“We’ll try this one more time.”
The Wig’ns Affair on Saturday had given her spirits a lift, but physically she was still not 100 percent. Sunday and Mondays were quiet, and she did look good despite the fact she was still tired. She, at least, was starting to eat more, and that was encouraging. She didn’t go into the office on Monday, but did spend a lot of time on the phone with Carol Nitschke, who was handling duties for her while she was absent. She also decided to not go in since tomorrow she was to go for labs, meet with Dr. Thomas and get the second round of chemo at St. Alexius. She wasn’t looking forward to the chemo, but was less excited about having to be hospitalized for the infusion.
Tuesday, and we saw the blood work done, and it was all good. They also took a urine sample because of her urinary tract infection, and they did a chest x-ray as well.
Then we waited to meet with Dr. Thomas. We had already talked with each other about any changes he might want to make, and had decided we were going to resist them. I had my arguments for not changing all ready to go. I hadn’t talked to Carson yet, even though I had called Marcia at her office and asked her to call me before we went in, but Dr. Thomas had talked to Carson.
He told us he wanted to drop Ifosfamide (Ifex) from the mix of drugs she would be getting. It seemed to him that Ifex was the culprit that had caused the problem in her first round, and put her in the hospital. Joanie told him we had suspected he was going to suggest something like that, and we were also going to resist that change.
Dr. Thomas looked at me, and asked me why we thought we shouldn’t change after what had happened following the first infusion. I told him there were several reasons. The first on was Joanie didn’t get the Kytril until just before we left the hospital the morning after the infusion. When she was taking chemo as part of the clinical trial in Minneapolis in 2003, I made sure she got Kytril at 5:00 or 6:00 in the morning following the infusion. She never had any major episodes of nausea following any of the six infusions. I told him it seemed to me that we got behind the curve as far as the nausea was concerned, and once that happens it is hell to catch up. I think we saw that happen.
The second reason I cited was the large pleural effusion her right lung that was causing a breathing problem. That issue had been resolved with the thoracentisis. And, I mentioned the fact she also had a urinary tract infection at the same time. Whether or not the infection was there before, or came after the infusion seemed to me to be academic. My last reason, it seemed to me was the most compelling one, and that was this combination had worked three years before, and we were banking on it working again. It was moments like this in this process, that the involvement of the caregiver, I think, are really important. The fact that he knew I was heavily involved in her care, and was paying attention to what was going on with Joanie gave some weight to my opinion, not that it was as important as his, but he knew he had another pair of eyes and ears on what was going on with her when she was not in the clinic or hospital.
Thomas listened carefully, and then he did allow as to how the anesthesia she had been given in the morning when they put in the new port-a-cath could have been a contributing factor. Then, with a wry smile, he said, “Okay, we’ll try this one more time.”
I was proud of Joanie for holding up. Ordinarily she might have acceded to Dr. Thomas’ plan, but this time she was going to have her input. She felt the same way I did, and had confidence in the regimen she had in 2003, and was now going to stay with it if she could. It was her overriding feeling that it was going to work again, She liked and had complete trust in Dr. Thomas, but, at least for this time, she wasn’t going to be a passive participant in her own treatment. She was determined it was going to work. She was my star, for if she had agreed with Thomas, the change would have been made.
We got her checked into her room about 1:00 that afternoon, and they got the IV started. There would be about 2 hours of hydration, and then they would begin with the drugs. Everything went fine. She did throw up one time, as we anticipated, but outside of that, the infusion went off without a hitch. The last of the drugs finished at about 10:30 that night.
I got the the hospital the next morning about 8:00, and she was sleeping. I just sat there, sipped on my Starbucks, and waited for her to wake up. Shortly after nine, she comes to, and she told me she had slept fairly well during the night. She told me they had given her the Kytril about five o’clock this morning, and so I figured, now if things go south, I can’t blame it on that.
While we waited for Dr.Thomas to show up, she ordered some cantaloupe, grapes and cranberry juice to drink. She ate all of the cantaloupe and all but two of the grapes, and I took that as another good sign. I thought to myself this is going to be a good day.
Thomas came in shortly thereafter, and told her to go home. He didn’t have to tell her twice. Before he left, he wrote a prescription for her for Megace, and mentioned to her that her potassium level was low. Megace, he told her was another appetite stimulant, and he didn’t expect she would have the same reaction to it she had with Marinol.
It was Wednesday morning when I got her home, and she was doing great. She was eating, and seemed to be getting her appetite back. By the end of the night, there were no signs of nausea at all. I was beginning to believe we would make it through this round without a repeat of what happened after the first one.
Thursday dawned, and though she hadn’t slept that well, there was no sign of nausea. She was drinking plenty of fluids, and that evening she had pork loin and mashed potatoes for dinner. She had yet to take a dose of Megace. She told me she didn’t need it. I believed her, judging from how her appetite had improved.
Friday, Saturday and Sunday was more of the same. Still no nausea, and I now felt for sure we had escaped the nausea issue, and was very happy. She was really happy, even though she was still having some trouble sleeping well, at least she was eating again.
On the Monday following the second round, she began going into the office in the afternoons, and did so for several days. By now, with nausea not a problem, we were sure we had made the right decision about the treatment by resisting the change Dr. Thomas had wanted to make.
Little did we know there were forces at work that would mean we’d have to face the possibility of that change again.