room for about 5 minutes before being wheeled back to the BMTU. There I got my paperwork and was ready to leave. Then I felt the nausea. I think having no food and the fact that my neck and chest hurt are what caused the nausea. I popped a Compazine and after a cool washcloth and laying down for a few minutes, Mark and I bounced. LOL. On the way back to our lovely townhouse, my dear husband stopped at Guthries and got me some chicken fingers and fries. He knows me too well. I have been devastated since the Columbus Guthries closed down a couple years ago. Once back to the townhouse, I ate, took a pain pill, and slept for what seemed like forever. I woke up around 7pm.

I was determined to get my booty out of bed and not just sit there all night (plus I had heard about this Vera Bradley store that I was dying to check out). Mark and I went to an outdoor mall that was amazing. I didn't get anything at the Vera Bradley store because it turned out to be not that great. However, I did visit the Brighton store where I bought myself 4 charms for my bracelet. Dinner was at the Cheesecake Factory. It was amazing. We decided to get a piece of the red velvet cheesecake to go. It was the best thing that I think I have ever tasted. Needless to say, we will be going back there on our next trip.

GOD IS GOOD

So I have to share my exciting news! Today we went to UAB for pre-transplant tests (EKG, Chest X-ray, Labs, Echocardiogram). Those went great. While waiting in the waiting room for the nurse, Dr. Forero walks by. As always he hugs me and says "Hello Anita" and "How are you, Mr. Kirshkoff". Lol...Love him and his Colombian accent. I asked him if he would have time to show me my PET scan images and he said of course. I proceeded with all of my tests and then went back to his office. He already had the images on the screen and didn't have to say a word. I gasped when I saw them and all I could say was WOW. To compare the two, the image taken in May showed the tumor in my chest the size of a golf ball and now the image taken in July showed it to be about the size of a grape. I politely asked him, "So the radiologist who read the images was a complete idiot, right?" He smiled and said, "We clinicians just see things differently. This is why it is important not only to rely on the report but also see the images for yourself". To clarify, I was just told last week that my tumor didn't reduce at least 50% based on the Report....Now I'm seeing for myself that it indeed has reduced at least 50% or more. This is such great news because it means that the cancer is responding better than we thought. All I can say is that GOD IS GOOD. I couldn't stop smiling and still can't. Crazy the things that make me happy these days :)

Meeting with the BMT team......

Yesterday we met with the bone marrow transplant team. What a scary day. Me, being the cheerful person that I am and all smiles was in tears by the time we left. Everything seemed so surreal until yesterday. Everything was brought to light. I have done my research and through my nursing experience knew about bone marrow transplantion and the process. However, when a doctor is sitting in front of YOU telling YOU all of the things that YOU will go through and what to expect it's a whole different ballgame.

Dr. Shelton politely came into the room and introduced herself to Mark and I. With her were her assistant and clinical coordinator. She started out by explaining my scans and moved to what her plans were for my care. She said that my PET scan that was taken a week ago was good but not where she wanted it to be for transplant. It needed to show at least a partial remission to proceed with transplant. Unfortunately, I am not there yet. So plans were made for another chemo and hospital stay. I will be admitted to the hospital on August 4th to recieve Cytoxan and VP-16. During this hospital stay I will also have another "line" placed in my chest called a Permcath that will be used for stem cell collection. The type of transplant I will have is called "autologus" because I will be my own donor.

Once home from the chemo treatment I will give myself 9 days worth of Neulasta shots. Remember, it is the white blood cell stimulator but it also pulls the stem cells into the peripheral blood. The dose I will be giving myself is much higher than the normal dose because I need lots of stem cells in the blood stream for collection. I have been told to expect "bone pain" because of the large number of stem cells coming out of the bone marrow in such a short period of time. On the 9th day of shots I have to go back for labs and stay in Birmingham until my bloodwork shows that there are enough circulating stem cells for collection. Hopefully this will only take a day or two. Collection requires being connected to a machine (similar to hemodialysis) and having the stem cells collected and what isn't used going back to the body. This process is call aphresis and can take several hours. Once enough stem cells are collected they will be frozen and stored until transplant. Sounds fun, huh? Not even to the good part!

Sometime around September 4th I will have another PET scan. Hopefully it will show a great response to the chemo. I pray it will amaze me and show remission. That would be wonderful! If not, we will discuss that then. If the scan shows that I am ready for transplant we will proceed, probably mid September.

Once admitted to the hospital, I will recieve approximately 10 days of "high dose" chemotherapy. The drugs Busulfan, Cytoxan, and VP-16 will be used. This chemotherapy will completely deplete my bone marrow of all cells (Red blood cells,White blood cells, and Platelets). In turn, my immune system will be wiped out. This is where the transplant comes to play. I will be given my stem cells back and once transfused they will migrate to the bone marrow and start to produce healthy cells. This process called engraftment, can take 2 weeks or more. During this time I will be very vulnerable to infection and bleeding. When my blood cells show that they are high enough to leave the hospital with no complication, I will be released from the hospital. However, I will not be allowed to go home because we live too far away. I will be released to a townhouse nearby the hospital because I will have to follow up with the doctors daily for a while and in case of fever or infection. Hopefully I will only have to do this for about 2 weeks before I can come home.

That's really all I know for now. I hope it didn't overwhelm or confuse you. You may wonder why I have to do all of this. The reason is I have no other choice. It is a lot to go through but I have to be around for my Allie. The consequence of not having the transplant is near certain death from cancer. Sorry to sound so harsh, but it's the truth. The transplants main purpose is to rid the body of cancer and all of the minute cancer cells that may be undetectable and to prevent another relapse. The high dose chemo can do this for some. The scary part is that there is only a 50% chance that it will cure my cancer. Heads or tails. I'm determined to be a part of the 50% that call themselves survivors. I was once, and I will be again.

On another note, I am thankful to be given to opportunity to fight. Some people aren't so lucky. I'm thankful for everything I have been blessed with and I'll do my part to beat this horrible disease. I have faith in the Lord and pray that he will use me for his purpose. All I ask for is prayers from everyone. Thank you in advance.

"For I know the plans I have for you", declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future". --Jeremiah 29:11

What Cancer Cannot Do

Cancer is so limited...
It cannot cripple love
It cannot shatter hope
It cannot corrode faith
It cannot destroy peace
It cannot kill friendship
It cannot suppress memories
It cannot silence courage
It cannot invade the soul
It cannot steal eternal life
It cannot conquer the spirit.

Author: Unknown

 

 

 

Chemo......I'm gonna smile :)

I wanted to touch on chemotherapy. The dreaded chemotherapy. After confirmed relapse I began my 2 cycles of ICE chemotherapy. Three drugs: Ifosfamide, Etoposide, and Carboplatin. Three little devils. First I had to have a port placed again. Luckily, the radiologist agreed to put it in the same spot as my previous one so that we could minimize scaring. After it was in the chemo began! The Etoposide was given over an hour for 3 days. The Ifosfamide was given after the first dose of Etoposide over 24 hours. After it was finished a drug called Mesna was given over 12 hours to prevent bladder bleeding, a side effect of Etoposide. Also, on the second day a single dose of Carboplatin was given over 2 hours. Have I lost ya yet?? I was in the hospital for a total of 3 1/2 days the first cycle and 2 1/2 day the second cycle. The cycles were 3 weeks apart. All of the doctors and nurses at UAB were amazing!

While in the hospital, I was given an infusion of Decadron and Zofran each day to combat nausea. Thankfully they did their job and I had no trouble while in the hospital. I just rested a lot and would take walks with Mark. Coming home was a different story. The first days home I felt very tired and just blah. I took my oral Zofran 8mg every 8 hours and it helped with the nausea. I had no appetite at all and had to force myself to eat something. Totally not me. The second day home was always the worst. Went from feeling blah to feeling like I had the worst hangover known to man. Not sure if it was from the chemo or from the Neulasta shot I had to give myself on the first day home. The Neulasta shot is a white blood cell stimulator. By the third day I had more energy and felt better.

I had to be on "neutropenic" precautions 8 days after the chemo was started for 5 days. This meant no fresh fruits or veggies (everything had to be cooked), had to avoid crowds, no flowers, no sharing food or drinks with Allie. Its just a precautionary thing because this is the time my blood cell counts would be the lowest, increasing my risk for infection.

That's pretty much ICE chemo in a nutshell! It sucks but is well worth it to be healthy again. That is all :)

*The photo above was taken my first hospital stay on 06-01-11