We saw the oncologist again. He thinks that it would be best for Karen to do another 4 months of chemotherapy before starting on maintenance chemo. While this was on our minds, we hadn't mentioned it to the doctor. Perhaps this is normal when the initial round of chemotherapy is cut short? He warned us, however, that cancer is "very smart." It gets better at surviving the chemo after each round. And even though it doesn't seem to be shrinking the cancer, it can still slow it's growth, which will give Karen more time.
The particular regimen she will be on this time is called FOLFIRI (as opposed to the last regimen, FOLFOX). The difference being that they will be giving her irinotecan instead of oxaliplatin. This change is important because last time most of the harshest side effects - the neuropathy, intense cold sensitivity, and the extremely low blood counts - came about due to the oxaliplatin. The biggest side effect with irinotecan will be diarrhea, which isn't a comfort issue when you have an ostomy. We just have to watch Karen's hydration. A low white blood cell count is also expected. The oncologist will also be adding in bevacizumab this time. It was considered last time, but for one reason or another, was never thrown into the mix. It works by slowing the growth of new blood vessels, something that's important for tumor growth.
They will also be starting Karen off on very low dosages of everything, and slowly upping things as they see how her body responds to it all. Like last time, Karen will go home with a pump, which will administer chemo for another 46 hours. Overall, this should be an easier round of chemo than last time. Although that doesn't make Karen less nervous about it; she's really dreading starting chemo again.
The date kept changing, but we've finally settled on Friday the 21st. Mayo has a hospital that is open 7 days a week, so we can come in on Sunday to have the pump removed. Since chemotherapy is only given every other week, this puts thanksgiving, new years, and christmas on off weeks. Still, after last time, Karen isn't expecting to have much energy on her off weeks. She is also worried about having a low white blood cell count again, which she expects to limit her visiting during this time. I'm a bit more hopeful, but I've been wrong before.
