Follow-up with Dr. Chatson

After the bad weather and extreme  humidity of the last few days, today was beautiful.  It was all clear skis with warm dry air.  This happened to coincide with my having a 'good day' which is always welcomed.

I had an appointment with Dr. Chatson to determine if I was healing properly. After checking in, it wasn't long before I was called from the waiting room for a check of my vitals.  Great blood pressure readings, normal pulse and temperature. The nurse said, "The doctor will be right with you."

Shortly after, Dr Chatson came into the examination room and asked how I was doing and tolerating the chemo.  "Tolerating is a good word," I said then proceeded to talk about my good and bad days as well as the general experience.  He said, "The chemo is cumulative so it's expected that this round would be tolerable." [I'm beginning to have disdain for the word 'cumulative' - right now it's in the same category as 'it depends'.]

Shifting gears, he said, "Ok, take off your shirt so I can see how you are healing."  Now there's a very clear distinction between the viewer and the artist.  All things considered, I thought I was healing well and I am.  However, the artist was very quiet as he held his gaze on his future 'work'.

He pressed certain areas and asked that I hold my arms a certain way as he inspected.  He then said, "Let's look in the mirror together and I describe what I see and what I will do."

Looking at my (healthy) right side, he said he would 'liposuction' various areas (while pointing) to make that side more symmetric.  He said he may have to cut and remove some internal mass.  He said, "I would cut just below the aureola and remove mass/structures. [I should have asked if I would be needing my favorite drain.] As we shared the view he motioned to the concave breast and said he would take fat cells from (motioning to) my stomach area.  He said he didn't want to use any of the fat from the surgical area. 

Earlier I recall his saying that this would require two surgeries, but neither as massive as the mastectomy. [Thank heavens.]

We talked about timing and he reaffirmed that it would have to be after the chemo and recovery period.  He said that chemo does things to the body and that the recovery period will allow me to reach my stabilized body mass.  So he asked that I come back at the end of August.

I told him that I had a concern with insurance coverage seeing that this would be happening up to six months after receiving the first approval. He understood and said that he would create another case. To do this he would need some new pictures of the 'defect'.  He left to get his camera and returned for my photo shoot.  After about a dozen shots, he said, "That will do it."

He told me he would submit the case and let me know of the results.  In the interim, he said, "Good luck with the rest of your chemo treatments."

I scheduled an appointment for the last Wednesday in August.

More to come on this front.

Good days and bad days

Although my blood test results were 'normal' that might equate to being the 'acceptable average'.  I'm not certain if normal is 'my normal'.  That said, I can only attest to my having good days and bad days.

On good days, I seem to have energy and feel generally 'good'.  I wake early. Have coffee.  Create my 'list' and seem to be able to accomplish any task I begin and am able to finish my 'list' of things to do.  If the sun is out and the air is dry I tend to thrive and all is right with the world.

Conversely, on bad days I can't seem to get into gear or get out of my own way.  I feel lethargic, have low energy levels and talk myself out of doing or delaying any task unless it's critical or urgent. I feel out of sorts and tend to take many cat naps while channel surfing. On rainy days, this is exacerbated. I may have a day or two of these 'bad' days in a row and apparently for no known reason begin to feel good. I'm still trying to figure my new bio-rhythms and determine what the triggers are for feeling good and feeling bad.

Given I'm at the end of my first chemo cycle, I've noted lingering symptoms/side effects including: muscle spasms (charlie horse) which seems to be somewhat better since I've begun eating a banana a day; numbness in my thumb and forefinger; numbness in the balls of my feet (although diminishing); soreness in the area where the chemo was delivered (vein) by IV; occasional but ongoing sniffles; thrush of the throat (mitigated with baking soda and water rinse).  In addition I've noted some new issues that may be a side effect: split skin in my oral cavity (not visible but noticeable when I have something acidic like vinegar); acne (in the strangest places).

I am making the most of my good and bad days though.  I have picked up my guitar a few times (first time since February).  I lost my callouses, so I'm driven to get those back. I researched home network storage (NAS) and will be setting that up so I can cancel some of my cloud storage for pay services. When energy is low, I binge watch series on Netflix or On Demand.  I'm currently on season two of Game of Thrones. [I highly recommend this series if you haven't seen it.]

Day one of my retirement starts a week from today - July 1.  Wow!

One week check-up with Dr. Mehta

Arrived today for my appointment at Dana Farber, Methuen.  Clearly I'm becoming a regular.  I'm even becoming familiar with other patients' comings and goings.  At the reception/check-in all I needed to say was I was here for my appointment with Dr. Mehta.  She didn't even ask my name, but did ask my date of birth and a few other security questions.  My wrist bracelet was pre-printed and was soon on my wrist.  I had mentioned that I needed labs and was told that I would be called shortly for my blood drawer.

I hadn't waited too long when a nurse (Connie) called for Richard P.  [Not just Richard?  Maybe there were more than one Richard in the waiting room.]

Connie walked me to an adjacent room where she said, "Oh, I took your blood last week." And before I knew it the pinch and blood draw was done.  Back to the waiting room.

About ten minutes later another nurse called out Richard and both myself and the guy next to me sat at attention.  The nurse then said Richard P.  [Two Richards confirmed.]  I followed her to the examination room and had a weighed in.  I was back to my 'normal' weight having lost that 10 pounds of water retention due to the prednisone. Temp and blood pressure were good too.  "Dr. Mehta is finishing up with another patient and will be with you shortly."  No problem, I'll wait, I said.

Almost 15 minutes later, Dr Mehta arrived and asked, "How are things going?"  I said, "On the plus side, I had no symptoms of nausea or vomiting.  Had an appetite, was regular, and was sleeping alright."  However, I did mention that I have been getting easily fatigued.  Regular activities could wipe me out for the day leading me to sitting and resting in my chair.  I had tried to determine my limits, but often found that it was too much.  Some days were better than others too.

I had mentioned that I re-read the possible side effects/symptoms and had experienced a numbness in my thumb and forefinger of my left hand.  In addition, the balls of my feet felt numb and tingly. Nothing that would limit my walking or standing and not to the point of any pain, but I was concerned.  I had also experienced some tightness in my chest last weekend, but that had passed after I was able to belch (from drinking a ginger-ale). I was also experiencing 'charlie horses' in both my calves mostly when I was sleeping. And finally told him of a strange nagging pain on my left side near my large intestine.

Dr. Mehta said that neuropathy is symmetric and he has never heard of it manifesting on one side.  He mentioned again that the chemo is cumulative and he didn't expect any of those types of side effects during this initial dose.  He also added that he didn't expect them at all. [Sure hope he's right.]

As for the nagging pain or the 'charlie horse' he didn't seem too concerned.  He said the blood test didn't show a decrease in potassium, but advised that I eat bananas.

He said that my blood test result came back 'normal levels'.  So I said, "Then I've reached Nadir already?"  Dr. Mehta said, "the dosage was the correct amount for your body to fight."  So I asked, "My fatigue is a result of my body fighting the chemo and creating white and red blood cells and platelets?"  He said, "most likely."

He listened to my breathing, heart beat and looked into my mouth.  He did notice a little rush in my throat which he instructed me to gargle with warm water and baking soda.

He then told me that I should be ready for my next chemo on July 2.  He wants my labs done on the first of July so the results can be used to determine the next dose. "Happy 4th of July to me," I said.  Dr Mehta said I should be fine and go on to enjoy living.  [Good advice]

Remembering one thing, I said, "Speaking of chemo.  I noticed that the vein used for the last dose was a bit red and sore to the touch."  He asked if there was any spillage.  I said no.  He looked and pressed the area (a little uncomfortable), but said, "That's healed." [OK.  I hope in two weeks it will look and feel even better.]

So this 62 year old body is a fighter.  I'm hopeful to regain strength and stamina going forward.

More to come.

Day three status update

Since Thursday's chemo treatment I've been keenly in-tune with the changes taking place in my body.  Not knowing what to expect next, I've been religious about taking my temperature three times daily, drinking plenty of fluids and noting all things general.

At this writing, I can say that the medication for anti-nausea administered Thursday has worked fantastically.  I have had an appetite and have graduated from a very bland diet to an almost 'regular' diet.  However, I'm not jumping off into the Szechuan or Mexican cuisine just yet - not that I have a hankering or anything.

According to my literature of possible side effects, I have been exhibiting some. I have had a lingering headache, slight sore throat and get easily listless with little effort exuded. Thankfully, I'm regular and have not had to open the Miralax or even the Kaopectate for that matter. But, I am generally feeling out of sorts.  My sleep patterns are out of step, I seem to dropping things and feel achy from time to time.  According to my instructions, I'm to brush my teeth (and tougue) four times a day as well as gargle so to ward off germs that could cause mouth sores.

One disturbing side effect is a general numbness to my left forefinger and thumb.  Not deadening, but more tingly. My paperwork did have a section of side effects not found in clinical trials and neuropathy was listed.  The remedy is to have the next dose customized as to not promote that (and other unwanted or untreatable side effects).

I was told on Thursday that the anti-nausea drugs in my system should be used up by my body today (Sunday).  I'm not sure if I will need to resort to the two prescriptions I have on hand.  I'll have to wait and see.

On the bright side, the weather has been really nice and conducive to taking it easy. So I'm going with the flow and doing just that.

More to come.

Houston: We have lift-off

On June 11th, I felt the most anxious to date during this semi-charted voyage.  The fear of the unknown and the 'might happen' made me feel most vulnerable, but I was accepting of what happens; will deal with whatever happens; and have faith in those that I have placed my health and well-being.

Arriving at Dana Farber (Methuen), I've become a regular.  The check-in desk receptionist begins to sort through the pre-made wrist bracelets as soon as I'm next in queue. After asking the required security and privacy questions, I was 'cuffed' and then (surprisingly) was told to, "Go right on in through the double doors."  Wow.  No waiting.  Almost like a VIP pass at Disney World.

Arriving at the inner sanctum, I was greeted by a vision of a newly remodeled unit, replete with new furnishings and other accoutrements. It was quite busy with eight stations.  Most were occupied with patients hooked to IV apparatus.  I found station seven to be open and made myself comfortable. Not long after a nurse came up and apologetically said, "You need your labs."  I indicated that I had them done [as instructed] on 5/26.  "Oh, Dana Farber wants the test 14 days prior to chemo.", she decreed. [What am I two days over the limit?  How much would change?]  I didn't want to argue, so I said 'Whatever' and she proceeded to draw blood.

While waiting for the next shoe to drop, I overheard another nurse say as she arrived holding a rather large plastic bag filled with many items filled with liquid, "This packet is for Richard Page".  [I could hear the clunk clunk of Law and Order play in my head.] This is real. 

Nurse Elizabeth introduced herself and said she would be administering my treatment today.  While talking she sat and delicately pierced the vein she found suitable.  She hooked up an IV and said that it would feel cold.  I was wondering if it was the chemo when she added that this was a saline drip to flush out the 'system'.  Yes I began feeling the chill and not long after the need to 'go'.  I was directed to the facilities which I ending using many times this day.

After the first drip was completed, Elizabeth told me that she was going to give me two more drips.  These included two types of anti-nausea meds.  [Why two?  She said that there are receptors in the brain and this combination blocks those and eliminates that response.  It stays with the body for up to 36 hours.]  Both IV bags were emptied and I needed to empty before yet another saline bag was attached. The bag was about half full when she said that she was going to attach yet another because there was 'so much AC [chemo] for me'.  She wasn't kidding.  Next in the bag were two huge pistons full of red Kool-ade looking fluid.  Looking at the size of the opening, I asked if those too would be delivered via drip.  "No", she said.  She needed to manually 'push it' through my veins and alternate with saline.  YIKES.

Elizabeth finally pulled up a chair and said that she finished other tasks so she could devote her full attention to administering the AC.  She had a fact sheet that she reviewed with me [the same as the Sandra Creamer hand-out].  Elizabeth's explanations were consistent with Sandra's.

With a very serous tone, Elizabeth said that she was going to start the AC.  She indicated that she would push the solution in and alternate with the saline drip to protect the vein.  She repeated the dangers about any AC escaping from the point of injection.  She said, "If you feel any discomfort or pain, let me know immediately."  "What level of pain should be reported?", I asked.  She said ANYTHING more than what I feel at this moment.  "Understood", I replied.  "OK here we go.", she said. "Because there is so much it will take about a half hour."

I watched as the red chemo entered my vein and didn't sense any changes.  She inquired and I responded in kind.  From this point it was only waiting and having conversation on a variety of subjects from Cancer to world events. Very nice person who was flattered that I thought she was in her 20's.  (She said she was in her forties.  But she looked fantastic.  I made her blush.)

Finally the first piston was finished.  She disconnected it and said that she'd let a little more saline pass before starting the second.  It wasn't long before round two was in full swing.  More conversation and waiting.  "Done.", she said.  She then connected yet another IV bag, this time it was some type of steroid that she said would help my immune system and may give me a boost of energy.  It may also keep me from sleeping.

After that IV was emptied, I needed to empty my bladder.  She reminded me that I will see red - not yellow.  Well, it was more like blush rose and not Cabernet. But there was definitely color.

After the steroid bag was emptied, I finished all remaining saline packs.  And of course had to check on more freshly made rose. It was now OK to leave. Which I did after checking out and confirming my next appointment in a week.

I generally felt OK, but had a slight head ache and was 'fuzzy'.  Not like Aunt Clara brand, but more like "I didn't have my coffee today - fuzziness".  That didn't go away and still persists but not as bad.  It may be the side effect of the two anti-nausea drugs in my system.  Just a dull head ache and no nausea.  A more than decent trade-off.

I was told to drink, drink, drink water.  Which I did, did, did until the rose color was gone.  I was even able to eat a few bland things.  Wasn't really hungry, but knew I should eat something.

I chilled out watching the tube between bathroom visits and refills on water.  I guess I napped a bit too.  Went to bed around 11 and slept OK considering.  I had strange dreams.  I'm sure my subconscious was worried about my mental recall capacities and went into the way back machine with recalling a story my mother told me years ago. It was  about a disagreement she had with her brother Edward over their correct phone number which ended up with my mother (as a little girl) getting a pencil jabbed in her head because his answer wasn't complete.  Back then (and even when I was a kid) local numbers were 5 numbers preceded by two letters (corresponding to numbers on the rotary dialer, but not used).  In Haverhill it was DRAKE - or DR for 3, 7.  I guess he said their number was 2-5344 and my mother insisted he was wrong.  "It's DRAKE 2-5344."  He wasn't amused and stuck a pencil in her head.

Yup, strange dreams and memories.

More to come.

Post script: My older sister told me that when my mother was a kid they didn't have a prefix to the telephone number, but there was a suffix, for example 5344-R.  My Uncle Edward had left out the 'dash' when telling my mother of the number.  It was my mother's insistence and attention to detail that called him wrong, thus the poke in the head.  [Thanks Donna]

Buckle up the seat belts and prepare for lift-off - Prepare for the worst and expect the unexpected

I’m on the last few days of prednisone.  The rash is 98% gone.  The top layer of skin is peeling and is the cause of some current unsightliness of the area.  As long as I apply over the counter ointment (cortisone 10) it looks OK. 

I had an echocardiogram yesterday.  The good news is, the attendant didn’t stop and bring in throngs of health workers to ‘witness’ something found (as what transpired during my breast ultrasound).  The better news I received today, and for all you nay-Sayers: my heart is functioning normally. 

I had chemo orientation today.  I thought there would be scores of health care professionals meeting with me but there was no need after meeting with Sandra Creamer, PHD OCN. She was extremely learned and took time to explain pretty much everything.  Even as I had my next question queued up to ask, she inherently anticipated it and provided an answer without my needing to ask.  Impressive.

Not only were items validated today, but I also received new information.  For example, my chemo AC is made up of two drugs doxorubicin (Adriamycin) and cyclophosphamide.  It's a very pretty color red (my favorite red is ruby) and until it passes through the system (up to 48 hours), tears, sweat, and urine will be red.  I once ate an extra large helping of a baked beet and brussel sprouts and was shocked to see red urine (and more).  I thought I had internal bleeding.  So knowing about the AC side effect is helpful.Cyclophosphamide can cause swelling in the sac around the heart. [In the eighth grade I did a term paper on the heart and I think this is also referred to as the 'bundle of hiss'.]  

This chemo is truly toxic.  Extra care is taken that it doesn't spill from, or out of, the vein.  Sandra told me that it will literately 'burn' my skin tissue. So I asked, "If this burns skin, what does it do to the vein?".  She said that the movement of blood in the vein prevents it from pooling and causing damage.  She asked if I was going to have a VAD or Port-a-cath?  I has asked Dr. Mehta this and he said that I will not.  However, Sandra did say that if the veins can't take it anymore (or collapse), they will most likely place a port.  Seeing I can only have IV in my right arm (due to lymph node removal in my left), there 'may' be a chance I would need the port.  [Who is taking bets?]

Cyclophosphamide isn't my friend for sure.  It can cause bleeding in my bladder due to inflammation and cysts.  Because of the toxicity, it highly recommended to drink lots and lots of water and empty the bladder as much as possible.  "Don't hold it in", she said. There is also a chance of scarring on the lung tissue. Symptoms of this include coughing, shortness of breath, difficulty breathing, wheezing, tiredness. There is also a chance (although remote) of developing a serious skin condition. So the bottom line is to be highly aware of my body and various symptoms. And report any and all.

Because everyone is different, it's totally up to me what I choose to eat.  There are few restriction and it's based on what I can 'stomach', but I also must be very mindful of Nadir. [Not Ralph.  His name is spelled differently and I don't think he'd bother sticking around to haunt me. Although one of the other drugs I may need to take (discussed later) may cause hallucinations, so maybe I shouldn't get that Covair after all.]

Nadir (and not Nirvana) is that period in my treatment cycle when my white blood cell count is the lowest.  Other than cancer itself, it's the risk of infection that's the largest threat.  During Nadir, I should be extra vigilant to stay away from crowds, germs and uncooked vegetables.  Weekly blood tests will determine when this period is.  It is estimated to be within 10-15 days of the chemo injection.  I will need to be overly cognizant of my body temperature daily.  I've created a spreadsheet to record my temp: morning, noon and night.  I've been told that if my temperature goes above 100, then I need to call the doctor.  Boy, that's not much wiggle room since normal is 98.6.

Of course there's the nausea that chemo is so noted for.  I was given a 90 day supply of these two scary drugs. The Internet provided the following:

Ondansetron is used to prevent nausea and vomiting that may be caused by surgery or by medicine to treat cancer (chemotherapy).

Call your doctor at once if you have:

• fast or pounding heartbeats;
• jaundice (yellowing of the skin or eyes);
• blurred vision or temporary vision loss (lasting from only a few minutes to several hours); or
• high levels of serotonin in the body - agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting.

Common Ondansetron side effects may include:

• diarrhea or constipation;
• headache;
• drowsiness; or
• tired feeling.

Prochlorperazine is an antipsychotic and is used for controlling severe nausea and vomiting and treating schizophrenia. It may also be used for other conditions as determined by your doctor.

Prochlorperazine is a phenothiazine. It is not known exactly how it works. (WHAT?)

Possible side effects of prochlorperazine:

All medicines may cause side effects, but many people have no, or minor, side effects.

Check with your doctor if any of these most COMMON side effects persist or become bothersome:

• Agitation
• Constipation
• Dizziness
• Drowsiness
• Dry mouth
• Enlarged pupils
• Jitteriness
• Nausea (hmmm The CURE is The CAUSE)
• Stuffy nose.

To combat these possible (and most likely) side effects, I stocked up on Biotene, alcohol-free Listerine, Kaopectate, MiraLax, a straight-jacket and restraints. [Just kidding on the restraints.]

Sandra also touched on other side effects I knew of through my research and various consultations, but she did talk briefly about chemo-brain.

I had read a few articles on chemo-brain and I was piqued by her mentioning the topic.  Of course like most side effects, it depends on the person, but if and when it does happen (to me) I'm asking all be to lenient. [I don't expect it to get as bad as Aunt Clara of Bewitched fame.]  I've always been noted for my iron trap memory, but this could be my (temporary) undoing. I am a creature of habit, so I'm hoping my innate regimen of order will prevail over any temporary lapse.

Tomorrow is the big day.  Kind of scary -  the unknown.  It's going to be a very bumpy ride. I hope to see everyone on the other side.

 Three; Two; One;

Lift-off  !!!!

Follow-up with Dr. Mehta and my choice of poison

After my second opinion with Dr. Overmeyer, oncologist at Dana Farber- Brookline yesterday I had a follow-up with my oncologist at Dana Farber Community Care (at Holy Family) today. 

The newly renovated center resulting from the Dana Farber affiliation which officially commenced on June 1st, the location looked new and shiny, but like most IT projects, they were having problems with the computer system.  Of course I wasn't scheduled (according to what was showing).  The attendant said 'We have you for next Thursday.'  I added, "I am scheduled for chemo next Thursday. I have a follow-up with Dr Mehta that they scheduled when they were located in the other part of the building."  "Oh, that explains it", she gasped.  She took my information and asked me to be seated until she could talk to Dr. Mehta.

Shortly after, I was called and was cuffed with a hand-written wrist band.  Whatever.  I was directed back to the waiting area but it didn't take long before I was called to have my vitals checked. Guess I passed muster because Dr. Metha arrived just as this task was completed.

I briefed Dr. Mehta on what I learned through the paperwork he provided at our last visit and how Dr. Overmeyer was in agreement with the approach and benefit of chemo (for me).  I had mentioned that it was really down to AC or TC: Pepsi or Coke.  I did add that Dr. O. felt strongly that I should have an echocardiogram.  Dr. Mehta shook his head and reminded me that side effects of AC are cumulative. (And as Dr. O. stated), the amount I will be receiving lessens the risks.  He also reminded me he had said prior to AC, if chosen, he would ensure that I would be a candidate.  Meaning he was going to check the heart via echocardiogram [although he never said that word at the time]. This also holds true for the risk of leukemia.  The risk is lowered by the expected lower dosage of AC. So he asked me, "What's it going to be? Pepsi or Coke?"

I replied that based on both consultations, test data and various research efforts, I choose Adriamycin (AC) for my chemotherapy.  However,  I will undergo an echocardiogram to determine if I am a candidate for this approach. 

At this time the order of events is as follows:

• Day one - Echocardiogram and labs
• Day two - chemotherapy orientation – health care team approach to discuss/educate me on the drugs I’ll be taking, the drugs prescribed to counteract side effects, diet, do and do not's, and what to expect.
• The big day – more labs, a visit with Dr. Mehta and 4hrs in the chemo room(sounds like a blast - NOT)

Possible spoilers:

• That ‘something’ I contracted on my arm is being treated with prednisone (10 days) to eliminate what is thought to be contact dermatitis.  There is a still fear that it’s a skin infection.  If it is, I will need to be on an antibiotic (probably 10 days) and this will cause the chemo start to be moved out a week or two, depending.  By tomorrow (Friday) afternoon I will need to notify Dr. Mehta if it hasn't greatly improved.  He will prescribe antibiotics and we will need to reschedule everything else when it's cleared up.
• If the echocardiogram comes back unfavorably, I will need to choose the other chemo Taxotere (TC) which has side effects that are really concerning to me (neuropathy).  Given that this could be a quality of life or life/death situation, I would have little choice in this.  Also, if I am not a candidate resulting from the results of the echocardiogram it could be that there is an underlying condition that may also need attention.

In addition, if I do not or cannot go with AC, the chemo date will also need to be moved so TC can be ordered and available.  [I guess it's not really Coke and Pepsi - there seems to be an abundance of that.]

I notified work. Assuming I am a candidate and things go according to schedule, there is no telling how I will be feeling from the chemo and side effects.  From that point it’s going to be day to day on my coning into work.  

More joy to come.  

Cheers! [burp] Excuse me. ;-)

Consult with Dr. Overmeyer - Dana Farber

Why don't the authors of the electronic signage content ever think about what they are providing and what it really means to the average driver?

On my way to Dana Farber in Brookline today, I must have seen four electronic signs that displayed: "Construction Rte 28 S Expect delays Seek Alt Rte".  Sure, in Massachusetts where the state flower is a white and orange construction barrel, you often see signage similar to that or, "Can't get there from here" or, "Give up and die".   Route 28 S meant nothing to me as I was on 93 S and was expecting to take Storrow Dr. through to Brookline.  Having worked in Boston and vicinity for most of my career, I learned today that 28 S was Storrow Dr.  Of course this little gem of wisdom didn't become apparent until I was stuck in queue on the Leverett Connector with no chance of escape.  Suddenly what I had expected to be a breeze turned out to be stagnant air.  This was due to construction on the Longfellow Bridge, so traffic did clear up after passing that.  Still, I was less than pleased.

Not sure if I was fumbling through traffic reports or what, but my GPS seemed to be sending me to my brother's house in Cambridge.  Of course there's no safe spot to pull over and check, so I crossed the bridge and arrived at Pleasant St where I was able to pull into a driveway and recalibrate.  Back in action, I purposely turned right onto Memorial and not left since I knew it was leading me back to Longfellow.  Luckily I was able to back-track and get to Longwood and eventually to Dana Farber with a half hour to spare.  As luck would have it, the 'all full' sign for the parking garage was just being moved aside clearing my way to P3.  [This luck continued since all parking was free today.]

I made it up to the ninth floor and as a repeat visitor/patient, they found me and directed me to the waiting area.  Extremely busy today, but most seemed to be moving in and out - except me.  My appointment time came and I waited an additional hour before being seen.

Dr. Overmeyer joined me in an examination room and was profusely apologetic for the wait. [She mentioned a go live that was transpiring today, so I know how stressful IT roll-outs can be.  I was just thankful to be in her audience.]

Doctor O indicated that she read my file had spoken with Dr. Mehta and was up to speed.  She had hoped that she had the post op notes and the slides (pathology), but they were not in her file (electronic or paper). But she said, based on the information she had, she was ready to provide consult and answer any questions I had.

At the highest level she said she was in agreement with Dr. Mehta that I would benefit from chemo.  She reviewed the OncoDX assay and explained the results that support a two drug therapy. She also understood that there were two drugs that required a choice - Adriamycin (AC) or Taxotere (TC).

Adriamycin (AC) [A.K.A. - Doxorubicin] is the conventional chemo.  However, among the host of side effects there is a 1% chance of my having congestive heart failure. In a patient's lifetime there is a certain amount of this drug that can ever be taken. My therapy would call for my having half this amount. She cautioned that I would need to have an echo cardiogram to determine if I were even a candidate for this.  Not knowing my medical history (or that of my family) she couldn't provide more information, but stressed having this done.  She did add that AC affects the (heart) muscle not the vessels, so the Triple A is not a concern.  In addition, she said that there's a 2% chance of my developing Leukemia.

Taxotere (TC) [ A.K.A. - Docetaxel] is the preferred treatment since the major side effects are fatigue and fluid retention.  She indicated that there are drugs (and thought I heard her say therapy) to counteract the fluid retention.  She did say that there is a chance of some degree of neuropathy, but thought that it wouldn't be that much of a hindrance.  She said there are some homeopathic remedies such as a B6 regimen and a vinegar soak (for fingers) that can lessen the impact. [I'll need to research these.]

I said, "So basically it's flip a coin." She said yes, but the echo cardiogram results may make the decision for me.

Dr. O asked what was going on with my arm (rash).  After explaining the background, she said that I need to watch that.  If it's there's no dramatic improvement over the next few days (after my taking the prednisone) [which was filled today], I would need to see my primary care doctor for an antibiotic.  She suspects that it's an infection.  She's concerned for spreading and having fluid 'back up' into the chest wall and causing cellulitis. She cautioned me not to start chemo until this is under control. 

In summary she said the order of precedence would be: the arm, echo cardiogram and finally genetic panel, but the panel can wait.

Looking through her notes she said that a genetic panel (over and above the BRACA1 and 2 panel) should be done.  (As she had stated before) this would identify if I (or my genetics) predisposes me for breast cancer.  The long term therapy of Tamoxifen will prevent (or halt) the growth of ER (estrogen receptor) fed cancer, but rogue cancer cells and 'friend' cells can escape the affects of Tamoxifen and this panel will identify those 'other' cancers so it can be determined if those cancers are preventable.

She did give me her number (again) and said that she would schedule something with a genetic counselor after the panel results are known.

So I have more information, questions and action items.

I'll balme it on the full moon

I’m apparently allergic to garden work. 

On Memorial Day while waiting for a friend to pick me up, I saw some weeds among the flowers that grow with little attention from me.  I pulled a few long stemmed weeds  with my hands and I guess I brushed against something that gave me 'contact dermatitis'.  My forearm started to get red and 'bumpy' later that day, but I wasn't too concerned. Thinking that over the counter cream(s)  would take care of it, I started a regimen of Cortizone 10, then switched to Wal-dryl,  and finally a triple oat with calamine ointment only to be thwarted by its spreading.  

Concerned that this might delay my pending chemo treatment, I initially delayed going to work and broke down and scheduled an appointment with my primary care today (Tuesday).  

The check-in was uneventful and the wait wasn't too long.  I was called in for the weigh-in and the check for vitals and was asked to wait in the examination room for Dr. Rees.  Upon his arrival and exchange of pleasantries, he looked at the expanding patch of redness and quickly retreated to his laptop.  He expressed that he was unsure exactly what it was since it didn’t exhibit the classic signs of poison ivy or poison oak, but concluded it was something treatable.  He prescribed a ten day script of prednisone.  He didn’t believe that either the dermatitis or prednisone would have any ill affects to my upcoming chemotherapy.

He said he sent it to my pharmacy and it should be ready by the time I get there.  In parting he said, 'See you in August.' [My next appointment.] 

I wanted to give the pharmacy time to fill this, so I decided to gas up first.  Arriving at Walgreens, I approached the pick-up window and announced my intentions.  After the necessary screening to ensure I was consistent in my answers the pharmacy technician pecked at the computer keyboard while demonstrating a quizzical look.  "I don't see anything yet.  Sometimes it's slow getting here."  Apparently.  I indicated that I would be back and with my luck, I'd be notified just as I arrived home.

It didn't make sense to go into work for a few hours, so I checked in and took some vacation time, then got into some email exchanges.  At 4 PM, I decided to look at my online pharmacy account and was surprised to see that the prescription was sent to the mail service.   I chatted with a representarive (in the chat window) and was advised to call the 800 number.  After calling and navigating through the maze of prompts, I was connected with a live agent who couldn't help me.  I was transferred to another who was  (I thought) briefed on my situation.  She said that she would cancel the order.  "Great", I said.

"Ok, Richard, you are all set".  I asked if she sent it to my local pharmacy and she said she couldn't do that.  "The doctor will need to call it into retail", she said.  She suggested that I call the pharmacy directly so 'they could help'. [Grrrrr]

I called the pharmacy and got through to the pharmacy staff member who reaffirmed that the doctor needed to call in another prescription.  Of course it's 4:45 PM and the office is closed, so she said she'd call and leave a message and advised me to do the same. [Why am I thinking she'll do nothing?]

I called my primary care's after hours message service and tried to leave a brief message and request.

So here I am with a spreading red patch of swollen itchiness with globs of ointment that basically does nothing but smear on clothing, bedding, etc.

Yes, it's a full moon.  We'll leave it at that.  Maybe I'll get my script filled sometime Wednesday.  

I can't make this stuff up.

[6/3/15 Post Script: I received my prednisone and took my first dose at 4PM.  By 6PM I could see a marked improvement.]