So today was the start of Karen's second chemotherapy treatment. She had pretty much recovered from the first one, but it was quite hard on her. So hard in fact, they almost didn't do chemo this time. You could tell she was really fretting another treatment.
Our day started with an appointment with the physician's assistant (PA). The title might make it sound like she's just someone who runs around doing little things for the physician, but it's a formal title and PAs are licensed to practice medicine. She asked us about how it went last time to see what they could do to make things better this time around.
The cramping in her hand was the worst that first day, and calmed down a lot when they took the pump off on the third day. The PA wasn't fazed by this. We didn't feel the cramps were bad enough to medication, and Karen's all for taking less medication if she doesn't need it.
The cold sensitivity pretty much stuck with Karen both weeks. After that first week she could eventually drink cold liquids, but even during the second week her hands were sensitive to cold. As I had mentioned before, grabbing something out of the fridge felt like she was taking something out of a -70° freezer at work. I don't know if there's anything that can be done about this, but the PA did note it.
Karen only experienced the one migraine early on, and she wasn't even sure it hadn't been brought on by the weather system that blew into town and made it storm like crazy. The PA was content that the medication Karen had for migraines worked.
The diarrhea I mentioned last time subsisted through Friday. Due to the stoma, it's not as difficult or frustrating a problem as it would otherwise be. But she did have trouble staying hydrated even after that had stopped. They told us hydration is a common problem and that she'd probably feel better if she got some fluids via IV when she came in to get the pump disconnected.
The cheap thermometer we had broke, so when things turned bad again that second week, we got another one. It's a much nicer one this time, a temporal artery thermometer. They're very quick and easy to use; you just run it across your forehead. That whole last week she had low grade fevers at night. Mostly around 99.5°. The highest we saw it at was 99.7°. We were instructed to call if it ever got up to 100.5°. So we never had to call in, but we mentioned it to the PA during our visit. She said fevers are not uncommon for people on chemo, and if it does break 100, to try taking some Tylenol to bring it back down.
We also explained that Karen was nauseous most of the two weeks. While she started to feel better Sunday - four days after she finished with the pump - and was pretty good Monday, she was nauseous and weak again by Tuesday night. It wasn't until this Friday that she started to feel good once more. The PA wasn't happy to hear this or how little Karen had been eating. So Karen is going to get something in addition to the other anti-nausea medication during chemo to help with the nausea, and something extra when she comes in to have the pump removed on Wednesdays. She also increased her dosage of ondansetron (Zofran).
We didn't notice until later that the Zofran had been "increased" to from 4 mg every 4 hours, to 8 mg every 8 hours. It works by blocking the receptors in the brain that receive the signal telling your body to be nauseous, so they recommended, rather then waiting till she's starting to feel nauseous, or before a meal as we had been doing, to just take it 3 times a day, the same time, every day, so it would constantly be in her system.
From there we found some seats in the chemotherapy room. The first thing they do when you sit down, aside from access your port, is blood work. They run a complete blood count to check your blood cell levels since chemotherapy can mess with them. While both her white and red blood cell counts were low, it was the white blood cell count that really seemed to concern them. They said if it were any lower they'd have to delay things a week. They ran some more blood tests and finally decided she would be OK for chemo.
The steroid they gave her last time didn't give her that boost of energy this time. They said the extra anti-nausea medication would knock her out, which leads me to believe it's actually lorazepam (Ativan). It's normally for anxiety, but off label it's used as an anti-nausea medication. A couple times when Karen was having trouble with nausea at Mayo Clinic they told her if she were anxious she could get Ativan which would also help with nausea. And then they'd ask if she were anxious. But she almost always said no. I wonder now if it was just some sort of technicality. When she did get it at Mayo Clinic, it made her drowsy like this.
Her cold sensitivity started much sooner this time, and she says she's more sensitive this time, and the effects last longer. Even just touching a cold door knob can set it off, but to be fair, I think it's much colder now. And also like last time, her hands are cramping and it hurts in her jaw and neck when she chews things. Water has that same bad taste as well. She hasn't had any trouble with nausea but if I recall correctly, it didn't get bad until after the pump was removed. She also didn't get the hiccups last time until then as well. I'm not sure if these things will start happening sooner though, or if it will follow the same pattern every time.
When we got home she ate a little bit of food but was having trouble staying awake and went to bed. She slept most of the day but got up a bit in the evening long enough to eat and get another migraine. Once again she had to take the maximum dosage of her anti-migraine medication to get rid of it, which also tends to make her sleepy. So that was it for her Monday. I assume she'll sleep through most of Tuesday and Wednesday as well, since she did last time. She has an appointment tomorrow with her general care physician, but I'm not sure she's going to be up for it. I don't think we had the chemo schedule fully planned out yet when the appointment was scheduled. I guess we'll see.
