On the road again....

It's been a while since I've written on here so I thought I would check in with everyone. Things have been going great. We've just been enjoying life and having a good time. I have been to Panama City Beach twice since my last appointment and this past weekend we visited Mark's dad and stepmom in Southwest Florida. I have felt great and have been spending my time just enjoying being with Allie. The highlight of my life this week is that my hair has started to grow back :) I feels weird to have the stubbles but for some reason I get so excited. It will definitely come out when I have the high dose chemo but it will be fun until then.

Today was our first trip back to Birmingham since the mobilization chemotherapy. We went for the pre-transplant scans and blood work. It took forever. My first appointment was at 0830 for a Pulmonary Function test. I have had many of these and so I knew what to expect. When we arrived I was pleasantly suprised to find out that I would also need an ABG (Arterial Blood Gas). We were taught in nursing school about how to draw an ABG and read the results. We also were told how painful these could be because the blood is drawn from an artery. I have never personally drawn an ABG but have seen many patients have these done. Needless to say, I didn't want to have it. After speaking my opinion to the poor Respiratory technologist, I agreed. She attempted my left arm twice. The 1st time wasn't that bad but the 2nd stick did it for me. I became dizzy and nauseaus and clammy. Almost passing out. I felt retarded because I couldn't take it but she said that it happens regularly. She didn't get any arterial blood unfortunately and didn't stick again. After I was over my episode, we proceeded with the Pulmonary Function test.

Next we headed to a different facility to have my CT and Chest XRay. This was the first time in my history of CTs that I have not gagged at the smell and taste of the CT contrast. This time it was purple and tasted just like grape kool aid. I couldn't taste a bit of the contrast. Who ever invented this type of contrast should recieve an award. I will definetely have all of my future CTs at this facility. The CT itself was a breeze. The worst part was the IV contrast because it makes you have this warm sensation all over your body. It makes you literally feel like you are peeing on yourself. I'm used to it now. I remember when I had my first CT years ago, I freaked out and just kept telling myself to breath. The Chest XRay was a breeze also.

We then visited the BMT Unit at the hospital to have labs and cultures taken from my Permcath and Medi Port. The nurse took 15 vials of blood!! I guess they need all of that info for the pre-transplant stuff but gahhh.. About that time my clinical coordinator Wendy came in and talked to Mark and I for a bit. She said that I would have to have the ABG done again. I wasn't thrilled at all. Mitzi, the nurse who took my labs, stuck me for my ABG. This time in my right wrist. She did a wonderful job and got it on the first stick. This stick wasn't that bad. I've had IVs that hurt worse. On another note, Wendy gave Mark and I a tentative calendar with a schedule on the upcoming events. Here's a quick rundown of events. I will have sign transplant consents on the 26th and my Medi Port taken out of the 27th of this month. I will then go back on October 3rd to have my other central venous catheter (Double lumen Hickman catheter) placed in my chest where my port was previously.  I will start my 10 day stretch of high dose chemotherapy on October 4th with transplant sceduled for October 14th. I'm so ready to get all of this over with so I can put it all behind me and move on with life.

We ended the day back at the Kirklin Clinic where I had a MUGA scan and EKG. The purpose of the MUGA scan it to detect any suble changes in the functioning of the heart caused by chemo. The test consisted of recieving injections of radioactive substances and then lying in a machine and having pictures taken of my heart. The EKG was normal showing a silly Sinus Arrythmia. Probably because I was talking while he was taking it. Together the tests took about 2 hours so by the time they were over we were ready to go and starving!

We only hit a few minutes of traffic and stopped at Dairy Queen for food. Wasn't my 1st choice but Mark loves it. We made it home by 8pm. Once home Mark saw on Yahoo that there was a 3.0 Earthquake in Birmingham at 5:59pm CST. Thankfully we were home by the time it happened.

That's about it on my travels for now. Thanks everyone for the continued prayers and support. I'll blog again soon :)

*I found this quote today and I love it.....

"Cancer makes a woman out of you. After that you become a warrior" ~ Danita Vance

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