Tag Archive | elements

Maintenance visits

I had two other doctor’s appointments last week – a MuGA scan and a Herceptin treatment. The MuGA was first. I had the same technician I had the first time (this is scan #3). He’s a talker, which is nice because then I learn all kinds of little tidbits about the procedure. It was the first scan since my mastectomy, which limits any bloodwork or injections to my left arm. I wasn’t looking forward to two injections in the same arm, but I needn’t have worried. The tech called for an IV instead. The only downside to an IV is I could feel the cold from the saline flush moving through the vein in my hand. I couldn’t taste the saline like I can when they use my port, though.

I thought to get a picture of the cylinder the tech carried the technetium injection in.

The lead holder for my technetium injection

The lead holder for my technetium injection

The body of the hypodermic needle is also jacketed in metal, but the cylinder is solid lead. Apparently, it gets dropped all the time, which explains all the dents in the cylinder. I tried to pick it up, and it is seriously heavy (which probably explains the dropping). That’s good enough for me to add lead to my element collection.lead

Friday was my every-three-weeks Herceptin treatment (which is why I’m still getting the once every three month MuGA scan). I brought a really good book I was reading with me, so I was all set to sit quietly for my half-hour injection. I did get interrupted once by a Mercyhurst art therapy intern. She had just started at the Cancer Center and was wondering if I was interested in doing an art project. I’m always up for a bit of art, so I said sure.

The project she had brought was to make a road sign, real or imaginary, that reflected your mental state. Once I drew the sign, I was supposed to write why I had chosen that particular image.

My road sign

My road sign

As you can see, I chose to go with “Slow. Road work ahead.” Sometimes it feels like I’m never going to be done with treatment, or I’m never going to feel like my old self again. I know it’s not true, but my brain isn’t always rational. So, the sign was an acknowledgement that it takes time to be done and healed. I was quite surprised how much better I felt after drawing the sign and talking about it. The big box of freshly sharpened colored pencils probably helped a bit as well.

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Third time’s a charm

I had my third (and last, for a while I hope) breast MRI yesterday. Dr. Li ordered it to see if that last little bit of cancer is gone after three more cycle of chemo. I am trusting that it is, but I’ll find out the result when I meet with Dr. Engel, the surgeon, next week.

Yesterday was the beginning of the upswing from chemo, but I still felt a bit nauseous. This particular cycle has been a little higher in the nausea than many of the previous ones. I didn’t think anything about it, though, until I had to lay on my stomach for 20 minutes inside the MRI. Not the most comfortable of positions. Even worse, it was actually warm inside the MRI room. By the time I was done, I felt a bit light-headed. The room was all sparkly for at least five minutes. I got a glass of cold water and put my head between my knees for a minute or two and felt much better. The higher level of nausea didn’t really go away until I got home and took some meds, though.

Here’s what my MRI machine looked like:

Machine set up for breast MRI

Machine set up for breast MRI

I wanted to get a photo of the apparatus they use to capture breast tissue, but the magnets from the MRI would have fried my iPod if I had taken it into the room. This photo was taken from the door. I lay on my stomach on the bed projecting from the MRI, with my forehead cradled on a foam structure. You can just see the cutout for the right breast curving below the head support (there’s a similar hole for the left breast). Arms go over the head (see the grey rectangular pad for an arm on the upper left of the bed), and you slide into the MRI. They hook up your IV to be able to add the gadolinium for contrast, and listen to clonking and whirring for 20 minutes or so. Relax as much as possible since the MRI captures more tissue if you’re relaxed than if you’re tense.

The other item of note was the pattern for my gown – it was different from last time.

photo(15)

Not too bad, although gray really isn’t a festive color. At least we get some spots of red for cheer.

Second MuGA test

I’m just about done with chemo (have I mentioned there’s only one left!), which means I’m entering a new phase of testing. Today I had my second MuGA test. MuGA stands for Multi-Gated Acquisition. One of the potential side effects of Herceptin, which treats a specific mutation in my cancer, is heart failure. Since heart failure is generally considered a bad thing, I have to get a MuGA test every three months to make sure my heart is still functioning fine. This was first test since I started Herceptin, but I had one before treatment to get a baseline number.

In the myriad of tests I’ve had in the past six months, the MuGA is probably the easiest. The worst part is it requires two injections – one to prime my red blood cells, and one to inject the technetium that will then attach to my red blood cells, with about thirty minutes between injections. I had the waiting room all to myself, and I got to sit and read my book in peace. As an added bonus, the view from the waiting room was lovely:

View of the Erie Bayfront from the waiting room.

View of the Erie Bayfront from the waiting room.

I don’t remember the view from the first time, but I was probably a bit more stressed and distracted. This time, I spent some time at the window, enjoying the view of Presque Isle in fall colors and the bayfront. The hospital is built on a little rise just a block from the water, and it was quite a relaxing view.

As I said, MuGA tests are easy. You lie on a board under a sensor panel for about ten minutes. It’s a good thing I’m not claustrophobic, though, since the sensor panel is only about six inches above your head while you’re in there. I did learn some interesting things about the test from the technician afterwards. The technetium has a half-life of six hours, so it will be completely gone from my body within twenty-four hours. Because of the short half-life, the hospital gets technetium shipments three times a day and the technetium is produced as a byproduct of radioactive decay of molybdenum. The source of the molybdenum is either Canada or South Africa. I was sure to share those elemental facts with Mr. Curiosity, who immediately asked if he could get some molybdenum. I had to remind him we have a strict no radiation policy in our house.

Element added: I’m totally counting molybdenum

Iron infusions

I had my third iron infusion on Thursday, accompanied once again by my friend Rush. I was scheduled to start at 3:00, but didn’t get in until 3:30 which was unfortunate, since it takes two hours for the infusion. It’s shorter than a day of chemo, but still would be pushing 6:00 by the time the infusion and the half-hour observation period following the infusion was done. Luckily, I got the go ahead from one of the resident hematologists that I didn’t have to sit around for a half an hour afterwards since I’d already had two infusions and no reaction.

The bag of Venofer dripping into my veins.

The bag of Venofer dripping into my veins. It kind of looks like root beer in the bag.

I’m hoping this was my final iron infusion. I appreciate the extra energy I’m getting from having a full hemoglobin and hemocrit count (I’m assuming), but I don’t appreciate the side effects of the Venofer. The first two times, it really affected my taste buds and made everything taste flat. It also leads to a sore throat. I asked the nurse if there was anything I could do to prevent or minimize the sore throat, but she had never heard of that particular side effect. Apparently I got an uncommon one. We eventually decided to try some Tylenol PM – Tylenol for the pain and a bit of Benedryl to see if perhaps there was an allergic reaction going on.

It seems that the third time is a charm, or perhaps my body just needs to get used to the new drugs, but I haven’t had the taste changes this time around. That has made me happy because I get cranky when I’m hungry and can’t (or don’t want to) eat. I can feel a bit of a sore throat hanging around, so I doubt I’ll avoid that particular side effect. Better stop at the pharmacy soon!

The best part of the whole day was going out to dinner afterwards. I had planned on it, since I knew I’d be late getting out. We were out just after six and headed to the Thai place in downtown Erie. I love noodle dishes, but it is not child friendly, so we never go as a family. This was a perfect night to go. I didn’t get my all time favorite dish of Pad Thai, since I didn’t want it to taste bad. Instead I had Drunken Noodles which were quite tasty and full of veggies. After dinner, it was finally time to head home and hear how the family did without for the afternoon.

Elements added: Ironiron

First chemo

Nicole was my chemo nurse today, which meant she was the primary person who put each medication on my stand and started the IV through the port. You can see me all set and ready to get started in the photo.

All set to start adding drugs to my port

All set to start adding drugs to my port

I didn’t bother with the pain-numbing cream over my port. It just seemed like too much work for a little needle stick that hurts for only five seconds.

I get nine drugs each time I come for chemo. They start out with two anti-nausea drugs, Emend and Aloxi. Next I got an IV injection of a steroid, dexamethasone. I have to take the steroid the day before and for three days after to prevent edema from one of the chemo drugs. Yesterday, after taking my second dose of the dexamethasone, I noticed my first side effect – the lower side of my forearms was tingly and I felt pressure in the muscle. It was the weirdest feeling that went away about six hours after taking the dose. I know, because I was still awake at midnight, and 2am, and several other times in the night. I’m hoping that was mostly nerves, because I’d like to be able to sleep for the next few days.

After the steroid, I got Pepsid, to prevent heartburn and an allergic reaction. Then came Benadryl, which made me feel a little drunk and made my legs twitch (odd, but a common side effect). Finally, I got to my chemo drugs. We started out with a slow drip of Taxotere. Allergic reactions are common enough with this drug, they monitor you closely, and start it slow, increasing the drip rate over time. Next was Carboplatin, a pt78platinum-based chemo drug. I got two Tylenol, and then the last drug, Herceptin. Herceptin is a biological, treating specifically HER2-positive cancers. It’s not technically chemo, so it has less side effects, but I will get that one for a full year.

All the nurses are quite chipper and helpful. Although I pretty much had the place to myself when I started at 9am, by 1pm, all the chemo chairs have filled up. However, any of the nurses in the chemo area were able to help out. Ever once in a while, someone would be by with snacks and drinks if I wanted anything. The chemo room is pretty cold, and you’re sitting all the time. I ended up in a sweater, long pants, and still needed a blanket over my legs. I’ll have to force myself to wear pants to all chemo days, or I will be quite cold.

Overall, wasn’t a bad start to the process. We got in at 8am to see the doctor, and were out by 3:30pm. The only drug I noticed going in was Benadryl, and that wasn’t at all surprising. Now to see what the side effects are going to be like.

Element added: platinum

Tests to clear up the previous tests

One more round of tests before the chemo starts. I needed an abdominal CT scan with contrast and a vaginal ultrasound to check on the abnormalities the PET scan found. I would also need a baseline MUGA test.

ba56The CT scan required a 6-hour fast, so I got up at 5:45 for a quick breakfast, and went back to bed. There was no way I’d make it to noon without some food in my stomach, and I really didn’t want to start my day that early. Turns out the fasting was to allow the barium contrast in my gastrointestinal tract to show up most strongly. I had to drink 900 mL of barium sulfate in about a half an hour. I got berry flavor, which wasn’t actually too bad. The worst was the slightly thick texture of the drink which made me gag occasionally, but I managed to get it all down. Once I finished the barium, it was time to get into the CT scanner – just another table that slides through a tube. I also needed IV iodine to add contrast to the blood vessels. Since I have a PowerPort, they actually got to use my port for the first time – yeah! Nurse said I had good blood return, so the port was working well. 153The iodine injection caused the weirdest sensations. It made the inside of my ears feel hot, and made me feel like I was peeing, although I wasn’t. It only lasted a minute or two, but it was quite odd. The CT scan was quiet, but I did have to hold my breath a couple of times. The nice thing was there was a counter on the machine that told me how many seconds longer I would have to hold my breath, so I wasn’t wondering how much longer every time.

Elements added: Barium and Iodine

The ultrasound to look at my ovaries was the easiest test yet, since there were no injections needed. I just had to drink a lot of water before getting there so I had a full bladder for the first half of the test. I did get to empty the bladder before the tech did the intravaginal part of the test. Once again, I got talking to the tech, and she showed me the ovaries and where the developing eggs were on the ovaries.

The final test of the week was a MUGA scan (or Multi-Gated Acquisition scan). Because my tumor is HER2 positive, Dr. Li is adding Herceptin to my drug regimen. One of the less common (2-4% chance) side effects in heart failure, which would definitely count as a bad thing. So, as a precaution, everyone on Herceptin has periodic tests of their heart to make sure it’s fine. There’s a lot of natural variation in heart efficiency, though, so you need a baseline test to compare with future tests.

A MUGA scan uses radionucleotides, specifically tc43technetium, attached to your red blood cells to get a picture of how efficiently your ventricles contract. Technetium will attach to different cells in your body, depending on what loading medication they give you. I got the loading medication (a sn50tin-based solution), and then sat in a waiting room while it moved throughout my bloodstream. After about 20 minutes, I got the technetium injection, and then moved to the machine to measure my heart function. There, I laid under a set of white plates for eight minutes and was done. Since I had been talking quite a bit with the tech (are you sensing a theme here?), he called me over and showed me the pictures the machine took. It was pretty awesome seeing the blood move through the heart, and the walls of the heart moving. The scan is set up to compare the ratio of the left ventricle at minimum and maximum contraction. Once again, I was radioactive for the day, and a bit longer than the PET scan since the technetium has a half-life of six hours.

Elements added: Technetium and Tin

CT results showed the mass on my kidney was a cyst (yeah – not renal cancer!) and there’s a cyst on the ovaries. Ultrasound was inconclusive – there’s a mass on an ovary, but it wasn’t clear with it is exactly (probably the cyst seen on the CT). MUGA showed good heart functions to start with. All set to start chemo now!

First week of tests

So, before I start treatment, the doctors wanted to know how far the cancer has spread. We know it’s in the axillary lymph nodes, based on the biopsy, which means it could move about in the lymphatic system. Also, since it is lobular carcinoma, there’s a higher probability of it showing up in the opposite breast. Therefore, I was off to a PET scan and a breast MRI. With all the tests and injections for contrast, I’m also starting my own personal element collection of injections.

gd64Breast MRI. They have you lay face first on a cut-out structure so your breasts can hang down, and a plastic line goes down your breastbone. Your arms go over your head, and luckily there was no pressure on my port site or I couldn’t have done it. You get sent into the machine on your stomach, with a blanket over your eyes, so there’s no worries about claustrophobia. I even got headphones with my choice of music, not that I could hear it half the time because of the noise of the machine. They used an IV to inject the contract agent about half way through the test. I could feel the coldness as it flowed over the skin on my arm, but otherwise nothing. I did not enjoy the MRI because of the noise. So many different loud noises, randomly starting and stopping. Then, when you get out, you can hardly breathe because of the pressure on your breastbone that was supporting your weight during the test.

Element added: Gadolinium

f9PET scan. I had to fast for six hours before this test, although since it was first thing in the morning, it just meant skipping breakfast. They inject you with fluorine-doped glucose (I picked the other arm for the injection), that would move to any part of the body that was using lots of energy. To minimize false positives, and to make sure only cancer cells glow on the test, they inject you with the glucose, and have you sit quietly. You can listen to music, podcasts, or watch TV. No talking, no reading, just sitting quietly. After an hour, they send you through another tube. This one is at least quiet. They move you through the tube at a constant rate for an initial CT. After the CT is done, you sit at specific points in the tube, starting at the head and moving down the body, pausing for 5-10 minutes for each section. The isotope of fluorine they used had a half-life of only 110 minutes, but I was radioactive for the rest of the day. They even gave me a card if I went to the airport or court-house to show I wasn’t trying to bomb the place – just had a PET scan that day.

Element added: Fluorine