Topotecan is not an island in the South Pacific.
Nor is it a rare tropical bird found in some South American rainforest. It is another poison used in the chemotherapy treatment of advanced cervical cancer, and Joanie was about to be introduced to it.
Dr. Thomas had told us when they scrubbed the second round of the three drug chemo on Oct. 31st they were going to look at another drug. He had talked with Dr. Carson and they agreed on a treatment consisting of Cisplatin, along with Topotecan. Topotecan had just been approved for use against advanced cervical cancer that year, and, I guess there had been clinical trials that combined the two. According to what I was able to learn from my research, Cisplatin had been a drug that had been used a lot in fighting cervical cancer, and there was some evidence the two worked well together.
Well, that was the plan anyway. Joanie’s visit to the urologist, and the CT scan he had done seemed to provide no concrete information on what could be causing her creatinine level to remain elevated. Given that, Dr. Thomas had talked with Dr. Carson, and told us they were going to go with Topotecan alone. He said that Cisplatin was really hard on kidneys, and with her creatinine numbers not where they wanted them, they didn’t want to use it.
The plan was for Joanie to get an infusion of Topotecan every day for five days in a row, and then have two weeks off. After that, she would have another five days in a row, followed by two weeks off, and then they would do another CT scan to see where things were. Following that she would have another round of the chemo. She would also get a shot of Neulasta for her white blood cell count, and a shot of Aranesp for her red blood cell count after each five day treatment. We were told Topotecan was particularly hard on bone marrow production of these cells, and these two drugs would help stimulate that production following the chemotherapy.
The first infusion of this round of her treatment began on November 13th. The one positive aspect of this round, was that she wouldn’t have to be hospitalized overnight. The infusions would be done in the clinic, close to the office of her doctor, Dr. Thomas.
She tolerated the first week of Topotecan, with minimal side effects. In fact, just three days after she was done, she was back in her office at the Hoeven Committee. Nausea was minimal, but anemia which caused some fatigue was more of a problem.
The holiday season was upon us now, with Thanksgiving around the corner. We didn’t know what we would do, or how she would be feeling since that would only be a week after the last day of her treatment, so our plans were tentative. We got a call from Orell and Cathy Schmitz, inviting us to their home for Thanksgiving, so we gladly accepted. It marked the beginning of a different holiday season at 1205 N. Mandan St., one that was more subdued than our usual observance.
Joanie and I both liked the Christmas season. Joanie really liked it. On Thankgiving day, I would bring up the box of Christmas CD’s, and there would be holiday music in our house almost every day through Christmas Day. The week after Thanksgiving, the tree would go up, and my job was to string the lights, lots of lights. As far as she was concerned, you could never have to many.
She was never satisfied with just having lights on the tree. She put them everywhere. There were lights around the windows. There were lights on the fireplace mantle. There lights on top of the china hutch. There were lights wrapped around the railing of the stairway going down to the basement. There were lights around the wreath that hung over the fireplace, and there were lights in bowls that were anywhere near an outlet. I think she would have put lights on the cats if she could have figured out a way to do it.
She had once asked me about putting lights on the outside of the house, but I dodged that one. I just told her with the lights on the tree, the lights around the windows, and the lights on the wreath and the mantle, which were visible from the street, any passerby could see that this was a house that kept Christmas. That seemed to satisfy her.
Then came the ornaments for the tree. I would bring up boxes and boxes of ornaments from the basement, and she would proceed to decorate the tree. That was her job, and I don’t think she ever trusted me to do it right. That was okay with me.
When she was really feeling the Christmas Spirit, she would have things hung on the wall, on doorknobs, and all of the Christmas cards we received would be taped to the closet door in the living room where everyone could see them. And there would be candles everywhere there was a flat surface. I will admit, on some nights, especially on Christmas Eve, when all of the lights were on, and there were candles burning everywhere and there was a fire in fireplace, it was a rather warm and happy place to be.
One season, when she had really outdone herself, I told her what my sister Jane’s kids had said about seeing her place at Christmas one time, and they said, “It looks like Santa threw up.” Joanie just shrugged it off. She didn’t care, and besides, she knew I was kidding.
This year, it would be different. Her second round of the five day infusion was December 4th. It went well, but this time, she wasn’t back at her office in three days. It took a few more days than that before she had the energy to do anything.
We didn’t put the tree up until almost the middle of the month, and while I did get the lights on it, there wasn’t much else done to it. Joanie just lacked the physical and emotional energy to do much, and while I helped her get the lights up around the windows, the ornaments remained in the basement. I did bring out some of the snow globes I had bought for her on Christmas’s past, and did get the candles out. I did one other thing, and that was to get her a special ornament for the tree. I had done that every Christmas for years, and so that was the only ornament on the tree this year. Neither one of us could do much else.
There was a pall over this Christmas celebration, at least for me. When they had changed the regimen after they realized it wasn’t working and were now trying a different drug, I had gone back to my research. I wanted to know what I could find out about Topotecan, and in the process came face to face with the reality of the fact that there is no cure for advanced or recurrent cervical cancer. According to some of the material I read, the best that can be done is palliative, meaning treating the symptoms and easing the pain of the patient, and maybe slowing the progression of the disease. I had known that as far back as 1998, when the cancer had returned after the radiation she had in 1996, but since the exenteration, and the subsequent lung surgery and chemotherapy in 2003, I had begun to think we might be able to handle this. Now I wasn’t so sure.
Joanie’s third round was on the day after Christmas, and since Christmas Day was on a Monday, that meant the third round would be a four day deal, and they would boost the dosage to keep it in line with the others. They did a CT scan that day, and the results weren’t encouraging. It showed the chest lesions were stable, meaning while they hadn’t increased in size, neither had they diminished. Dr. Thomas also ordered an MRI of her pelvis to look at some thickening on her pelvic floor that had shown up on the CT scan, and they wanted a closer look.
The third round of Topotecan was over on the 29th, which meant that Joanie and I spent New Year’s Eve at home, and this year there was no champagne and strawberries. I did open a bottle of Chardonnay, and she had a few sips to toast the new year, and had me give Bailey and Brandy some treats. That was the extent of our celebration.
As we watched the ball drop that night, we both sat there and were thinking the same thing. 2006 had been a helluva year and we were glad to be done with it.